Tropical Medicine & International Health最新文献

Objective: The development patterns of depressive symptoms throughout the first year postpartum among Chinese women remain unclear. This study aimed to identify the trajectories of postpartum depressive symptoms over this period and explore factors associated with different trajectories.

Methods: A longitudinal study was conducted at two women's and children's hospitals in China. Postpartum depressive symptoms were assessed at 1, 3, 6, and 12 months after childbirth. Participants who completed at least three follow-up assessments were included in the final analysis. A group-based trajectory model was used to identify trajectories of postpartum depressive symptoms, and multivariable logistic regression was performed to explore factors associated with trajectory groups.

Results: Three trajectories were identified: "low-stable" (35.0%), "moderate-stable" (51.3%), and "high-stable" (13.7%), characterised by low, moderate, and high symptom levels at all waves, respectively. Employment status, antenatal depressive symptoms, postpartum complications, family function, and parenting sense of competence were associated with both the "moderate-stable" and "high-stable" trajectories. Additionally, feeding patterns and negative life events were related to "moderate-stable" and "high-stable" trajectories, respectively.

Conclusions: The findings demonstrate remarkable stability of depressive symptom trajectories throughout the first postpartum year. It is suggested to conduct depressive symptoms screening and intervention according to relevant risk factors for women in the early postpartum period.

Introduction: Dengue is a mosquito-borne disease prevalent in Latin America and the Caribbean. Transmission is determined by ecological, biological and social (eco-bio-social) factors. Understanding the knowledge, attitudes, practices and perceptions of dengue's eco-bio-social factors among at-risk populations is essential for dengue prevention. We used the Ecohealth approach to investigate the socioeconomic and demographic factors associated with dengue knowledge, attitudes, practices and perceptions among residents of São Paulo.

Methods: We conducted a concurrent nested mixed-methods study between May and November 2024 using an online knowledge, attitudes, practices and perceptions survey, focus group discussions and Photovoice activity. Quantitative data were analysed using descriptive statistics and multivariable logistic regressions. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated. Qualitative data were analysed thematically. Integration from both method strands used a weaving, narrative approach.

Findings: Overall, 388 participants completed the knowledge, attitudes, practices and perceptions survey. Having some or a lot of vegetation around the home (aOR 2.63, 95% CI: 1.05-6.60; aOR 3.90, 95% CI: 1.57-9.69, respectively) and never having dengue (self-reported; aOR 1.80, 95% CI: 1.10-2.94) were associated with high knowledge scores. Higher education was associated with positive vaccine attitudes (aOR 2.04, 95% CI: 1.14-3.64). Women (aOR 1.57, 95% CI: 1.01-2.45) and individuals with three and more than three household members (aOR 2.04, 95% CI: 1.07-3.87; aOR 3.10, 95% CI: 1.62-5.94, respectively) had higher odds of using mosquito repellents at home. Those who earned more than R$6000 monthly had higher odds of having a high perception of self-efficacy to prevent dengue compared to those who earned less than R$2000 monthly (aOR 2.03, 95% CI: 1.08-3.82). Focus group discussions and Photovoice participants perceived climate change as a risk factor of dengue transmission. The high cost of mosquito repellents was a perceived challenge to prevention.

Conclusion: Several individual- and household-level factors were associated with dengue knowledge, attitudes, practices and perceptions in São Paulo. There is a need to increase public awareness about dengue and its vaccine. Future research should assess the effectiveness of community-tailored interventions to reduce dengue risk in this urban, climate-vulnerable setting.

Background: Within a randomised controlled trial providing Bacillus Calmette-Guérin, measles vaccine, or placebo to women of fertile age, we aimed to study the risk of adverse events following vaccination. This study addresses the lack of data on adverse reactions in adults, especially women of childbearing age, to inform broader vaccination policies.

Methods: The trial included HIV-negative, non-pregnant women aged 15 to 35 years, who had given birth to at least one child, and residing in the Bandim Health Project study area in the capital Bissau of Guinea-Bissau. Excluded were individuals who were frail, had serious illnesses like active tuberculosis, or had no prior births. Participants were randomised 1:1:1 to bacillus calmette-guérin, measles vaccine, or placebo. A subset of participants was enrolled into the adverse events study. Adverse events were registered immediately 15 min post-vaccination and at home visits 7, 14, 28 and 90 days after enrolment to register symptoms that could be related to the trial interventions. We compared symptom distributions by randomisation using chi-squared tests.

Results: Of the total 366 women included in the study, 99% (363) were eligible to follow up for adverse events (Placebo, 121; measles vaccine, 121; Bacillus Calmette-Guérin, 121) and 97% (1414/1452) of the planned study contacts were successful, 1.3% (18/1414) of which were mobile phone interviews. The baseline characteristics did not differ between the randomisation groups. There were no immediate reactions within the first 15 min post-vaccination. Seven days after vaccination, there was a tendency for more episodes of headache reported among both the Bacillus Calmette-Guérin and measles vaccine vaccinated participants compared to placebo. We registered 11 medical consultations (placebo: 4, measles vaccine: 5, Bacillus Calmette-Guérin: 2) and no deaths or hospitalisations during 90 days of post-enrolment follow-up.

Conclusion: Bacillus Calmette-Guérin and measles vaccine were safe and tolerable for adult women of childbearing age, with few short- and medium-term adverse events.

Objective: This study aims to evaluate preclinical studies on the effects and toxicity of cannabis-derived compounds against Plasmodium sp.

Methods: A literature search was conducted in Web of Science, PubMed, Scopus and LILACS databases until December 2024. Studies that assessed the activity or toxicity of cannabis against Plasmodium sp. in in vitro or in vivo studies were included. Two reviewers independently performed the study selection, data extraction and methodological assessment.

Results: Eight studies published between 2001 and 2022 were included, with the majority conducted in North America (n = 5). Most in vitro studies focused on assessing antimalarial activity through half-maximal inhibitory concentration (IC₅₀), which ranged from 0.16 to 4.1 μg/mL, indicating mild to high activity. For the in vivo studies, all reported positive effects, including moderate antimalarial activity and disease tolerance. The toxicity profile of these compounds has not been extensively studied, and most studies present an unknown or unclear risk of bias due to insufficient methodological information.

Conclusions: Future studies should provide more comprehensive details on study design and further validate these findings, especially concerning toxicity.

Objectives: Artemisinin partial resistance has emerged in East Africa and is feared to spread across the continent, potentially compromising artemisinin-based combination treatment. Molecular markers can serve as early warning signals for the development of specific drug resistance. We aimed at updating information on relevant resistance markers among Plasmodium falciparum from Kumasi, Ghana, collected in 2023.

Methods: P. falciparum isolates were obtained from 200 patients with falciparum malaria. Mutations in pfk13 (propeller domain), pfcoronin (P76S), pfmdr1 (N86Y, Y184F, Y1246D) and pfaat1 (S258L) were genotyped. A subset of patients was microscopically examined for the presence of asexual malaria parasites on day-3 of treatment with artemether-lumefantrine.

Results: 2.2% of isolates exhibited non-synonymous pfk13 mutations including the candidate artemisinin partial resistance marker P527H in addition to S522C, C532S and I590V. Pfcoronin P76S, previously associated with artemether-lumefantrine failure in malaria imported from Africa, was present in 29.7% and associated with a lower parasite density. The predominance of the pfmdr1 pattern N86-184F-D1246 (NFD) suggested impaired sensitivity to lumefantrine. Pfaat1 S258L was common at 64.7%. The resistance markers were not associated with each other, and they were not linked with day-3 parasite positivity.

Conclusions: While the efficacy of artemisinin-based combination treatment in Ghana is still high, isolated critical pfk13 polymorphisms were identified as well as a considerable prevalence of a potentially relevant pfcoronin marker, against a background of pfmdr1 signals for impaired lumefantrine sensitivity. Continuous molecular monitoring is necessary to detect threats to artemisinin-based combination treatment efficacy at an early stage.

Background and objectives: Coronary artery disease remains the leading cause of cardiovascular mortality worldwide, with a disproportionate burden in low- and middle-income countries. Although observational studies have established a bidirectional relationship between depression and coronary artery disease, the underlying genetic basis of this association remains unclear, particularly in underrepresented diverse-ancestry populations. Establishing whether this relationship is causal and whether it differs by ancestry is critical for informing targeted and equitable prevention strategies.

Methodology: This study employed a bidirectional two-sample Mendelian randomisation framework to investigate the causal relationship between major depressive disorder and coronary artery disease across East Asian, European and African populations. Using summary statistics from large-scale genome-wide association studies, we assessed both the direction and strength of genetic associations between major depressive disorder and coronary artery disease. Sensitivity analyses were conducted to test the robustness of the findings.

Results: Genetically predicted major depressive disorder was associated with increased coronary artery disease risk in European populations, confirming a causal effect consistent with prior evidence. In East Asians, we found a potentially false-positive result suggesting an inverse association between genetic liability to coronary artery disease and major depressive disorder (IVW OR = 0.942; p = 0.040), which was not supported across Mendelian randomisation sensitivity analyses and did not hold true after Bonferroni correction. In African ancestry populations, no significant causal effects were detected in either direction, due to wide confidence intervals resulting from limited sample sizes.

Conclusions: Our findings provide evidence for a causal relationship between depression and coronary artery disease in Europeans and suggest potential ancestry-specific variation in this relationship, with a novel inverse association between coronary artery disease and major depressive disorder observed in East Asians requiring further replication and validation. These results highlight how limited data availability in underrepresented populations constrains causal inference, underscoring the need for more inclusive genetic research to inform equitable, population-relevant public health strategies.

Objectives: Human resource shortages create bottlenecks to preventive maternal and child health service provision in low-resource settings, making ad-hoc service rationing at the point of care necessary. Little is known about how healthcare providers prioritise. We explored healthcare providers' rationing decisions for preventive maternal and child health services in rural Guinea-Bissau through an experimental vignette design considering situational and care-seeker characteristics and performance goals.

Methods: We implemented two vignette experiments, one for antenatal care, and one for childhood vaccinations. At 55 health facilities, providers were requested to state their willingness to provide antenatal care/vaccination given a scenario of an acute facility-level human-resource shortage and combinations of contextualised factors, summarised in 16 vignettes per experiment: provider-care-seeker relationship (stranger/related) and distance (close/far) between care-seeker residence and facility (both experiments); gestational age (2nd/3rd trimester) and consultation number (1st/4th) (antenatal care experiment); child age (5/13 months), vaccine sought (Bacillus Calmette-Guérin/3rd Pentavalent vaccine (Penta3)), and number of other children waiting (3/12) (vaccination experiment). We also inquired about facility and interviewee characteristics. Using multilevel logistic regressions, we assessed associations between the factors and providers' stated willingness for each experiment.

Results: We interviewed a total of 159 healthcare providers; 112 provided antenatal care, 118 vaccinations. Interviewees in the antenatal care experiment stated willingness for antenatal care provision for 94% (1691/1792) of the vignettes (range across vignettes: 88%-99%). Last pregnancy trimester, long distance, and providers' work experience were associated with stated increased willingness. In the vaccination experiment, the interviewees stated their willingness to vaccinate for 72% (1357/1887) of the vignettes (range: 54%-95%). Younger child age, long distance, a higher number of other children waiting, and inquiring Penta3 rather than Bacillus Calmette-Guérin were associated with stated increased willingness, and we found a statistically significant interaction between age and the inquired vaccine.

Conclusions: Situational and care-seeker characteristics and performance goals may influence facility-based ad-hoc service rationing in rural Guinea-Bissau.

Introduction: Female genital schistosomiasis is a condition with a complex diagnosis and severe consequences such as infertility. In the absence of a reliable biomarker, in endemic settings the World Health Organization recommends colposcopy as a diagnostic tool for the detection of female genital schistosomiasis lesions. Nevertheless, it is seldom performed in low-resource contexts due to a lack of expertise or insufficient infrastructure. This study aims to assess Female Genital Schistosomiasis colposcopy at the primary level of care, evaluating its diagnostic accuracy in reference to gynaecologist diagnosis in a highly endemic context.

Materials and methods: This is a secondary analysis of a cross-sectional study conducted in the Boeny region of Madagascar, which collected colposcopy images and Female Genital Schistosomiasis decision at the primary health care level with re-evaluation by gynaecologists. Statistical analysis using R included descriptive statistics, measures of diagnostic accuracy with 95% confidence intervals and binary Poisson regression with robust standard errors, while reporting followed the STARD statement.

Results: Among 495 included participants, a high sensitivity [96.4% (95% CI 93.7-98.0)] and relatively low specificity [28.7% (95% CI 21.8-36.5)], with a fair agreement [κ 0.30 (95% CI 0.22-0.39)], was observed for midwife-led colposcopy. Practice of midwives (3.5 months) was associated with reduced concordance [APR 0.88 (95% CI 0.79-0.98)] and specificity [APR 0.27 (95% CI 0.15-0.49)]. The environment of one health care centre negatively influenced concordance and specificity of midwife-led colposcopy.

Conclusion: Midwives can detect female genital schistosomiasis with high sensitivity but limited specificity when compared to expert gynaecologists, revealing variation in performance between environments as well as the influence of practice and workload. This study suggests that implementing midwife-led colposcopy at primary care level for female genital schistosomiasis screening is feasible but requires appropriate quality assurance measures.

This study aimed to analyse the magnitude, temporal trend, and spatial pattern of Chagas disease mortality in the state of Alagoas, providing a detailed epidemiological profile and identifying priority areas for intervention. A retrospective, population-based study was conducted using data on Chagas disease-related deaths from 1999 to 2019, obtained from the Mortality Information System. Descriptive analyses were applied to characterise deaths by sex, age, education level, and geographic distribution. The temporal trend was assessed using joinpoint regression, with calculation of the annual percent change. For spatial analysis, the global Moran's I index and space-time scan statistics were applied to identify high-risk clusters. The results showed higher mortality in males (56%-64%), a predominance of deaths in individuals over 50 years old, and a concentration of the chronic cardiac form of Chagas disease in approximately 80% of the records. Low educational attainment was associated with higher mortality, indicating social vulnerability. The spatial distribution revealed that 95.0% of municipalities reported Chagas disease-related deaths, with risk clusters primarily located in the Zona da Mata region, particularly in the 1st, 2nd, 3rd, and 4th Regional Health Superintendencies. These areas have a history of high vector infestation and socio-environmental conditions conducive to transmission. Although the overall temporal trend remained stable or showed a slight decline, the persistence of endemic areas and clusters underscores the need for targeted actions. Thus, it is concluded that Alagoas remains an endemic area for Chagas disease, with mortality influenced by social and environmental factors. This study highlights the importance of strengthening surveillance, diagnosis, and control in priority regions and suggests that future research incorporate predictive models integrating social determinants to improve disease management.

Background: Vector-borne diseases, exacerbated by climate change, present an escalating global health threat, necessitating robust surveillance and climate-informed early warning systems to predict outbreaks and enable timely interventions. This systematic review aims to synthesise the challenges and strategies involved in developing and operationalising early warning systems for vector-borne diseases.

Methods: Following PRISMA guidelines, we conducted a systematic search across multiple databases (PubMed, Web of Science, Scopus and Embase) and performed a manual search using predefined keywords up to 05 November 2024. Eleven papers were selected for the reviewing process.

Results: While early warning systems show significant promise in enhancing outbreak prediction and guiding timely public health interventions, several key challenges persist. Inadequate data quality and integration-characterised by fragmented epidemiological, entomological and meteorological datasets-compromise predictive accuracy. The review also highlights gaps in stakeholder engagement and capacity building. Without comprehensive training and active collaboration among public health officials, climate scientists and data analysts, the practical application and sustainability of these systems are undermined. Enhancing data harmonisation through standardised collection processes and integration protocols is crucial for improving model reliability. The adoption of scalable, cloud-based platforms can mitigate technical and infrastructural limitations by enabling real-time data processing and robust computational capabilities. Strengthening interdisciplinary collaborations-bringing together experts from diverse fields-can refine predictive models and ensure that system outputs are both accurate and actionable. Furthermore, tailored capacity-building initiatives are vital for empowering local authorities to effectively interpret and implement early warning systems' warning signals. Finally, optimising communication strategies by simplifying technical outputs and developing user-friendly interfaces can bridge the gap between complex predictive analytics and practical decision-making processes.

Conclusion: Addressing these challenges through integrated solutions will enhance the effectiveness and sustainability of early warning systems, ultimately improving outbreak preparedness and response for vector-borne diseases in a changing climate.