Tropical Medicine & International Health最新文献

Objectives: Melioidosis, caused by Burkholderia pseudomallei , is an environmentally acquired disease endemic to Southeast Asia and northern Australia, and increasingly recognised as an important but underdiagnosed tropical infection. In Taiwan, the spatial distribution and environmental reservoirs of this pathogen remain poorly understood.

Methods: We analysed 796 melioidosis cases reported between 2003 and 2024 and identified a recurrent, statistically significant cluster zone using SaTScan, especially during 2009-2013 and again in 2024. To investigate environmental persistence, we conducted long-term surveillance across 46 GIS-defined grid squares within the cluster zone from 2012 to 2024.

Results: This zone accounted for 61%-72% of national cases, with annual incidence rates ranging from 0.3 to 4.0 per 100,000 people. Three adjacent squares (31-33) consistently showed high soil PCR positivity (68.4%-85.5%). During rainy seasons, DNA concentrations in aerosols and stagnant surface water followed similar temporal patterns, influenced by rainfall and wind gusts. A heavy rainfall event in 2024 increased soil PCR positivity from 77.7% to 97.4%. Seventeen viable B. pseudomallei isolates were cultured from soil, surface water, aerosols and cattle shed wastewater. All belonged to ST58, ST1115 or ST1354, with ST58 prevalent across environmental sources. Core genome single nucleotide polymorphism (SNP) analysis revealed close phylogenetic relatedness between environmental and clinical ST58 isolates, indicating localised environmental-to-human transmission.

Conclusions: These findings provide insights into the environmental persistence and transmission dynamics of B. pseudomallei , supporting more effective risk assessment and public health strategies for melioidosis in endemic tropical regions.

Background: Non-adherence to medication is a major challenge for patients with diabetes. Despite the growing burden of diabetes in Indonesia, nation-wide research on medication adherence remains limited.

Objective: To identify factors associated with adherence to glucose-lowering medication among adults with diabetes in Indonesia.

Methods: This cross-sectional study used data from the 2023 Indonesian National Health Survey (SKI), a nationwide survey using a stratified, multi-stage sampling method with probability-proportional-to-size household selection collecting data by personal interview at home. Respondents with diabetes using glucose-lowering medication were included. Multiple logistic regression for complex sample analysis was used to model the adherence to glucose-lowering medication, ensuring population-level representativeness and exploring the factors associated with adherence.

Results: Of 13,960 respondents, 12.3% were non-adherent. Regular follow-ups at health facilities showed the strongest association with adherence (OR = 11.56, 95% CI: 8.74-15.27, p < 0.001). Other significant factors included receiving medication from medical personnel (OR = 4.13, 95% CI: 3.25-5.26, p < 0.001), insulin use (OR = 2.74, 95% CI: 1.76-4.27, p < 0.001), self-purchasing medication (OR = 1.5, 95% CI: 1.17-1.91, p = 0.001), receiving diabetes management education (OR = 1.46, 95% CI: 1.20-1.79, p < 0.001), maintaining a healthy diet (OR = 1.57, 95% CI: 1.26-1.95, p < 0.001), and regular exercise (OR = 1.34, 95% CI: 1.10-1.65, p < 0.001). In contrast, herbal medicine use was negatively associated with adherence (OR = 0.54, 95% CI: 0.44-0.65, p = 0.005).

Conclusions: Medication adherence is associated with a combination of treatment and healthcare system/healthcare provider-related factors. Improved patients' engagement and better access to glucose-lowering medications could increase medication adherence.

Objectives: Postpartum haemorrhage, an excessive bleeding after childbirth, remains a leading cause of maternal mortality in low-resource settings. Improving the quality of postpartum haemorrhage care using audit and embedded quality improvement is essential for addressing this. A criteria-based audit, an objective, systematic and critical analysis of the quality of health care against a set of criteria, is essential for identifying appropriateness of care and areas for improvement in postpartum haemorrhage management. The aim of this study was to audit management of postpartum haemorrhage as quality assessment for postpartum haemorrhage care in a tertiary university hospital in eastern Ethiopia.

Methods: In 2023, we repeated the criteria-based audit cycle conducted in 2019 to re-evaluate management of postpartum haemorrhage using the same previously co-created eight audit criteria. Two midwives and one consultant obstetrician independently reviewed each woman's medical records to assess whether a criterion was met or not. Findings were compared with the 2019 reports using a chi-square test and discussed with birth attendants and administrators of the hospital to identify underlying factors and areas for improvement in postpartum haemorrhage care.

Results: Of 55 medical records reviewed, fulfilment of the audit criteria ranged from 24% (13/55) for fluid input and output monitoring to 100% (55/55) for documenting woman's history and general clinical conditions at admission, and haemoglobin measurement. Compared with the previous audit, where only 6.7% (3/45) women met all the audit criteria, there was substantial increase in proportion in the current audit as 22% (12/55) cases met all the criteria (p = 0.03). Lack of template for a postpartum haemorrhage management, refresher training, postpartum haemorrhage emergency kit, adherence to postpartum haemorrhage management guideline and adequate blood for transfusion were identified as major barriers to providing optimal postpartum haemorrhage care.

Conclusions: Just over one in five women met the local audit criteria for postpartum haemorrhage management, and major barriers to providing the best possible care persist. These results highlights the need to develop a postpartum haemorrhage management template, availing blood for transfusion, providing low-dose high frequency (refresher) training and drills for staff, and enhancing documentation and record keeping in the hospital for improving quality of postpartum haemorrhage management to stop preventable deaths and sequelae from postpartum haemorrhage.

Objectives: This study examined the overlapping burdens of pulmonary tuberculosis (PTB) and paragonimiasis in Sorsogon Province, Philippines, a setting characterised by high TB prevalence and paragonimiasis endemicity. It aimed to describe trends in PTB cases and treatment outcomes from 2016 to 2024, establish a baseline for paragonimiasis burden using newly available provincial data, and assess the extent to which paragonimiasis may be obscured within TB case reporting.

Methods: Tuberculosis data were obtained from the Integrated Tuberculosis Information System (ITIS) of the Sorsogon Provincial Health Office, covering 2016-2024. Indicators included prevalence, case classification, relapse, cure rate, treatment success rate, and case fatality rate. Paragonimiasis data were collected in August 2025 across five municipalities.

Results: Between 2016 and 2024, TB prevalence rose from 329.5 to 460.8 per 100,000, reflecting a 49% increase. Treatment success rates remained high (> 86% on average), yet relapse cases grew, particularly among clinically diagnosed (CD) patients, who comprised nearly half of all cases despite widespread GeneXpert availability. Although bacteriologically confirmed (BC) cases increased, the BC-to-CD ratio reversed after 2022, with CD cases again predominating by 2024. Among 883 TB suspects screened in August 2025, 172 were tested and 81 tested positive for paragonimiasis, highlighting diagnostic overlap and possible misclassification.

Conclusion: PTB remains a dominant health concern in Sorsogon, yet paragonimiasis persists as a concealed mimic. The high positivity rate among suspected TB patients underscores the risk of underdiagnosis. Integrating paragonimiasis surveillance, diagnostics, and treatment into existing TB programs could reduce misdiagnosis and strengthen control strategies in co-endemic regions.

Background: Cystic echinococcosis caused by Echinococcus granulosus is a major health concern. Hepatic cystic echinococcosis management depends on cyst activity, classified by the WHO-IWGE system. However, reliable criteria to predict cyst fluid (CF) viability are lacking. This study evaluates the correlation between cyst fertility, protoscolex viability and various clinical, biological and radiological parameters.

Methods: A prospective analytical study was conducted over 70 months, analysing hepatic cystic echinococcosis cysts excised during surgery. The CF was examined microscopically to assess cyst fertility and protoscolex viability. Associated factors for fertility and viability were determined.

Results: A total of 126 hepatic cystic echinococcosis cysts from 70 patients were analysed. The median patient age was 39 years (range: 13-76), with a female predominance. Abdominal pain was the most common symptom (78.6%), and hydatid serology was positive in 94.3% of cases. The overall fertility rate of CF was 71.4% (90 cysts). Associated factors for fertility in bivariate analysis included age > 35 years, female gender, AST < 21 IU/L, clear CF and vascular compression. CE4 cysts and gelatinous CF were associated with non-fertility. Multivariate analysis revealed age and vascular compression as independent predictors of fertility, whilst CE4 cysts and gelatinous CF were predictors of non-fertility. The median viable protoscolex count was 1.5 per 100 μL (range: 0-146). CE1 cysts, clear CF and vascular compression predicted protoscolex viability, whereas CE3b/CE4 cysts, cyst wall calcifications and gelatinous CF were associated with non-viability. Multivariate analysis identified WHO-IWGE cyst classification as the only independent predictor of viability.

Conclusion: Cyst fertility and viability in hepatic cystic echinococcosis are influenced by diverse factors. The WHO-IWGE classification emerged as the key predictor of viability, reinforcing its role as the basis for cyst classification.

Objective: Indonesia ranks third globally in leprosy burden, with 9.2% of new 2023 cases presenting with Grade 2 disabilities (G2D), indicating delayed detection. Gunungkidul District continues to exhibit high G2D rates despite ongoing screening programs. This study examined the determinants of health-seeking behaviour among leprosy contacts, a high-risk population with a 5- to 13-fold higher risk of developing G2D.

Methods: A community-based cross-sectional study was conducted across all 13 sub-districts of Gunungkidul District (February-March 2025). Stratified random sampling enrolled 264 leprosy contacts. Structured interviews assessed knowledge, attitudes, perceived effectiveness of leprosy treatment, family support, healthcare worker support, accessibility to healthcare services and stigma. Data were analyzed using univariate, bivariate and multivariate logistic regression. Results are presented as adjusted odds ratios (aORs) with 95% confidence intervals (CIs).

Results: Among the 264 participants (mean age 46.5 years; 63.3% female), most were of productive age (18-59 years, 79.2%) and had completed at least junior high school. Homemakers formed the largest occupational group (42.1%). Only 30.7% of contacts reported appropriate health-seeking behaviour. Multivariate analysis identified three key predictors of health-seeking behaviour: perceptions of leprosy treatment, accessibility to healthcare services and stigma. Favourable perceptions (aOR = 3.60; 95% CI: 1.90-6.80; p < 0.001), good accessibility (aOR = 2.46; 95% CI: 1.29-4.37; p = 0.006) and low stigma (aOR = 5.74; 95% CI: 3.03-10.87; p < 0.001) were strongly associated with health-seeking behaviour.

Conclusion: Addressing social stigma, improving healthcare accessibility and promoting positive perceptions of leprosy treatment are crucial to encouraging health-seeking behaviour. These findings highlight the need for targeted public health interventions to enhance early detection and treatment, particularly among high-risk groups such as leprosy contacts.

Toxocara species are zoonotic parasites increasingly linked to neurological and psychiatric conditions. This systematic review and meta-analysis synthesised evidence from observational studies assessing the association between Toxocara infection and neuropsychiatric disorders. Thirty-four eligible studies (32 case-control, 2 cross-sectional) were identified through comprehensive database searches up to May 2025. The pooled seroprevalence was 25.1% (95% CI: 21.3%-29.3%) amongst patients with neurological disorders and 9.6% (95% CI: 5.6%-15.8%) amongst those with psychiatric conditions. Toxocara seropositivity was significantly associated with several neurological disorders, including attention-deficit hyperactivity disorder (RR = 4.50), epilepsy (1.62), Alzheimer's disease (1.82), essential tremor (2.42) and mental retardation (2.37). For psychiatric disorders, the overall association did not reach statistical significance (RR = 2.22; p = 0.052), though schizophrenia showed a stronger link (3.83). Whilst causality cannot be inferred, mechanisms such as neuroinflammation and neurotransmitter disruption may contribute. These findings underscore the need for further longitudinal and mechanistic research to clarify the potential role of Toxocara exposure in neuropsychiatric disease.

Objective: To assess the effect of add-on corticosteroids on treatment outcomes in lymph node tuberculosis.

Methods: After registering the protocol on PROSPERO (CRD420251104064), we systematically searched Cochrane, MEDLINE, Embase and Web of Science for randomised controlled trials on adjunct corticosteroids for lymph node tuberculosis up to 20 October 2025. A random-effects model was applied, with heterogeneity quantified using I² and between-study variance (τ²) estimated by the Paule-Mandel method. Pooled effects were obtained using inverse-variance weighting, and confidence intervals were calculated with the Hartung-Knapp-Sidik-Jonkman (HKSJ) adjustment. Study quality was assessed using RoB 2, and the certainty of evidence was graded using the GRADE framework.

Results: Of a total of 485 articles, removing duplicates and irrelevant articles yielded three articles that fulfilled PICOTS criteria. Adjunctive oral prednisone was used as the intervention in all three trials, and treatment outcomes were compared with standard antitubercular treatment. Pooled estimates indicated no significant benefit from the use of adjunctive corticosteroids for complete resolution at 6 months (RR = 1.61; 95% CI: 0.73, 3.56; very low-quality evidence) or symptomatic relief at 2 months (RR = 1.21; 95% CI: 0.92-1.58; low-quality evidence). Adjunctive corticosteroid therapy reduced complications by 77% during the course of treatment in the primary analysis (RR = 0.23; 95% CI: 0.18-0.29). The three studies were at high risk of bias. The certainty of evidence was rated as very low for the outcome of complete resolution at 6 months, low for symptomatic relief at 2 months, and moderate for complications.

Conclusion: Though lymph node tuberculosis contributes to a significant portion of all tuberculosis cases, high-quality research related to the use of adjunctive corticosteroids is limited. There is a need for further studies to investigate this promising possibility.

Background: Many caregivers in Sub-Saharan Africa attempt to manage childhood illnesses at home, which can delay or complicate later diagnosis and treatment at a health facility. Understanding home treatment practices among children could help characterise treatment history when information is unavailable or unreliable. We investigated these practices among children seeking care at three levels of a healthcare system in Ghana.

Methods: Children under 15 years of age and their caregivers were recruited from Community-based Health Planning and Services, outpatient departments and inpatient departments in Agogo and Assin Foso, Ghana. Demographic, clinical, socioeconomic and home treatment data were collected via interviews. Urine samples from children were tested for antibiotic use. Hierarchical log-binomial regression models were calculated to estimate risk ratios and control for confounding.

Results: Caregivers of 1503 children were interviewed. Forty-six percent (n = 689) reported any home treatment prior to the visit: 37% (n = 560) reported antipyretic use, 11% (n = 167) antimalarial use and 7% (n = 103) antibiotic use. Home medication was lower at Community-based Health Planning and Services (30%, n/N = 148/500) compared to the outpatient departments (61%, n/N = 308/509) and inpatient departments (47%, n/N = 233/494). Children treated at home had longer delays in seeking treatment (median 3 days, IQR: 1, 3) compared to those not treated at home (median 2 days, IQR: 1, 3). In regression models, illness severity and specific symptoms were more strongly associated with antimalarial use than with antibiotic use. For most samples where antibiotic inhibition was detected, no prior antibiotic use had been reported (n/N = 33/46), indicating undisclosed or unrecognised antibiotic intake.

Conclusions: The discrepancy between self-reported antibiotic use and antibiotic inhibition suggests a lack of awareness about medication identification and appropriate use. This presents a challenge for clinicians in obtaining an accurate treatment history, which is highly relevant to the timely diagnosis and treatment of the illness in the facility.