Tropical Medicine & International Health最新文献

Objectives: Antimicrobial resistance is a growing global health threat that disproportionately affects socially and economically disadvantaged populations. National Action Plans are critical for coordinating national responses, but the extent to which they address equity remains unclear. This study assessed how antimicrobial resistance National Action Plans from 14 West African countries incorporate equity considerations.

Methods: We reviewed antimicrobial resistance National Action Plans from 14 West African countries using a four-domain equity framework: (1) recognition of equity, (2) identification of vulnerable populations, (3) inclusion of equity-oriented interventions and (4) integration of equity into governance and monitoring. We assessed whether National Action Plans acknowledged 16 high-risk groups, including people living with HIV, displaced or mobile populations, children and adolescents, older adults, people with mental health disorders, rural residents, people with chronic illnesses, people living with disabilities, pregnant women, low-income populations, healthcare workers, people with substance use disorders, incarcerated populations, indigenous or minority groups, homeless populations and migrants or seasonal workers.

Results: All National Action Plans adopted a One Health approach, but equity was inconsistently addressed. Most did not explicitly reference equity, and none included equity-related indicators in monitoring frameworks. Healthcare workers and rural populations were the most frequently mentioned groups. Common interventions included hygiene promotion, public awareness campaigns and training of healthcare workers, but these were largely generic and rarely adapted to the specific needs of marginalised populations. Stakeholder engagement was often multisectoral but seldom ensured the participation of disadvantaged groups. Across the region, the lack of disaggregated data and tailored strategies highlights a significant equity gap.

Conclusion: Equity remains insufficiently integrated into antimicrobial resistance governance in West Africa. Future National Action Plans must explicitly identify at-risk populations, include equity indicators and involve affected communities in planning and oversight. Embedding equity is essential to building resilient and people-centred antimicrobial resistance strategies.

Background: Tuberculosis remains a leading cause of death globally, particularly in countries with high tuberculosis and HIV burdens. Disruptions caused by the COVID-19 pandemic may have further impacted tuberculosis outcomes. This study examines on-treatment mortality and associated risk factors in five countries.

Method: We conducted a secondary analysis of data from ASCENT cluster-randomised trials of digital adherence tools for improved adherence involving 23,799 adults with drug-sensitive tuberculosis in South Africa, Tanzania, Ethiopia, the Philippines, and Ukraine. Analyses were conducted separately by country. Mortality rates were measured from treatment initiation to the earliest of 6 months, death, or loss to follow-up. Cox regression models (with random effects or robust standard errors for clustering) assessed the associations between mortality and HIV status, ART use, tuberculosis diagnosis type, and calendar periods (COVID-19 pandemic and conflict in Ukraine).

Results: Mortality rates ranged from 7.6 (Ethiopia) to 23.2 (Tanzania) and 23.3 (Ukraine) per 100 person-years. Higher mortality was associated with: older age in all countries (age < 30 versus ≥ 60 years, adjusted rate ratio [aRR] ranging from 2.38 to 6.57 by country); HIV status (positive versus negative, aRR ranging from 1.44 to 2.98 by country); tuberculosis diagnosis type (clinical vs. bacteriological, aRR 1.5-1.6 in Ethiopia, Tanzania and South Africa); extrapulmonary tuberculosis (aRR 1.44 to 1.60 in Ukraine and Tanzania). ART versus HIV-positive not on ART was linked to lower mortality in South Africa and Ukraine but not in Tanzania. Analyses suggested possible mortality variations by calendar period.

Conclusion: Our findings suggest variability in tuberculosis mortality across settings, influenced by HIV/ART and diagnosis type. The high mortality rates across countries may reflect underlying causes or potential misdiagnoses. Further investigation into these factors may be needed to improve tuberculosis outcomes globally.

Background: Drug-resistant tuberculosis remains a major public health challenge in Lao PDR, with low second-line treatment uptake and suboptimal outcomes. To improve effectiveness, safety, and tolerability, a shorter all-oral regimen for multidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB) was introduced under the TDR Short, all-Oral Regimens for Rifampicin-resistant Tuberculosis (ShORRT) initiative.

Methods: A retrospective and prospective comparative cohort study was conducted across five drug-resistant tuberculosis treatment centres from January 2020 to December 2023. Two programmatic cohorts were analysed during partially overlapping calendar periods: a standard injectable-containing regimen cohort and an all-oral regimen cohort. Outcomes were assessed at the end of treatment and 12 months post-treatment. Safety was evaluated through adverse events, including serious adverse events and adverse events of special interest. Health-related quality of life was measured using EQ-5D-5L and EQ-VAS tools.

Results: Among 126 participants, 65 received the all-oral regimen and 61 the standard regimen. Treatment success was higher in the all-oral group (90.8% vs. 80.3%), with lower mortality (7.5% vs. 16.4%) and fewer serious adverse events (12.3% vs. 19.7%). Anaemia was more common in the all-oral group (46.2%), while hepatotoxicity and QTcF prolongation were more frequent in the standard group. Both groups showed improvements in health-related quality of life, but greater recovery in mobility, daily activities, and anxiety reduction was observed in the all-oral group. Between group differences did not reach statistical significance. No cases of tuberculosis recurrence were reported at 12-month follow-up in either group.

Conclusion: In this programmatic setting, the all-oral, bedaquiline and linezolid-based regimen demonstrated high effectiveness and acceptable safety. Non-significant trends favoured the all-oral regimen for treatment success, mortality, and quality of life, consistent with but not definitive for improved outcomes. These findings support the transition to all-oral regimens as the preferred approach for drug-resistant tuberculosis care, while acknowledging the observational design and limited power.

Objectives: Distribution of inaccurate or misleading information concerning snakebite first aid can potentiate inappropriate and harmful practices in real-life snakebite incidents. This study aimed to develop a consensus-based checklist for evaluating the quality of educational materials on snakebite first aid.

Methods: Experts in snakebite management, emergency medicine and toxicology were recruited through a structured invitation process. In a two-round Delphi exercise, the experts completed questionnaires to rate each item of a pre-developed 24-item checklist. Item inclusion was determined by a consensus threshold of ≥ 7 points from ≥ 75% of the expert panel. Anonymous inputs on modifying or adding items were solicited.

Results: Of the 48 initial participants, 38 (79.2%) completed both rounds (representatives of 21 nations with a median of 16 years of experience in acute medicine and toxicology). The Delphi process resulted in a 20-item final checklist encompassing critical aspects of snakebite first aid, including safety (n = 3), call for help (n = 1), assessment (n = 2), transport (n = 1), vital signs (n = 1), recovery position (n = 1), CPR (n = 1), support (n = 1), positioning (n = 1), observation (n = 1), handling the bite site (n = 3), restricting physical activity (n = 1), immobilisation (n = 2) and avoidance of unnecessary actions (n = 1).

Conclusion: The formulated consensus-based checklist may serve as a tool for educators, healthcare professionals and organisations to ensure the accuracy and completeness of educational materials, ultimately contributing to improved snakebite first aid management outcomes. Future work should focus on validating the checklist's effectiveness and adapting it to various languages and regional practices, contributing to a standardised framework for snakebite education globally.

Background: Tuberculosis and depression frequently coexist, with interleukin-associated inflammation recognised as a potential mechanistic link. Nevertheless, the precise causal relationships and mechanisms underlying the associations between tuberculosis, interleukins and their receptors, and depression remain incompletely elucidated.

Method: We analysed summary statistics from European individual genome-wide association studies (GWAS) to analyse the genetic causal relationships between tuberculosis (FinnGen), 216 interleukins and receptors (IEU OpenGWAS) and depression (UK Biobank). The genetic causality between tuberculosis and depression was explored by applying bidirectional Mendelian Randomization analysis, supplemented by two-step and multivariate Mendelian Randomization mediation analysis to identify potential mediating interleukins. Inverse variance weighting regression served as the primary method for estimating causal effects. In addition, heterogeneity tests, horizontal pleiotropy tests and sensitivity analyses were performed to validate the robustness of the results.

Results: A significant genetic causal effect (β _total = 0.015 [0.004, 0.026]) was demonstrated between tuberculosis and depression. Only one mediating pathway, involving the interleukin receptor interleukin-1R2, was identified linking tuberculosis to depression. The causal effect size from tuberculosis to interleukin-1R2 in the upstream causal pathway was 0.032 [0.002, 0.062], and the multivariate Mendelian Randomisation effect size from interleukin-1R2 to depression in the downstream causal pathway was 0.023 [0.003, 0.043]. The mediation proportion of interleukin-1R2 was 7.30% [0.27%, 15.44%]. None of the identified causal associations exhibited reverse Mendelian Randomisation relationships.

Conclusion: Interleukin-1R2 may mediate depressive symptoms in tuberculosis patients, potentially through specific inhibition of interleukin-1-related inflammatory signalling. These findings elucidate genetic mechanisms underlying tuberculosis-depression comorbidity and suggest novel targets for preventive and therapeutic interventions.

Introduction: Cutaneous leishmaniasis is a neglected tropical disease affecting humans worldwide. Leishmania donovani is the causative agent of cutaneous leishmaniasis in Sri Lanka, whereas it typically causes visceral leishmaniasis in other regional countries. Identifying pretreatment innate immune responses may offer insights into diverse disease manifestations.

Methods: We studied lesion biopsy specimens from 103 cutaneous leishmaniasis patients. Total leucocytes, keratinocyte activation, and the distribution of Langerhans cells were semi-quantified using CD45, Osteopontin, and CD1a immunohistochemistry markers. M1/M2 macrophage polarisation was assessed using CD68, HLA-DR, and CD163 immunohistochemistry markers and quantified via open-source image analysis.

Results: Langerhans cell distribution was significantly higher in early lesions (p = 0.017), whereas activated keratinocytes were more prevalent in late lesions (p = 0.004). Total leucocyte count showed no significant association with clinicopathological parameters. Sixty-six patients (64.1%) had M1-dominant macrophage profiles. Macrophage polarisation type was significantly associated with treatment outcome (p = 0.048). Among 17 patients with exclusively M2-dominant profiles, 15 (88.2%) required prolonged Sodium Stibogluconate treatment for complete healing.

Conclusions: Our findings suggest that early innate immune responses, particularly M1 macrophage polarisation, keratinocyte activation, and Langerhans cell involvement, contribute to treatment success in Sri Lankan cutaneous leishmaniasis caused by L. donovani , highlighting localised mechanisms of protective immunity.

Antimicrobial resistance is a growing concern, especially in regions with intense agricultural production. This study investigates the presence of antimicrobial-resistant bacteria in Caramuru, Espírito Santo state, a rural district focused on large-scale agricultural production in Brazil. Samples of water, soil, animal faeces and environmental surfaces were analysed using culture-based methods, revealing the presence of multidrug-resistant strains in agricultural and livestock environments, where antimicrobial use is common. Several bacterial species were detected, with a predominance of Escherichia coli , Enterobacter spp. and Acinetobacter spp., with 58.5% of the samples being resistant to at least one antimicrobial tested. The highest resistance rates among Gram-negative bacilli were ampicillin (80%), followed by cefuroxime (70%) and ceftriaxone (55%). In addition, resistance to polymyxin B was found in 14% of the GNB isolates, including Enterobacter asburiae , Enterobacter cloacae , E. coli , Acinetobacter baumannii and Pseudomonas aeruginosa . The production of extended-spectrum β-lactamases was detected in six multidrug-resistant E. coli samples isolated from river water, dog faeces and pigsty floors, while the production of metallo-β-lactamases was observed in E. asburiae from water samples from the river and toilet, as well as E. cloacae from coffee grounds. The bla _TEM-like gene was identified in multidrug-resistant E. coli strains isolated from all the Caramuru River water and the pigsty floor samples, while bla _CTX-M-1/2-like was found in an Enterobacter bugandensis and E. asburiae strains isolated from flies in the toilet, respectively. These findings indicate the presence of extended-spectrum β-lactamase genes in different environmental and animal-associated sources within the study area. The overlap of these detections with agricultural and surface water sites underscores the importance of monitoring antimicrobial resistance in diverse environmental compartments.

Introduction: In recent years, the global burden of tegumentary leishmaniasis (TL) has significantly increased in the Americas.

Objective: To estimate the prevalence of TL in South America based on publications from the past 13 years.

Methods: Three databases were searched, and articles were selected based on inclusion criteria and methodological relevance. The random effects model was used to calculate pooled prevalence, and heterogeneity was assessed with the I ² statistic.

Results: Out of the 225 articles initially identified, six studies remained eligible for review and meta-analysis. No publication bias was found. TL prevalence in South America ranged from 0.2% to 87.7%, showing significant heterogeneity (I ² = 99.83%, p < 0.001). Colombia and Ecuador had the highest prevalence rates (> 76.6%). The pooled prevalence in the general population was 0.4% (95% CI: 0.1-1.0), and 81.8% (95% CI: 75.4-87.4) in symptomatic patients attending health units.

Conclusions: TL prevalence varied widely across countries, reflecting national epidemiological disparities. High positivity rates in suspicious samples and molecular detection in samples confirmed by microscopy underscore the importance of accurate diagnosis and clinical expertise. This meta-analysis emphasises the need for tailored health policies and accessible laboratory diagnoses to guide disease control strategies.

Objectives: Diagnosing dengue accurately, especially in resource-limited settings, remains challenging due to overlapping symptoms with other febrile illnesses and limitations of current diagnostic methods. This study aimed to develop machine learning models that leverage readily available clinical data to improve diagnostic accuracy for dengue, potentially offering a more accessible and rapid diagnostic tool for healthcare providers.

Methods: We used data from the Sentinel Enhanced Dengue Surveillance System in Puerto Rico (May 2012-June 2024). The Sentinel Enhanced Dengue Surveillance System primarily targets acute febrile illness but also includes cases with other symptoms during outbreaks (e.g., Zika and COVID-19). Machine learning models (logistic regression, random forest, support vector machine, artificial neural network, adaptive boosting, light gradient boosting machine [LightGBM] and extreme gradient boosting [XGBoost]) were evaluated across different feature sets, including demographic, clinical, laboratory and epidemiological variables. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), where higher AUC values indicate better performance in distinguishing dengue cases from non-dengue cases.

Results: Among 49,679 patients in SEDSS, 1640 laboratory-confirmed dengue cases were identified. The XGBoost and LightGBM models achieved the highest diagnostic accuracy, with AUCs exceeding 90%, particularly with comprehensive feature sets. Incorporating predictors such as monthly dengue incidence, leukopenia, thrombocytopenia, rash, age and absence of nasal discharge significantly enhanced model sensitivity and specificity for diagnosing dengue. Adding more relevant clinical and epidemiological features consistently improved the models' ability to correctly identify dengue cases.

Conclusions: Machine learning models, especially XGBoost and LightGBM, show promise for improving diagnostic accuracy for dengue using widely accessible clinical data, even in resource-limited settings. Future research should focus on developing user-friendly tools, such as mobile apps, web-based platforms, or clinical decision systems integrated into electronic health records, to implement these models in clinical practice and exploring their application for predicting dengue.

Background: Children and adolescents with mental health conditions represent a uniquely vulnerable population, particularly in Africa where mental health systems are under-resourced and understudied. Conducting research with this group raises complex ethical questions that require robust legislative and ethical oversight.

Methods: This systematic review included searches from Medline, Embase, PsycInfo, Global Health and grey literature, conducted without any time restrictions up to 10 September 2023. Publications included focused on individuals aged 0-17. All study designs were included if they addressed governance and regulations in child and adolescent mental health research in Africa. Excluded publications did not report findings specific to children, to Africa, to governance or regulations in mental health research, or had no available full text. Articles were critically appraised using JBI checklists and data was extracted into Excel. Articles were narratively synthesised using frequencies for dates of regulations and ages of consent and coded in NVivo for attitudes toward regulation. The study protocol is available at PROSPERO (CRD42023464864).

Results: This review identified 14 articles from nine countries across Africa. Most regulations were over a decade old, with the most recent from 2017. The publications covered five themes: concerns toward unfavourable existing legislation, concerns about risks of undertaking research on a clinical frontline, a call to action regarding the dearth of African literature in this field, specific recommendations for future research and suggested new research directions.

Conclusions: This study highlights the need for improved research governance and legislation to protect children and adolescents in mental health research in Africa. Overall, most African countries place a low priority on child and adolescent mental health research.