Tropical Medicine & International Health最新文献

Objectives: This study aimed to investigate the social and economic impacts and disease burden of Chikungunya Fever globally through a systematic literature review.

Methods: We performed a comprehensive literature search through MEDLINE (via PubMed), LILACS, and Embase databases, and grey literature, including studies of populations diagnosed with Chikungunya Fever or at risk of infection published in English, Spanish, French, or Portuguese, without date restrictions. Two reviewers independently performed study selection, data extraction, and quality assessment. Methodological quality was assessed using different tools.

Results: Forty-three publications were included. Until 2013, publications originated solely from the Asian and African continents. From 2015 onwards, South America emerged as the predominant source. Publications were classified as cost studies (25), including cost-of-illness (18) and program cost (6); burden of disease studies (10); cost-outcome studies (4), including cost-effectiveness (3) and cost-utility (1); and quality-of-life studies (15). Reported total direct costs associated with Chikungunya Fever ranged from US$ 3.5 million (US Virgin Islands, 2014-2015) to US$ 83.6 billion (Region of the Americas, 2013-2015). Direct medical costs varied from US$ 308.94 (Tamil Nadu, India, 2006) to US$ 33.7 million (Réunion Island, 2005-2006). Vector control program costs ranged from US$ 888,000 annually (Greece, 2013-2017) to US$ 466 million (Brazil, 2016). Estimated disability-adjusted life years per 100,000 population ranged from 4.53 (India, 2006) to 2432 (Region of the Americas, 2013-2015). Quality-of-life studies demonstrated substantial declines across multiple domains, indicating significant functional impairment due to Chikungunya Fever.

Conclusion: Chikungunya Fever imposes a considerable economic and social burden, surpassing that of other endemic arboviral diseases such as dengue and yellow fever. These findings underscore the need for further research to accurately quantify the full scope of Chikungunya Fever-related costs and impacts on affected populations.

Objectives: Sexually transmitted infections are a global public health concern. We aimed to assess the burden of a diverse range of sexually transmitted infections in a high HIV burden setting in Eswatini and associated risk factors.

Methods: This cross-sectional study enrolled adults accessing routine outpatient care at six sites in Shiselweni, from July 2022 to April 2023. Laboratory investigations included antibody-based tests for HIV, Treponema pallidum , hepatitis B, hepatitis C, and herpes simplex 2 viruses. The molecular-based Xpert platform tested urine samples for Chlamydia trachomatis , Neisseria gonorrhoea, Trichomonas vaginalis, self-collected vaginal/anal swabs for Human papillomavirus, and plasma for HIV viremia. We calculated the proportion of laboratory-confirmed sexually transmitted infections among available test results and identified predictors of combined Chlamydia trachomatis /Neisseria gonorrhoea/Trichomonas vaginalis infection.

Results: Of 1396 study participants, 65.4% were women, the median age was 29 (IQR 23-36) years, and 19.6% were known HIV-positive. Overall, 68.6% had symptoms suggestive of Chlamydia trachomatis /Neisseria gonorrhoea/Trichomonas vaginalis infections. Laboratory-confirmed Chlamydia trachomatis /Neisseria gonorrhoea/Trichomonas vaginalis infection was found in 31.7% (n = 443/1396), of whom 20.8% were asymptomatic. Combined Chlamydia trachomatis /Neisseria gonorrhoea/Trichomonas vaginalis infections were common even among individuals with low risk of infection (e.g., no sexual intercourse: 20.7%) and were associated with young age, factory employment, and transactional sex. Prevalences for individual sexually transmitted infections were 16.9% (n = 236/1394) for Chlamydia trachomatis , 12.4% (n = 173/1394) for Neisseria gonorrhoea, 10.6% (n = 148/1390) for Trichomonas vaginalis, and 9.7% (n = 135) for Treponema pallidum . Viral infections were high for herpes simplex 2 viruses (n = 792/1279, 61.9%) and human papillomavirus (n = 166/324, 51.2%) and lower for hepatitis B virus (n = 55/1396, 3.9%) and hepatitis C virus (n = 3/1396, 0.2%). Of 1122 clients undergoing HIV testing, 4.1% (n = 46/1122) tested positive, with 21.7% (n = 10/46) being acute/early HIV infection.

Conclusions: The substantial sexually transmitted infections burden highlights the urgent need to strengthen sexually transmitted infections service integration, expand access to affordable diagnostics, and target prevention in decentralised care. These findings support the development of context-adapted strategies to improve detection, treatment, and partner services in high-burden settings.

Objective: To evaluate the temporal trend and spatial distribution of oral cancer cases in Brazil, and to evaluate the relationship between oral cancer cases and socioeconomic conditions.

Methods: Data on oral cancer cases, between 2013 and 2019, were extracted from the Painel-Oncologia website, and the socioeconomic indicators selected were Municipal Human Development Index and Social Vulnerability Index. The endpoints were late diagnosis (staging III and IV) and delay in treatment (>60 days), along with oral cancer prevalence. Spearman's correlation was done between oral cancer cases and Municipal Human Development Index/ Social Vulnerability Index. Temporal trends were evaluated using a segmented linear regression model. As for spatial analysis, global and local Moran indices were applied, together with spatiotemporal scan statistics, to detect risk clusters.

Results: In the period studied, there was a prevalence of 5.3 oral cancer cases/100,000 inhabitants. A significant inverse correlation was found with the Social Vulnerability Index, and a direct correlation linking the Municipal Human Development Index and oral cancer cases, delayed treatment, and diagnosis cases too. An increasing trend of oral cancer prevalence rate and a stable trend of delayed diagnosis and treatment cases were observed in the country. There was a concentration of oral cancer cases in the South and Southeast regions. A high-risk oral cancer cluster was identified covering the South and Southeast regions, and part of the Midwest region and four secondary clusters of delayed treatment cases in the Northeast region.

Conclusion: There was no short-term improvement in data related to oral cancer in Brazil, since the prevalence trend was increasing and there was a correlation with socioeconomic conditions.

Objectives: The use of mobile phone surveys in low- and middle-income countries is increasing as a low-cost and rapid alternative to in-person interviews. However, ensuring they are representative of women and, when women are included reducing potential response bias and harm are important considerations. To improve women's participation in phone surveys, we conducted a qualitative study in Mozambique to better understand women's experiences of participating in mobile phone surveys.

Methods: This study was part of the Rapid Mortality Mobile Phone Survey (RaMMPS) project implemented in Mozambique to test the use of mobile phone interviews for childhood mortality measurement at the national level. We conducted a qualitative study with 32 women who had previously participated in the RAMMPS mobile phone survey. Interviews were conducted both in-person and over the phone. Thematic analysis was done manually using the Framework approach.

Results: Gender-related considerations that emerged from the data regarding women's participation included women's access to mobile phones, the reduced time burden and convenience of participating in mobile phone interviews compared to in-person interviews, difficulties ensuring privacy in mobile phone surveys, the effect of the interviewer's gender on participant responses, and women's safety concerns.

Conclusion: Important considerations for including women in mobile phone surveys relate to efforts to reduce response bias and mitigate harm, such as ensuring privacy and considering the gender of the data collector. Addressing these issues is crucial to improving women's participation and experience in mobile phone surveys.

Objectives: We investigated the prevalence of anti-phenolic glycolipid-I (PGL-I) IgM antibodies among temporarily unfit blood donors at the Pará State Blood Bank (HEMOPA), located in the Amazon region of northern Brazil. Using an arbitrary high cutoff for optical density (OD ≥0.750) in ELISA, a subset of donors was invited for clinical evaluation for leprosy.

Methods: Temporarily unfit individuals were invited to participate, and blood samples were collected for anti-PGL-I IgM titration by ELISA. Donors with high OD values were referred for clinical examination, slit skin smear (SSS) bacilloscopy, and quantitative PCR (qPCR) targeting M. leprae-specific repetitive element (RLEP) sequences from dermal scrapes of the earlobes and peripheral blood.

Results: From an annual average of 2762 temporarily unfit donors (2019-2023), 500 (16.6%) were tested for anti-PGL-I IgM. Of these, 20/500 (4.0%) had high antibody titres, and 8/20 (40.0%) attended clinical evaluation, resulting in 5/8 (62.5%) newly diagnosed cases of leprosy. Among these, Mycobacterium leprae detection yielded positivity rates of 2/8 (25.0%) by SSS bacilloscopy, 3/7 (42.9%) by qPCR of dermal scrapes, and 2/8 (25.0%) by qPCR of peripheral blood.

Conclusions: Using an anti-PGL-I IgM cutoff of OD ≥0.750, we identified a significant proportion of undiagnosed leprosy cases among temporarily unfit blood donors. These findings support the need for targeted leprosy screening in this population. Regardless of qPCR results, individuals with clinical signs of leprosy require appropriate treatment and assessment of their eligibility for blood donation.

Objectives: To inform patient management and disease prevention, we sought to estimate the prevalence of, and identify risk factors for, scrub typhus, murine typhus, and spotted fever group rickettsioses (SFGR) among febrile patients presenting to hospital in Myanmar.

Methods: We recruited patients ≥12 years old with fever ≥38°C among those seeking care at Yangon General Hospital from 5 October 2015 through 4 October 2016. Standardised clinical and risk factor assessments were conducted. Confirmed scrub typhus, murine typhus, and SFGR infections were defined as a positive polymerase chain reaction or ≥4-fold rise in immunofluorescence assay antibody titre to Orientia tsutsugamushi, Rickettsia typhi or Rickettsia honei or Rickettsia conorii, respectively. Probable infection was defined as IgM titre ≥1:400 to O. tsutsugamushi, an IgM titre of ≥1:800 or IgG ≥1:1600 to R. typhi or an IgG titre of ≥1:200 to R. honeii or R. conorii. Univariate and multivariable logistic regression was used to identify associations.

Results: Among 944 participants, the median (range) age was 37 (12-94) years, 444 (47.0%) were female, and 704 (74.6%) resided in rural areas. Among participants, 63 (6.7%) had confirmed or probable scrub typhus and 15 (1.6%) had confirmed or probable murine typhus. No SFGR infections were identified. The odds of confirmed or probable scrub typhus were lower among females than males (adjusted odds ratio [aOR] 0.5, p = 0.014), lower among those earning >300,000 Kyat per month compared with those earning less than 100,000 Kyat per month (aOR 0.28, p = 0.039), and higher among agricultural workers compared with others (aOR 2.9, p = 0.004).

Conclusion: Scrub typhus was common among patients presenting with fever in Yangon, murine typhus was uncommon, and SFGR was not found. Empiric treatment of severe febrile illness should include an antimicrobial with activity against rickettsial diseases. Public health campaigns targeting agricultural workers are recommended.

Background: Cutaneous leishmaniasis has long been a neglected tropical disease mainly due to therapy limitations. The search for safe and effective alternative treatments, particularly oral medications, has led to the development of second-line treatments, such as azole antifungals, including itraconazole. This study aimed to evaluate and compare the therapeutic effectiveness of itraconazole alone and in combination with pentamidine in patients with cutaneous leishmaniasis, caused by Leishmania Viannia guyanensis.

Methods: A randomised clinical trial was conducted at the leishmaniasis outpatient clinic of the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado in Manaus, Amazonas. Ninety eligible patients diagnosed with cutaneous leishmaniasis were selected and randomly assigned to three treatment groups. Control group-Group 1 (G1) received pentamidine isethionate; experimental group-Group 2 (G2) received itraconazole monotherapy; and experimental group-Group 3 (G3) received a combination of itraconazole and one dose of pentamidine isethionate, in standardised doses. Patients were monitored at 30, 60, 90 and 180 days after the completion of treatment. Leishmania species were identified using biomolecular methods.

Results: The patients were predominantly males (84.4%), with a mean age of 40.5 ± 12.9 years. 93% of cases originated from the peripheral areas of Manaus, Amazonas. The average duration of skin lesion evolution was 30 days, with 84% presenting as ulcerated lesions. A single lesion was observed in 57% of cases, 41% measured 2 to 3 cm², and were predominantly on the lower limbs. Four species of Leishmania were identified, with L. guyanensis causing 90% of cases, L. brasiliensis causing 6% of cases, L. amazonensis causing 2.5% of cases and L. naiffi causing 1.2% of cases. Among 72 cases of L. (V.) guyanensis, cure rates were 96% with itraconazole + pentamidine, 83% with itraconazole alone and 58% with pentamidine alone. No serious adverse events were observed in terms of toxicity and tolerability. Injection site pain or induration was the most common adverse effect in G1. In terms of efficacy, patients in G2 and G3 experienced more favourable outcomes, with 90-day cure rates of 56% (G1), 73% (G2) and 90% (G3).

Conclusion: After 90 days, the itraconazole-pentamidine combination therapy was more effective (90%) than either itraconazole or pentamidine alone against cutaneous leishmaniasis in Amazonas state caused by L. guyanensis.

Background: Helminthiasis co-exists with malaria in endemic areas; this co-existence can influence anaemia, iron, and folate levels in patients. This study was aimed at assessing the effect of malaria, helminthiasis, and co-infection on anaemia, iron, and folate deficiencies in children.

Methods: The study participants comprised of 1003 children, from whom venous blood and stool samples were obtained. Structured questionnaires were used to assess sociodemographic and household data. Venous blood from children (aged 1-15 years) was analysed for malaria parasitaemia and full blood count. Kato Katz and formol ether concentration techniques were used to analyse stool samples for intestinal parasites. Indirect ELISA was performed on the serum samples to determine iron and folate levels.

Results: Overall, malaria and intestinal helminths prevalence were 54.4% (546/1003) and 15.7% (172/1003), respectively. Ascaris lumbricoides, Taenia spp., hookworm, Trichuris trichiura and Strongyloides stercoralis were identified as mono-infection or in co-infection with malaria (11.4%) or intestinal protozoa (1.5%). These prevalence rates were significantly higher in less urbanised northern study sites (p < 0.0001) and among younger children (p < 0.0001). Malaria (p < 0.0320), intestinal helminths (p < 0.0001) and malaria-helminthiasis co-infection (p < 0.0320) were independent predictors of anaemia. Malaria and intestinal helminths co-infection significantly worsens anaemia (p < 0.001), folate deficiency (p < 0.001) and iron deficiency (p < 0.001) compared to those with malaria only.

Conclusion: Malaria and helminthiasis predominantly affect children and are influenced by age, gender, locality, and urbanisation. Co-infection exacerbates the adverse outcomes associated with malaria.

Objectives: Rickettsioses are frequent causes of treatable febrile illness in Southeast Asia, including Myanmar. Accurate estimates of the incidence of rickettsioses are needed to inform investments in disease prevention and control. We sought to estimate the incidence of rickettsioses among adults and adolescents by combining sentinel hospital surveillance with a healthcare utilisation survey in Yangon, Myanmar.

Methods: We conducted a household-based healthcare utilisation survey in the Yangon Region from 12 March through 5 April 2018. Multipliers derived from this survey were then applied to scrub typhus, murine typhus, and spotted fever group rickettsioses infections identified from a study of adolescent and adult community-onset febrile illness done from 5 October 2015 through 4 October 2016 at Yangon General Hospital to estimate disease incidence. Acute serum was collected at enrolment and convalescent serum 14-30 days after enrolment. Confirmed acute scrub typhus, murine typhus, and spotted fever group infections were diagnosed by a ≥ 4-fold rise between acute and convalescent immunofluorescent antibody test titre to Orientia tsutsugamushi pooled Karp, Kato, and Gilliam antigens; Rickettsia typhi Wilmington strain; and Rickettsia honei and Rickettsia conorii antigens, respectively.

Results: After applying multipliers, we estimated the overall annual incidence of acute scrub typhus among adolescents and adults in the Yangon Region at 211 cases per 100,000 persons, and the overall estimate of acute murine typhus among adults and adolescents was 44 cases per 100,000 persons per year for 2015-2016. There were no confirmed spotted fever group infections.

Conclusions: We provide the first estimates of scrub typhus and murine typhus community incidence in Myanmar. Similar research in children and from other parts of Myanmar, as well as studies of illness duration, complications, and deaths, is needed to estimate the disease burden.

Objectives: Our study aims to (i) evaluate the yield and costs of a fully automated interactive voice response survey as a screening tool for identifying rural respondents for participation in a mortality mobile phone survey, and (ii) compare mortality survey call outcomes among interactive voice response pre-screened and unscreened numbers.

Methods: In order to identify respondents living in rural areas, a short interactive voice response survey was conducted among 24,924 unique mobile phone numbers to determine place of residence (Rural vs. Other). We calculated the proportion of rural numbers derived from the interactive voice response survey among all numbers dialled. Mobile phone numbers screened with interactive voice response were then combined with those generated via random digit dialling and used in a national mortality mobile phone survey in Malawi. Final dispositions for each mobile number dialled were compared for both groups by testing the difference in proportions.

Results: Approximately half of all phone numbers dialled in the interactive voice response survey were answered, and among them, 33.9% indicated that they lived in a rural area. The cost per completed interactive voice response was US$8.75 and just under half of the numbers screened by interactive voice response later resulted in a completed mortality mobile phone survey, at a cost of US$17.4 per completed mortality survey. In comparison, less than a quarter of the numbers that were not screened through interactive voice response resulted in a completed mortality survey (45.3% vs. 22.3%, p <0.001). On average, 12 call attempts were required to complete a mortality survey interview in the unscreened group, compared to 6.3 call attempts among the interactive voice response pre-screened numbers.

Conclusions: Interactive voice response surveys can be used to increase the representation of rural respondents in mobile phone surveys at an acceptable cost. Modifications to the interactive voice response survey process (e.g., survey timing and number of call attempts) should be explored further to increase engagement.