Infectious Diseases of Poverty最新文献

Background: Hookworm disease remains a global health issue. In China, it persists with a 0.67% infection rate and uneven distribution in 2021. Optimized control strategies are needed. This study aims to optimize intervention strategies for hookworm disease in China.

Methods: Structural analysis and parameter estimation were conducted using system dynamics theory. Key variables were identified via the Delphi method, leading to the creation of a causal loop diagram (CLD) and stock flow chart (SFC). Based on the SFC, parameter estimation and quantitative relationships were established and the model was validated. A cost-effectiveness model was then integrated into the intervention mechanism model. Various intervention measures were tested in the model to determine their cost-effectiveness ratio (CER) and effectiveness. Generalized linear models were constructed from simulation data, accounting for the impact of survey sites. The results were used to develop an optimized strategy for hookworm disease control.

Results: In comparing drug treatment methods, whole population deworming (WPD) and key population deworming (KPD) showed lower CERs than examination and voluntarily deworming (EVD), saving 384.79-504.64 CNY and 354.35-506.21 CNY per infection reduced, respectively (P < 0.001). For WPD or KPD alone, CER decreased with increased drug coverage. For examination and deworming (ED) and EVD, CER was highest at 30% coverage for a 1-year intervention, but at 90% coverage for 2-5 years (P < 0.05). WPD, ED, and EVD had higher infection reduction rates than KPD, with ratios of 0.14-0.25, 0.10-0.19, and 0.08-0.17, respectively, over 1-5 years (P < 0.001). Continuous health education over 1-5 years showed that increasing coverage from a 10% baseline led to enhancing cost-effectiveness and intervention outcomes.

Conclusions: In high-endemic areas (infection rate ≥ 20%) in China, prioritize WPD for better cost-effectiveness and outcomes. In medium-endemic areas (5% ≤ infection rate < 20%) where WPD isn't feasible, use ED for cost-effectiveness and KPD for infection reduction, based on local needs. In low-endemic areas (infection rate < 5%), encourage voluntary examination and treatment due to limited cost-effectiveness of mass treatment. Combining drug treatment with extensive health education can enhance long-term control effect. This strategy can guide control efforts for hookworm diseases in China.

Clinical trial number: Not applicable.

Background: The association between gut microbial metabolites and immunologic non-response among people living with HIV (PLHIV) receiving antiretroviral therapy (ART) has not been well established. We aimed to characterize gut microbial metabolites among HIV-infected men who have sex with men (MSM) with different immunologic responses.

Methods: We recruited HIV-infected MSM from Guangzhou Eighth People's Hospital and HIV-uninfected MSM (healthy controls, HC) from a local MSM community-based organization in Guangzhou between June and October 2021. HIV-infected MSM were grouped into good immunological responders (GIR) (CD4 + T cell count ≥ 350 cells/μl) and poor immunological responders (PIR) (CD4 + T cell count < 350 cells/μl) after 24 months of ART treatment. Online questionnaires and stool samples were collected. Microbial metabolites in stool were obtained through ultra-performance liquid chromatography coupled to a tandem mass spectrometry (UPLC-MS/MS) system. Differential metabolites were identified and analyzed using the Kruskal-Wallis test, followed by pairwise comparisons with the Wilcoxon rank-sum test. The least absolute selection and shrinkage operator was used to select potential metabolites biomarkers.

Results: A total of 51 HC, 56 GIR, and 42 PIR were included. No statistically significant differences were observed in the median time since HIV diagnosis and ART duration between GIR and PIR. Among the 174 quantified metabolites, 81 significantly differed among HC, GIR, and PIR (P < 0.05). Among differential metabolites, indole-3-propionic acid significantly decreased from HC (11.39 nmol/g) and GIR (8.16 nmol/g) to PIR (6.50 nmol/g). The pathway analysis showed that tryptophan metabolism differed significantly between GIR and PIR (P < 0.05). Four potential metabolites biomarkers (dimethylglycine, cinnamic acid, 3-hydroxyisovaleric acid, and propionic acid) that distinguish GIR and PIR were identified, and the corresponding area under the curve based on potential biomarkers was 0.773 (95% CI: 0.675-0.871).

Conclusions: This study identified significant differences in gut microbial metabolites among HIV-infected MSM with different immunologic responses. These results indicate the potential of gut microbial metabolites as novel disease progression markers and therapeutic targets.

Schistosomiasis, also known as bilharzia, is a widespread neglected tropical disease (NTD) in Africa, with more significant research and development (R&D) challenges and gaps compared to other preventive chemotherapy NTDs (PC-NTDs) like onchocerciasis, lymphatic filariasis, and trachoma. In response to this challenge, some global initiatives have advocated for bridging this gap, focusing on coordinated engagement with research donors. In this opinion article we highlight key R&D priorities for combating schistosomiasis in the WHO Africa region. These include defining morbidity indicators, expanding prevention, and developing innovative diagnostics, treatments, and public health strategies like test-and-treat. We emphasize integrating efforts with broader health campaigns, assessing zoonotic transmission through One Health, and using environmental surveillance tools like xenomonitoring and eDNA. We stress the need to study climate and environmental impacts on transmission, zoonotic transmission, schistosome hybridization, and snail ecology, advancing snail control, and developing vaccines, while calling for new treatments beyond praziquantel, addressing drug resistance, and improving access for children and remote populations. Further, operational research should refine hotspot interventions, enhance water, sanitation and hygiene integration, and address socio-cultural barriers. Lastly, sustainable funding and global collaboration are vital to achieve 2030 NTD Roadmap goals.

Background: Schistosoma haematobium and S. mansoni are endemic in Madagascar, but reliable diagnostic tools are often lacking, contributing to exacerbate transmission and morbidity. This study evaluated the diagnostic accuracy of three tests for schistosome infection in Malagasy adults from areas of medium to high endemicity.

Methods: This cross-sectional study enrolled adults from three primary health care centres in Madagascar. Urine and blood samples were tested for schistosome infection using polymerase chain reaction (PCR), up-converting reporter particle lateral flow for the circulating anodic antigen (UCP-LF CAA), and point-of-care circulating cathodic antigen (POC-CCA) tests. Bayesian latent class models were used to assess diagnostic accuracies and disease prevalence.

Results: Of 1339 participants, 461 were from S. haematobium and 878 from S. mansoni endemic areas. Test detection rates were 52% (POC-CCA), 60% (UCP-LF CAA), and 66% (PCR) in the S. haematobium area, and 54%, 55%, and 59% respectively in the S. mansoni area. For S. haematobium, PCR and UCP-LF CAA showed high sensitivity (Se, median 95.2% and 87.8%) but moderate specificity (Sp, 60.3% and 66.2%), while POC-CCA performed moderately (Se: 64.5%; Sp: 59.6%). For S. mansoni, PCR and POC-CCA demonstrated high diagnostic accuracy (Se > 90%, Sp > 80%), while UCP-LF CAA showed good sensitivity (79.9%) but moderate specificity (69.7%).

Conclusions: While population-level prevalence estimates were similar across tests, individual-level agreement was only low to moderate. Our findings suggest that optimal diagnostic strategies should be tailored to specific endemic settings, continued development of accurate diagnostics suitable for highly endemic settings remains a priority.

Hepatitis B is the single most common cause of liver cancer, affecting > 250 million people worldwide (mostly in resource limited communities) and killing > 1 million people annually. The condition is marked by poor rates of diagnosis (14%) and treatment (8% of eligible individuals). As with many health conditions, engagement with the affected community is crucial for designing, promoting, and advocating for effective solutions in the health system. However, engagement with the affected community remains difficult in many instances due to variable understanding of the roles, capacities, and expertise of people with lived experience. Through community-led consensus, we provide here several practical approaches for how public health, clinical, scientific, industrial, and policy-making bodies should engage with the hepatitis B affected community. These expert consensus practices have been developed by people living with hepatitis B and/or advocating for them. We suggest that these practices should be incorporated into any engagements with communities affected by hepatitis B and can be generalisable to other health conditions.

Background: Leptospirosis, a zoonotic disease caused by pathogenic species of the genus Leptospira, is an important public health concern globally. Leptospirosis has been notifiable under statute in China since 1955, and its epidemiological characteristics have evolved during near 70 years. This study aimed to describe the spatial and temporal patterns and demographic characteristics of leptospirosis from 1955 to 2022 in China, and explore the possible factors that influence leptospirosis transmission risk.

Methods: Wavelet time series analysis, global Moran's I coefficients, space-time scanning statistics, and so on were used to analyze temporal, seasonal, geographic, and demographic trends in leptospirosis using reported national surveillance data from Chinese mainland from 1955 to 2022. Additionally, a Bayesian spatiotemporal model was used in a preliminary analysis to explore potential factors associated with leptospirosis occurrence.

Results: Between 1955 and 2022, China reported 25,236,601 leptospirosis cases, with 91% occurring from July to October. The annual incidence rate peaked at 38.28/100,000 during outbreaks in the 1960s-1980s but stabilized at a low level (0.07/100,000) between 2005 and 2022, with over 99% of cases in southern China. Clustering increased over time, being greatest during the period 2015-2022 (Moran's I = 0.41, P < 0.01). Space-time cluster analysis indicated that the most likely clusters were in northern provincial-level administrative divisions (PLADs) from 1955 to 1984, in southern PLADs from 1985 to 2022. The main identified risk factors of leptospirosis occurrence were annual average precipitation (3.68, 95% CI: 2.50 to 5.12), GDP per capita (-3.70, 95% CI: - 5.97 to - 1.41), and the total power of agricultural machinery (- 2.51, 95% CI: - 3.85 to - 1.17).

Conclusions: Over past 70 years, leptospirosis in China has occurred as significant outbreaks but has ultimately declined to stable, low levels of occurrence. However, a clear north-south disparity persists, with tropical and subtropical regions in southern China remaining high-risk areas. The nearly 70-year dataset underscores the complex interplay of climate and socioeconomic factors influencing the disease's occurrence. Targeted prevention and control measures are critical to prevent outbreaks, especially in regions prone to extreme climatic events like heavy rainfall and floods, which may signal the resurgence of leptospirosis.

Background: Despite global efforts to reduce tuberculosis (TB) incidence, Nepal remains burdened by approximately 70,000 new cases annually, with an incidence rate of 229 per 100,000 people in 2022. This study investigated the geographic patterns of TB notifications in Nepal from fiscal year 2020 to 2023, focusing on environmental determinants such as land surface temperature (LST), urbanization, precipitation and cropland coverage.

Methods: This study examined the spatial association between environmental factors and TB prevalence in Nepal at the district level, utilizing Geographic Information System (GIS) techniques, bivariate Local Indicators of Spatial Association (LISA) and spatial regression analyses. The tuberculosis prevalence data were obtained from the National Tuberculosis Control Center (NTCC) Nepal for the fiscal years (FY) 2020-2023.

Results: Over the three fiscal years, high TB prevalence consistently clustered in districts such as Banke, Parsa, and Rautahat, while low prevalence areas included Mustang and Kaski. Significant positive spatial autocorrelation was found between environmental factors and TB prevalence. Moran's I values were as follows: for LST (day), 0.379, 0.424, and 0.423; for LST (night), 0.383, 0.420, and 0.425; for cropland coverage, 0.325, 0.339, and 0.373; for urbanization, 0.197, 0.245, and 0.246; and for precipitation, 0.222, 0.349, and 0.104 across FY 2020-2021, FY 2021-2022 and FY 2022-2023, respectively. Regression analyses, including Ordinary Least Squares (OLS), Spatial Lag Model (SLM), and Spatial Error Model (SEM), demonstrated that Land Surface Temperature Night (LSTN), urbanization, and precipitation significantly influenced TB prevalence, explaining up to 72.1% of the variance in FY 2021-2022 (R²: 0.721).

Conclusions: Environmental factors significantly influence the spatial distribution of TB in Nepal. This underscores the importance of integrating disease management strategies with environmental health policies in effectively addressing TB prevalence.

Background: Low tuberculosis (TB) case detection remains a major challenge in achieving the End TB targets. New strategies that consider local contexts are needed in countries with high TB burdens like Ethiopia. This study examined the effect of integrating traditional and modern TB care to increase the TB case detection rate.

Methods: A cluster randomized controlled trial was conducted from February 2023 to January 2024 in six districts of South Gondar Zone, Northwest Ethiopia, where districts were randomly assigned to intervention or control groups. The interventions included training, screening, and referral of presumptive TB patients, delivered over one year, while the control group continued with the standard passive case detection approach. A paired t-test and two sample independent t-test were used to compare baseline and end line data for both groups. Cohen's d was also used to compare the effect size between the intervention and the control groups. A mixed-effect Poisson regression was employed to determine the association between the dependent variable and the exposure variables.

Results: In the intervention group, a total of 620 TB cases were identified post-intervention, compared with 473 cases pre-intervention, including 14 cases identified through referrals by traditional care providers. In contrast, the control group identified 298 TB cases post-intervention and 279 pre-intervention. The TB detection rate increased to 93 cases per 100,000 population in the intervention group, making an approximate 29.2% improvement, compared to a 2.9% increase in the control group. Integrating traditional care with the modern healthcare system significantly increased case detection, with a standardized mean difference of 2.6 (95% confidence interval CI: (1.8, 3.5; t = 8.3; P < 0.001) in a two-sample independent t-test.

Conclusions: Integrating traditional care with the modern healthcare system significantly increased TB case detection in high-burden settings. This approach not only enhances current TB control strategies but also has potential applications in managing other chronic diseases in resource-limited areas. Future research should evaluate the cost-effectiveness, scalability, and sustainability of this integrative model. Trial registration Unique Protocol ID: 353/2021.

Clinicaltrials: gov ID: NCT05236452. The date recruitment began: July 1, 2022. Registration date: July 22, 2022.

Background: The WHO Eastern Mediterranean Region (EMR) faces major social, economic, and demographic challenges, with nearly half of its countries affected by conflicts that severely disrupt health systems. This study compared antimicrobial resistance (AMR) rates and surveillance efforts in conflict-affected, fragile, and non-conflict countries, further subdivided by income.

Methods: Data on bacteriologically confirmed bloodstream infections (BC-BSIs) from 2017 to 2021 were extracted from the WHO GLASS database. Countries were classified as conflict-affected, fragile, or non-conflict (subdivided by income) using World Bank criteria. Descriptive statistics (mean ± SD) were calculated, and group comparisons were performed using unpaired t-tests with Welch's correction. Mean differences (MD) and 95% confidence intervals (CI) were reported.

Results: Conflict-affected countries reported significantly fewer surveillance sites than non-conflict countries (MD: 0.60, 95% CI: 0.361 to 0.836, P < 0.001) and fewer BC-BSIs per million population (MD: 31.00, 95% CI: 17.210 to 44.790, P < 0.001). In conflict zones, Acinetobacter spp. and S. aureus represented a higher proportion of BSIs compared to non-conflict countries (Acinetobacter spp. MD: -11.86, 95% CI: - 27.130 to 3.399, P = 0.099; S. aureus MD: - 10.68, 95% CI: - 30.030 to 8.680, P = 0.203). Carbapenem resistance in Acinetobacter spp. exceeded 65% across the groups, peaking in fragile zones (83.38%). Third-generation cephalosporin-resistant E. coli (3GCREC) prevalence ranged from 47.99% to 76.34%, peaking in conflict zones (76.34%). Carbapenem-resistant E. coli (CREC) prevalence ranged from 2.31% to 15.95%, highest in non-conflict low-middle income countries (15.95%). Third-generation cephalosporin-resistant K. pneumoniae (3GCRKP) exceeded 50% in all groups, peaking in conflict zones (80.42%). The prevalence of carbapenem-resistant K. pneumoniae (CRKP) ranged from 14.49% to 45.70%, peaking in conflict zones and non-conflict low-middle income countries (45.70%). Methicillin-resistant S. aureus (MRSA) exceeded 30%, peaking in conflict zones (70.09%).

Conclusions: Conflict-affected countries have weaker AMR surveillance and lower BC-BSI detection but a higher burden of resistant pathogens, notably carbapenem-resistant Acinetobacter spp. and MRSA. Tailored strategies are essential to restore infrastructure, strengthen surveillance, and mitigate the long-term impact of AMR in these zones.

Background: Acute respiratory infection (ARI) and diarrhea remain critical public health concerns. In Indonesia, various interventions have been implemented to reduce the prevalence of ARIs and diarrhea among children in low- and middle-income households. Hence, the absence of detailed data on the prevalence of ARIs and diarrhea among children under five in low- and middle-income households in Indonesia restricts the formulation of targeted health interventions and policies. This study sought to evaluate the prevalence of ARI and diarrhea while examining modifiable risk factors related to malnutrition, sanitation, and social protection characteristics in Indonesia.

Methods: This study utilized a cross-sectional design based on data from the Nutrition Status Survey 2022 covering 514 districts/cities in Indonesia. It analyzed 289,631 children under five years out of 334,848 households with low and middle wealth indices. Multivariable binary logistic regression analysis was employed to calculate the risk associated with cases of ARI and diarrhea.

Results: The prevalence of ARI and diarrhea among low- and middle-wealth households were 5.7% and 6.0%, respectively, with infants under six months being the most vulnerable group to these infections, including malnutrition. The most significant risk factors for ARI and diarrhea are unclean cooking fuel [adjusted odds ratio (aOR) = 1.53, 95% CI 1.47-1.60] and shared toilet facilities (aOR = 1.45, 95% CI 1.38-1.51), with households using shared toilets having 1.45 times higher risk of diarrhea (aOR = 1.45, 95% CI 1.38-1.51) compared to those with private access. Additionally, households lacking social protection support are also at increased risk for these infections and malnutrition issues.

Conclusions: This study revealed a notable prevalence of ARI and diarrhea among low- and middle-wealth households, particularly affecting infants under six months. Vulnerable children, especially those who were stunted or underweight, and households lacking sanitation and social protection faced heightened risks for these health issues.