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Innovative sterile male release strategies for Aedes mosquito control: progress and challenges in integrating evidence of mosquito population suppression with epidemiological impact. 伊蚊控制的创新不育雄蚊释放策略:结合蚊虫种群抑制与流行病学影响证据的进展与挑战
IF 8.1 1区 医学 Pub Date : 2024-12-03 DOI: 10.1186/s40249-024-01258-5
Arya Rahul, Appadurai Daniel Reegan, A N Shriram, Florence Fouque, Manju Rahi

Background: Aedes mosquitoes pose a significant global threat as vectors for several debilitating arboviruses, including dengue, Zika, yellow fever, and chikungunya. Their unique breeding habits, behavior, and daytime activity complicate control efforts, prompting the search for innovative solutions. The sterile insect technique (SIT) and incompatible insect technique (IIT) are promising new techniques under investigation. This review synthesizes findings from field trials on SIT and/or IIT for Aedes mosquito control.

Methods: A scoping review was conducted through comprehensive searches on Scopus, Web of Science, MEDLINE, PubMed, and preprint repositories up to April 25, 2024. Studies were initially screened for relevance based on their titles and abstracts, followed by a full-text review conducted by two independent extractors. Only field trials with control groups were included, with the final assessment focusing on trials reporting epidemiological outcomes. Data were abstracted into templates, emphasizing study design, intervention details, and outcomes. The review adhered to the PRISMA-ScR guidelines.

Results: The search identified 21 field trials in various countries against Aedes mosquitoes. These trials employed diverse methodologies and mosquito release strategies, achieving varying levels of mosquito population suppression. Notably, two SIT and two Wolbachia-based IIT trials reported epidemiological outcomes, including reductions in dengue incidence and associated risk ratios. However, the reliance on national surveillance data for assessing dengue incidence suggests caution due to the potential underreporting of subclinical cases.

Conclusions: The review underscores the promise of SIT and IIT for controlling Aedes mosquito populations, citing successful reductions in mosquito densities and dengue transmission. However, it calls for more rigorous study designs and standardized methodologies, as well as the adoption of comprehensive frameworks to accurately assess the effectiveness of these interventions. Future research should focus on bridging gaps in real-world effectiveness by addressing factors such as feasibility, acceptability, scalability, and cost, which are crucial for guiding their successful large-scale deployment in any country.

背景:伊蚊作为登革热、寨卡病毒、黄热病和基孔肯雅热等几种致残虫媒病毒的媒介,对全球构成重大威胁。它们独特的繁殖习惯、行为和日间活动使控制工作复杂化,促使人们寻找创新的解决方案。昆虫不育技术(SIT)和昆虫不亲和性技术(IIT)是目前正在研究的有前途的新技术。本综述综合了用于伊蚊控制的SIT和/或IIT的现场试验结果。方法:通过综合检索截止到2024年4月25日的Scopus、Web of Science、MEDLINE、PubMed和预印本数据库进行范围综述。研究最初根据题目和摘要筛选相关性,然后由两个独立的提取者进行全文审查。仅纳入了有对照组的现场试验,最终评估的重点是报告流行病学结果的试验。数据被抽象为模板,强调研究设计、干预细节和结果。该审查遵循PRISMA-ScR指南。结果:检索确定了不同国家针对伊蚊的21个田间试验。这些试验采用了不同的方法和蚊子释放策略,实现了不同程度的蚊子种群抑制。值得注意的是,两项SIT试验和两项基于沃尔巴克氏体的IIT试验报告了流行病学结果,包括登革热发病率和相关风险比的降低。然而,在评估登革热发病率时依赖国家监测数据表明,由于可能漏报亚临床病例,应谨慎行事。结论:这篇综述强调了SIT和IIT在控制伊蚊种群方面的前景,并指出成功地降低了蚊子密度和登革热传播。然而,它要求更严格的研究设计和标准化的方法,以及采用全面的框架来准确评估这些干预措施的有效性。未来的研究应侧重于通过解决可行性、可接受性、可扩展性和成本等因素来弥合现实世界有效性的差距,这些因素对于指导它们在任何国家成功大规模部署都至关重要。
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引用次数: 0
Rapid test for Mycobacterium leprae infection: a practical tool for leprosy. 麻风分枝杆菌感染快速检测:麻风的实用工具。
IF 8.1 1区 医学 Pub Date : 2024-12-02 DOI: 10.1186/s40249-024-01262-9
Louise Pierneef, Anouk van Hooij, Danielle de Jong, Gaby Wassenaar, Els Verhard, Elisa Tjon Kon Fat, Nadine Engel, Marufa Khatun, Santosh Soren, Abu Sufian Chowdhury, Colette van Hees, Paul Corstjens, Annemieke Geluk

Background: Detection of infection with Mycobacterium leprae allows timely prophylactic treatment, thereby reducing transmission as well as the risk of permanent, leprosy-associated nerve damage. However, since there is no worldwide-implemented standard test for M. leprae infection, detection of infection in asymptomatic individuals remains a major challenge for control programs in endemic areas. In previous studies, we developed and field-tested a lateral flow assay (LFA) quantitatively detecting human IgM against M. leprae-specific phenolic glycolipid I (anti-PGL-I), a marker for both active and past infection. This rapid test utilizes luminescent, background-free, up-converting reporter particles (UCP) and immunochromatography (i.e. the UCP-LF test platform) for accurate quantitation of anti-PGL-I IgM without operator bias. The aim of this study was to evaluate the final version of this quantitative UCP-based rapid test (i.e. PGL-I QURapid), using serum and fingerstick blood (FSB).

Methods: The test comprises a lateral flow strip, in a standard plastic or biodegradable cassette. It can be provided with a humanized, recombinant control to monitor test performance and calculate accurate anti-PGL-I IgM levels. The performance of this QUR-test was assessed using serum and FSB from patients with leprosy (n = 214), tuberculosis (n = 20), buruli ulcer (n = 19), leishmaniasis (n = 14), non-tuberculous mycobacterial (n = 35) infections, as well as healthy Dutch individuals (n = 710) and humanized, recombinant anti-PGL-I IgM antibodies. Plot receiver operating characteristic curves were created and sensitivity (Sn), specificity (Sp) and the area under the curve were calculated to evaluate test performance.

Results: Test results classified multibacillary leprosy patients with 95.0% Sn and 100% Sp using serum and 91.5% Sn and 99.8% Sp using FSB. Qualitative test results could be read after 2 min flow time, with accurate quantitation from 10 min onwards. The new anti-PGL-I IgM control supports production of batches with predetermined seropositivity thresholds and monitoring of the PGL-I QUR-test in various settings.

Conclusion: The operational version of the PGL-I QURapid with point-of-care applicability, meets the WHO target product profile criteria. Thus, this QUR-test is ready for public health implementations.

背景:检测麻风分枝杆菌感染可以及时进行预防性治疗,从而减少传播以及永久性麻风相关神经损伤的风险。然而,由于没有全球范围内实施的麻风分枝杆菌感染标准检测,在无症状个体中检测感染仍然是流行地区控制规划的主要挑战。在之前的研究中,我们开发并现场测试了一种横向流动试验(LFA),定量检测人类抗麻风分枝杆菌特异性酚类糖脂I(抗pgl -I)的IgM,这是一种活跃和过去感染的标记。这种快速测试利用发光,无背景,上转换的报告粒子(UCP)和免疫层析(即UCP- lf测试平台)来准确定量抗pgl - 1 IgM,没有操作员偏差。本研究的目的是评估这种基于ucp的定量快速检测(即PGL-I qurrapid)的最终版本,使用血清和指刺血(FSB)。方法:测试包括一个横向流动条,装在标准塑料或可生物降解的盒子里。它可以提供人性化的重组控制,以监测测试性能并计算准确的抗pgl - 1 IgM水平。使用麻风病(n = 214)、结核病(n = 20)、布鲁里溃疡(n = 19)、利什曼病(n = 14)、非结核分枝杆菌(n = 35)感染患者以及健康荷兰人(n = 710)和人源化重组抗pgl - 1 IgM抗体的血清和FSB来评估该qur测试的性能。绘制受试者工作特征曲线,计算灵敏度(Sn)、特异度(Sp)和曲线下面积,评价试验性能。结果:多菌性麻风患者血清中Sn含量为95.0%,Sp含量为100%,FSB中Sn含量为91.5%,Sp含量为99.8%。流式时间2 min后可读取定性检测结果,10 min后可准确定量。新的抗pgl - 1 IgM控制支持生产具有预定血清阳性阈值的批次,并在各种设置下监测pgl - 1 qur测试。结论:PGL-I型qurrapid的操作版具有点护理适用性,符合WHO目标产品概要标准。因此,此qur测试已准备好用于公共健康实现。
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引用次数: 0
Diagnostic performance of hepatitis C virus core antigen testing for detecting hepatitis C in people living with hepatitis B: a systematic review and meta-analysis. 丙型肝炎病毒核心抗原检测在乙型肝炎患者中检测丙型肝炎的诊断性能:一项系统综述和荟萃分析
IF 8.1 1区 医学 Pub Date : 2024-12-02 DOI: 10.1186/s40249-024-01264-7
Ana Treviño-Nakoura, Daniel Sepúlveda-Crespo, José M Bellon, Helena Codina, Marta Quero-Delgado, Pablo Ryan, Isidoro Martínez, Salvador Resino

Background: The current diagnostic strategy for hepatitis C virus (HCV) infection involves a two-step approach: antibody HCV screening followed by confirmatory nucleic acid testing. This study aimed to evaluate the diagnostic performance of the Abbott ARCHITECT HCV Ag assay in serum/plasma samples as a potential one-step alternative for diagnosing active HCV infection in people living with hepatitis B virus (PLWHB) through a systematic review and meta-analysis.

Methods: A systematic review and meta-analysis were conducted following PRISMA-DTA guidelines. This protocol was registered on PROSPERO (CRD42023402093). A comprehensive search of electronic databases identified studies published up to 1 November 2024, comparing the ARCHITECT HCV Ag assay to an HCV-RNA reference standard. Sensitivity, specificity, and likelihood ratios were pooled using a random-effects model within the MIDAS module of Stata software. Study quality was assessed using QUADAS-2. Heterogeneity was evaluated using the Q statistic, quantified using the I², and further explored through meta-regression.

Results: Ten studies (n = 494 participants) met inclusion criteria. The Abbott ARCHITECT HCV Ag assay demonstrated high sensitivity [91%, 95% confidence interval (CI): 76-97%] and specificity (99%, 95% CI: 99-100%). The positive likelihood ratio (PLR) was 81.20 (95% CI: 12.34-534.36), and the negative likelihood ratio (NLR) was 0.09 (95% CI: 0.03-0.27). The area under the summary receiver operating characteristic curve (AUC-SROC) was 99% (95% CI 98-100%). In regions with high HCV prevalence (≥ 10%), the test accurately confirmed active HCV infection in over 90% of cases. However, confirmatory testing remains necessary in low-prevalence settings (≤ 5%). The assay demonstrated an excellent ability to identify individuals without HCV infection, with a low false-negative rate (≤ 2%) regardless of HCV prevalence. Heterogeneity analysis revealed moderate to substantial variation in test performance (I² = 72.09% for sensitivity, 35.47% for PLR, and 78.33% for NLR). QUADAS-2 applicability concerns predicted heterogeneity, but differences were likely insignificant due to minimal variations and limited studies.

Conclusions: The Abbott ARCHITECT HCV Ag assay exhibited promising accuracy in detecting active HCV infection among PLWHB. This test might help diagnose active HCV infection in high-prevalence scenarios (≥ 10%) but needs further confirmation in low-prevalence settings (≤ 5%).

背景:目前丙型肝炎病毒(HCV)感染的诊断策略包括两步方法:抗体HCV筛查,然后进行确认性核酸检测。本研究旨在通过系统回顾和荟萃分析,评估雅培ARCHITECT HCV Ag检测在血清/血浆样本中的诊断性能,作为诊断乙型肝炎病毒(PLWHB)活动性HCV感染的潜在一步替代方法。方法:根据PRISMA-DTA指南进行系统评价和荟萃分析。该协议在PROSPERO上注册(CRD42023402093)。对电子数据库的全面搜索确定了截至2024年11月1日发表的研究,将ARCHITECT HCV Ag检测方法与HCV- rna参考标准进行了比较。灵敏度、特异性和似然比使用Stata软件MIDAS模块中的随机效应模型进行汇总。采用QUADAS-2评估研究质量。使用Q统计量评估异质性,使用I²量化,并通过元回归进一步探讨。结果:10项研究(n = 494名受试者)符合纳入标准。雅培ARCHITECT HCV Ag检测显示出高灵敏度[91%,95%置信区间(CI): 76-97%]和特异性(99%,95% CI: 99-100%)。阳性似然比(PLR)为81.20 (95% CI: 12.34 ~ 534.36),阴性似然比(NLR)为0.09 (95% CI: 0.03 ~ 0.27)。总体受试者工作特征曲线(AUC-SROC)下面积为99% (95% CI 98-100%)。在HCV患病率高的地区(≥10%),该检测在90%以上的病例中准确确诊了活动性HCV感染。然而,在低患病率环境中(≤5%),仍有必要进行确认性检测。该检测显示出极好的识别无HCV感染个体的能力,无论HCV流行程度如何,其假阴性率都很低(≤2%)。异质性分析显示,测试性能存在中度至实质性差异(I²为灵敏度= 72.09%,PLR = 35.47%, NLR = 78.33%)。QUADAS-2的适用性涉及预测异质性,但由于变异很小且研究有限,差异可能不显著。结论:雅培ARCHITECT HCV Ag检测在PLWHB患者中检测活动性HCV感染具有良好的准确性。该测试可能有助于在高流行情况下(≥10%)诊断活动性HCV感染,但在低流行情况下(≤5%)需要进一步确认。
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引用次数: 0
Role of social innovations in health in the prevention and control of infectious diseases: a scoping review. 卫生领域的社会创新在预防和控制传染病方面的作用:范围审查。
IF 8.1 1区 医学 Pub Date : 2024-11-20 DOI: 10.1186/s40249-024-01253-w
Maryam Khazaee-Pool, Tahereh Pashaei, Maryam Zarghani, Koen Ponnet

Background: The implementation of social innovations for addressing societal challenges, particularly in health, leverages community participation and technology to optimally meet social needs compared to traditional approaches. A key feature of these innovations is their ability to utilize existing capacities for contributing to resolving infectious disease outbreaks, which has attracted significant attention from health organizations. Given the potential of these innovations, this study has investigated social innovations in the prevention and control of infectious diseases as one of the major global challenges in the form of a comprehensive literature review.

Methods: This review study examined the relevant literature from January 1, 2010 to December 31, 2022. Based on inclusion and exclusion criteria, 50 documents were retained and fully examined. The documents were analyzed by applying a thematic analysis, and important content related to the application of social innovations for the prevention and control of pandemic infectious diseases was extracted using a data collection form.

Results: Five major themes concerning social innovation in the prevention and control of epidemic diseases were discerned as follows: new products, novel processes and policies, empowerment, innovative practices and behaviors, and community engagement. New products include technological products for control and management of epidemics, preventive products, diagnostic and therapeutic products. Novel processes and policies are related to reorienting and reorganizing care methods, control and monitoring policies, participatory and creative strategies. Empowerment is focused on enhancing the capabilities of health workers, community leaders, and communities. Innovative practices and behaviors involve technology-based participation and support mechanisms. Community engagement is related to awareness, consultation, community mobilization, and participation in production and support.

Conclusions: During the outbreak of infectious diseases, governments are faced with many challenges, including health, economic and social challenges. To answer these challenges, tools should be used that have the ability to answer the problem from several aspects. Social innovation as an appropriate process in response to health crises has led to new forms of relationships and empowered the communities. And to promote public health, it provides the opportunity for all members of the society to participate in crisis resolution and optimal use of resources.

背景:与传统方法相比,实施社会创新以应对社会挑战,特别是在卫生领域,可以利用社区参与和技术,以最佳方式满足社会需求。这些创新的一个主要特点是能够利用现有能力来帮助解决传染病爆发问题,这已引起卫生组织的极大关注。鉴于这些创新的潜力,本研究以全面文献综述的形式,调查了作为全球主要挑战之一的传染病预防和控制方面的社会创新:本综述研究考察了 2010 年 1 月 1 日至 2022 年 12 月 31 日期间的相关文献。根据纳入和排除标准,保留并全面审查了 50 篇文献。采用主题分析法对文献进行了分析,并使用数据收集表提取了与社会创新在大流行性传染病防控中的应用相关的重要内容:有关社会创新在流行病防控中的应用的五大主题如下:新产品、新流程和政策、赋权、创新实践和行为以及社区参与。新产品包括控制和管理流行病的技术产品、预防产品、诊断和治疗产品。新的程序和政策涉及调整和重组护理方法、控制和监测政策、参与性和创造性战略。赋权的重点是提高卫生工作者、社区领导和社区的能力。创新做法和行为涉及以技术为基础的参与和支持机制。社区参与与认识、咨询、社区动员以及参与生产和支持有关:在传染病爆发期间,政府面临着许多挑战,包括健康、经济和社会挑战。为了应对这些挑战,应使用能够从多个方面解决问题的工具。社会创新作为应对卫生危机的适当程序,促成了新形式的关系,增强了社区的能力。为了促进公共卫生,它为所有社会成员提供了参与解决危机和优化资源利用的机会。
{"title":"Role of social innovations in health in the prevention and control of infectious diseases: a scoping review.","authors":"Maryam Khazaee-Pool, Tahereh Pashaei, Maryam Zarghani, Koen Ponnet","doi":"10.1186/s40249-024-01253-w","DOIUrl":"10.1186/s40249-024-01253-w","url":null,"abstract":"<p><strong>Background: </strong>The implementation of social innovations for addressing societal challenges, particularly in health, leverages community participation and technology to optimally meet social needs compared to traditional approaches. A key feature of these innovations is their ability to utilize existing capacities for contributing to resolving infectious disease outbreaks, which has attracted significant attention from health organizations. Given the potential of these innovations, this study has investigated social innovations in the prevention and control of infectious diseases as one of the major global challenges in the form of a comprehensive literature review.</p><p><strong>Methods: </strong>This review study examined the relevant literature from January 1, 2010 to December 31, 2022. Based on inclusion and exclusion criteria, 50 documents were retained and fully examined. The documents were analyzed by applying a thematic analysis, and important content related to the application of social innovations for the prevention and control of pandemic infectious diseases was extracted using a data collection form.</p><p><strong>Results: </strong>Five major themes concerning social innovation in the prevention and control of epidemic diseases were discerned as follows: new products, novel processes and policies, empowerment, innovative practices and behaviors, and community engagement. New products include technological products for control and management of epidemics, preventive products, diagnostic and therapeutic products. Novel processes and policies are related to reorienting and reorganizing care methods, control and monitoring policies, participatory and creative strategies. Empowerment is focused on enhancing the capabilities of health workers, community leaders, and communities. Innovative practices and behaviors involve technology-based participation and support mechanisms. Community engagement is related to awareness, consultation, community mobilization, and participation in production and support.</p><p><strong>Conclusions: </strong>During the outbreak of infectious diseases, governments are faced with many challenges, including health, economic and social challenges. To answer these challenges, tools should be used that have the ability to answer the problem from several aspects. Social innovation as an appropriate process in response to health crises has led to new forms of relationships and empowered the communities. And to promote public health, it provides the opportunity for all members of the society to participate in crisis resolution and optimal use of resources.</p>","PeriodicalId":48820,"journal":{"name":"Infectious Diseases of Poverty","volume":"13 1","pages":"87"},"PeriodicalIF":8.1,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Approaching onchocerciasis elimination in Equatorial Guinea: Near zero transmission and public health implication. 赤道几内亚即将消灭盘尾丝虫病:接近零传播和公共卫生影响。
IF 8.1 1区 医学 Pub Date : 2024-11-14 DOI: 10.1186/s40249-024-01254-9
Policarpo Ncogo, Ana Hernández-González, Thuy-Huong Ta-Tang, Lidia Redondo, Ana Álvarez, Maria J Perteguer, José M Rubio, Rufino Nguema, Justino Nguema, Marta García, Laura Reguero, Teresa Valverde, Marta Lanza, Laura Cerrada-Gálvez, Maria Rebollo, Jorge Cano, Agustín Benito, Zaida Herrador

Background: Onchocerciasis and lymphatic filariasis (LF) are endemic in Equatorial Guinea with notable variations in disease incidence between island and mainland regions. Historically, efforts to control and map these diseases were concentrated in Bioko Island, where loiasis is absent, allowing for targeted onchocerciasis interruption strategies. With the cessation of onchocerciasis transmission on Bioko and no reported cases on Annobon island, assessing the transmission status in the previously unaddressed mainland region has become imperative. Mapping efforts in mainland Equatorial Guinea have proven low to moderate level of transmission for LF and onchocerciasis, although the results so far have not been very conclusive. The current study aims to update the prevalence estimates for onchocerciasis and LF in mainland Equatorial Guinea using various diagnostic techniques.

Methods: This is the first cross-sectional study carried out to estimate the prevalence of onchocerciasis and LF in the mainland area of Equatorial Guinea, from September to December 2019, based on the combination of skin snip biopsies, thick blood smears, laboratory serological tests (ELISA tests for the detection of IgG4 antibodies against Onchocerca volvulus recombinant antigen Ov16 and Wuchereria bancrofti recombinant antigen Wb123) and molecular laboratory tests. Frequencies and prevalence rates, along with 95% confidence intervals for interval estimation of a binomial proportion, were computed.

Results: The overall onchocerciasis seroprevalence calculated for the study was 0.3% (95% CI: 0.1 to 0.5%). Microscopic examination of skin biopsies from the eight individuals seropositive for Ov16, out of the 3951 individuals initially tested, revealed no O. volvulus microfilariae. However, DNA extracted from one skin snip was successfully amplified, with subsequent sequencing confirming the presence of O. volvulus. Among the 3951 individuals, 182 were found to have anti-Wb123 antibodies, suggesting exposure to W. bancrofti, with an estimated seroprevalence of 4.6% (95% CI: 4.0 to 5.3%). Microscopy and Filaria-real time-PCR (F-RT-PCR) analysis for W. bancrofti were negative across all samples.

Conclusions: The findings indicate that onchocerciasis may no longer constitutes a public health problem in Equatorial Guinea, positioning the country on the verge of achieving elimination. Additionally, the mapped prevalence of LF will facilitate the formulation of national strategies aimed at eradicating filariases countrywide.

背景:盘尾丝虫病和淋巴丝虫病(LF)是赤道几内亚的地方病,岛屿和大陆地区的发病率有明显差异。从历史上看,控制和绘制这两种疾病地图的工作主要集中在比奥科岛,该岛没有丝虫病,因此可以采取有针对性的盘尾丝虫病阻断战略。随着盘尾丝虫病在比奥科岛的传播停止,安诺本岛也没有病例报告,评估以前未涉及的大陆地区的传播状况已成为当务之急。赤道几内亚大陆的测绘工作已证明,尽管迄今为止的结果还不是非常确凿,但当地的狼疮和盘尾丝虫病的传播程度处于中低水平。本研究旨在利用各种诊断技术更新赤道几内亚大陆盘尾丝虫病和狼疮的流行率估计值:这是 2019 年 9 月至 12 月在赤道几内亚大陆地区开展的首次横断面研究,根据皮肤切片活检、厚血涂片、实验室血清学检测(ELISA 检测盘尾丝虫重组抗原 Ov16 和班克罗非虫重组抗原 Wb123 的 IgG4 抗体)和分子实验室检测相结合的方法,估计盘尾丝虫病和 LF 的流行率。计算了频率和流行率,以及二项式比例区间估计的 95% 置信区间:研究计算出的盘尾丝虫病血清阳性率为 0.3%(95% 置信区间:0.1% 至 0.5%)。在最初检测的 3951 人中,对 8 人的 Ov16 血清阳性皮肤活检进行显微镜检查,未发现盘尾丝虫微丝蚴。不过,从一个皮肤切片中提取的 DNA 成功进行了扩增,随后的测序证实了 O. volvulus 的存在。在 3951 人中,发现 182 人有抗 Wb123 抗体,这表明他们接触了班克罗夫蒂虫,估计血清流行率为 4.6%(95% CI:4.0 至 5.3%)。所有样本的班克罗夫特丝虫显微镜检查和实时荧光定量PCR(F-RT-PCR)分析结果均为阴性:研究结果表明,盘尾丝虫病可能不再构成赤道几内亚的公共卫生问题,该国即将实现消灭盘尾丝虫病的目标。此外,摸清盘尾丝虫病的流行情况将有助于制定旨在全国范围内根除丝虫病的国家战略。
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引用次数: 0
One-year impact of behavioural interventions on schistosomiasis-related knowledge, attitude and practices of primary schoolchildren in Pemba, Tanzania. 行为干预对坦桑尼亚奔巴岛小学生血吸虫病相关知识、态度和做法的一年期影响。
IF 8.1 1区 医学 Pub Date : 2024-11-13 DOI: 10.1186/s40249-024-01251-y
Naomi C Ndum, Lydia Trippler, Sarah O Najim, Anisa S Ali, Jan Hattendorf, Shaali M Ame, Fatma Kabole, Jürg Utzinger, Said M Ali, Stefanie Knopp

Background: Elimination of schistosomiasis as a public health problem and interruption of transmission in selected areas are goals set by the World Health Organization for 2030. Behaviour change communication (BCC), coupled with other interventions, is considered an essential measure to reduce the transmission of Schistosoma infection. Focusing on elimination, we assessed the 1-year impact of BCC interventions on schistosomiasis-related knowledge, attitude and practices (KAP) of schoolchildren in hotspot schools versus low-prevalence schools that did not receive the interventions.

Methods: School-based cross-sectional surveys were implemented in 16 schools on Pemba Island, Tanzania, in 2020 and 2022, respectively. The schistosomiasis-related KAP were assessed in children attending grades 3-5, using pre-tested questionnaires. Between the surveys, in 2021, children from hotspot schools were exposed to BCC interventions. The difference in mean knowledge and attitude scores, respectively, between schoolchildren from hotspot and low-prevalence schools during the survey in 2022 was determined with a linear mixed-effect model.

Results: In the five hotspot schools that received BCC interventions, 315 children participated in the survey in 2020 and 349 in 2022. There was a 21.0% increase in children with moderate knowledge and a 13.8% decrease in no knowledge; a 8.3% increase in good attitude and a 19.2% decrease in poor attitude; 3.4% and 3.2% fewer children reported to use waterbodies for washing clothes or body, respectively. In the 11 low-prevalence schools without BCC interventions, 778 children participated in 2020 and 732 in 2022. The percentage of children with poor knowledge (56.4% and 63.1%) and poor attitude (55.3% and 53.1%) remained relatively stable from 2020 to 2022, but 4.9% and 3.0% less children reported to use waterbodies for washing clothes or their body, respectively. In 2022, the difference in mean knowledge scores was 0.8 [95% confidence interval (CI): 0.5-1.1] and the difference in mean attitude scores was 0.6 (95% CI: 0.4-0.7) between children in hotspot compared with low-prevalence schools.

Conclusions: After one year of implementation, the BCC interventions markedly improved the KAP of exposed children. Complemented by improved access to clean water and sanitation, BCC holds promise to contribute successfully to the achievement of schistosomiasis control and elimination targets. Trial registration ISRCTN, ISRCTN91431493. Registered 11 February. 2020, https://www.isrctn.com/ISRCTN91431493 .

背景:消除血吸虫病这一公共卫生问题并在选定地区阻断传播是世界卫生组织为 2030 年设定的目标。行为改变沟通(BCC)与其他干预措施相结合,被认为是减少血吸虫感染传播的基本措施。我们以消除血吸虫病为重点,评估了BCC干预措施对热点学校与未接受干预措施的低流行率学校学童的血吸虫病相关知识、态度和做法(KAP)的1年影响:分别于 2020 年和 2022 年在坦桑尼亚奔巴岛的 16 所学校开展了校本横断面调查。使用预先测试过的调查问卷,对 3-5 年级的儿童进行血吸虫病相关 KAP 评估。在两次调查之间的2021年,热点学校的儿童接受了BCC干预。在 2022 年的调查中,采用线性混合效应模型确定了热点学校和低发病率学校的学童在知识和态度方面的平均得分差异:在接受 BCC 干预的五所热点学校中,315 名儿童参加了 2020 年的调查,349 名儿童参加了 2022 年的调查。掌握中等知识的儿童增加了21.0%,不掌握知识的儿童减少了13.8%;态度良好的儿童增加了8.3%,态度较差的儿童减少了19.2%;报告使用水体清洗衣物或身体的儿童分别减少了3.4%和3.2%。在未采取 BCC 干预措施的 11 所低流行率学校中,2020 年有 778 名儿童参与,2022 年有 732 名儿童参与。从 2020 年到 2022 年,知识贫乏(56.4% 和 63.1%)和态度贫乏(55.3% 和 53.1%)的儿童比例保持相对稳定,但报告使用水体清洗衣物或身体的儿童分别减少了 4.9% 和 3.0%。2022 年,热点学校与低普及率学校儿童的平均知识得分相差 0.8 [95% 置信区间 (CI):0.5-1.1],平均态度得分相差 0.6 (95% CI:0.4-0.7):经过一年的实施,BCC 干预措施显著改善了暴露儿童的 KAP。在改善清洁水和卫生条件的同时,BCC有望成功实现控制和消除血吸虫病的目标。试验注册号为 ISRCTN,ISRCTN91431493。2 月 11 日注册。2020, https://www.isrctn.com/ISRCTN91431493 .
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引用次数: 0
Global burden associated with rare infectious diseases of poverty in 2021: findings from the Global Burden of Disease Study 2021. 2021 年与罕见贫困传染病有关的全球负担:2021 年全球疾病负担研究的结果。
IF 8.1 1区 医学 Pub Date : 2024-11-13 DOI: 10.1186/s40249-024-01249-6
Yujia Bao, Yongxuan Li, Yibin Zhou, Ne Qiang, Tianyun Li, Yuzheng Zhang, Marc K C Chong, Shi Zhao, Xiaobei Deng, Xiaoxi Zhang, Lefei Han, Jinjun Ran

Background: Rare infectious diseases of poverty (rIDPs) involve more than hundreds of tropical diseases, which dominantly affect people living in impoverished and marginalized regions and fail to be prioritized in the global health agenda. The neglect of rIDPs could impede the progress toward sustainable development. This study aimed to estimate the disease burden of rIDPs in 2021, which would be pivotal for setting intervention priorities and mobilizing resources globally.

Methods: Leveraging data from the Global Burden of Disease Study 2021, the study reported both numbers and age-standardized rates of prevalence, mortality, disability-adjusted life-years (DALYs), years lived with disability, and years of life lost of rIDPs with corresponding 95% uncertainty intervals (UIs) at global, regional, and national levels. The temporal trends between 1990 and 2021 were assessed by the joinpoint regression analysis. A Bayesian age-period-cohort model was used to project the disease burden for 2050.

Results: In 2021, there were 103.76 million (95% UI: 102.13, 105.44 million) global population suffered from rIDPs with an age-standardized DALY rate of 58.44 per 100,000 population (95% UI: 42.92, 77.26 per 100,000 population). From 1990 to 2021, the age-standardized DALY rates showed an average annual percentage change of - 0.16% (95% confidence interval: - 0.22, - 0.11%). Higher age-standardized DALY rates were dominated in sub-Saharan Africa (126.35 per 100,000 population, 95% UI: 91.04, 161.73 per 100,000 population), South Asia (80.80 per 100,000 population, 95% UI: 57.31, 114.10 per 100,000 population), and countries with a low socio-demographic index. There was age heterogeneity in the DALY rates of rIDPs, with the population aged under 15 years being the most predominant. Females aged 15-49 years had four-times higher age-standardized DALY rates of rIDPs than males in the same age. The projections indicated a slight reduction in the disease burden of rIDPs by 2050.

Conclusions: There has been a slight reduction in the disease burden of rIDPs over the past three decades. Given that rIDPs mainly affect populations in impoverished regions, targeted health strategies and resource allocation are in great demand for these populations to further control rIDPs and end poverty in all its forms everywhere.

背景:罕见贫困传染病(rIDPs)涉及数百种热带疾病,主要影响生活在贫困和边缘化地区的人们,在全球健康议程中没有被列为优先事项。对贫困疾病的忽视可能会阻碍可持续发展的进程。本研究旨在估算2021年rIDPs的疾病负担,这对于确定干预重点和在全球范围内调动资源至关重要:方法:本研究利用《2021 年全球疾病负担研究》的数据,报告了全球、地区和国家层面上 rIDPs 的患病率、死亡率、残疾调整生命年 (DALYs)、残疾生存年数和生命损失年数的数量和年龄标准化比率,以及相应的 95% 不确定区间 (UIs)。接合点回归分析评估了 1990 年至 2021 年间的时间趋势。采用贝叶斯年龄-时期-队列模型预测 2050 年的疾病负担:结果:2021 年,全球有 1.0376 亿(95% UI:1.0213 亿,1.0544 亿)人罹患 rIDPs,年龄标准化 DALY 率为每 10 万人 58.44(95% UI:每 10 万人 42.92,77.26)。从 1990 年到 2021 年,年龄标准化 DALY 率的年均百分比变化为 -0.16%(95% 置信区间:-0.22,-0.11%)。撒哈拉以南非洲(每 10 万人 126.35 例,95% 置信区间:每 10 万人 91.04 例,161.73 例)、南亚(每 10 万人 80.80 例,95% 置信区间:每 10 万人 57.31 例,114.10 例)和社会人口指数较低的国家的年龄标准化残疾调整寿命年率较高。急性呼吸系统综合症的残疾调整寿命年数率存在年龄差异,其中以 15 岁以下人群居多。15-49 岁女性的 rIDP 年龄标准化残疾调整寿命率是同龄男性的四倍。预测显示,到 2050 年,rIDPs 的疾病负担将略有减轻:结论:在过去三十年中,rIDPs 的疾病负担略有减少。鉴于 rIDPs 主要影响贫困地区的人口,这些地区的人口亟需有针对性的卫生战略和资源分配,以进一步控制 rIDPs,消除各地各种形式的贫困。
{"title":"Global burden associated with rare infectious diseases of poverty in 2021: findings from the Global Burden of Disease Study 2021.","authors":"Yujia Bao, Yongxuan Li, Yibin Zhou, Ne Qiang, Tianyun Li, Yuzheng Zhang, Marc K C Chong, Shi Zhao, Xiaobei Deng, Xiaoxi Zhang, Lefei Han, Jinjun Ran","doi":"10.1186/s40249-024-01249-6","DOIUrl":"10.1186/s40249-024-01249-6","url":null,"abstract":"<p><strong>Background: </strong>Rare infectious diseases of poverty (rIDPs) involve more than hundreds of tropical diseases, which dominantly affect people living in impoverished and marginalized regions and fail to be prioritized in the global health agenda. The neglect of rIDPs could impede the progress toward sustainable development. This study aimed to estimate the disease burden of rIDPs in 2021, which would be pivotal for setting intervention priorities and mobilizing resources globally.</p><p><strong>Methods: </strong>Leveraging data from the Global Burden of Disease Study 2021, the study reported both numbers and age-standardized rates of prevalence, mortality, disability-adjusted life-years (DALYs), years lived with disability, and years of life lost of rIDPs with corresponding 95% uncertainty intervals (UIs) at global, regional, and national levels. The temporal trends between 1990 and 2021 were assessed by the joinpoint regression analysis. A Bayesian age-period-cohort model was used to project the disease burden for 2050.</p><p><strong>Results: </strong>In 2021, there were 103.76 million (95% UI: 102.13, 105.44 million) global population suffered from rIDPs with an age-standardized DALY rate of 58.44 per 100,000 population (95% UI: 42.92, 77.26 per 100,000 population). From 1990 to 2021, the age-standardized DALY rates showed an average annual percentage change of - 0.16% (95% confidence interval: - 0.22, - 0.11%). Higher age-standardized DALY rates were dominated in sub-Saharan Africa (126.35 per 100,000 population, 95% UI: 91.04, 161.73 per 100,000 population), South Asia (80.80 per 100,000 population, 95% UI: 57.31, 114.10 per 100,000 population), and countries with a low socio-demographic index. There was age heterogeneity in the DALY rates of rIDPs, with the population aged under 15 years being the most predominant. Females aged 15-49 years had four-times higher age-standardized DALY rates of rIDPs than males in the same age. The projections indicated a slight reduction in the disease burden of rIDPs by 2050.</p><p><strong>Conclusions: </strong>There has been a slight reduction in the disease burden of rIDPs over the past three decades. Given that rIDPs mainly affect populations in impoverished regions, targeted health strategies and resource allocation are in great demand for these populations to further control rIDPs and end poverty in all its forms everywhere.</p>","PeriodicalId":48820,"journal":{"name":"Infectious Diseases of Poverty","volume":"13 1","pages":"85"},"PeriodicalIF":8.1,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11558835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Establishing a dominant early larval sex-selection strain in the Asian malaria vector Anopheles stephensi. 在亚洲疟疾病媒疟原虫中建立优势早期幼虫性别选择株系。
IF 8.1 1区 医学 Pub Date : 2024-11-11 DOI: 10.1186/s40249-024-01256-7
Shih-Che Weng, Fangying Chen, Ming Li, Sammy Lee, Connor Gerry, Dylan Can Turksoy, Omar S Akbari

Background: Genetic biocontrol interventions targeting mosquito-borne diseases require the release of male mosquitoes exclusively, as only females consume blood and transmit pathogens. Releasing only males eliminates the risk of increasing mosquito bites and spreading pathogens while enabling effective population control. The aim of this study is to develop robust sex-sorting methods for early larval stages in mosquitoes, enabling scalable male-only releases for genetic biocontrol interventions.

Methods: To address the challenge of sex-sorting in the Asian malaria vector Anopheles stephensi, we engineer Sexing Element Produced by Alternative RNA-splicing of a Transgenic Observable Reporter (SEPARATOR). This dominant fluorescent-based method, previously proven effective in Aedes aegypti, exploits sex-specific alternative splicing of a reporter to ensure exclusive male-specific expression early in development. The sex-specific alternative RNA splicing of the doublesex gene was selected as a target for engineering SEPARATOR due to its evolutionary conservation in insects. To expand SEPARATOR's applicability for genetic sexing, we assessed the cross-species sex-specific RNA splicing activity of the An. gambiae doublesex (AngDsx) splicing module in An. stephensi. Male-specific enhanced green fluorescent protein (EGFP) expression was verified throughout the mosquito life cycle using a fluorescent stereomicroscope.

Results: Our results confirm that SEPARATOR regulates male-specific EGFP expression in An. stephensi and enables reliable positive male selection from the first instar larval stages. Molecular analysis demonstrates that male-specific EGFP expression is dependent on doublesex sex-specific splicing events. Additionally, the splicing module from An. gambiae operates effectively in An. stephensi, demonstrating evolutionary conservation in sex-specific splicing events between these species.

Conclusions: SEPARATOR's independence from sex-chromosome linkage provides resistance to breakage that could be mediated by meiotic recombination and chromosomal rearrangements, making it highly suitable for mass male releases. By enabling precise male selection from the first instar larval stages, SEPARATOR represents a significant advancement that will aid in the genetic biocontrol for Anopheles mosquitoes.

背景:针对蚊媒疾病的基因生物控制干预措施要求只释放雄蚊,因为只有雌蚊才吸血和传播病原体。只释放雄蚊可以消除增加蚊虫叮咬和传播病原体的风险,同时实现有效的种群控制。这项研究的目的是为蚊子的早期幼虫阶段开发可靠的性别分选方法,使基因生物控制干预中的只释放雄性成为可能:方法:为了解决亚洲疟疾病媒申氏疟蚊性别分类的难题,我们设计了通过替代 RNA 剪接转基因可观察报告(SEPARATOR)产生的性别元素。这种基于显性荧光的方法以前曾在埃及伊蚊中被证明是有效的,它利用报告基因的性别特异性替代剪接来确保在发育早期只表达雄性特异性。由于在昆虫的进化过程中,双性基因的性别特异性替代 RNA 剪接一直被视为 SEPARATOR 工程的目标。为了扩大 SEPARATOR 在遗传性别鉴定中的适用性,我们评估了冈比亚蚁双性基因(AngDsx)剪接模块在史蒂芬蚁(An. stephensi)中的跨物种性别特异性 RNA 剪接活性。使用荧光体视显微镜验证了蚊子整个生命周期中雄性特异性增强绿色荧光蛋白(EGFP)的表达:结果:我们的研究结果证实,SEPARATOR调控了史蒂芬蚊的雄性特异性EGFP表达,并从第一龄幼虫阶段就实现了可靠的阳性雄性选择。分子分析表明,雄性特异性 EGFP 表达依赖于双倍性性别特异性剪接事件。此外,冈比亚蚁的剪接模块在史蒂芬蚁中也能有效运作,这表明这些物种之间的性别特异性剪接事件在进化上是一致的:SEPARATOR独立于性染色体连接,可抵御由减数分裂重组和染色体重排引起的断裂,因此非常适合大规模雄性释放。SEPARATOR 能够从第一龄幼虫阶段就开始进行精确的雄性选择,是一项重大进步,将有助于对疟蚊进行遗传生物控制。
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引用次数: 0
Global burden of zoonotic infectious diseases of poverty, 1990-2021. 1990-2021 年全球贫困的人畜共患传染病负担。
IF 8.1 1区 医学 Pub Date : 2024-11-06 DOI: 10.1186/s40249-024-01252-x
Chao Lv, Yiwen Chen, Zile Cheng, Yongzhang Zhu, Weiye Chen, Nan Zhou, Yiming Chen, Yinlong Li, Wangping Deng, Xiaokui Guo, Min Li, Jing Xu

Background: The zoonotic infectious diseases of poverty (zIDPs) are a group of diseases contributing to global poverty, with significant impacts on a substantial population. This study aims to describe the global, regional, and national burden of zIDPs-schistosomiasis, cystic echinococcosis, cysticercosis, and food-borne trematodiases (FBTs)-to support policy making and resource allocation for their control and elimination.

Methods: Data of zIDPs from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 were retrieved from 1990 to 2021. The age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life-year (DALY) rate were described and the estimated annual percentage changes (EAPCs) were calculated to quantify their burden and temporal trends. Spearman correlation analysis was conducted to examine the relationship between age-standardized rates and Socio-demographic Index (SDI).

Results: In 2021, these zIDPs exhibited a certain level of ASPRs and age-standardized DALY rates, while maintaining relatively low ASMRs. Noticeably, schistosomiasis presented the highest ASPR of 1914.299 (95% UI: 1378.920, 2510.853 per 100,000 population) and an age-standardized DALY rate of 21.895 (95% UI: 12.937, 37.278 per 100,000 population) among the zIDPs. The tapestry of burden-woven predominantly through low and lower-middle SDI regions-stretched across Africa, Latin America, and parts of Asia. From 1990 to 2021, a kaleidoscopic shift was observed globally as ASPRs, ASMRs, and age-standardized DALY rates declined significantly, as reflected by the EAPC values. Negative correlations were observed between the ASPRs, ASMRs, age-standardized DALY rates of schistosomiasis (r value = - 0.610, - 0.622 and - 0.610), cystic echinococcosis (- 0.676 of ASMR, - 0.550 of age-standardized DALYs), cysticercosis (- 0.420, - 0.797 and - 0.591) and the SDI. In contrast, a slight positive correlation was noted between the ASPR, age-standardized DALY rates of FBTs and SDI with r value of 0.221 and 0.213, respectively.

Conclusion: The burden of zIDPs declined across almost all endemic regions from 1990 to 2021, yet still predominated in low and low-middle SDI regions. Substantial challenges exist to achieve the goal of control and elimination of zIDPs, and integrated approaches based on One Health need to be strengthened to improve health outcomes.

背景:贫困的人畜共患传染病(zIDPs)是导致全球贫困的一组疾病,对大量人口产生重大影响。本研究旨在描述人畜共患病--血吸虫病、囊性棘球蚴病、囊尾蚴病和食源性颤抖病(FBTs)--的全球、地区和国家负担,以支持控制和消除这些疾病的政策制定和资源分配:方法:从《2021 年全球疾病负担、伤害和风险因素研究》(GBD)中检索了 1990 年至 2021 年的 zIDPs 数据。描述了年龄标准化患病率(ASPR)、年龄标准化死亡率(ASMR)和年龄标准化残疾调整生命年(DALY)率,并计算了估计年度百分比变化(EAPC),以量化其负担和时间趋势。对年龄标准化比率与社会人口指数(SDI)之间的关系进行了斯皮尔曼相关分析:结果:2021 年,这些 zIDPs 显示出一定水平的 ASPRs 和年龄标准化 DALY 率,同时保持相对较低的 ASMRs。值得注意的是,在 zIDPs 中,血吸虫病的 ASPR 最高,为每 10 万人 1914.299(95% UI:1378.920, 2510.853),年龄标准化 DALY 率为每 10 万人 21.895(95% UI:12.937, 37.278)。负担的织锦主要通过中低SDI地区编织而成,横跨非洲、拉丁美洲和亚洲部分地区。从 1990 年到 2021 年,全球出现了万花筒式的转变,ASPRs、ASMRs 和年龄标准化残疾调整寿命年率显著下降,这在 EAPC 值中得到了反映。血吸虫病(r 值 = - 0.610、- 0.622 和 - 0.610)、囊性棘球蚴病(- 0.676 ASMR、- 0.550 年龄标准化残疾调整寿命年数)、囊尾蚴病(- 0.420、- 0.797 和 - 0.591)的 ASPRs、ASMRs 和年龄标准化残疾调整寿命年数与 SDI 之间呈负相关。相比之下,ASPR、FBTs 的年龄标准化残疾调整寿命年率和 SDI 之间存在轻微的正相关,r 值分别为 0.221 和 0.213:从 1990 年到 2021 年,几乎所有流行地区的 zIDPs 负担都有所下降,但仍主要集中在 SDI 中低的地区。要实现控制和消除 zIDPs 的目标还存在巨大挑战,需要加强基于 "一体健康 "的综合方法,以改善健康成果。
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引用次数: 0
Out-of-pocket payment and catastrophic health expenditure of tuberculosis patients in accessing care at public-private mix clinics in Myanmar, 2022. 2022 年缅甸结核病患者在公私混合诊所就医时的自付费用和灾难性医疗支出。
IF 8.1 1区 医学 Pub Date : 2024-11-05 DOI: 10.1186/s40249-024-01248-7
Myat Noe Thiri Khaing, Nandi U, Luu Maw, Htet Arkar, Saw Pa Pa Naing, May Me Thet

Background: The financial burden of tuberculosis (TB) can hinder patients and their families, creating obstacles throughout the care cascade, despite TB prevention and control being provided free of charge. In Myanmar, patients can visit private providers operating under public-private mix (PPM) schemes, where TB services (diagnosis and treatment) are typically offered at no cost. The study focused on quantifying the financial burden faced by TB patients seeking care from Myanmar's PPM providers.

Methods: This cross-sectional telephone survey included 695 adults seeking TB treatment [drug-susceptible TB (DS-TB) and retreatment TB] from various private providers in four states and regions with high TB burden in Myanmar. Telephone interviews were conducted in May and June 2022. Both direct and indirect costs incurred from the patient and their household perspective were valued in 2022 and estimated throughout pre- and post-TB treatment episodes. The TB-affected households were defined as experiencing catastrophic health expenditure if their expenditure due to TB exceeded 20% of their capacity to pay, as recommended by the World Health Organization. All cost data were collected in Myanmar Kyats (MMK) and converted to USD (1 USD = 1850 MMK as of July 20, 2022). Logistic regression analysis was done to identify the determinants of catastrophic health expenditure.

Results: The findings showed patients made a median of 7 times for clinic visits throughout their treatment, with the median total cost for the entire TB treatment being 53.4 US dollars (USD), including direct medical and testing costs (11.9 USD) and direct non-medical patient expenditure (11.6 USD). Pre-treatment costs were higher compared to post-treatment costs (the intensive phase and continuation phase). During the intensive phase, TB care cost was nearly free, but during the continuation phase, it was a median of 2.6 USD. About 34.5% of patients experienced catastrophic health expenditure due to TB treatment, with expenses exceeding 20% of their capacity to pay. Multivariate regression analysis revealed that patients with a history of hospitalization (aOR = 14.84; P < 0.01), seeking care from regions other than Yangon (aOR = 2.6; P < 0.01), and using coping strategies (aOR = 12.53; P < 0.01), were more likely to face catastrophic financial burdens. Higher monthly household income (over 162 USD) was associated with a decreased risk of incurring catastrophic health expenditure (aOR = 0.38; P < 0.01).

Conclusions: TB patients and their households in Myanmar faced risk of catastrophic costs, even when treated in the private sector with free diagnostic charges and anti-TB medicine. The study highlighted the need for additional strategies or policies to make TB care affordable and mitigate the financial burden of TB-affected households.

背景:尽管结核病预防和控制是免费提供的,但结核病(TB)带来的经济负担会阻碍患者及其家人的治疗,给整个治疗过程造成障碍。在缅甸,患者可以到公私合营(PPM)计划下的私营医疗机构就诊,那里通常免费提供结核病服务(诊断和治疗)。这项研究的重点是量化向缅甸公私合营医疗机构寻求治疗的肺结核患者所面临的经济负担:这项横断面电话调查包括在缅甸四个结核病负担较重的邦和地区寻求各种私营医疗机构提供的结核病治疗(药物敏感性结核病(DS-TB)和再治疗结核病)的 695 名成年人。电话访谈于 2022 年 5 月和 6 月进行。从患者及其家庭的角度出发,对 2022 年发生的直接和间接费用进行了估价,并对结核病治疗前后的整个过程进行了估算。根据世界卫生组织的建议,如果受结核病影响的家庭因结核病产生的支出超过其支付能力的 20%,则将其定义为灾难性医疗支出。所有费用数据均以缅甸缅元(MMK)为单位收集,并兑换成美元(截至 2022 年 7 月 20 日,1 美元=1850 缅甸缅元)。为确定灾难性医疗支出的决定因素,我们进行了逻辑回归分析:结果显示,患者在整个治疗过程中的就诊次数中位数为 7 次,整个结核病治疗的总费用中位数为 53.4 美元,其中包括直接医疗和检测费用(11.9 美元)以及患者的直接非医疗支出(11.6 美元)。治疗前的费用高于治疗后的费用(强化阶段和继续治疗阶段)。在强化治疗阶段,结核病治疗费用几乎为零,但在继续治疗阶段,费用中位数为 2.6 美元。约 34.5% 的患者因结核病治疗而出现灾难性医疗支出,支出超过了其支付能力的 20%。多变量回归分析表明,有过住院史的患者(aOR = 14.84;P 结论:.....:缅甸的肺结核患者及其家庭面临着灾难性费用的风险,即使在私营部门接受免费诊断和抗结核药物治疗也是如此。该研究强调,有必要制定更多的战略或政策,使结核病治疗费用可负担得起,并减轻受结核病影响家庭的经济负担。
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Infectious Diseases of Poverty
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