International Health最新文献

Background: Schistosomiasis (SCH) and soil-transmitted helminthiasis (STH) are endemic in Chad, particularly in areas with inadequate water, sanitation and hygiene (WASH) infrastructure. This study aimed to assess the prevalence and spatial distribution of SCH and STH among school-age children (SAC) to optimize mass drug administration (MDA) strategies.

Methods: A cross-sectional parasitological survey was conducted in 308 schools in 247 subdistricts across 25 health districts of seven provinces in Chad. Kato-Katz and urine filtration techniques were used to examine 15 828 SAC for Schistosoma haematobium, Schistosoma mansoni and STH. WASH conditions in schools and communities were also investigated.

Results: The prevalence of S. haematobium was 2.28%, while S. mansoni was 0.74%, with significant geographical heterogeneity. STH infections were generally <5%, predominantly Ascaris lumbricoides. Based on World Health Organization treatment thresholds, two health districts now require annual praziquantel MDA, while one district (Korbol) has moved to the surveillance phase for SCH. WASH indicators showed gaps, with 73.27% of SAC not practice handwashing and 78.90% lacking access to safe drinking water.

Conclusions: Data generated from this survey filled the gaps for programmatic decisions and showed an overall low endemicity level of SCH and STH across the health districts surveyed. Improved WASH infrastructure and continued surveillance are critical for sustaining gains in morbidity control and elimination efforts.

Background: While no national vision impairment (VI) data exist for Mali, population-based eye health surveys among people aged ≥50 y were conducted in several regions over the last two decades, including in the Koulikoro region in 2008. In 2024, a similar survey was repeated. This paper describes the changes in VI prevalence, causes and service coverage during the 16-y period.

Methods: The standard Rapid Assessment of Avoidable Blindness methodology was used with two-stage sampling to select a representative sample of 2600 adults (aged ≥50 y) in 2008 and 2040 in 2024. Ophthalmologists conducted a rapid vision examination on participants, assessing their presenting and best corrected visual acuity (VA), cause of any VI and cataract surgical status. Data were analysed using Stata.

Results: The age- and sex-adjusted prevalence of blindness decreased from 9.0% in 2008 to 4.4% in 2024, a -51.1% (p<0.001) decrease. Cataract surgical coverage at all levels of VA increased significantly from 2008 to 2024. The absolute increases were 29.3% (95% CI 26.5 to 32.1%; p<0.001), 28.5% (95% CI 25.6 to 31.4%; p<0.001) and 27.9% (95% CI 25.1 to 30.7%; p<0.001) for VA<3/60, VA<6/60 and VA<6/18, respectively.

Conclusion: The significant reduction in blindness and VI in Koulikoro from 2008 to 2024 was associated with improved cataract surgical services, which need to be further expanded.

Background: People with disabilities are likely to experience stigma and discrimination. Our study aimed to understand the distribution of disability-related stigma and its correlates among smallholder farmers in western Kenya.

Methods: We used hurdle models to explore the factors associated with the occurrence and magnitude of enacted stigma among farmers without disabilities and of experienced stigma among farmers with disabilities.

Results: Overall, 41.3% of those without disabilities reported enacted stigma. Those who had attended school were more likely to report enacted stigma compared with those who had never been to school (multivariable model adjusted odds ratio [OR] 1.40 [95% confidence interval {CI} 1.09 to 1.80]). Employees were more likely to report enacted stigma compared with independent workers without employees (OR 1.28 [95% CI 1.03 to 1.58]) while those who were not employed were less likely to (OR 0.77 [95% CI 0.65 to 0.92]). Overall, 36.6% of those with disabilities reported having experienced stigma or discrimination. Men, those with a physical disability or a psychosocial disability were more likely to experience stigma than women and those who did not have these conditions (OR 1.89 [95% CI 1.04 to 3.42], OR 2.98 [95% CI 1.68 to 5.28] and OR 1.91 [95% CI 1.09 to 3.33], respectively). Employees were less likely to experience stigma than independent workers without employees (OR 0.53 [95% CI 0.30 to 0.96]).

Conclusions: Relationships between individual characteristics and disability-related stigma need to be further understood to help guide stigma-reduction programmes.

Background: There is limited evidence on prevalence of uncorrected refractive errors (URE) in younger population. This study assessed prevalence of URE, spectacle coverage and barriers to RE services among individuals aged 15-49 y in Kasganj district, North India.

Methods: This was a cross-sectional population-based survey, where uncorrected, corrected and best-corrected visual acuity and lens status were assessed. Updated WHO definitions were used for VI, URE, refractive error coverage (REC) and effective REC (eREC).

Results: Of 3167 people examined, VI was identified in 73 cases (2.3%). Age-sex adjusted prevalence of URE was 3.2% (2.5-4.1%) which increased significantly above 40 years (8.8%). Females were more affected than males (3.7% vs 2.8%). Presbyopia affected 42.7% of people aged >35yrs, with higher rates among females (44.6% vs males 40.9%). REC and eREC for distance were 32.5% and 27.5%, respectively, with notable gender disparities. REC for presbyopia was 14.7% (males: 19.7%; females: 9.6%). Distance to services (40%), social constraints (28%) and 'low perceived need' (22%) were identified as the key barriers to accessing RE services.

Conclusions: URE is a major public health challenge amongst working population in rural North India. Targeted interventions to increase coverage are needed to meet WHO's 2030 target.

Background: Individuals who do not perceive they have a health problem will not seek care, risking a deterioration of health status. We sought to understand how visually impaired individuals aged ≥50 y from 12 studies across sub-Saharan Africa self-reported their difficulties seeing, and to identify the factors associated with under-reporting.

Methods: We used R software to assess overall agreement between self-report and clinical assessment with a weighted kappa, and described the proportion of individuals accurately reporting, over-reporting and under-reporting their difficulties seeing. We used logistic regression to explore factors associated with under-reporting.

Results: In total, 5777/32 548 participants had moderate vision impairment (VI) or worse. Overall, agreement between clinically diagnosed VI and self-reported difficulties seeing was 0.41; 74.7% of participants self-reported a level of difficulty seeing that corresponded with their clinical VI but this varied significantly: individuals with no VI reported most accurately (83.8%), and blind individuals least accurately (18.7%). Individuals were less likely to under-report if they had other self-reported functional difficulties, 'other' primary causes of VI (compared with cataract), or were from certain locations. Individuals with unaddressed refractive error were more likely to under-report.

Conclusions: Health planners need to design programmes to reach individuals who are less likely to perceive they have eye health problems.

Contexte: Les personnes qui ne se rendent pas compte qu'elles ont un problème de santé ne consultent pas, ce qui peut entraîner une détérioration de leur état de santé. Nous avons cherché à comprendre comment les personnes malvoyantes âgées de 50 ans et plus inclues dans 12 études menées en Afrique subsaharienne ont auto-déclaré leurs difficultés à voir, et à identifier les facteurs associés à la sous-déclaration.

Sightsavers is committed to a 'leave no one behind' approach, recognising that marginalised communities are at greater risk of being excluded from neglected tropical disease interventions. In this article we reflect on the rollout of a Leave No One Behind risk assessment tool across various contexts. We highlight lessons learned from implementation and share findings, including a use case from Cameroon's East Region. We conclude that actions generated from the tool lead to positive programme outcomes for marginalised populations. Such approaches are needed if countries are to progress towards disease control and elimination.

Background: Confirmatory trachoma-plus surveys conducted in 2021 revealed persistent and recrudescent trachoma transmission in Kajiado West, South and Central subcounties. These findings prompted targeted investigations and programmatic adaptations to improve intervention effectiveness.

Methods: Mass drug administration (MDA) coverage improvements were validated through Coverage Evaluation Surveys (CESs). Impact was monitored via prevalence surveys from 2021 to 2024, which included ocular swabs and dried blood spots (DBS) from children. Ocular swabs were tested for Chlamydia trachomatis (Ct) using GeneXpert IV PCR, while DBS were analysed for anti-Pgp3 antibodies using a multiplex bead assay.

Results: CESs showed significant increases in MDA coverage: Kajiado West (56.9% to 88.2%), South (81.2% to 95.3%) and Central (69.3% to 95.3%). Trachomatous inflammation-follicular prevalence declined in all subcounties-Kajiado West (13.8% to 6.6%), South (8.1% to 5.2%), Central (18.0% to 8.0%)-and Ct infection rates dropped below 1%. Seroconversion rate trends varied, with increases in West and Central and a decrease in South.

Conclusions: The programmatic adaptations were effective in achieving high treatment coverage and in reducing active trachoma and infection, with varying trends in transmission dynamics. This resulted in major progress towards elimination of trachoma and areas with residual infection requiring closer monitoring to sustain progress.

Background: Uncorrected refractive error is a leading cause of visual impairment globally, significantly affecting an individual's educational outcomes, economic opportunities and overall well-being. This study evaluates the compliance with spectacle use among schoolchildren in Islamabad, Pakistan, and identifies factors influencing spectacle wearing.

Methods: A quasi-experimental study was conducted within 14 conveniently selected schools, targeting children aged 5-18 y. Children in Group 1 received free spectacles following an eye examination, while children in Group 2 received only a prescription for spectacles. Data were collected through interviews and the influence of mode of delivery on spectacles ownership and use was analysed.

Results: A total of 790 children participated. The overall compliance with spectacle use was 42.5%, significantly higher in Group 1 (53.6%) compared with Group 2 (34.7%) (p<0.005). The main reasons for non-compliance included broken/lost spectacles, a lack of time to obtain spectacles and a belief that they did not need them.

Conclusions: Providing free spectacles significantly improves ownership and compliance with spectacle use among schoolchildren compared with children who received a prescription only. However, enhanced awareness and education about the value of eye health and the importance of spectacle use are recommended to maximise the benefits of these programmes.

Background: Effective disability inclusion in education requires that teachers and others in the education system have access to accurate and reliable information about children's disabilities. Washington Group (WG) tools are increasingly used in low- and middle-income countries, however, the feasibility and accuracy of such tools is poorly understood. The aim of this study was to assess the feasibility of using WG tools to assess functional difficulty (FD) in children in rural Sierra Leone and to examine the prevalence of FD.

Methods: Class teachers in eight schools completed an FD assessment for each child on their class register using either the WG Short Set (WG-SS) or Child Functioning Module-Teacher Version (CFM-TV). Teacher experiences with the tools were explored during focus group discussions. The prevalence of FD was explored using descriptive statistics.

Results: Teachers found both tools broadly feasible, although there was some concern with the length and complexity of the CFM-TV. A total of 30 teachers used the WG-SS to assess 1346 children ages 5-17 y; 1.1% were reported to have FD. A total of 35 teachers used the CFM-TV to assess 1738 children; 14.9% were reported to have FD.

Conclusions: The use of WG tools by teachers is feasible for generating data on children's FD and potentially valuable for effective disability inclusion.