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Vande Velde F, Overgaard HJ, Bastien S. Nudge strategies for behavior-based prevention and control of neglected tropical diseases: A scoping review and ethical assessment. PLoS Negl Trop Dis 2021; 15:e0009239. [PMID: 34723983 PMCID: PMC8584752 DOI: 10.1371/journal.pntd.0009239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 11/11/2021] [Accepted: 10/13/2021] [Indexed: 12/19/2022] Open
Abstract
Background Nudging, a strategy that uses subtle stimuli to direct people’s behavior, has recently been included as an effective and low-cost behavior change strategy in low- and middle- income countries (LMIC), targeting behavior-based prevention and control of neglected tropical diseases (NTDs). The present scoping review aims to provide a timely overview of how nudge interventions have been applied within this field. In addition, the review proposes a framework for the ethical consideration of nudges for NTD prevention and control, or more broadly global health promotion. Methods A comprehensive search was performed in several databases: MEDLINE, PsycINFO, and Embase (Ovid), Web of Science Core Collection, CINAHL, ERIC and Econ.Lit (EBSCO), as well as registered trials and reviews in CENTRAL and PROSPERO to identify ongoing or unpublished studies. Additionally, studies were included through a handpicked search on websites of governmental nudge units and global health or development organizations. Results This scoping review identified 33 relevant studies, with only two studies targeting NTDs in particular, resulting in a total of 67 nudge strategies. Most nudges targeted handwashing behavior and were focused on general health practices rather than targeting a specific disease. The most common nudge strategies were those targeting decision assistance, such as facilitating commitment and reminder actions. The majority of nudges were of moderate to high ethical standards, with the highest standards being those that had the most immediate and significant health benefits, and those implemented by agents in a trust relationship with the target audience. Conclusion Three key recommendations should inform research investigating nudge strategies in global health promotion in general. Firstly, future efforts should investigate the different opportunities that nudges present for targeting NTDs in particular, rather than relying solely on integrated health promotion approaches. Secondly, to apply robust study designs including rigorous process and impact evaluation which allow for a better understanding of ‘what works’ and ‘how it works’. Finally, to consider the ethical implications of implementing nudge strategies, specifically in LMIC. Behavior is at the core of neglected tropical disease (NTD) prevention and control, certainly within low-, and middle- income countries (LMIC) where resources are often limited. Therefore, strategies to promote behavior change should be included and investigated in future efforts. Nudging, a low-cost strategy that subtly directs people towards positive behavioral choices, has recently gained attention in global health promotion. Nudge strategies have been applied to a wide range of health-promoting behaviors such as handwashing. To understand which strategies were used, where and how these were applied, and whether these were ethically informed and implemented, we undertook a comprehensive review of the available sources. This resulted in 33 included studies, with a total of 67 nudge strategies for behavior-based prevention and control of NTDs in LMIC. Only two studies targeted NTDs in particular, the other 31 included studies were focused on more general health promoting behaviors, with the majority targeting handwashing with soap. The most common nudge strategies were those targeting decision assistance, such as fostering commitment and reminder actions. In general, the ethical assessment presented favorable results. We identified the need for robust study designs to better understand how nudges can be implemented in the future.
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Affiliation(s)
- Fiona Vande Velde
- Department of Public Health Science, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway
- * E-mail:
| | - Hans J. Overgaard
- Faculty of Science and Technology, Norwegian University of Life Sciences, Ås, Norway
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sheri Bastien
- Department of Public Health Science, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- The Centre for Evidence-Based Public Health: A JBI Affiliated Group, Department of Public Health Science, NMBU, Ås, Norway
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Fehr A, Muela J, Nieto-Sanchez C, Manneh E, Baldeh D, Ceesay O, Bardají A, Zuiderent-Jerak T, Bunders-Aelen J. The role of social cohesion in the implementation and coverage of a mass drug administration trial for malaria control in the Gambia: An in-depth comparison of two intervention villages. Soc Sci Med 2021; 291:114487. [PMID: 34715624 DOI: 10.1016/j.socscimed.2021.114487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
Mass drug administration (MDA), used increasingly in malaria eradication efforts, involves administering medication to an entire target population regardless of individual-level disease status. This strategy requires high levels of coverage and compliance. Previous studies have assessed individual and structural factors affecting MDA coverage, but there is a need to better understand the influence and expressions of community dynamics and social structures, such as social cohesion. We conducted a social science study concurrent to an MDA clinical trial for malaria control in The Gambia; ethnographic research was conducted prior to, throughout, and between MDA implementation July-November 2018, January-March 2019, and July-November 2019. We assessed how social cohesion, as expressed by the trial population, affects trial coverage through an in-depth ethnographic analysis of two trial villages, using observations, interviews, and focus group discussions with community members who took the trial medication and those who did not. We found that the villages had unique expressions of social cohesion. This was reflected through community participation in the trial implementation and may have affected coverage and compliance. The village with low coverage expressed a form of social cohesion where members followed advice to participate through a hierarchal system but did not actively participate in the MDA or its implementation. The village with high coverage expressed social cohesion as more participatory: individuals took the directive to participate but contextualized the trial implementation to their needs and wants. We analyze these different expressions of social cohesion and the important differences they make for the coverage and compliance levels reached in the two different villages.
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Affiliation(s)
- Alexandra Fehr
- Athena Institute, Faculty of Science, Vrije Universitiet Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, the Netherlands; Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Kronenburgstraat 43, 2000, Antwerpen, Belgium; Medical Anthropology Research Center, Universitat Rovira I Virgili, Carrer de l'Escorxador, 43003, Tarragona, Spain.
| | - Joan Muela
- Medical Anthropology Research Center, Universitat Rovira I Virgili, Carrer de l'Escorxador, 43003, Tarragona, Spain.
| | - Claudia Nieto-Sanchez
- Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Kronenburgstraat 43, 2000, Antwerpen, Belgium.
| | - Ebrima Manneh
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Atlantic Blvd, Serrekunda, Gambia.
| | - Dullo Baldeh
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Atlantic Blvd, Serrekunda, Gambia.
| | - Omar Ceesay
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Atlantic Blvd, Serrekunda, Gambia.
| | - Azucena Bardají
- ISGlobal, Barcelona Institute for Global Health - Campus Clinic, Hospital Clinic - Universitat de Barcelona, Carrer Rosselló, 08036, Barcelona, Spain.
| | - Teun Zuiderent-Jerak
- Athena Institute, Faculty of Science, Vrije Universitiet Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, the Netherlands.
| | - Joske Bunders-Aelen
- Athena Institute, Faculty of Science, Vrije Universitiet Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, the Netherlands.
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Lund AJ, Sokolow SH, Jones IJ, Wood CL, Ali S, Chamberlin A, Sy AB, Sam MM, Jouanard N, Schacht AM, Senghor S, Fall A, Ndione R, Riveau G, De Leo GA, López-Carr D. Exposure, hazard, and vulnerability all contribute to Schistosoma haematobium re-infection in northern Senegal. PLoS Negl Trop Dis 2021; 15:e0009806. [PMID: 34610025 PMCID: PMC8525765 DOI: 10.1371/journal.pntd.0009806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 10/19/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022] Open
Abstract
Background Infectious disease risk is driven by three interrelated components: exposure, hazard, and vulnerability. For schistosomiasis, exposure occurs through contact with water, which is often tied to daily activities. Water contact, however, does not imply risk unless the environmental hazard of snails and parasites is also present in the water. By increasing reliance on hazardous activities and environments, socio-economic vulnerability can hinder reductions in exposure to a hazard. We aimed to quantify the contributions of exposure, hazard, and vulnerability to the presence and intensity of Schistosoma haematobium re-infection. Methodology/Principal findings In 13 villages along the Senegal River, we collected parasitological data from 821 school-aged children, survey data from 411 households where those children resided, and ecological data from all 24 village water access sites. We fit mixed-effects logistic and negative binomial regressions with indices of exposure, hazard, and vulnerability as explanatory variables of Schistosoma haematobium presence and intensity, respectively, controlling for demographic variables. Using multi-model inference to calculate the relative importance of each component of risk, we found that hazard (Ʃwi = 0.95) was the most important component of S. haematobium presence, followed by vulnerability (Ʃwi = 0.91). Exposure (Ʃwi = 1.00) was the most important component of S. haematobium intensity, followed by hazard (Ʃwi = 0.77). Model averaging quantified associations between each infection outcome and indices of exposure, hazard, and vulnerability, revealing a positive association between hazard and infection presence (OR = 1.49, 95% CI 1.12, 1.97), and a positive association between exposure and infection intensity (RR 2.59–3.86, depending on the category; all 95% CIs above 1) Conclusions/Significance Our findings underscore the linkages between social (exposure and vulnerability) and environmental (hazard) processes in the acquisition and accumulation of S. haematobium infection. This approach highlights the importance of implementing both social and environmental interventions to complement mass drug administration. While the impacts of natural hazards tend to be described in terms of social determinants such as exposure and vulnerability, the risk for infectious disease is often expressed in terms of environmental determinants without fully considering the socio-ecological processes that put people in contact with infective agents of disease. In the case of schistosomiasis, risk is determined by human interactions with freshwater environments where schistosome parasites circulate between people and aquatic snails. In this study, we quantified the relative contributions of exposure, hazard, and vulnerability to schistosome re-infection among schoolchildren in an endemic region of northern Senegal. We find that hazard and vulnerability influence whether a child becomes infected, while exposure and hazard influence the burden of worms once infection is acquired. Increasing numbers of worms is known to be positively associated with increasing severity of disease. Our findings underscore the importance of evaluating social and environmental determinants of disease simultaneously; omitting measures of exposure, hazard or vulnerability may limit our understanding of risk.
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Affiliation(s)
- Andrea J. Lund
- Emmett Interdisciplinary Program in Environment and Resources, Stanford University, Stanford, California, United States of America
- * E-mail:
| | - Susanne H. Sokolow
- Hopkins Marine Station, Stanford University, Pacific Grove, California, United States of America
- Woods Institute for the Environment, Stanford University, Stanford, California, United States of America
| | - Isabel J. Jones
- Hopkins Marine Station, Stanford University, Pacific Grove, California, United States of America
| | - Chelsea L. Wood
- School of Aquatic and Fishery Sciences, University of Washington, Seattle, Washington, United States of America
| | - Sofia Ali
- Stanford University, Stanford, California, United States of America
| | - Andrew Chamberlin
- Hopkins Marine Station, Stanford University, Pacific Grove, California, United States of America
| | - Alioune Badara Sy
- Centre de Recherche Biomédicale–Espoir Pour La Sante, Saint Louis, Sénégal
| | - M. Moustapha Sam
- Centre de Recherche Biomédicale–Espoir Pour La Sante, Saint Louis, Sénégal
| | - Nicolas Jouanard
- Centre de Recherche Biomédicale–Espoir Pour La Sante, Saint Louis, Sénégal
- Station d’Innovation Aquacole, Saint Louis, Sénégal
| | - Anne-Marie Schacht
- Centre de Recherche Biomédicale–Espoir Pour La Sante, Saint Louis, Sénégal
- University of Lille, CNRS, INSERM, CHU Lille, Institut Pasteur de Lille, Center for Infection and Immunity of Lille, Lille, France
| | - Simon Senghor
- Centre de Recherche Biomédicale–Espoir Pour La Sante, Saint Louis, Sénégal
| | - Assane Fall
- Centre de Recherche Biomédicale–Espoir Pour La Sante, Saint Louis, Sénégal
| | - Raphael Ndione
- Centre de Recherche Biomédicale–Espoir Pour La Sante, Saint Louis, Sénégal
| | - Gilles Riveau
- Centre de Recherche Biomédicale–Espoir Pour La Sante, Saint Louis, Sénégal
- University of Lille, CNRS, INSERM, CHU Lille, Institut Pasteur de Lille, Center for Infection and Immunity of Lille, Lille, France
| | - Giulio A. De Leo
- Hopkins Marine Station, Stanford University, Pacific Grove, California, United States of America
- Woods Institute for the Environment, Stanford University, Stanford, California, United States of America
| | - David López-Carr
- Department of Geography, University of California, Santa Barbara, CA, United States of America
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Yu QF, Zhang JY, Sun MT, Gu MM, Zou HY, Webster JP, Lu DB. In vivo praziquantel efficacy of Schistosoma japonicum over time: A systematic review and meta-analysis. Acta Trop 2021; 222:106048. [PMID: 34273315 DOI: 10.1016/j.actatropica.2021.106048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/10/2021] [Accepted: 07/08/2021] [Indexed: 12/20/2022]
Abstract
Praziquantel (PZQ), the only choice of chemotherapy for schistosomiasis recommended by World Health Organization (WHO), has been widely used over 40 years. The long-term, and rapid expansion of, PZQ use for disease control across a large populations continues to raise concern regarding the potential for emergence and establishment of drug resistance. Recent research has also proposed that the long survival and low sensitivity of unpaired worms, derived from either incomplete treatment cure rates or single-sex schistosome infections within final hosts, could exacerbate the risk of PZQ resistance (PZQ-R) emerging. With the aim of assessing whether PZQ efficacy amongst S. japonicum may have changed over time in China, we performed a unique systematic review and meta-analyses on datasets which evaluated the efficacy of PZQ via laboratory assays of field S. japonicum isolates on experimental mice over time. Relevant published literatures from four electronic bibliographic databases and lists of article references were searched. Two indexes, d, a measure used in meta-analyses for worm burden difference between two groups, and r, a traditional measure for worm reduction percentage after treatment but without considering sample size were calculated for each study. A total of 25 papers including 127 experimental studies with eligible data on 2230 mice were retrieved. The pooled d (D) was 3.91 (3.56-4.25) and pooled r (R) was 54.52% (52.55%-56.52%). D significantly increased over time, whereas R non-significantly decreased; both estimates were significantly associated with the total drug dose. Such findings suggested no evidence of PZQ-R emergence S. japonicum to date. However, we consider the potential role of parasite origins, PZQ dosage, and single versus mixed gender infections of the results published to date, and the avenues now needed for further research.
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Affiliation(s)
- Qiu-Fu Yu
- Department of Epidemiology and Statistics, School of Public Health, Soochow University, Suzhou, China; Key Laboratory of National Health and Family Planning Commission on Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, China
| | - Jie-Ying Zhang
- Department of Epidemiology and Statistics, School of Public Health, Soochow University, Suzhou, China; Key Laboratory of National Health and Family Planning Commission on Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, China
| | - Meng-Tao Sun
- Department of Epidemiology and Statistics, School of Public Health, Soochow University, Suzhou, China; Key Laboratory of National Health and Family Planning Commission on Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, China
| | - Man-Man Gu
- Department of Epidemiology and Statistics, School of Public Health, Soochow University, Suzhou, China; Key Laboratory of National Health and Family Planning Commission on Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, China
| | - Hui-Ying Zou
- Department of Epidemiology and Statistics, School of Public Health, Soochow University, Suzhou, China; Key Laboratory of National Health and Family Planning Commission on Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, China
| | - Joanne P Webster
- Key Laboratory of National Health and Family Planning Commission on Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, China; Centre for Emerging, Endemic and Exotic Diseases (CEEED), Department of Pathology and Population Sciences, Royal Veterinary College, University of London, Herts, United Kingdom
| | - Da-Bing Lu
- Department of Epidemiology and Statistics, School of Public Health, Soochow University, Suzhou, China; Key Laboratory of National Health and Family Planning Commission on Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, China.
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Byrne A, Manalo G, Clarke NE, Vaz Nery S. Impact of hookworm infection and preventive chemotherapy on haemoglobin in non-pregnant populations. Trop Med Int Health 2021; 26:1568-1592. [PMID: 34587315 DOI: 10.1111/tmi.13681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the impact of hookworm infection and preventive chemotherapy on haemoglobin levels in non-pregnant populations in endemic areas. METHOD Systematic review and meta-analysis searching PubMed and Web of Science for articles published since 2010 reporting either hookworm prevalence and Hb concentration (cross-sectional studies) or Hb concentration before and after the implementation of preventive chemotherapy (before-after studies and randomised controlled trials [RCTs]). For papers published before 2010, data were extracted from a previously published systematic review. Random effects meta-analyses were conducted to examine the relationship between Hb concentration and hookworm infection intensity (from cross-sectional studies) and the effect of preventive chemotherapy on Hb concentration (from before-after studies and RCTs). Sensitivity analyses investigated the impact of malaria endemicity and combined interventions for schistosomiasis and nutrition status on Hb concentration. RESULTS Among cross-sectional studies, both light- and heavy-intensity hookworm infections were associated with lower Hb in school-aged children. School-aged children with heavy hookworm infection in settings of high malaria endemicity had lower mean Hb than those in settings of low malaria endemicity. In non-pregnant populations, deworming with albendazole was associated with an increase in Hb of 3.02 g/L (95% CI 0.1, 6.0 g/L). No additional benefit was seen with deworming using albendazole co-administered with praziquantel for schistosomiasis infection or iron supplementation for nutrition status. CONCLUSION Our findings confirm the benefits of preventive chemotherapy as a public health intervention.
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Affiliation(s)
- Aisling Byrne
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Giselle Manalo
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Naomi E Clarke
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Susana Vaz Nery
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Tsang K, de Wildt G, Mwingira U, Mtuy TB. Implementing trachoma control programmes in marginalised populations in Tanzania: A qualitative study exploring the experiences and perspectives of key stakeholders. PLoS Negl Trop Dis 2021; 15:e0009727. [PMID: 34506482 PMCID: PMC8432809 DOI: 10.1371/journal.pntd.0009727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 08/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite aspects of the SAFE strategy for reducing trachoma in Tanzania have been somewhat successful, the disease still persists in marginalised communities even with repeated trachoma control interventions. This study aims to understand the facilitators and barriers associated with implementing trachoma control programmes in these communities, from the perspective of non-governmental organisations (NGOs). METHODS Participants were the representatives of NGOs who had knowledge and experience in the implementation of trachoma control programmes. Data was collected using in-depth, semi-structured interviews guided by a topic guide, which was updated after each interview using a constant comparative method. Interviews were audio-recorded and then transcribed verbatim. Thematic analysis was done inductively. Codes were generated from the transcripts and then clustered into themes. FINDINGS The context within marginalised communities often acted as a perceived barrier to successful implementation of control programmes. This included poor environmental cleanliness, lack of trust, poor disease knowledge and traditional lifestyles. Community values could either be a facilitator or a barrier, depending on the scenario. The anatomical location of the disease and the poor understanding of the disease progression also served as barriers. Considerations affecting decision-making among NGO's include financial feasibility, community needs and whether the quality of the intervention could be improved. NGOs felt that the collaboration and the opportunity to learn from other organisations were beneficial aspects of having different actors. However, this also resulted in variability in the effectiveness of interventions between districts. CONCLUSION NGOs should focus on behaviour change and health education that is tailored to marginalised communities and seek innovative ways to implement trachoma intervention programmes whilst being minimally intrusive to the traditional way of life. Partners should also implement ways to ensure high quality programmes are being provided, by increasing staff accountability and compensating volunteers fairly.
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Affiliation(s)
- Kaki Tsang
- The Department of Population Sciences and Humanities, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Gilles de Wildt
- The Department of Population Sciences and Humanities, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Upendo Mwingira
- RTI International, Washington DC, United States of America
- NTD Control Programme, National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Tara B. Mtuy
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Glenn J, Adams AB, Sankar G, Henry C, Palacio K, Thuo W, Williams K. Towards a shared understanding of sustainability for neglected tropical disease programs. PLoS Negl Trop Dis 2021; 15:e0009595. [PMID: 34415903 PMCID: PMC8378706 DOI: 10.1371/journal.pntd.0009595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/24/2021] [Indexed: 11/22/2022] Open
Abstract
Background Sustainability within neglected tropical disease (NTD) programs is a complex and challenging issue. The need for a shared understanding about what sustainability means for NTD programs is more important than ever as stakeholders are currently realigning for the next decade of NTD programming with the launch of WHO’s new NTD roadmap for 2012–2030. The aim of this paper is to assess different perspectives to generate a working definition of sustainability for NTD programs. Methodology/Principal findings This study surveyed affiliates of the NTD NGO Network (NNN) about their definitions of sustainability and then analyzed the data using an inductive and deductive process. The research team drafted a sustainability statement based on the survey findings and then solicited and incorporated feedback on the statement from a diverse group of expert reviewers. The final statement includes a working definition of sustainability for NTD programs that highlights three key essential components to sustainability: domestic commitment, responsive resource mobilization, and accountability. Conclusions/Significance This research resulted in a sustainability statement, based on a survey and extensive consultation with stakeholders, that represents a starting point for shared understanding around the concept of sustainability for NTD programs. Future collaborative work should build off this definition and seek to incorporate indicators for sustainability into programmatic decision-making. The question of whether a global public health program can be sustainable is as important as whether that program is effective. While neglected tropical disease (NTD) programs have achieved tangible success in reducing the burden of NTDs over the past decade through a massive collaboration between global and local stakeholders, the achievement of global NTD control and elimination goals will depend in large part on whether these efforts are sustained. This study seeks to encourage more and better dialogue around NTD program sustainability by incorporating a wide variety of expert perspectives to create and propose a shared definition of sustainability upon which future NTD programming decisions can be made. The sustainability statement based on the findings from this study suggests that three essential components to NTD program sustainability are commitment from decision-makers within NTD-endemic countries, resource mobilization that is responsive to local needs, and enhanced mechanisms for accountability.
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Affiliation(s)
- Jeffrey Glenn
- Sustainable Systems Cross-Cutting Group, Neglected Tropical Disease NGO Network, London, United Kingdom
- Department of Public Health, College of Life Sciences, Brigham Young University, Provo, Utah, United States of America
- * E-mail:
| | - Aparna Barua Adams
- Sustainable Systems Cross-Cutting Group, Neglected Tropical Disease NGO Network, London, United Kingdom
- International Coalition for Trachoma Control, London, United Kingdom
| | - Girija Sankar
- Sustainable Systems Cross-Cutting Group, Neglected Tropical Disease NGO Network, London, United Kingdom
- CBM International, Bensheim, Germany
| | - Carolyn Henry
- Sustainable Systems Cross-Cutting Group, Neglected Tropical Disease NGO Network, London, United Kingdom
- SCI Foundation, London, United Kingdom
| | - Karen Palacio
- Sustainable Systems Cross-Cutting Group, Neglected Tropical Disease NGO Network, London, United Kingdom
- The END Fund, New York City, New York, United States of America
| | - Wangeci Thuo
- Sustainable Systems Cross-Cutting Group, Neglected Tropical Disease NGO Network, London, United Kingdom
- RTI International, Washington, DC, United States of America
| | - Katherine Williams
- Sustainable Systems Cross-Cutting Group, Neglected Tropical Disease NGO Network, London, United Kingdom
- The END Fund, New York City, New York, United States of America
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El-Moamly AA. Scabies as a part of the World Health Organization roadmap for neglected tropical diseases 2021-2030: what we know and what we need to do for global control. Trop Med Health 2021; 49:64. [PMID: 34399850 PMCID: PMC8366162 DOI: 10.1186/s41182-021-00348-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/05/2021] [Indexed: 01/02/2023] Open
Abstract
Background Scabies is an under-recognized global health problem with an unacceptably high prevalence in many settings worldwide. Fortunately, the World Health Organization (WHO) has formally designated scabies as a neglected tropical disease in 2017, in the hope of increasing awareness and encouraging efforts to eradicate it. Also, scabies has recently been included as part of the WHO roadmap for neglected tropical diseases 2021–2030, aimed at ending the neglect to attain the Sustainable Development Goals. Main abstract body This review article places scabies in focus. The literature was reviewed to explore discussions on controversial issues in scabies control, with the aim of clarifying whether global control of scabies is a feasible and worthwhile objective. The existing status of scabies and its burden are discussed along with future prospects for its global control. The article investigates the feasibility of scabies control and provides updates on the various impediments to this goal, such as challenges related to transmission, diagnosis, treatment, and vaccine development. Also examined are relevant research needs, success factors, and reasons for failure. This article aims to increase the global awareness of scabies and promote discussion, enhance coordinated international efforts, and ultimately, enact change at the national and worldwide levels toward the control of this preventable disease of the poor. Conclusion Despite the current challenges, scabies control is now within reach. With sustained interventions, continuous resources, and sincere commitment and support, scabies global control appears to be a worthwhile, realistic goal that is potentially achievable in the not so distant future.
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Affiliation(s)
- Amal A El-Moamly
- Department of Medical Parasitology, Faculty of Medicine, Suez Canal University, Round Road, Ismailia, Postal Code 41522, Egypt.
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Turner HC, Stolk WA, Solomon AW, King JD, Montresor A, Molyneux DH, Toor J. Are current preventive chemotherapy strategies for controlling and eliminating neglected tropical diseases cost-effective? BMJ Glob Health 2021; 6:bmjgh-2021-005456. [PMID: 34385158 PMCID: PMC8362715 DOI: 10.1136/bmjgh-2021-005456] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 02/07/2023] Open
Abstract
Neglected tropical diseases (NTDs) remain a significant cause of morbidity and mortality in many low-income and middle-income countries. Several NTDs, namely lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminthiases (STH) and trachoma, are predominantly controlled by preventive chemotherapy (or mass drug administration), following recommendations set by the WHO. Over one billion people are now treated for NTDs with this strategy per year. However, further investment and increased domestic healthcare spending are urgently needed to continue these programmes. Consequently, it is vital that the cost-effectiveness of preventive chemotherapy is understood. We analyse the current estimates on the cost per disability-adjusted life year (DALY) of the preventive chemotherapy strategies predominantly used for these diseases and identify key evidence gaps that require further research. Overall, the reported estimates show that preventive chemotherapy is generally cost-effective, supporting WHO recommendations. More specifically, the cost per DALY averted estimates relating to community-wide preventive chemotherapy for lymphatic filariasis and onchocerciasis were particularly favourable when compared with other public health interventions. Cost per DALY averted estimates of school-based preventive chemotherapy for schistosomiasis and STH were also generally favourable but more variable. Notably, the broader socioeconomic benefits are likely not being fully captured by the DALYs averted metric. No estimates of cost per DALY averted relating to community-wide mass antibiotic treatment for trachoma were found, highlighting the need for further research. These findings are important for informing global health policy and support the need for continuing NTD control and elimination efforts.
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Affiliation(s)
- Hugo C Turner
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK .,Oxford University Clinical Research Unit, Wellcome Africa Asia Programme, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Wilma A Stolk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Jonathan D King
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - David H Molyneux
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jaspreet Toor
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK,Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
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Modelling the ability of mass drug administration to interrupt soil-transmitted helminth transmission: Community-based deworming in Kenya as a case study. PLoS Negl Trop Dis 2021; 15:e0009625. [PMID: 34339450 PMCID: PMC8360579 DOI: 10.1371/journal.pntd.0009625] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 08/12/2021] [Accepted: 07/05/2021] [Indexed: 12/05/2022] Open
Abstract
The World Health Organization has recommended the application of mass drug administration (MDA) in treating high prevalence neglected tropical diseases such as soil-transmitted helminths (STHs), schistosomiasis, lymphatic filariasis, onchocerciasis and trachoma. MDA—which is safe, effective and inexpensive—has been widely applied to eliminate or interrupt the transmission of STHs in particular and has been offered to people in endemic regions without requiring individual diagnosis. We propose two mathematical models to investigate the impact of MDA on the mean number of worms in both treated and untreated human subpopulations. By varying the efficay of drugs, initial conditions of the models, coverage and frequency of MDA (both annual and biannual), we examine the dynamic behaviour of both models and the possibility of interruption of transmission. Both models predict that the interruption of transmission is possible if the drug efficacy is sufficiently high, but STH infection remains endemic if the drug efficacy is sufficiently low. In between these two critical values, the two models produce different predictions. By applying an additional round of biannual and annual MDA, we find that interruption of transmission is likely to happen in both cases with lower drug efficacy. In order to interrupt the transmission of STH or eliminate the infection efficiently and effectively, it is crucial to identify the appropriate efficacy of drug, coverage, frequency, timing and number of rounds of MDA. We determine the best options for annual and biannual mass drug administration to control soil-transmitted helminths. An additional round of drugs can allow weaker drugs to be used. We apply the results to a community-based deworming project in Kenya.
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de L Paula LA, Cândido ACBB, Santos MFC, Caffrey CR, Bastos JK, Ambrósio SR, Magalhães LG. Antiparasitic Properties of Propolis Extracts and Their Compounds. Chem Biodivers 2021; 18:e2100310. [PMID: 34231306 DOI: 10.1002/cbdv.202100310] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/06/2021] [Indexed: 11/09/2022]
Abstract
Propolis is a bee product that has been used in medicine since ancient times. Although its anti-inflammatory, antioxidant, antimicrobial, antitumor, and immunomodulatory activities have been investigated, its anti-parasitic properties remain poorly explored, especially regarding helminths. This review surveys the results obtained with propolis around the world against human parasites. Regarding protozoa, studies carried out with the protozoa Trypanosoma spp. and Leishmania spp. have demonstrated promising results in vitro and in vivo. However, there are fewer studies for Plasmodium spp., the etiological agent of malaria and less so for helminths, particularly for Fasciola spp. and Schistosoma spp. Despite the favorable in vitro results with propolis, helminth assays need to be further investigated. However, propolis has shown itself to be an excellent natural product for parasitology, thus opening new paths and approaches in its activity against protozoa and helminths.
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Affiliation(s)
- Lucas A de L Paula
- Research Group on Natural Products, Center for Research in Sciences and Technology, University of Franca, Avenida Dr. Armando Salles of Oliveira 201, CEP 14404-600, Franca, SP, Brazil
| | - Ana C B B Cândido
- Research Group on Natural Products, Center for Research in Sciences and Technology, University of Franca, Avenida Dr. Armando Salles of Oliveira 201, CEP 14404-600, Franca, SP, Brazil
| | - Mario F C Santos
- Research Group on Natural Products, Center for Research in Sciences and Technology, University of Franca, Avenida Dr. Armando Salles of Oliveira 201, CEP 14404-600, Franca, SP, Brazil
| | - Conor R Caffrey
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Jairo K Bastos
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Av. do Café, s/n, CEP 14.040-903, Ribeirão Preto, SP, Brazil
| | - Sérgio R Ambrósio
- Research Group on Natural Products, Center for Research in Sciences and Technology, University of Franca, Avenida Dr. Armando Salles of Oliveira 201, CEP 14404-600, Franca, SP, Brazil
| | - Lizandra G Magalhães
- Research Group on Natural Products, Center for Research in Sciences and Technology, University of Franca, Avenida Dr. Armando Salles of Oliveira 201, CEP 14404-600, Franca, SP, Brazil.,Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
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Morales ML, Tanabe MB, White AC, Lopez M, Bascope R, Cabada MM. Triclabendazole Treatment Failure for Fasciola hepatica Infection among Preschool and School-Age Children, Cusco, Peru 1. Emerg Infect Dis 2021; 27:1850-1857. [PMID: 34152949 PMCID: PMC8237897 DOI: 10.3201/eid2707.203900] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We conducted a retrospective cohort study of children who had chronic fascioliasis in the highlands of Peru to determine triclabendazole treatment efficacy. Children passing Fasciola eggs in stool were offered directly observed triclabendazole treatment (>1 doses of 10 mg/kg). Parasitologic cure was evaluated by using microscopy of stool 1–4 months after each treatment. A total of 146 children who had chronic fascioliasis participated in the study; 53% were female, and the mean ± SD age was 10.4 ± 3.1 years. After the first treatment, 55% of the children achieved parasitologic cure. Cure rates decreased after the second (38%), third (30%), and fourth (23%) treatments; 17 children (11.6%) did not achieve cure after 4 treatments. Higher baseline egg counts and lower socioeconomic status were associated with triclabendazole treatment failure. Decreased triclabendazole efficacy in disease-endemic communities threatens control efforts. Further research on triclabendazole resistance and new drugs to overcome it are urgently needed.
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Rinaldi G, Porter K. Mass drug administration for endemic scabies: a systematic review. Trop Dis Travel Med Vaccines 2021; 7:21. [PMID: 34193305 PMCID: PMC8247067 DOI: 10.1186/s40794-021-00143-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/01/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Scabies is an extremely fastidious infestation caused by the Sarcoptes scabiei mite. It causes a persistent itch that can disrupt a person's mental health, sleep, and overall quality of life. In endemic areas, treatment by targeting symptomatic individuals and their contacts is often unsuccessful due to an asymptomatic period and high rates of re-infection. To overcome this, Mass Drug Administration (MDA) is often used to treat the whole community, irrespective of whether individuals presently have scabies. This review summarises the evidence for the effectiveness of MDA in treating scabies. METHODS An exhaustive literature review was conducted on MEDLINE, EMBASE, Web of Science and Scopus. All peer-reviewed articles published in English January 1990 to March 2020 were eligible and only if the studies were primary and interventional. Furthermore, the intervention had to be a pharmacological MDA method involving human subjects. RESULTS TWELVE articles that qualified for inclusion were identified. MDA for scabies significantly reduced its prevalence in communities at follow up. Some of the drivers of success were communities with low levels of migration, an uptake of MDA of > 85%, the use of oral Ivermectin therapy, the treatment of children and pregnant women within the treated population, and repeated treatment for participants diagnosed with scabies at baseline. CONCLUSIONS The average absolute reduction in prevalence of scabies was 22.0% and the relative reduction average was 73.4%. These results suggest MDA is effective in treating scabies in the endemic community. Further evidence is needed surrounding MDA use in urban areas with increased levels of migration. Importantly, MDA should not substitute the tackling of socioeconomic factors which contribute to endemic disease such as good sanitation and hygiene.
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Affiliation(s)
- Giulia Rinaldi
- Institute for Global Health, University College London, London, UK.
| | - Kholoud Porter
- Institute for Global Health, University College London, London, UK
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Addiss DG, Kienast Y, Lavery JV. Ethical dimensions of neglected tropical disease programming. Trans R Soc Trop Med Hyg 2021; 115:190-195. [PMID: 33339025 PMCID: PMC7842092 DOI: 10.1093/trstmh/traa155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/14/2020] [Accepted: 11/20/2020] [Indexed: 11/13/2022] Open
Abstract
The global movement to control and eliminate neglected tropical diseases (NTDs) is grounded in an ethic of social justice, solidarity and health equity. NTD programmes deliver significant health benefits in socially complex environments characterized by poverty and economic disparity. We used two ethics frameworks—principlism and Upshur's public health framework—to examine ethical challenges faced by NTD programmes. They include management of serious adverse reactions associated with preventive chemotherapy, centralization of decision-making, ‘opt-out’ policies for school-based deworming, incomplete evidence for ‘pro-poor’ impact and persistent inequities in global partnerships. NTD programmes must actively address ethical challenges while pursuing global health goals.
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Affiliation(s)
- David G Addiss
- Focus Area for Compassion and Ethics, Task Force for Global Health, Decatur, GA, USA
| | - Yvonne Kienast
- Focus Area for Compassion and Ethics, Task Force for Global Health, Decatur, GA, USA.,Center for Ethics, Emory University, Atlanta, GA, USA
| | - James V Lavery
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Okebe J, Dabira E, Jaiteh F, Mohammed N, Bradley J, Drammeh NF, Bah A, Masunaga Y, Achan J, Muela Ribera J, Yeung S, Balen J, Peeters Grietens K, D'Alessandro U. Reactive, self-administered malaria treatment against asymptomatic malaria infection: results of a cluster randomized controlled trial in The Gambia. Malar J 2021; 20:253. [PMID: 34098984 PMCID: PMC8186162 DOI: 10.1186/s12936-021-03761-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/11/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Selectively targeting and treating malaria-infected individuals may further decrease parasite carriage in low-burden settings. Using a trans-disciplinary approach, a reactive treatment strategy to reduce Plasmodium falciparum prevalence in participating communities was co-developed and tested. METHODS This is a 2-arm, open-label, cluster-randomized trial involving villages in Central Gambia during the 2017 and 2018 malaria transmission season. Villages were randomized in a 1:1 ratio using a minimizing algorithm. In the intervention arm, trained village health workers delivered a full course of pre-packed dihydroartemisinin-piperaquine to all residents of compounds where clinical cases were reported while in the control arm, compound residents were screened for infection at the time of the index case reporting. All index cases were treated following national guidelines. The primary endpoint was malaria prevalence, determined by molecular methods, at the end of the intervention period. RESULTS The trial was carried out in 50 villages: 34 in 2017 and 16 additional villages in 2018. At the end of the 2018 transmission season, malaria prevalence was 0.8% (16/1924, range 0-4%) and 1.1% (20/1814, range 0-17%) in the intervention and control arms, respectively. The odds of malaria infection were 29% lower in the intervention than in the control arm after adjustment for age (OR 0.71, 95% CI 0.27-1.84, p = 0.48). Adherence to treatment was high, with 98% (964/979) of those treated completing the 3-day treatment. Over the course of the study, only 37 villages, 20 in the intervention and 17 in the control arm, reported at least one clinical case. The distribution of clinical cases by month in both transmission seasons was similar and the odds of new clinical malaria cases during the trial period did not vary between arms (OR 1.04, 95% CI 0.57-1.91, p = 0.893). All adverse events were classified as mild to moderate and resolved completely. CONCLUSION The systematic and timely administration of an anti-malarial treatment to residents of compounds with confirmed malaria cases did not significantly decrease malaria prevalence and incidence in communities where malaria prevalence was already low. Treatment coverage and adherence was very high. Results were strongly influenced by the lower-than-expected malaria prevalence, and by no clinical cases in villages with asymptomatic malaria-infected individuals. TRIAL REGISTRATION This study is registered with ClinicalTrials.gov, NCT02878200. Registered 25 August 2016. https://clinicaltrials.gov/ct2/show/NCT02878200 .
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Affiliation(s)
- Joseph Okebe
- Medical Research Council Unit The Gambia At the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Edgard Dabira
- Medical Research Council Unit The Gambia At the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Fatou Jaiteh
- Medical Anthropology Unit, Institute of Tropical Medicine, Antwerp, Belgium
- Amsterdam Institute of Social Science Research, Amsterdam, The Netherlands
| | - Nuredin Mohammed
- Medical Research Council Unit The Gambia At the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - John Bradley
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Ndey-Fatou Drammeh
- Medical Research Council Unit The Gambia At the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Amadou Bah
- Medical Research Council Unit The Gambia At the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Yoriko Masunaga
- Medical Anthropology Unit, Institute of Tropical Medicine, Antwerp, Belgium
- Amsterdam Institute of Social Science Research, Amsterdam, The Netherlands
| | - Jane Achan
- Medical Research Council Unit The Gambia At the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Malaria Consortium, Cambridge Heath, London, UK
| | | | - Shunmay Yeung
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Julie Balen
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | | | - Umberto D'Alessandro
- Medical Research Council Unit The Gambia At the London School of Hygiene and Tropical Medicine, Fajara, The Gambia.
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Revisiting density-dependent fecundity in schistosomes using sibship reconstruction. PLoS Negl Trop Dis 2021; 15:e0009396. [PMID: 33983965 PMCID: PMC8148369 DOI: 10.1371/journal.pntd.0009396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 05/25/2021] [Accepted: 04/19/2021] [Indexed: 11/19/2022] Open
Abstract
The stability of parasite populations is regulated by density-dependent processes occurring at different stages of their life cycle. In dioecious helminth infections, density-dependent fecundity is one such regulatory process that describes the reduction in egg production by female worms in high worm burden within-host environments. In human schistosomiasis, the operation of density-dependent fecundity is equivocal and investigation is hampered by the inaccessibility of adult worms that are located intravascularly. Current understanding is almost exclusively limited to data collected from two human autopsy studies conducted over 40 years ago, with subsequent analyses having reached conflicting conclusions. Whether egg production is regulated in a density-dependent manner is key to predicting the effectiveness of interventions targeting the elimination of schistosomiasis and to the interpretation of parasitological data collected during monitoring and evaluation activities. Here, we revisit density-dependent fecundity in the two most globally important human Schistosoma spp. using a statistical modelling approach that combines molecular inference on the number of parents/adult worms in individual human hosts with parasitological egg count data from mainland Tanzania and Zanzibar. We find a non-proportional relationship between S. haematobium egg counts and inferred numbers of female worms, providing the first clear evidence of density-dependent fecundity in this schistosome species. We do not find robust evidence for density-dependent fecundity in S. mansoni because of high sensitivity to some modelling assumptions and the lower statistical power of the available data. We discuss the strengths and limitations of our model-based analytical approach and its potential for improving our understanding of density dependence in schistosomiasis and other human helminthiases earmarked for elimination. Schistosomiasis is a devastating disease of poverty currently estimated to infect over 220 million people. It is caused by parasitic worms (blood flukes) that live for, on average, 5–7 years inside the blood vessels of infected hosts and produce hundreds of eggs daily. Whether egg production is regulated in a density-dependent manner, and if so under what conditions, has been controversial for schistosomiasis, and investigation is hampered due to the inaccessible location of adult worms. Resolving this fundamental question is important because density dependencies determine the resilience of helminthiases to interventions. Here, we have revisited this longstanding and unresolved question of density-dependent fecundity in human schistosomes using a novel statistical modelling approach that combines information from molecular and parasitological data. We report the first clear evidence of density-dependent fecundity in S. haematobium, the causative agent of millions of cases of urogenital schistosomiasis. Our findings are of critical importance both to mathematical modellers predicting the impact of interventions and to public health policy makers striving to meet the 2030 elimination targets for schistosomiasis. This study also serves to illustrate a new biostatistical approach that could be applied to investigate density dependencies in other helminthiases where adult parasites are inaccessible.
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Fehr A, Nieto-Sanchez C, Muela J, Jaiteh F, Ceesay O, Maneh E, Baldeh D, Achan J, Dabira E, Conteh B, Bunders-Aelen J, Smekens T, Broekhuizen H, D'Alessandro U, Peeters Grietens K. From informed consent to adherence: factors influencing involvement in mass drug administration with ivermectin for malaria elimination in The Gambia. Malar J 2021; 20:198. [PMID: 33902611 PMCID: PMC8073909 DOI: 10.1186/s12936-021-03732-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background The World Health Organization (WHO) recommends consideration of mass drug administration (MDA) for malaria control in low-endemic settings approaching elimination. However, MDA remains a controversial strategy, as multiple individual, social, and operational factors have shown to affect its acceptability at local levels. This is further complicated by inconsistent definitions of key indicators derived from individual and community involvement—coverage, adherence, and compliance—that cast doubts about the actual and potential epidemiological impact of MDA on disease control and elimination. This study aimed to identify limitations and enabling factors impacting involvement at different stages of a large cluster-randomized trial assessing the effect of combining dihydroartemisinin-piperaquine (DP) and ivermectin (IVM) in malaria transmission in The Gambia. Methods This social science study used a mixed-methods approach. Qualitative data were collected in intervention and control villages through ethnographic methods, including in-depth interviews (IDIs), focus group discussions (FGDs), and participant observation conducted with trial participants and decliners, community leaders, and field staff. A cross-sectional survey was conducted in the intervention villages after the first year of MDA. Both strands of the study explored malaria knowledge and opinions, social dynamics influencing decision-making, as well as perceived risks, burdens, and benefits associated with this MDA. Results 157 IDIs and 11 FGDs were conducted, and 864 respondents were included in the survey. Barriers and enabling factors to involvement were differentially influential at the various stages of the MDA. Issues of social influence, concerns regarding secondary effects of the medication, costs associated with malaria, and acceptability of the implementing organization, among other factors, differently affected the decision-making processes throughout the trial. Rather than a linear trajectory, involvement in this MDA trial was subjected to multiple revaluations from enrolment and consent to medicine intake and adherence to treatment. Conclusions This study went beyond the individual factors often associated with coverage and adherence, and found that nuanced social dynamics greatly influence the decision-making process at all phases of the trial. These issues need to be consider for MDA implementation strategies and inform discussions about more accurate ways of reporting on critical effectiveness indicators. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03732-z.
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Affiliation(s)
- Alexandra Fehr
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Claudia Nieto-Sanchez
- Unit of Socio-Ecological Health Research, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Joan Muela
- Medical Anthropology Research Center, Universitat Rovira I Virgill, Tarragona, Spain
| | - Fatou Jaiteh
- Unit of Socio-Ecological Health Research, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Omar Ceesay
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Ebrima Maneh
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Dullo Baldeh
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Jane Achan
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Edgard Dabira
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Bakary Conteh
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Tom Smekens
- Unit of Socio-Ecological Health Research, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Umberto D'Alessandro
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Koen Peeters Grietens
- Unit of Socio-Ecological Health Research, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Vande Velde F, Longva J, Overgaard HJ, Bastien S. Identifying nudge strategies for behavior-based prevention and control of neglected tropical diseases: a scoping review protocol. JBI Evid Synth 2021; 18:2704-2713. [PMID: 32740033 DOI: 10.11124/jbies-20-00042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The aim of this scoping review is to synthesize the existing body of studies that use nudge strategy and focus on behavioral practices suitable for prevention and control of neglected tropical diseases. The review will map the existing literature, identify gaps in knowledge, and provide a series of recommendations for future research. INTRODUCTION There is a well-established body of knowledge related to "nudging," a strategy that uses subtle stimuli to direct people's behavior within public health interventions, with the aim of changing behaviors to reduce the prevalence of non-communicable diseases. Recently, interventions to promote prevention and control of neglected tropical diseases have included nudging as a strategy for altering behavior. However, these interventions not been synthesized and present the opportunity for a scoping review. INCLUSION CRITERIA Eligible studies are those that include nudge strategies aimed at changing behavior to prevent and control neglected tropical diseases. All types of behavioral practices suitable for targeting neglected tropical diseases (e.g. handwashing behaviors) will be considered, not exclusively focusing on a specific type or group of neglected tropical diseases. The nudge strategy must be described in full, without restrictions to the study design. The context or population will be limited to low- and middle-income countries. METHODS A comprehensive search will be performed in the following databases: MEDLINE, PsycINFO, and Embase (Ovid), Web of Science Core Collection, CINAHL, ERIC, and EconLit (EBSCO), as well as registered trials and reviews in CENTRAL and PROSPERO to identify ongoing or unpublished studies. Titles will be screened by one reviewer, and non-eligible studies excluded. Two reviewers (SB and FVV) will screen abstracts independently. Eligible studies will be selected through a questionnaire that specifies the inclusion criteria. Papers selected for inclusion will be subject to data extraction using a tool designed by one review author and agreed upon by the other review authors. Data will be presented in a table and other conceptual styles.
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Affiliation(s)
- Fiona Vande Velde
- Department of Public Health Science, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway
| | - Johanne Longva
- University Library, Norwegian University of Life Sciences, Ås, Norway.,The Centre for Evidence-Based Public Health: A JBI Affiliated Group, Norwegian University of Life Sciences, Ås, Norway
| | - Hans J Overgaard
- Faculty of Science and Technology, Norwegian University of Life Sciences, Ås, Norway.,Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sheri Bastien
- Department of Public Health Science, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway.,The Centre for Evidence-Based Public Health: A JBI Affiliated Group, Norwegian University of Life Sciences, Ås, Norway.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Burthe SJ, Schäfer SM, Asaaga FA, Balakrishnan N, Chanda MM, Darshan N, Hoti SL, Kiran SK, Seshadri T, Srinivas PN, Vanak AT, Purse BV. Reviewing the ecological evidence base for management of emerging tropical zoonoses: Kyasanur Forest Disease in India as a case study. PLoS Negl Trop Dis 2021; 15:e0009243. [PMID: 33793560 PMCID: PMC8016103 DOI: 10.1371/journal.pntd.0009243] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Zoonoses disproportionately affect tropical communities and are associated with human modification and use of ecosystems. Effective management is hampered by poor ecological understanding of disease transmission and often focuses on human vaccination or treatment. Better ecological understanding of multi-vector and multi-host transmission, social and environmental factors altering human exposure, might enable a broader suite of management options. Options may include "ecological interventions" that target vectors or hosts and require good knowledge of underlying transmission processes, which may be more effective, economical, and long lasting than conventional approaches. New frameworks identify the hierarchical series of barriers that a pathogen needs to overcome before human spillover occurs and demonstrate how ecological interventions may strengthen these barriers and complement human-focused disease control. We extend these frameworks for vector-borne zoonoses, focusing on Kyasanur Forest Disease Virus (KFDV), a tick-borne, neglected zoonosis affecting poor forest communities in India, involving complex communities of tick and host species. We identify the hierarchical barriers to pathogen transmission targeted by existing management. We show that existing interventions mainly focus on human barriers (via personal protection and vaccination) or at barriers relating to Kyasanur Forest Disease (KFD) vectors (tick control on cattle and at the sites of host (monkey) deaths). We review the validity of existing management guidance for KFD through literature review and interviews with disease managers. Efficacy of interventions was difficult to quantify due to poor empirical understanding of KFDV-vector-host ecology, particularly the role of cattle and monkeys in the disease transmission cycle. Cattle are hypothesised to amplify tick populations. Monkeys may act as sentinels of human infection or are hypothesised to act as amplifying hosts for KFDV, but the spatial scale of risk arising from ticks infected via monkeys versus small mammal reservoirs is unclear. We identified 19 urgent research priorities for refinement of current management strategies or development of ecological interventions targeting vectors and host barriers to prevent disease spillover in the future.
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Affiliation(s)
- Sarah J. Burthe
- UK Centre for Ecology & Hydrology, Edinburgh, United Kingdom
| | | | | | - Natrajan Balakrishnan
- ICAR-National Institute of Veterinary Epidemiology and Disease Informatics, Bengaluru, India
| | | | - Narayanaswamy Darshan
- Department of Health and Family Welfare Services, Government of Karnataka, Shivamogga, India
- ICMR-National Institute for Traditional Medicine, Belgavi, India
| | - Subhash L. Hoti
- ICMR-National Institute for Traditional Medicine, Belgavi, India
| | - Shivani K. Kiran
- Department of Health and Family Welfare Services, Government of Karnataka, Shivamogga, India
| | - Tanya Seshadri
- Vivekananda Gorukana Kalyana Kendra (VGKK), Chamarajanagar, India
| | - Prashanth N. Srinivas
- Ashoka Trust for Ecology and the Environment, Bengaluru, India
- DBT/Wellcome Trust India Alliance Fellow, Hyderabad, India
- Institute of Public Health, Bangalore, India
| | - Abi T. Vanak
- Ashoka Trust for Ecology and the Environment, Bengaluru, India
- DBT/Wellcome Trust India Alliance Fellow, Hyderabad, India
- School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Bethan V. Purse
- UK Centre for Ecology & Hydrology, Wallingford, United Kingdom
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70
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Beltrame L, Rose Vineer H, Walker JG, Morgan ER, Vickerman P, Wagener T. Discovering environmental management opportunities for infectious disease control. Sci Rep 2021; 11:6442. [PMID: 33742016 PMCID: PMC7979760 DOI: 10.1038/s41598-021-85250-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 02/24/2021] [Indexed: 11/09/2022] Open
Abstract
Climate change and emerging drug resistance make the control of many infectious diseases increasingly challenging and diminish the exclusive reliance on drug treatment as sole solution to the problem. As disease transmission often depends on environmental conditions that can be modified, such modifications may become crucial to risk reduction if we can assess their potential benefit at policy-relevant scales. However, so far, the value of environmental management for this purpose has received little attention. Here, using the parasitic disease of fasciolosis in livestock in the UK as a case study, we demonstrate how mechanistic hydro-epidemiological modelling can be applied to understand disease risk drivers and the efficacy of environmental management across a large heterogeneous domain. Our results show how weather and other environmental characteristics interact to define disease transmission potential and reveal that environmental interventions such as risk avoidance management strategies can provide a valuable alternative or complement to current treatment-based control practice.
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Affiliation(s)
- Ludovica Beltrame
- Department of Civil Engineering, University of Bristol, Bristol, UK. .,Department of Agricultural and Environmental Sciences, University of Milan, Milan, Italy.
| | - Hannah Rose Vineer
- Department of Infection Biology and Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | | | - Eric R Morgan
- School of Biological Sciences, Queen's University Belfast, Belfast, UK
| | | | - Thorsten Wagener
- Department of Civil Engineering, University of Bristol, Bristol, UK.,Cabot Institute for the Environment, University of Bristol, Bristol, UK.,Institute for Environmental Science and Geography, University of Potsdam, Potsdam, Germany
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71
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Mawa PA, Kincaid-Smith J, Tukahebwa EM, Webster JP, Wilson S. Schistosomiasis Morbidity Hotspots: Roles of the Human Host, the Parasite and Their Interface in the Development of Severe Morbidity. Front Immunol 2021; 12:635869. [PMID: 33790908 PMCID: PMC8005546 DOI: 10.3389/fimmu.2021.635869] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/25/2021] [Indexed: 12/14/2022] Open
Abstract
Schistosomiasis is the second most important human parasitic disease in terms of socioeconomic impact, causing great morbidity and mortality, predominantly across the African continent. For intestinal schistosomiasis, severe morbidity manifests as periportal fibrosis (PPF) in which large tracts of macro-fibrosis of the liver, visible by ultrasound, can occlude the main portal vein leading to portal hypertension (PHT), sequelae such as ascites and collateral vasculature, and ultimately fatalities. For urogenital schistosomiasis, severe morbidity manifests as pathology throughout the urinary system and genitals, and is a definitive cause of squamous cell bladder carcinoma. Preventative chemotherapy (PC) programmes, delivered through mass drug administration (MDA) of praziquantel (PZQ), have been at the forefront of schistosomiasis control programmes in sub-Saharan Africa since their commencement in Uganda in 2003. However, despite many successes, 'biological hotspots' (as distinct from 'operational hotspots') of both persistent high transmission and morbidity remain. In some areas, this failure to gain control of schistosomiasis has devastating consequences, with not only persistently high infection intensities, but both "subtle" and severe morbidity remaining prevalent. These hotspots highlight the requirement to revisit research into severe morbidity and its mechanisms, a topic that has been out of favor during times of PC implementation. Indeed, the focality and spatially-structured epidemiology of schistosomiasis, its transmission persistence and the morbidity induced, has long suggested that gene-environmental-interactions playing out at the host-parasite interface are crucial. Here we review evidence of potential unique parasite factors, host factors, and their gene-environmental interactions in terms of explaining differential morbidity profiles in the human host. We then take the situation of schistosomiasis mansoni within the Albertine region of Uganda as a case study in terms of elucidating the factors behind the severe morbidity observed and the avenues and directions for future research currently underway within a new research and clinical trial programme (FibroScHot).
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Affiliation(s)
- Patrice A. Mawa
- Immunomodulation and Vaccines Programme, Medical Research Council-Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit, Entebbe, Uganda
- Department of Immunology, Uganda Virus Research Institute, Entebbe, Uganda
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Julien Kincaid-Smith
- Centre for Emerging, Endemic and Exotic Diseases (CEEED), Department of Pathobiology and Population Sciences (PPS), Royal Veterinary College, University of London, Herts, United Kingdom
| | | | - Joanne P. Webster
- Centre for Emerging, Endemic and Exotic Diseases (CEEED), Department of Pathobiology and Population Sciences (PPS), Royal Veterinary College, University of London, Herts, United Kingdom
| | - Shona Wilson
- Department of Pathology, University of Cambridge, Cambridge, United Kingdom
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72
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Capone D, Chigwechokha P, de los Reyes FL, Holm RH, Risk BB, Tilley E, Brown J. Impact of sampling depth on pathogen detection in pit latrines. PLoS Negl Trop Dis 2021; 15:e0009176. [PMID: 33651818 PMCID: PMC7954291 DOI: 10.1371/journal.pntd.0009176] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/12/2021] [Accepted: 01/25/2021] [Indexed: 01/03/2023] Open
Abstract
Wastewater based epidemiology (WBE) is increasingly used to provide decision makers with actionable data about community health. WBE efforts to date have primarily focused on sewer-transported wastewater in high-income countries, but at least 1.8 billion people in low- and middle-income countries (LMIC) use onsite sanitation systems such as pit latrines and septic tanks. Like wastewater, fecal sludges from such systems offer similar advantages in community pathogen monitoring and other epidemiological applications. To evaluate the distribution of enteric pathogens inside pit latrines-which could inform sampling methods for WBE in LMIC settings unserved by sewers-we collected fecal sludges from the surface, mid-point, and maximum-depth of 33 pit latrines in urban and peri-urban Malawi and analyzed the 99 samples for 20 common enteric pathogens via multiplex quantitative reverse transcription PCR. Using logistic regression adjusted for household population, latrine sharing, the presence of a concrete floor or slab, water source, and anal cleansing materials, we found no significant difference in the odds of detecting the 20 pathogens from the mid-point (adjusted odds ratio, aOR = 1.1; 95% confidence interval = 0.73, 1.6) and surface samples (aOR = 0.80, 95% CI = 0.54, 1.2) compared with those samples taken from the maximum depth. Our results suggest that, for the purposes of routine pathogen monitoring, pit latrine sampling depth does not strongly influence the odds of detecting enteric pathogens by molecular methods. A single sample from the pit latrines' surface, or a composite of surface samples, may be preferred as the most recent material contributed to the pit and may be easiest to collect.
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Affiliation(s)
- Drew Capone
- Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
- Department of Environmental Sciences and Engineering, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Petros Chigwechokha
- Directorate of Research, Malawi University of Science and Technology, Blantyre, Malawi
| | - Francis L. de los Reyes
- Department of Civil, Construction, and Environmental Engineering, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Rochelle H. Holm
- Centre of Excellence in Water and Sanitation, Mzuzu University, Mzuzu, Malawi
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, Kentucky, United States of America
| | - Benjamin B. Risk
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, United States of America
| | - Elizabeth Tilley
- Department of Environmental Health, University of Malawi, Blantyre, Malawi
- Department of Sanitation, Water and Solid Waste for Development, Swiss Federal Institute of Aquatic Science and Technology, Duebendorf, Switzerland
| | - Joe Brown
- Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
- Department of Environmental Sciences and Engineering, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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73
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Barry A, Olsson S, Khaemba C, Kabatende J, Dires T, Fimbo A, Minzi O, Bienvenu E, Makonnen E, Kamuhabwa A, Oluka M, Guantai A, van Puijenbroek E, Bergman U, Nkayamba A, Mugisha M, Gurumurthy P, Aklillu E. Comparative Assessment of the Pharmacovigilance Systems within the Neglected Tropical Diseases Programs in East Africa-Ethiopia, Kenya, Rwanda, and Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041941. [PMID: 33671293 PMCID: PMC7922898 DOI: 10.3390/ijerph18041941] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 11/16/2022]
Abstract
Monitoring the safety of medicines used in public health programs (PHPs), including the neglected tropical diseases (NTD) program, is a WHO recommendation, and requires a well-established and robust pharmacovigilance system. The objective of this study was to assess the pharmacovigilance systems within the NTD programs in Ethiopia, Kenya, Rwanda, and Tanzania. The East African Community Harmonized Pharmacovigilance Indicators tool for PHPs was used to interview the staff of the national NTD programs. Data on four components, (i) systems, structures, and stakeholder coordination; (ii) data management and signal generation; (iii) risk assessment and evaluation; and (iv) risk management and communication, were collected and analyzed. The NTD programs in the four countries had a strategic master plan, with pharmacovigilance components and mechanisms to disseminate pharmacovigilance information. However, zero individual case safety reports were received in the last 12 months (2017/2018). There was either limited or no collaboration between the NTD programs and their respective national pharmacovigilance centers. None of the NTD programs had a specific budget for pharmacovigilance. The NTD program in all four countries had some safety monitoring elements. However, key elements, such as the reporting of adverse events, collaboration with national pharmacovigilance centers, and budget for pharmacovigilance activity, were limited/missing.
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Affiliation(s)
- Abbie Barry
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden; (A.B.); (S.O.); (U.B.)
| | - Sten Olsson
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden; (A.B.); (S.O.); (U.B.)
| | - Christabel Khaemba
- Pharmacy and Poisons Board, Kenya Lenana Road, P.O. Box 27663-00506 Nairobi, Kenya;
| | - Joseph Kabatende
- Rwanda Food and Drugs Authority, Nyarutarama Plaza, KG 9 Avenue Kigali, Rwanda;
| | - Tigist Dires
- Ethiopian Food and Drug Authority, Africa Avenue, Kirkos Sub City, P.O. Box 5681 Addis Ababa, Ethiopia;
| | - Adam Fimbo
- Tanzania Medicines and Medical Devices Authority, Off Mandela Road, Mabibo, P.O. Box 77150 Dar Es Salaam, Tanzania; (A.F.); (A.N.)
| | - Omary Minzi
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P. O. Box 65013 Dar es Salaam, Tanzania; (O.M.); (A.K.)
| | - Emile Bienvenu
- College of Medicine and Health Sciences, University of Rwanda, KK 737 Kigali, Rwanda; (E.B.); (M.M.)
| | - Eyasu Makonnen
- Department of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, P.O. Box 9086 Addis Ababa, Ethiopia;
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086 Addis Ababa, Ethiopia
| | - Appolinary Kamuhabwa
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P. O. Box 65013 Dar es Salaam, Tanzania; (O.M.); (A.K.)
| | - Margaret Oluka
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, P.O. Box 19676-00202 Nairobi, Kenya; (M.O.); (A.G.)
| | - Anastasia Guantai
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, P.O. Box 19676-00202 Nairobi, Kenya; (M.O.); (A.G.)
| | | | - Ulf Bergman
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden; (A.B.); (S.O.); (U.B.)
| | - Alex Nkayamba
- Tanzania Medicines and Medical Devices Authority, Off Mandela Road, Mabibo, P.O. Box 77150 Dar Es Salaam, Tanzania; (A.F.); (A.N.)
| | - Michael Mugisha
- College of Medicine and Health Sciences, University of Rwanda, KK 737 Kigali, Rwanda; (E.B.); (M.M.)
| | - Parthasarathi Gurumurthy
- Pharmacovigilance and Clinical Trials, Botswana Medicines Regulatory Authority, P.O. Box 505155 Gaborone, Botswana;
| | - Eleni Aklillu
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden; (A.B.); (S.O.); (U.B.)
- Correspondence: ; Tel.: +46-735116131
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Wainwright E, Evans D, Rotondo L, Pou B, Yevstigneyeva V, Zoerhoff KL, Ottesen EA, Reithinger R. The Elimination of Neglected Tropical Diseases: A Case Study Exemplifying How Foreign Assistance Funding Can Be Catalytic in Reducing the Burden of Major Global Health Conditions. Clin Infect Dis 2021; 70:958-964. [PMID: 31402376 DOI: 10.1093/cid/ciz742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/01/2019] [Indexed: 11/13/2022] Open
Abstract
In 2006, following direct advocacy and published rationale, the US Agency for International Development (USAID) established a neglected tropical diseases (NTDs) program to support the scale-up of integrated platforms to target the elimination and control of 5 NTDs-lymphatic filariasis, trachoma, onchocerciasis, schistosomiasis, and soil-transmitted helminthiasis. By 2017, more than 2.3 billion NTD treatments had been delivered to at-risk populations in 25 countries, leveraging $19 billion in donated drugs-approximately $26 dollars in donated medicine per $1 spent by USAID. As a result, most of the supported countries are on track to achieve their elimination goals (for lymphatic filariasis and trachoma) by 2020 or 2021 and their control goals soon thereafter. Though "small" when compared to other global health initiatives, this investment proved to be catalytic, and indeed highlights how foreign assistance funding can be transformative, in reducing the burden of major global health conditions such as NTDs.
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Affiliation(s)
| | - Darin Evans
- US Agency for International Development, Washington, DC, USA
| | | | | | | | | | - Eric A Ottesen
- RTI International, Washington, DC, USA.,Task Force for Global Health, Decatur, Georgia, USA
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75
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Abstract
Large-scale control efforts in sub-Saharan Africa may leave long-term lingering transmission. Large-scale screening of snail infection prevalence by loop-mediated isothermal amplification will enable accurate determination of man-to-snail transmission, as well as the effects of biota in snail habitat on host capacity and thus on snail-to-man transmission. Next-generation sequencing will enable identification of gut content of snails and thus their feeding preferences in hot spots and in non–hot spots, as well as for identification of attractive vegetation types for attracting snails to molluscicides.
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Affiliation(s)
- Joseph Hamburger
- Department of Microbiology and Molecular Genetics, The Kuvin Center for the Study of Infectious and Tropical Diseases, The Hebrew University of Jerusalem, Hadassah Medical School, Jerusalem, Israel
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76
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Fornace KM, Fronterrè C, Fleming FM, Simpson H, Zoure H, Rebollo M, Mwinzi P, Vounatsou P, Pullan RL. Evaluating survey designs for targeting preventive chemotherapy against Schistosoma haematobium and Schistosoma mansoni across sub-Saharan Africa: a geostatistical analysis and modelling study. Parasit Vectors 2020; 13:555. [PMID: 33203463 PMCID: PMC7672864 DOI: 10.1186/s13071-020-04413-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Schistosomiasis control programmes primarily use school-based surveys to identify areas for mass drug administration of preventive chemotherapy. However, as the spatial distribution of schistosomiasis can be highly focal, transmission may not be detected by surveys implemented at districts or larger spatial units. Improved mapping strategies are required to accurately and cost-effectively target preventive chemotherapy to remaining foci across all possible spatial distributions of schistosomiasis. METHODS Here, we use geostatistical models to quantify the spatial heterogeneity of Schistosoma haematobium and S. mansoni across sub-Saharan Africa using the most comprehensive dataset available on school-based surveys. Applying this information to parameterise simulations, we assess the accuracy and cost of targeting alternative implementation unit sizes across the range of plausible schistosomiasis distributions. We evaluate the consequences of decisions based on survey designs implemented at district and subdistrict levels sampling different numbers of schools. Cost data were obtained from field surveys conducted across multiple countries and years, with cost effectiveness evaluated as the cost per correctly identified school. RESULTS Models identified marked differences in prevalence and spatial distributions between countries and species; however, results suggest implementing surveys at subdistrict level increase the accuracy of treatment classifications across most scenarios. While sampling intensively at the subdistrict level resulted in the highest classification accuracy, this sampling strategy resulted in the highest costs. Alternatively, sampling the same numbers of schools currently recommended at the district level but stratifying by subdistrict increased cost effectiveness. CONCLUSIONS This study provides a new tool to evaluate schistosomiasis survey designs across a range of transmission settings. Results highlight the importance of considering spatial structure when designing sampling strategies, illustrating that a substantial proportion of children may be undertreated even when an implementation unit is correctly classified. Control programmes need to weigh the increased accuracy of more detailed mapping strategies against the survey costs and treatment priorities.
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Affiliation(s)
- Kimberly M Fornace
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
| | - Claudio Fronterrè
- Centre for Health Informatics, Computing and Statistics (CHICAS), Lancaster University, Lancaster, UK
| | | | - Hope Simpson
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Honorat Zoure
- Expanded Special Project of the Elimination of Neglected Tropical Diseases (ESPEN), Africa Regional Office of the World Health Organisation, Brazzaville, Congo
| | - Maria Rebollo
- Expanded Special Project of the Elimination of Neglected Tropical Diseases (ESPEN), Africa Regional Office of the World Health Organisation, Brazzaville, Congo
| | - Pauline Mwinzi
- Expanded Special Project of the Elimination of Neglected Tropical Diseases (ESPEN), Africa Regional Office of the World Health Organisation, Brazzaville, Congo
| | | | - Rachel L Pullan
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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77
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Hillyer JF. Parasites and Parasitology in this SARS-CoV-2, COVID-19 World: An American Society of Parasitologists Presidential Address. J Parasitol 2020; 106:859-868. [PMID: 33450760 DOI: 10.1645/20-158] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) is one of the worst global health crises of this generation. The core of this pandemic is the rapid transmissibility of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, its high morbidity and mortality, and the presence of infectious asymptomatic carriers. As a result, COVID-19 has dominated this year's headlines and commanded significant research attention. As we consider SARS-CoV-2 and the COVID-19 pandemic, it is essential that scientists, governments, the media, and the general population also come to grips with the everyday cost of parasitic diseases. Plasmodium (malaria), schistosomes, filarial worms, hookworms, Ascaris, whipworms, and other protozoan and metazoan parasites take a tremendous toll on local communities. Yet, because most of these diseases are no longer endemic to developed countries, their research and intervention are not funded at levels that are proportional to their global morbidity and mortality. The scientific and public health communities must indeed vigorously fight SARS-CoV-2 and COVID-19, but while doing so and beyond, it will be essential to demonstrate steadfast resolve toward understanding and combating the parasitic diseases that for centuries have haunted humankind.
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Affiliation(s)
- Julián F Hillyer
- Department of Biological Sciences, Vanderbilt University, Nashville, Tennessee 37235
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78
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Gupta H, Galatas B, Chidimatembue A, Huijben S, Cisteró P, Matambisso G, Nhamussua L, Simone W, Bassat Q, Ménard D, Ringwald P, Rabinovich NR, Alonso PL, Saúte F, Aide P, Mayor A. Effect of mass dihydroartemisinin-piperaquine administration in southern Mozambique on the carriage of molecular markers of antimalarial resistance. PLoS One 2020; 15:e0240174. [PMID: 33075062 PMCID: PMC7571678 DOI: 10.1371/journal.pone.0240174] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/21/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Mass drug administration (MDA) can rapidly reduce the burden of Plasmodium falciparum (Pf). However, concerns remain about its contribution to select for antimalarial drug resistance. METHODS We used Sanger sequencing and real-time PCR to determine the proportion of molecular markers associated with antimalarial resistance (k13, pfpm2, pfmdr1 and pfcrt) in Pf isolates collected before (n = 99) and after (n = 112) the implementation of two monthly MDA rounds with dihydroartemisinin-piperaquine (DHAp) for two consecutive years in Magude district of Southern Mozambique. RESULTS None of the k13 polymorphisms associated with artemisinin resistance were observed in the Pf isolates analyzed. The proportion of Pf isolates with multiple copies of pfpm2, an amplification associated with piperaquine resistance, was similar in pre- (4.9%) and post-MDA groups (3.4%; p = 1.000). No statistically significant differences were observed between pre- and post-MDA groups in the proportion of Pf isolates neither with mutations in pfcrt and pfmdr1 genes, nor with the carriage of pfmdr1 multiple copies (p>0.05). CONCLUSIONS This study does not show any evidence of increased frequency of molecular makers of antimalarial resistance after MDA with DHAp in southern Mozambique where markers of antimalarial resistance were absent or low at the beginning of the intervention.
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Affiliation(s)
- Himanshu Gupta
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Beatriz Galatas
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique
| | | | - Silvie Huijben
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Pau Cisteró
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | | | - Lidia Nhamussua
- Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique
| | - Wilson Simone
- Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique
| | - Quique Bassat
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique
- ICREA, Pg. Lluís Companys, Barcelona, Spain
- Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
| | - Didier Ménard
- Institut Pasteur, Paris, France
- INSERM U1201, Paris, France
- CNRS ERL9195, Paris, France
| | - Pascal Ringwald
- World Health Organization (WHO), Global Malaria Programme, Geneva, Switzerland
| | - N. Regina Rabinovich
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Pedro L. Alonso
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique
| | - Francisco Saúte
- Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique
| | - Pedro Aide
- Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique
- National Institute of Health, Ministry of Health, Manhica, Mozambique
| | - Alfredo Mayor
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique
- ICREA, Pg. Lluís Companys, Barcelona, Spain
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Loukouri A, Méité A, Koudou BG, Goss CW, Lew D, Weil GJ, N’Goran EK, Fischer PU. Impact of annual and semi-annual mass drug administration for Lymphatic Filariasis and Onchocerciasis on Hookworm Infection in Côte d'Ivoire. PLoS Negl Trop Dis 2020; 14:e0008642. [PMID: 32976514 PMCID: PMC7540880 DOI: 10.1371/journal.pntd.0008642] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/07/2020] [Accepted: 07/26/2020] [Indexed: 01/10/2023] Open
Abstract
Mass Drug Administration (MDA) programs to eliminate Lymphatic Filariasis (LF) in western Africa use the anthelminthics ivermectin plus albendazole. These drugs have the potential to impact also Soil-Transmitted Helminth (STH) infections, since the drugs have a broad range of anthelminthic activity. Integration of preventive chemotherapy efforts for LF, onchocerciasis and STH is recommended by the World Health Organization (WHO) in order to avoid duplication of MDA and to reduce costs. The objective of the current study was to determine whether five semi-annual rounds of community-wide MDA to eliminate LF and onchocerciasis have a greater impact on STH than three annual rounds of MDA with similar compliance. The effects of MDA using ivermectin (IVM, 0.2 mg/kg) combined with albendazole (ALB, 400 mg) on the prevalence and intensity of hookworm infection were evaluated in the Abengourou (annual MDA) and Akoupé (semi-annual MDA) health Districts in eastern Côte d’Ivoire from 2014 to 2017. A cross-sectional approach was used together with mixed logistic regression, and mixed linear models. Subjects were tested for STH using the Kato-Katz technique before the first round of MDA and 12, 24, and 36 months after the first round of MDA. The mean self-reported MDA compliance assessed during the survey was 65%, and no difference was observed between treatment areas. These results were confirmed by an independent coverage survey as recommended by WHO. Hookworm was the most prevalent STH species in both areas (23.9% vs 12.4%) and the prevalence of other STH species was less than 1%. The crude prevalence of hookworm dropped significantly, from 23.9% to 5.5% (p <0.001, 77% reduction) in the annual MDA treatment area and from 12.4% to 1.9% (p <0.001, 85% reduction) in the semi-annual treatment area. The average intensity of hookworm infection decreased in the annual MDA area (406.2 epg to 118.3 epg), but not in the semi-annual MDA area (804.9 epg to 875.0 epg). Moderate and heavy infections (1% and 1.3% at baseline) were reduced to 0% and 0.4% in the annual and semi-annual treatment areas, respectively. Using a mixed logistic regression model, and after adjusting for baseline prevalence, only the year 2 re-examination showed a difference in prevalence between treatments (OR: 2.26 [95% CI: 1.03, 4.98], p = 0.043). Analysis of intensity of hookworm infection indicated also that treatment differences varied by follow-up visit. In conclusion twelve months after the last treatment cycle, three annual and five semi-annual rounds of community-wide MDA with the combination of IVM and ALB showed strong, but similar impact on hookworm prevalence and intensity in eastern Côte d’Ivoire. Therefore, an annual MDA regimen seems to be an efficient strategy to control hookworm infection in endemic areas with low and moderate infection prevalence. Trial registration: The study was registered at ClinicalTrial.gov under the number NTC02032043. Community-wide MDA to eliminate LF and onchocerciasis has the beneficial effect to reduce also STH infections. The objective of the current study was to determine whether five semi-annual rounds of MDA have a greater impact on STH than three annual rounds of MDA using ivermectin combined with albendazole. In Abengourou and Akoupé health Districts in eastern Côte d’Ivoire the prevalence and intensity of hookworm infection were evaluated before and after MDA. Prior to MDA and after each annual treatment cycle, study participants were tested for STH using the Kato-Katz technique. The mean MDA compliance assessed during the survey was 65%, and no difference was observed between treatment areas. Compliance results were confirmed by an independent coverage survey as recommended by WHO. Hookworm was the most prevalent STH species in both areas and the prevalence of other STH species was less than 1%. The crude prevalence of hookworm dropped significantly, from 23.9% to 5.5% in the annual and from 12.4% to 1.9% in the semi-annual treatment areas. The intensity of hookworm infection in infected persons decreased significantly in the annual MDA area (406.2 epg to 118.3 epg, p = 0.017), but not in the semi-annual MDA area (804.9 epg to 875.0 epg, p = 0.216). Moderate and heavy infections were reduced to less than 1% in both treatment areas. Three annual and five semi-annual rounds of community-wide MDA with the combination of IVM and ALB showed strong, but similar effects on hookworm prevalence and intensity in eastern Côte d’Ivoire. Therefore, an annual MDA regimen seems to be an efficient strategy for controlling hookworm infection in endemic areas with low and moderate infection prevalence.
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Affiliation(s)
- Agodio Loukouri
- Laboratoire de Zoologie et Biologie Animale, UFR Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Aboulaye Méité
- Programme National de Lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive, Abidjan, Côte d’Ivoire
| | - Benjamin G. Koudou
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Abidjan, Côte d’Ivoire
- Laboratoire de Cytologie et Biologie Animale, UFR Science de la Nature, Université Nangui Abrogoua Abidjan, Abidjan, Côte d’Ivoire
| | - Charles W. Goss
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Daphne Lew
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Gary J. Weil
- Infectious Diseases Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Eliezer K. N’Goran
- Laboratoire de Zoologie et Biologie Animale, UFR Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
- Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Abidjan, Côte d’Ivoire
| | - Peter U. Fischer
- Infectious Diseases Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
- * E-mail:
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Mutapi F, Tagwireyi P, Lim R, Mangwanda B, Fourier C, Mduluza T. Positive impact of preventative chemotherapy during a national helminth control program: Perception and KAP. PLoS Negl Trop Dis 2020; 14:e0008494. [PMID: 32833994 PMCID: PMC7446881 DOI: 10.1371/journal.pntd.0008494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/18/2020] [Indexed: 11/18/2022] Open
Abstract
Helminth control at the national level is currently based on mass drug administration (MDA) programs. Perception of the MDA programs for helminth control by the affected populations influences compliance and future designs of the programs. We determined the perception of Zimbabwe's National Helminth Control Program (2012-2017) with a specific focus on schistosomiasis in the school children treated with praziquantel, schoolteachers and village health workers (VHW). The study enrolled 409 children from Grades 6 and 7 who had the full benefit of the 6 years of MDA from 2012 to 2017. Thirty-six schoolteachers and 22 VHW serving the schools were also recruited. A structured questionnaire developed in English, translated into the local language Shona, and validated prior to the study was administered to the children and the adults. The questions focused on the perceived impact on health, school attendance and performance and Knowledge Attitudes and Practice (KAP) among the school children. Data were captured electronically on android platforms using the Open Data Kit. Overall, 84% of the children responded that their awareness of schistosomiasis (transmission, disease, treatment and infection avoidance) had improved because of participating in the MDAs. Of the 151 children self-diagnosed with schistosomiasis, 74% reported that their health had improved following treatment with praziquantel. This included resolution of haematuria, painful urination, sore stomach, tiredness and falling asleep during class lessons. The children and teachers reported improvements in both pupil school attendance and performance at school while the VHW and teachers reported an increase in health-seeking behaviour amongst the school children for schistosomiasis treatment in-between MDAs. The majority of VHW (96%) reported improvement in handwashing behaviour, schistosomiasis awareness (96%) and treatment uptake (91%) within the communities where the school children belonged. However, only 59% of the VHW reported improvement in toilet use while only 50% of the VHW reported improvement in clean water use within their communities. This study indicated that the surveyed children perceived the MDA program had improved their health, school attendance, school performance and awareness of schistosomiasis. The VHW also perceived that the MDA program had improved the community KAP.
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Affiliation(s)
- Francisca Mutapi
- Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA) at the University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
- * E-mail:
| | - Paradzayi Tagwireyi
- Department of Geography and Environmental Science, Geo-information and Earth Observation Centre, University of Zimbabwe, Mount Pleasant, Harare, Zimbabwe
| | - Rivka Lim
- Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA) at the University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
| | - Blessing Mangwanda
- Department of Geography and Environmental Science, Geo-information and Earth Observation Centre, University of Zimbabwe, Mount Pleasant, Harare, Zimbabwe
| | - Charmaine Fourier
- Department of Biochemistry, University of Zimbabwe, Mount Pleasant, Harare, Zimbabwe
| | - Takafira Mduluza
- Department of Biochemistry, University of Zimbabwe, Mount Pleasant, Harare, Zimbabwe
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Léger E, Borlase A, Fall CB, Diouf ND, Diop SD, Yasenev L, Catalano S, Thiam CT, Ndiaye A, Emery A, Morrell A, Rabone M, Ndao M, Faye B, Rollinson D, Rudge JW, Sène M, Webster JP. Prevalence and distribution of schistosomiasis in human, livestock, and snail populations in northern Senegal: a One Health epidemiological study of a multi-host system. Lancet Planet Health 2020; 4:e330-e342. [PMID: 32800151 PMCID: PMC7443702 DOI: 10.1016/s2542-5196(20)30129-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 05/30/2023]
Abstract
BACKGROUND Schistosomiasis is a neglected tropical disease of global medical and veterinary importance. As efforts to eliminate schistosomiasis as a public health problem and interrupt transmission gather momentum, the potential zoonotic risk posed by livestock Schistosoma species via viable hybridisation in sub-Saharan Africa have been largely overlooked. We aimed to investigate the prevalence, distribution, and multi-host, multiparasite transmission cycle of Haematobium group schistosomiasis in Senegal, West Africa. METHODS In this epidemiological study, we carried out systematic surveys in definitive hosts (humans, cattle, sheep, and goats) and snail intermediate hosts, in 2016-18, in two areas of Northern Senegal: Richard Toll and Lac de Guiers, where transmission is perennial; and Barkedji and Linguère, where transmission is seasonal. The occurrence and distribution of Schistosoma species and hybrids were assessed by molecular analyses of parasitological specimens obtained from the different hosts. Children in the study villages aged 5-17 years and enrolled in school were selected from school registers. Adults (aged 18-78 years) were self-selecting volunteers. Livestock from the study villages in both areas were also randomly sampled, as were post-mortem samples from local abattoirs. Additionally, five malacological surveys of snail intermediate hosts were carried out at each site in open water sources used by the communities and their animals. FINDINGS In May to August, 2016, we surveyed 375 children and 20 adults from Richard Toll and Lac de Guiers, and 201 children and 107 adults from Barkedji and Linguère; in October, 2017, to January, 2018, we surveyed 386 children and 88 adults from Richard Toll and Lac de Guiers, and 323 children and 85 adults from Barkedji and Linguère. In Richard Toll and Lac de Guiers the prevalence of urogenital schistosomiasis in children was estimated to be 87% (95% CI 80-95) in 2016 and 88% (82-95) in 2017-18. An estimated 63% (in 2016) and 72% (in 2017-18) of infected children were shedding Schistosoma haematobium-Schistosoma bovis hybrids. In adults in Richard Toll and Lac de Guiers, the prevalence of urogenital schistosomiasis was estimated to be 79% (52-97) in 2016 and 41% (30-54) in 2017-18, with 88% of infected samples containing S haematobium-S bovis hybrids. In Barkedji and Linguère the prevalence of urogenital schistosomiasis in children was estimated to be 30% (23-38) in 2016 and 42% (35-49) in 2017-18, with the proportion of infected children found to be shedding S haematobium-S bovis hybrid miracidia much lower than in Richard Toll and Lac de Guiers (11% in 2016 and 9% in 2017-18). In adults in Barkedji and Linguère, the prevalence of urogenital schistosomiasis was estimated to be 26% (17-36) in 2016 and 47% (34-60) in 2017-18, with 10% of infected samples containing S haematobium-S bovis hybrids. The prevalence of S bovis in the sympatric cattle population of Richard Toll and the Lac de Guiers was 92% (80-99), with S bovis also found in sheep (estimated prevalence 14% [5-31]) and goats (15% [5-33]). In Barkedji and Linguère the main schistosome species in livestock was Schistosoma curassoni, with an estimated prevalence of 73% (48-93) in sheep, 84% (61-98) in goats and 8% (2-24) in cattle. S haematobium-S bovis hybrids were not found in livestock. In Richard Toll and Lac de Guiers 35% of infected Bulinus spp snail intermediate hosts were found to be shedding S haematobium-S bovis hybrids (68% shedding S haematobium; 17% shedding S bovis); however, no snails were found to be shedding S haematobium hybrids in Barkedji and Linguère (29% shedding S haematobium; 71% shedding S curassoni). INTERPRETATION Our findings suggest that hybrids originate in humans via zoonotic spillover from livestock populations, where schistosomiasis is co-endemic. Introgressive hybridisation, evolving host ranges, and wider ecosystem contexts could affect the transmission dynamics of schistosomiasis and other pathogens, demonstrating the need to consider control measures within a One Health framework. FUNDING Zoonoses and Emerging Livestock Systems programme (UK Biotechnology and Biological Sciences Research Council, UK Department for International Development, UK Economic and Social Research Council, UK Medical Research Council, UK Natural Environment Research Council, and UK Defence Science and Technology Laboratory).
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Affiliation(s)
- Elsa Léger
- Centre for Emerging, Endemic and Exotic Diseases, Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hertfordshire, UK; London Centre for Neglected Tropical Disease Research, School of Public Health, Imperial College London, London, UK.
| | - Anna Borlase
- Centre for Emerging, Endemic and Exotic Diseases, Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hertfordshire, UK; London Centre for Neglected Tropical Disease Research, School of Public Health, Imperial College London, London, UK; NTD Modelling Consortium, Big Data Institute, University of Oxford, Oxford, UK
| | - Cheikh B Fall
- Faculté de Médecine, Pharmacie et Odontologie, Université Cheikh Anta Diop, Dakar, Senegal
| | - Nicolas D Diouf
- Institut Supérieur de Formation Agricole et Rurale, Université de Thiès, Bambey, Senegal; Unité de Formation et de Recherche des Sciences Agronomiques, d'Aquaculture et de Technologies Alimentaires, Université Gaston Berger, Saint-Louis, Senegal
| | - Samba D Diop
- Institut Supérieur de Formation Agricole et Rurale, Université de Thiès, Bambey, Senegal
| | - Lucy Yasenev
- Centre for Emerging, Endemic and Exotic Diseases, Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hertfordshire, UK
| | - Stefano Catalano
- Centre for Emerging, Endemic and Exotic Diseases, Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hertfordshire, UK; London Centre for Neglected Tropical Disease Research, School of Public Health, Imperial College London, London, UK
| | - Cheikh T Thiam
- Unité de Formation et de Recherche des Sciences Agronomiques, d'Aquaculture et de Technologies Alimentaires, Université Gaston Berger, Saint-Louis, Senegal
| | - Alassane Ndiaye
- Unité de Formation et de Recherche des Sciences Agronomiques, d'Aquaculture et de Technologies Alimentaires, Université Gaston Berger, Saint-Louis, Senegal
| | - Aidan Emery
- London Centre for Neglected Tropical Disease Research, School of Public Health, Imperial College London, London, UK; Parasites and Vectors Division, Life Sciences Department, Natural History Museum, London, UK
| | - Alice Morrell
- Centre for Emerging, Endemic and Exotic Diseases, Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hertfordshire, UK
| | - Muriel Rabone
- London Centre for Neglected Tropical Disease Research, School of Public Health, Imperial College London, London, UK; Parasites and Vectors Division, Life Sciences Department, Natural History Museum, London, UK
| | - Momar Ndao
- National Reference Centre for Parasitology, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Babacar Faye
- Faculté de Médecine, Pharmacie et Odontologie, Université Cheikh Anta Diop, Dakar, Senegal
| | - David Rollinson
- London Centre for Neglected Tropical Disease Research, School of Public Health, Imperial College London, London, UK; Parasites and Vectors Division, Life Sciences Department, Natural History Museum, London, UK
| | - James W Rudge
- London Centre for Neglected Tropical Disease Research, School of Public Health, Imperial College London, London, UK; Communicable Diseases Policy Research Group, London School of Hygiene & Tropical Medicine, London, UK; Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Mariama Sène
- Unité de Formation et de Recherche des Sciences Agronomiques, d'Aquaculture et de Technologies Alimentaires, Université Gaston Berger, Saint-Louis, Senegal
| | - Joanne P Webster
- Centre for Emerging, Endemic and Exotic Diseases, Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hertfordshire, UK; London Centre for Neglected Tropical Disease Research, School of Public Health, Imperial College London, London, UK
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Laidoudi Y, Medkour H, Levasseur A, Davoust B, Mediannikov O. New Molecular Data on Filaria and its Wolbachia from Red Howler Monkeys ( Alouatta macconnelli) in French Guiana-A Preliminary Study. Pathogens 2020; 9:pathogens9080626. [PMID: 32752052 PMCID: PMC7460519 DOI: 10.3390/pathogens9080626] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 11/16/2022] Open
Abstract
Previous studies have reported filarial parasites of the genus Dipetalonema and Mansonella from French Guiana monkeys, based on morphological taxonomy. In this study, we screened blood samples from nine howler monkeys (Alouatta macconnelli) for the presence of filaria and Wolbachia DNA. The infection rates were 88.9% for filaria and 55.6% for wolbachiae. The molecular characterization, based on the 18S gene of filariids, revealed that A. macconnelli are infected with at least three species (Mansonella sp., Brugia sp. and an unidentified Onchocercidae species.). Since the 18S and cox1 generic primers are not very effective at resolving co-infections, we developed ITS genus-specific PCRs for Mansonella and Brugia genus. The results revealed coinfections in 75% of positives. The presence of Mansonella sp. and Brugia sp. was also confirmed by the 16S phylogenetic analysis of their associated Wolbachia. Mansonella sp., which close to the species from the subgenus Tetrapetalonema encountered in New World Monkeys, while Brugia sp. was identical to the strain circulating in French Guiana dogs. We propose a novel ITS1Brugia genus-specific qPCR. We applied it to screen for Brugia infection in howler monkeys and 66.7% were found to be positive. Our finding highlights the need for further studies to clarify the species diversity of neotropics monkeys by combining molecular and morphological features. The novel Brugia genus-specific qPCR assays could be an effective tool for the surveillance and characterization of this potential zoonosis.
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Affiliation(s)
- Younes Laidoudi
- IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), IHU Méditerranée Infection, 19–21, Bd Jean Moulin, 13005 Marseille, France; (Y.L.); (H.M.); (A.L.); (B.D.)
- Aix Marseille Univ, 19–21, Bd Jean Moulin, 13005 Marseille, France
| | - Hacène Medkour
- IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), IHU Méditerranée Infection, 19–21, Bd Jean Moulin, 13005 Marseille, France; (Y.L.); (H.M.); (A.L.); (B.D.)
- Aix Marseille Univ, 19–21, Bd Jean Moulin, 13005 Marseille, France
| | - Anthony Levasseur
- IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), IHU Méditerranée Infection, 19–21, Bd Jean Moulin, 13005 Marseille, France; (Y.L.); (H.M.); (A.L.); (B.D.)
- Aix Marseille Univ, 19–21, Bd Jean Moulin, 13005 Marseille, France
| | - Bernard Davoust
- IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), IHU Méditerranée Infection, 19–21, Bd Jean Moulin, 13005 Marseille, France; (Y.L.); (H.M.); (A.L.); (B.D.)
- Aix Marseille Univ, 19–21, Bd Jean Moulin, 13005 Marseille, France
| | - Oleg Mediannikov
- IRD, AP-HM, Microbes, Evolution, Phylogeny and Infection (MEPHI), IHU Méditerranée Infection, 19–21, Bd Jean Moulin, 13005 Marseille, France; (Y.L.); (H.M.); (A.L.); (B.D.)
- Aix Marseille Univ, 19–21, Bd Jean Moulin, 13005 Marseille, France
- Correspondence: ; Tel.: +3304-1373-24-01
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Nasir MA, Elsawy F, Omar A, Haque SO, Nadir R. Eliminating Trachoma by 2020: Assessing Progress in Nigeria. Cureus 2020; 12:e9450. [PMID: 32760636 PMCID: PMC7392186 DOI: 10.7759/cureus.9450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Trachoma is a neglected tropical disease that causes an eye infection which can lead to blindness if left untreated. In 1998, the World Health Organisation (WHO) launched a new goal to eradicate trachoma by 2020. Over the years, in partnership with the WHO, an effective strategy plan was devised to help tackle and control the disease. This involved surgery for trichiasis, antibiotic treatment, facial cleanliness, and environmental improvement (SAFE). Consequently, the number of people affected by trachoma has significantly decreased in recent times. Despite this, trachoma remains a major public health concern in 44 countries worldwide, including Nigeria. Although improvements have been seen throughout Nigeria, the disjointed application of the SAFE strategy has delayed progress compared to other countries. Providing quality treatment to those with trachoma, in addition to improving preventative measures are challenges faced throughout the country. However, a multi-pronged approach emulating the methods of other countries is recommended to achieve trachoma elimination. This review aims to evaluate the progress and challenges faced in Nigeria with regards to eliminating trachoma.
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Affiliation(s)
| | - Fayez Elsawy
- Medicine, Manchester University, Manchester, GBR
| | | | - Shah O Haque
- Medicine, Manchester University, Manchester, GBR
| | - Rans Nadir
- Medicine, Imperial College London, London, GBR
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Differentiation of Trichuris species eggs from non-human primates by geometric morphometric analysis. INTERNATIONAL JOURNAL FOR PARASITOLOGY-PARASITES AND WILDLIFE 2020; 12:214-219. [PMID: 32695575 PMCID: PMC7364051 DOI: 10.1016/j.ijppaw.2020.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 12/26/2022]
Abstract
Human trichuriasis is a neglected tropical disease which affects millions of people worldwide, mostly living in low socio-economic conditions. Numerous studies have been conducted over the past 10 years to compare the different techniques for T. trichiura eggs detection. Our study provides the first geometric morphometric analysis for the specific detection of eggs of Trichuris sp. isolated from stools of macaque (M. sylvanus), colobus (C. g. kikuyensis), grivets (C. aethiops) and the Brazza's monkey (C. neglectus) from zoos in Spain. Principal Component Analysis (PCA) arises as an efficient method to determine Trichuris spp. eggs. The selected measurements to be included in the PCA were proposed for the first time in the present work, as far as we know, as we could not find previous studies reporting standardized parameters. Morphometrics represents a new methodology to differentiate Trichuris species eggs. Trichuris spp. eggs from macaque, colobus, grivet and Brazza’s monkey were analysed. The measurements included in the PCA were proposed for the first time.
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Webster JP, Neves MI, Webster BL, Pennance T, Rabone M, Gouvras AN, Allan F, Walker M, Rollinson D. Parasite Population Genetic Contributions to the Schistosomiasis Consortium for Operational Research and Evaluation within Sub-Saharan Africa. Am J Trop Med Hyg 2020; 103:80-91. [PMID: 32400355 PMCID: PMC7351308 DOI: 10.4269/ajtmh.19-0827] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/08/2020] [Indexed: 12/27/2022] Open
Abstract
Analyses of the population genetic structure of schistosomes under the "Schistosomiasis Consortium for Operational Research and Evaluation" (SCORE) contrasting treatment pressure scenarios in Tanzania, Niger, and Zanzibar were performed to provide supplementary critical information with which to evaluate the impact of these large-scale control activities and guide how activities could be adjusted. We predicted that population genetic analyses would reveal information on a range of important parameters including, but not exclusive to, recruitment and transmission of genotypes, occurrence of hybridization events, differences in reproductive mode, and degrees of inbreeding, and hence, the evolutionary potential, and responses of parasite populations under contrasting treatment pressures. Key findings revealed that naturally high levels of gene flow and mixing of the parasite populations between neighboring sites were likely to dilute any effects imposed by the SCORE treatment arms. Furthermore, significant inherent differences in parasite fecundity were observed, independent of current treatment arm, but potentially of major impact in terms of maintaining high levels of ongoing transmission in persistent "biological hotspot" sites. Within Niger, naturally occurring Schistosoma haematobium/Schistosoma bovis viable hybrids were found to be abundant, often occurring in significantly higher proportions than that of single-species S. haematobium infections. By examining parasite population genetic structures across hosts, treatment regimens, and the spatial landscape, our results to date illustrate key transmission processes over and above that which could be achieved through standard parasitological monitoring of prevalence and intensity alone, as well as adding to our understanding of Schistosoma spp. life history strategies in general.
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Affiliation(s)
- Joanne P. Webster
- Department of Pathobiology and Population Sciences, Centre for Emerging, Endemic and Exotic Diseases (CEEED), Royal Veterinary College, University of London, Hawkshead Campus, Herts, United Kingdom
- London Centre for Neglected Tropical Disease Research (LCNTDR), Imperial College Faculty of Medicine, London, United Kingdom
| | - Maria Inês Neves
- Department of Pathobiology and Population Sciences, Centre for Emerging, Endemic and Exotic Diseases (CEEED), Royal Veterinary College, University of London, Hawkshead Campus, Herts, United Kingdom
- London Centre for Neglected Tropical Disease Research (LCNTDR), Imperial College Faculty of Medicine, London, United Kingdom
| | - Bonnie L. Webster
- London Centre for Neglected Tropical Disease Research (LCNTDR), Imperial College Faculty of Medicine, London, United Kingdom
- Department of Life Sciences, Wolfson Wellcome Biomedical Laboratories, The Natural History Museum, London, United Kingdom
| | - Tom Pennance
- London Centre for Neglected Tropical Disease Research (LCNTDR), Imperial College Faculty of Medicine, London, United Kingdom
- Department of Life Sciences, Wolfson Wellcome Biomedical Laboratories, The Natural History Museum, London, United Kingdom
- School of Biosciences, Cardiff University, Cardiff, United Kingdom
| | - Muriel Rabone
- London Centre for Neglected Tropical Disease Research (LCNTDR), Imperial College Faculty of Medicine, London, United Kingdom
- Department of Life Sciences, Wolfson Wellcome Biomedical Laboratories, The Natural History Museum, London, United Kingdom
| | - Anouk N. Gouvras
- London Centre for Neglected Tropical Disease Research (LCNTDR), Imperial College Faculty of Medicine, London, United Kingdom
- Department of Life Sciences, Wolfson Wellcome Biomedical Laboratories, The Natural History Museum, London, United Kingdom
| | - Fiona Allan
- London Centre for Neglected Tropical Disease Research (LCNTDR), Imperial College Faculty of Medicine, London, United Kingdom
- Department of Life Sciences, Wolfson Wellcome Biomedical Laboratories, The Natural History Museum, London, United Kingdom
| | - Martin Walker
- Department of Pathobiology and Population Sciences, Centre for Emerging, Endemic and Exotic Diseases (CEEED), Royal Veterinary College, University of London, Hawkshead Campus, Herts, United Kingdom
- London Centre for Neglected Tropical Disease Research (LCNTDR), Imperial College Faculty of Medicine, London, United Kingdom
| | - David Rollinson
- London Centre for Neglected Tropical Disease Research (LCNTDR), Imperial College Faculty of Medicine, London, United Kingdom
- Department of Life Sciences, Wolfson Wellcome Biomedical Laboratories, The Natural History Museum, London, United Kingdom
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86
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Mduluza T, Jones C, Osakunor DNM, Lim R, Kuebel JK, Phiri I, Manangazira P, Tagwireyi P, Mutapi F. Six rounds of annual praziquantel treatment during a national helminth control program significantly reduced schistosome infection and morbidity levels in a cohort of schoolchildren in Zimbabwe. PLoS Negl Trop Dis 2020; 14:e0008388. [PMID: 32569278 PMCID: PMC7332090 DOI: 10.1371/journal.pntd.0008388] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 07/02/2020] [Accepted: 05/13/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The World Health Organization recommends that schistosomiasis be treated through Mass Drug Administration (MDA). In line with this recommendation, Zimbabwe commenced a national helminth control program in 2012 targeting schoolchildren throughout the country for 6 years. This study, part of a larger investigation of the impact of helminth treatment on the overall health of the children, determined the effect of annual praziquantel treatment on schistosome infection and morbidity in a cohort of children during Zimbabwe's 6-year national helminth control program. METHODOLOGY/PRINCIPAL FINDINGS A school-based longitudinal study was carried out in 35 sentinel sites across Zimbabwe from September 2012 to November 2017. The sentinel sites were selected following a countrywide survey conducted in 280 primary schools. Schistosoma haematobium was diagnosed using the urine filtration technique. Schistosoma mansoni was diagnosed using both the Kato-Katz and formol-ether concentration techniques. S. haematobium morbidity was determined through detection of macro and microhaematuria. A cohort of children aged 6-15 years old was surveyed annually before MDA and 6 weeks post treatment. Maximum treatment coverage reached 90% over the 6 rounds of MDA. At baseline S. haematobium infection prevalence and intensity were 31.7% (95% CI = 31.1-32.2) and 28.75 eggs/10ml urine (SEM = 0.81) respectively, while S. mansoni prevalence and intensity were 4.6% (95% CI = 4.4-4.8) and 0.28 eggs/25mg (SEM = 0.02). Prior to the 6th round of MDA, S. haematobium infection prevalence had reduced to 1.56% (p<0.001) and infection intensity to 0.07 (SEM 0.02). Six weeks later after the 6th MDA, both were 0. Similarly the prevalence of S. haematobium morbidity as indicated by haematuria also fell significantly from 32.3% (95% CI = 29.9-34.6) to 0% (p< 0.0001) prior to the final MDA. For S.mansoni, both prevalence and intensity had decreased to 0 prior to the 6th MDA. After 6 rounds of annual MDA, prevalence and intensity of both schistosome species decreased significantly to 0% (p< 0.0001). CONCLUSION Zimbabwe's helminth control program significantly reduced schistosome infection intensity and prevalence and urogenital schistosomiasis morbidity prevalence in a cohort of school-aged children, moving the schistosome prevalence in the children from moderate to low by WHO classification. These findings will inform the design of the country's next stage interventions for helminth control and eventual elimination.
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Affiliation(s)
- Takafira Mduluza
- Department of Biochemistry, University of Zimbabwe, Mount Pleasant, Harare, Zimbabwe.,TIBA Zimbabwe, NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA) at the University of Edinburgh, Edinburgh, United Kingdom
| | - Caitlin Jones
- Centre for Infection, Immunity & Evolution and Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, King's Buildings, Edinburgh, United Kingdom.,NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA) at the University of Edinburgh, Ashworth Laboratories, King's Buildings, Edinburgh, United Kingdom
| | - Derick N M Osakunor
- Centre for Infection, Immunity & Evolution and Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, King's Buildings, Edinburgh, United Kingdom
| | - Rivka Lim
- Centre for Infection, Immunity & Evolution and Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, King's Buildings, Edinburgh, United Kingdom.,NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA) at the University of Edinburgh, Ashworth Laboratories, King's Buildings, Edinburgh, United Kingdom
| | - Julius K Kuebel
- Centre for Infection, Immunity & Evolution and Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, King's Buildings, Edinburgh, United Kingdom.,NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA) at the University of Edinburgh, Ashworth Laboratories, King's Buildings, Edinburgh, United Kingdom
| | - Isaac Phiri
- Epidemiology & Disease Control, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Portia Manangazira
- Epidemiology & Disease Control, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Paradzayi Tagwireyi
- Department of Geography and Environmental Science, Geo-information and Earth Observation Centre, University of Zimbabwe, Mount Pleasant, Harare, Zimbabwe
| | - Francisca Mutapi
- Centre for Infection, Immunity & Evolution and Institute of Immunology & Infection Research, University of Edinburgh, Ashworth Laboratories, King's Buildings, Edinburgh, United Kingdom.,NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA) at the University of Edinburgh, Ashworth Laboratories, King's Buildings, Edinburgh, United Kingdom
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87
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Glenn J, Kamara K, Umar ZA, Chahine T, Daulaire N, Bossert T. Applied systems thinking: a viable approach to identify leverage points for accelerating progress towards ending neglected tropical diseases. Health Res Policy Syst 2020; 18:56. [PMID: 32493485 PMCID: PMC7268457 DOI: 10.1186/s12961-020-00570-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 05/07/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Systems thinking is a conceptual approach that can assist stakeholders in understanding complexity and making progress on persistent public health challenges. Neglected tropical diseases (NTDs), a complex global health problem, are responsible for a large disease burden among impoverished populations around the world. This aim of this study was to better discern the many complexities of the global NTD system in order to identify and act on leverage points to catalyse progress towards ending NTDs. METHODS Existing frameworks for systems change were adapted to form the conceptual framework for the study. Using a semi-structured interview guide, key informant interviews were conducted with NTD stakeholders at the global level and at the country level in Nigeria. The interview data were coded and analysed to create causal loop diagrams that resulted in a qualitative model of the global NTD system. RESULTS The complete qualitative model is discussed and presented visually as six separate sub-components that highlight key forces and feedback loops within the global NTD system. CONCLUSIONS We identified five leverage points for NTD system change, namely (1) clarify the potential for and assess realistic progress towards NTD elimination, (2) increase support for interventions besides drug delivery, (3) reduce dependency on international donors, (4) create a less insular culture within the global NTD community, and (5) systemically address the issue of health worker incentives. The specific findings for NTDs raise a number of uncomfortable questions that have not been addressed, at least in part, because it is easier to continue focusing on 'quick win' solutions. The study provides a model of a systems thinking approach that can be applied to other complex global health and development challenges in order to understand complexity and identify leverage points for system change.
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Affiliation(s)
- Jeffrey Glenn
- Department of Public Health, College of Life Sciences, Brigham Young University, 2032 LSB, Provo, UT, United States of America.
| | | | | | - Teresa Chahine
- Yale School of Management, New Haven, CT, United States of America
| | - Nils Daulaire
- Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Thomas Bossert
- Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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88
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Taylor M, Oliver S, Garner P. Mass drug administration for filariasis: community views and programme design influences - a qualitative evidence synthesis. Hippokratia 2020. [DOI: 10.1002/14651858.cd013638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Melissa Taylor
- Department of Clinical Sciences; Liverpool School of Tropical Medicine; Liverpool UK
| | - Sandy Oliver
- EPPI-Centre, Social Science Research Unit, UCL Institute of Education; University College London; London UK
| | - Paul Garner
- Department of Clinical Sciences; Liverpool School of Tropical Medicine; Liverpool UK
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89
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Secor WE, Wiegand RE, Montgomery SP, Karanja DMS, Odiere MR. Comparison of School-Based and Community-Wide Mass Drug Administration for Schistosomiasis Control in an Area of Western Kenya with High Initial Schistosoma mansoni Infection Prevalence: A Cluster Randomized Trial. Am J Trop Med Hyg 2020; 102:318-327. [PMID: 31802733 PMCID: PMC7008345 DOI: 10.4269/ajtmh.19-0626] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
We conducted a cluster randomized trial comparing the target population and timing of mass drug administration (MDA) with praziquantel for control of schistosomiasis in villages in western Kenya with high initial prevalence (> 25%) according to a harmonized protocol developed by the Schistosomiasis Consortium for Operational Research and Evaluation. A total of 150 villages were randomized into six treatment arms (25 villages per arm), were assessed at baseline, and received two or four rounds of MDA using community-wide (CWT) or school-based (SBT) treatment over 4 years. In the fifth year, a final evaluation was conducted. The primary outcomes were prevalence and intensity of Schistosoma mansoni infections in children aged 9–12 years, each year their village received MDA. Baseline and year 5 assessments of first-year students and adults were also performed. Using Poisson and negative binomial regression with generalized estimating equations, we found similar effects of CWT and SBT MDA treatment strategies in children aged 9–12 years: significant reductions of prevalence of infection in all arms and of heavy-intensity (≥ 400 eggs/gram) infections in most arms but no significant differences between arms. Combined arms of villages that received four rounds of treatment had greater reduction than villages in arms that only received two rounds of treatment. Surprisingly, we also found benefits of SBT for first-year primary students and adults, who never received treatment in those arms. Our data support the use of annual SBT for control programs when coupled with attention to infections in younger children and occasional treatment of adults.
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Affiliation(s)
- W Evan Secor
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ryan E Wiegand
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan P Montgomery
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Diana M S Karanja
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Maurice R Odiere
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
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90
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Orive G, Lertxundi U. Mass drug administration: time to consider drug pollution? Lancet 2020; 395:1112-1113. [PMID: 32247389 DOI: 10.1016/s0140-6736(20)30053-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 01/03/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Gorka Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz 01006, Spain; Biomedical Research Networking Centre in Bioengineering, Biomaterials and Nanomedicine, Vitoria-Gasteiz, Spain; University Institute for Regenerative Medicine and Oral Implantology, Eduardo Anitua Foundation, Vitoria-Gasteiz, Spain; Singapore Eye Research Institute, Singapore, Singapore.
| | - Unax Lertxundi
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, Vitoria-Gasteiz, Spain
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91
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Development and evaluation of a loop-mediated isothermal amplification (LAMP) diagnostic test for detection of whipworm, Trichuris trichiura, in faecal samples. J Helminthol 2020; 94:e142. [PMID: 32238209 DOI: 10.1017/s0022149x2000022x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Whipworm infection or trichuriasis caused by Trichuris trichiura is of major public health concern in sub-Saharan Africa, particularly among pre-school and school-going children. It is among the neglected tropical diseases targeted for elimination through mass drug administration (MDA). One of the outcomes of MDA is a rapid decline in levels of infection intensity, making it difficult to monitor effectiveness of control measures using the conventional Kato-Katz procedure, which relies on the microscopic detection of parasite ova in faecal samples. In the present study, a loop-mediated isothermal amplification (LAMP) test was developed for the detection of T. trichiura infection in faecal samples. LAMP technology offers greater sensitivity and specificity than the microscopy-based tests. A set of four specific primers targeting the internal transcribed spacer 2 region of the ribosomal DNA were designed using Primer Explorer software. DNA was extracted from faecal samples using the alkaline lysis method (HotSHOT) and the LAMP reaction performed at 63°C for 1 h. The amplicons were visualized by both gel electrophoresis and with the naked eye following staining with SYBR green dye. Sensitivity and specificity tests were determined using the standard Kato-Katz diagnostic procedure as a reference test. The developed LAMP assay reliably detected T. trichiura DNA in faecal samples, with a specificity and sensitivity of 88% and 77%, respectively. No cross-reactivity was observed with several common helminth parasites. The developed LAMP assay is an appropriate diagnostic method for the detection of T. trichiura DNA in human faecal samples due to its simplicity, low cost, high sensitivity and specificity.
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92
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Mutuku MW, Laidemitt MR, Beechler BR, Mwangi IN, Otiato FO, Agola EL, Ochanda H, Kamel B, Mkoji GM, Steinauer ML, Loker ES. A Search for Snail-Related Answers to Explain Differences in Response of Schistosoma mansoni to Praziquantel Treatment among Responding and Persistent Hotspot Villages along the Kenyan Shore of Lake Victoria. Am J Trop Med Hyg 2020; 101:65-77. [PMID: 31162012 PMCID: PMC6609173 DOI: 10.4269/ajtmh.19-0089] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Following a 4-year annual praziquantel (PZQ) treatment campaign, the resulting prevalence of Schistosoma mansoni was seen to differ among individual villages along the Kenyan shore of Lake Victoria. We have investigated possible inherent differences in snail-related aspects of transmission among such 10 villages, including six persistent hotspot (PHS) villages (≤ 30% reduction in prevalence following repeated treatments) located along the west-facing shore of the lake and four PZQ-responding (RESP) villages (> 30% prevalence reduction following repeated treatment) along the Winam Gulf. When taking into account all sampling sites, times, and water hyacinth presence/absence, shoreline-associated Biomphalaria sudanica from PHS and RESP villages did not differ in relative abundance or prevalence of S. mansoni infection. Water hyacinth intrusions were associated with increased B. sudanica abundance. The deeper water snail Biomphalaria choanomphala was significantly more abundant in the PHS villages, and prevalence of S. mansoni among villages both before and after control was positively correlated with B. choanomphala abundance. Worm recoveries from sentinel mice did not differ between PHS and RESP villages, and abundance of non-schistosome trematode species was not associated with S. mansoni abundance. Biomphalaria choanomphala provides an alternative, deepwater mode of transmission that may favor greater persistence of S. mansoni in PHS villages. As we found evidence for ongoing S. mansoni transmission in all 10 villages, we conclude that conditions conducive for transmission and reinfection occur ubiquitously. This argues for an integrated, basin-wide plan for schistosomiasis control to counteract rapid reinfections facilitated by large snail populations and movements of infected people around the lake.
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Affiliation(s)
- Martin W Mutuku
- School of Biological Sciences, College of Biological and Physical Sciences, University of Nairobi, Nairobi, Kenya.,Centre for Biotechnology Research and Development, Kenya Medical Research Institute, Nairobi, Kenya
| | - Martina R Laidemitt
- Department of Biology, Center for Evolutionary and Theoretical Immunology, Museum of Southwestern Biology, Parasitology Division, University of New Mexico, Albuquerque, New Mexico
| | - Brianna R Beechler
- Department of Biomedical Sciences, College of Veterinary Medicine, Oregon State University, Corvallis, Oregon
| | - Ibrahim N Mwangi
- Centre for Biotechnology Research and Development, Kenya Medical Research Institute, Nairobi, Kenya
| | - Fredrick O Otiato
- Influenza Surveillance Program, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Eric L Agola
- Centre for Biotechnology Research and Development, Kenya Medical Research Institute, Nairobi, Kenya
| | - Horace Ochanda
- School of Biological Sciences, College of Biological and Physical Sciences, University of Nairobi, Nairobi, Kenya
| | - Bishoy Kamel
- Department of Biology, Center for Evolutionary and Theoretical Immunology, Museum of Southwestern Biology, Parasitology Division, University of New Mexico, Albuquerque, New Mexico
| | - Gerald M Mkoji
- Centre for Biotechnology Research and Development, Kenya Medical Research Institute, Nairobi, Kenya
| | - Michelle L Steinauer
- Department of Basic Medical Sciences, Western University of Health Sciences, Lebanon, Oregon
| | - Eric S Loker
- Department of Biology, Center for Evolutionary and Theoretical Immunology, Museum of Southwestern Biology, Parasitology Division, University of New Mexico, Albuquerque, New Mexico
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93
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Brander RL, Weaver MR, Pavlinac PB, John-Stewart GC, Hawes SE, Walson JL. Projected impact and cost-effectiveness of community-based versus targeted azithromycin administration strategies for reducing child mortality in sub-Saharan Africa. Clin Infect Dis 2020; 74:ciz1220. [PMID: 31905386 PMCID: PMC8834658 DOI: 10.1093/cid/ciz1220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/02/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Trials of mass drug administration (MDA) of azithromycin (AZM) report reductions in child mortality in sub-Saharan Africa (SSA). AZM targeted to high-risk children may preserve benefit while minimizing antibiotic exposure. We modeled the cost-effectiveness of MDA to children 1-59 months of age, MDA to children 1-5 months of age, AZM administered at hospital discharge, and the combination of MDA and post-discharge AZM. METHODS AND FINDINGS Models employed a payer perspective with a 1-year time horizon. Cost-effectiveness was presented as cost per DALY averted and death averted, with probabilistic sensitivity analyses. The model included parameters for macrolide resistance, adverse events, hospitalization, and mortality sourced from published data. Assuming a base-case 1.64% mortality risk among children 1-59 months old, 3.1% among children 1-5 months old, 4.4% mortality risk post-discharge, and 13.5% mortality reduction per trial data, post-discharge AZM would avert ~45,000 deaths, at a cost of $2.84/DALY (95% uncertainty interval [UI]: 1.71-5.57) averted. MDA to only children 1-5 months old would avert ~186,000 deaths at a cost of $4.89/DALY averted (95% UI: 2.88-11.42), MDA to all under-5 children would avert ~267,000 deaths a cost of $14.26/DALY averted (95% UI: 8.72-27.08). Cost-effectiveness decreased with presumed diminished efficacy due to macrolide resistance. CONCLUSIONS Targeting AZM to children at highest risk of death may be an antibiotic-sparing and cost-effective, or even cost-saving, strategy to reduce child mortality. However, targeted AZM averts fewer absolute deaths and may not reach all children who would benefit. Any AZM administration decision must consider implications for antibiotic resistance.
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Affiliation(s)
- Rebecca L Brander
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Marcia R Weaver
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Health Services, University of Washington, Seattle, Washington, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, Washington, USA
| | - Patricia B Pavlinac
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Grace C John-Stewart
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Stephen E Hawes
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Judd L Walson
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Childhood Acute Illness and Nutrition Network, University of Washington, Seattle, Washington, USA
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94
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Capone D, Berendes D, Cumming O, Knee J, Nalá R, Risk BB, Stauber C, Zhu K, Brown J. Analysis of fecal sludges reveals common enteric pathogens in urban Maputo, Mozambique. ENVIRONMENTAL SCIENCE & TECHNOLOGY LETTERS 2020; 7:889-895. [PMID: 38881628 PMCID: PMC11177333 DOI: 10.1021/acs.estlett.0c00610] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Sewage surveillance is increasingly used in public health applications: metabolites, biomarkers, and pathogens are detectable in wastewater and can provide useful information about community health. Work on this topic has been limited to wastewaters in mainly high-income settings, however. In low-income countries, where the burden of enteric infection is high, non-sewered sanitation predominates. In order to assess the utility of fecal sludge surveillance as a tool to identify the most prevalent enteric pathogens circulating among at-risk children, we collected 95 matched child stool and fecal sludge samples from household clusters sharing latrines in urban Maputo, Mozambique. We analyzed samples for 20 common enteric pathogens via multiplex real-time quantitative PCR. Among the 95 stools matched to fecal sludges, we detected the six most prevalent bacterial pathogens (Enteroaggregative E. coli, Shigella/Enteroinvasive E. coli, Enterotoxigenic E. coli, Enteropathogenic E. coli, shiga-toxin producing E. coli, Salmonella) and all three protozoan pathogens (Giardia duodenalis, Cryptosporidium parvum, Entamoeba histolytica) in the same rank order in both matrices. We did not observe the same trend for viral pathogens or soil-transmitted helminths, however. Our results suggest that sampling fecal sludges from onsite sanitation offers potential for localized pathogen surveillance in low-income settings where enteric pathogen prevalence is high.
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Affiliation(s)
- Drew Capone
- Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, 30332, United States of America
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7431, United States
| | - David Berendes
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, 30329, United States of America
| | - Oliver Cumming
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, WC1E 7HT, London, United Kingdom
| | - Jackie Knee
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, WC1E 7HT, London, United Kingdom
| | - Rassul Nalá
- Ministério da Saúde, Instituto Nacional de Saúde Maputo, Maputo, Mozambique
| | - Benjamin B. Risk
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, 30322, United States of America
| | - Christine Stauber
- School of Public Health, Georgia State University, Atlanta, Georgia, 30302, United States of America
| | - Kevin Zhu
- Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, 30332, United States of America
| | - Joe Brown
- Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, 30332, United States of America
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7431, United States
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95
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Ameya G, Zerdo Z, Tesfaye M, Jabesa C, Awaje A, Dejene K, Shika P, Eshetu M. Intestinal parasite infections and associated factors among inmates of Arba Minch prison, southern Ethiopia: cross sectional study. BMC Infect Dis 2019; 19:1086. [PMID: 31888496 PMCID: PMC6937967 DOI: 10.1186/s12879-019-4703-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 12/11/2019] [Indexed: 11/29/2022] Open
Abstract
Background Intestinal parasitic infection is one of the parasitic infections affecting people living in prison. Helminths and intestinal protozoan infections are the most common parasitic infection that may cause serious life-threatening diseases in inmates living in developing countries. This study was aimed to investigate the prevalence and associated factors of intestinal parasitic infections (IPIs) among inmates living in Arba Minch prison, southern Ethiopia. Methods Institutional based cross sectional study was conducted on Arba Minch inmates, southern Ethiopian. Pre-tested semi-structured questionnaire was used to gather the data of socio-demographic characteristics, hygiene status of the prisoners, sanitation condition of the prison, and associated factors for IPIs by face to face interview. Direct wet-mount examination and formol-ether sedimentation techniques were used to examine intestinal parasitic infection from stool specimens. Binary logistic regression analysis was used to see the association between different variables and the IPI. Odds ratio with 95% CI was computed to determine the presence association and strength of the associated factors. Result A total of 320 prisoners were participated in this study. Of these, 154(48.1%) of them were infected with one or more intestinal parasites. Eight different intestinal parasites species were identified and Giardia lamblia was the predominant parasite. Among infected inmates, nearly one out of four of them had multiple parasitic infections dominated by Giardia lamblia and E. histolytica/dispar co-infection. Sleeping in group [AOR = 1.9; 95% CI: (1.0–3.8)], married prisoners [AOR = 1.8; 95% CI: (1.1–2.9)], and hand washing habits after handling soil [AOR = 2.4; 95% CI: (1.0–5.6)] were independently associated with IPI. Conclusion High prevalence of intestinal parasitic infection was detected in Arba Minch inmates, southern Ethiopian. Absence of hand washing, marital status, and way of sleeping were the factors associated with the IPI. Implementation of mass drug administration, education on water, sanitation and hygiene (WASH) and periodic screening of intestinal parasitic infection is very important to reduce the high prevalence IPIs in prison.
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Affiliation(s)
- Gemechu Ameya
- Department of medical laboratory sciences, College of medicine and health sciences, Kotebe Metropolitan University, P.O. Box: 31248, Addis Ababa, Ethiopia.
| | - Zerihun Zerdo
- Department of medical laboratory sciences, College of medicine and health sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Mihret Tesfaye
- Department of medical laboratory sciences, College of medicine and health sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Chimdo Jabesa
- Department of Medical laboratory Science, Hiwot Fana specialized referral hospital, Haramaya University, Harar, Ethiopia
| | - Abayneh Awaje
- Department of Medical laboratory Science, Shone Primary Hospital, Shone, Ethiopia
| | - Kaleb Dejene
- Department of Medical laboratory Science, Sawla General Hospital, Sawla, Ethiopia
| | - Petros Shika
- Department of Medical laboratory Science, Chire Primary Hospital, Chire Kanama, Ethiopia
| | - Mohammed Eshetu
- Department of Medical laboratory Science, Semera Health Center, Semera, Afar, Ethiopia
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Faust CL, Crotti M, Moses A, Oguttu D, Wamboko A, Adriko M, Adekanle EK, Kabatereine N, Tukahebwa EM, Norton AJ, Gower CM, Webster JP, Lamberton PHL. Two-year longitudinal survey reveals high genetic diversity of Schistosoma mansoni with adult worms surviving praziquantel treatment at the start of mass drug administration in Uganda. Parasit Vectors 2019; 12:607. [PMID: 31881923 PMCID: PMC6935072 DOI: 10.1186/s13071-019-3860-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 12/17/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND A key component of schistosomiasis control is mass drug administration with praziquantel. While control interventions have been successful in several endemic regions, mass drug administration has been less effective in others. Here we focus on the impact of repeated praziquantel treatment on the population structure and genetic diversity of Schistosoma mansoni. METHODS We examined S. mansoni epidemiology, population genetics, and variation in praziquantel susceptibility in parasites isolated from children across three primary schools in a high endemicity region at the onset of the Ugandan National Control Programme. Children were sampled at 11 timepoints over two years, including one week and four weeks post-praziquantel treatment to evaluate short-term impacts on clearance and evidence of natural variation in susceptibility to praziquantel. RESULTS Prevalence of S. mansoni was 85% at baseline. A total of 3576 miracidia larval parasites, isolated from 203 individual children, were genotyped at seven loci. Overall, genetic diversity was high and there was low genetic differentiation, indicating high rates of parasite gene flow. Schistosome siblings were found both pre-treatment and four weeks post-treatment, demonstrating adult worms surviving treatment and natural praziquantel susceptibility variation in these populations at the beginning of mass drug administration. However, we did not find evidence for selection on these parasites. While genetic diversity decreased in the short-term (four weeks post-treatment), diversity did not decrease over the entire period despite four rounds of mass treatment. Furthermore, within-host genetic diversity was affected by host age, host sex, infection intensity and recent praziquantel treatment. CONCLUSIONS Our findings suggest that praziquantel treatments have short-term impacts on these parasite populations but impacts were transient and no long-term reduction in genetic diversity was observed. High gene flow reduces the likelihood of local adaptation, so even though parasites surviving treatment were observed, these were likely to be diluted at the beginning of the Ugandan National Control Programme. Together, these results suggest that MDA in isolation may be insufficient to reduce schistosome populations in regions with high genetic diversity and gene flow.
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Affiliation(s)
- Christina L. Faust
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
- Wellcome Centre for Integrative Parasitology, University of Glasgow, Glasgow, UK
| | - Marco Crotti
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | - Arinaitwe Moses
- Vector Control Division, Ministry of Health, Kampala, Uganda
| | - David Oguttu
- Vector Control Division, Ministry of Health, Kampala, Uganda
| | - Aidah Wamboko
- Vector Control Division, Ministry of Health, Kampala, Uganda
| | - Moses Adriko
- Vector Control Division, Ministry of Health, Kampala, Uganda
| | - Elizabeth K. Adekanle
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
| | | | | | - Alice J. Norton
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Charlotte M. Gower
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Joanne P. Webster
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hawkshead, UK
| | - Poppy H. L. Lamberton
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
- Wellcome Centre for Integrative Parasitology, University of Glasgow, Glasgow, UK
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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97
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Deol AK, Fleming FM, Calvo-Urbano B, Walker M, Bucumi V, Gnandou I, Tukahebwa EM, Jemu S, Mwingira UJ, Alkohlani A, Traoré M, Ruberanziza E, Touré S, Basáñez MG, French MD, Webster JP. Schistosomiasis - Assessing Progress toward the 2020 and 2025 Global Goals. N Engl J Med 2019; 381:2519-2528. [PMID: 31881138 PMCID: PMC6785807 DOI: 10.1056/nejmoa1812165] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND With the vision of "a world free of schistosomiasis," the World Health Organization (WHO) set ambitious goals of control of this debilitating disease and its elimination as a public health problem by 2020 and 2025, respectively. As these milestones become imminent, and if programs are to succeed, it is important to evaluate the WHO programmatic guidelines empirically. METHODS We collated and analyzed multiyear cross-sectional data from nine national schistosomiasis control programs (in eight countries in sub-Saharan Africa and in Yemen). Data were analyzed according to schistosome species (Schistosoma mansoni or S. haematobium), number of treatment rounds, overall prevalence, and prevalence of heavy-intensity infection. Disease control was defined as a prevalence of heavy-intensity infection of less than 5% aggregated across sentinel sites, and the elimination target was defined as a prevalence of heavy-intensity infection of less than 1% in all sentinel sites. Heavy-intensity infection was defined as at least 400 eggs per gram of feces for S. mansoni infection or as more than 50 eggs per 10 ml of urine for S. haematobium infection. RESULTS All but one country program (Niger) reached the disease-control target by two treatment rounds or less, which is earlier than projected by current WHO guidelines (5 to 10 years). Programs in areas with low endemicity levels at baseline were more likely to reach both the control and elimination targets than were programs in areas with moderate and high endemicity levels at baseline, although the elimination target was reached only for S. mansoni infection (in Burkina Faso, Burundi, and Rwanda within three treatment rounds). Intracountry variation was evident in the relationships between overall prevalence and heavy-intensity infection (stratified according to treatment rounds), a finding that highlights the challenges of using one metric to define control or elimination across all epidemiologic settings. CONCLUSIONS These data suggest the need to reevaluate progress and treatment strategies in national schistosomiasis control programs more frequently, with local epidemiologic data taken into consideration, in order to determine the treatment effect and appropriate resource allocations and move closer to achieving the global goals. (Funded by the Children's Investment Fund Foundation and others.).
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Affiliation(s)
- Arminder K Deol
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Fiona M Fleming
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Beatriz Calvo-Urbano
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Martin Walker
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Victor Bucumi
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Issah Gnandou
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Edridah M Tukahebwa
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Samuel Jemu
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Upendo J Mwingira
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Abdulhakeem Alkohlani
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Mahamadou Traoré
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Eugene Ruberanziza
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Seydou Touré
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Maria-Gloria Basáñez
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Michael D French
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Joanne P Webster
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
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98
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Kamdem SD, Konhawa F, Kuemkon EM, Meyo Kamguia L, Tchanana GK, Nche F, Oumarou A, Hamza M, Ouratou Y, Tcheutchoua MN, Ghislain Essomba R, Ngogang MP, Kengne M, Netongo PM, Ondigui BE, Okomo Assoumou MC, Brombacher F, Nono JK. Negative Association of Interleukin-33 Plasma Levels and Schistosomiasis Infection in a Site of Polyparasitism in Rural Cameroon. Front Immunol 2019; 10:2827. [PMID: 31849991 PMCID: PMC6901687 DOI: 10.3389/fimmu.2019.02827] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/18/2019] [Indexed: 12/20/2022] Open
Abstract
Background: This study aimed to investigate the association of plasma levels of IL-33, a mucosal alarmin known to elicit type-2 immunity, with infection and liver fibrosis profiles of school children from an endemic area for Schistosoma mansoni, malaria and hepatitis (B & C) in rural Cameroon. Methods: A cross-sectional study enrolling schoolchildren from 5 public schools was conducted. Single schistosomiasis, malaria and hepatitis infections or co-infections were assessed by kato katz, microscopy, and rapid diagnostic tests, respectively. Hepatic fibrosis was assessed by ultrasound according to WHO Niamey guidelines and plasma levels of Interleukin 33 were determined by ELISA. All statistics were performed using R studio software. Principal findings: We found a prevalence of 13.5% (37/275), 18.2% (50/275), and 8% (22/275), respectively for schistosomiasis, malaria and hepatitis (B or C) single infections. Only 7.6% (21/275) of co-infections were reported. Although Plasma IL-33 showed a minimal negative risk for schistosomiasis infection (AOR 0.99; 95% CI 0.97–1.01), S. mansoni infected participants had lower levels of plasma IL-33 (p = 0.003) which decreased significantly as eggs burdens increased (p = 0.01) with a negative Pearson coefficient of r = −0.22. Hepatic fibrosis occurred in 47.3% (130/275) of our study population independently from plasma levels of IL-33 (AOR 1.00; 95% CI 0.99–1.01). Conclusion/Significance: Our data failed to show an association between plasma IL-33 levels and liver disease but convincingly report on a negative association between plasma IL-33 levels and schistosomiasis infection and egg burden in school children from a polyparasitic schistosomiasis endemic area.
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Affiliation(s)
- Severin Donald Kamdem
- Division of Immunology, Health Science Faculty, University of Cape Town, Cape Town, South Africa.,Cape Town Component, International Centre for Genetic Engineering and Biotechnology, Cape Town, South Africa.,Immunology of Infectious Diseases Unit, South African Medical Research Centre, Cape Town, South Africa
| | - Francis Konhawa
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Erve Martial Kuemkon
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Leonel Meyo Kamguia
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Gladys K Tchanana
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon.,CIAB EXACT Medical Laboratory, Yaoundé, Cameroon
| | - Frungwa Nche
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | | | | | - Yasmine Ouratou
- Biotechnology Centre, University of Yaoundé 1, Yaoundé, Cameroon
| | | | - René Ghislain Essomba
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon.,National Public Health Laboratory, Ministry of Public Health, Yaoundé, Cameroon
| | | | - Michel Kengne
- School of Health Sciences, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Palmer Masumbe Netongo
- Biotechnology Centre, University of Yaoundé 1, Yaoundé, Cameroon.,Department of Biochemistry, University of Yaoundé 1, Yaoundé, Cameroon
| | | | | | - Frank Brombacher
- Division of Immunology, Health Science Faculty, University of Cape Town, Cape Town, South Africa.,Cape Town Component, International Centre for Genetic Engineering and Biotechnology, Cape Town, South Africa.,Immunology of Infectious Diseases Unit, South African Medical Research Centre, Cape Town, South Africa.,Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Justin Komguep Nono
- Division of Immunology, Health Science Faculty, University of Cape Town, Cape Town, South Africa.,Cape Town Component, International Centre for Genetic Engineering and Biotechnology, Cape Town, South Africa.,Immunology of Infectious Diseases Unit, South African Medical Research Centre, Cape Town, South Africa.,The Medical Research Centre, Institute of Medical Research and Medicinal Plant Studies, Ministry of Scientific Research and Innovation, Yaoundé, Cameroon
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99
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Platt RN, McDew-White M, Le Clec’h W, Chevalier FD, Allan F, Emery AM, Garba A, Hamidou AA, Ame SM, Webster JP, Rollinson D, Webster BL, Anderson TJC. Ancient Hybridization and Adaptive Introgression of an Invadolysin Gene in Schistosome Parasites. Mol Biol Evol 2019; 36:2127-2142. [PMID: 31251352 PMCID: PMC6759076 DOI: 10.1093/molbev/msz154] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Introgression among parasite species has the potential to transfer traits of biomedical importance across species boundaries. The parasitic blood fluke Schistosoma haematobium causes urogenital schistosomiasis in humans across sub-Saharan Africa. Hybridization with other schistosome species is assumed to occur commonly, because genetic crosses between S. haematobium and livestock schistosomes, including S. bovis, can be staged in the laboratory, and sequencing of mtDNA and rDNA amplified from microscopic miracidia larvae frequently reveals markers from different species. However, the frequency, direction, age, and genomic consequences of hybridization are unknown. We hatched miracidia from eggs and sequenced the exomes from 96 individual S. haematobium miracidia from infected patients from Niger and the Zanzibar archipelago. These data revealed no evidence for contemporary hybridization between S. bovis and S. haematobium in our samples. However, all Nigerien S. haematobium genomes sampled show hybrid ancestry, with 3.3-8.2% of their nuclear genomes derived from S. bovis, providing evidence of an ancient introgression event that occurred at least 108-613 generations ago. Some S. bovis-derived alleles have spread to high frequency or reached fixation and show strong signatures of directional selection; the strongest signal spans a single gene in the invadolysin gene family (Chr. 4). Our results suggest that S. bovis/S. haematobium hybridization occurs rarely but demonstrate profound consequences of ancient introgression from a livestock parasite into the genome of S. haematobium, the most prevalent schistosome species infecting humans.
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Affiliation(s)
- Roy N Platt
- Disease Intervention and Prevention, Texas Biomedical Research Institute, San Antonio, TX
| | - Marina McDew-White
- Disease Intervention and Prevention, Texas Biomedical Research Institute, San Antonio, TX
| | - Winka Le Clec’h
- Disease Intervention and Prevention, Texas Biomedical Research Institute, San Antonio, TX
| | - Frédéric D Chevalier
- Disease Intervention and Prevention, Texas Biomedical Research Institute, San Antonio, TX
| | - Fiona Allan
- Department of Life Sciences, The Natural History Museum, London, United Kingdom
- London Centre for Neglected Tropical Disease Research (LCNTDR), Imperial College London, St Mary’s Campus, London, United Kingdom
| | - Aidan M Emery
- Department of Life Sciences, The Natural History Museum, London, United Kingdom
- London Centre for Neglected Tropical Disease Research (LCNTDR), Imperial College London, St Mary’s Campus, London, United Kingdom
| | - Amadou Garba
- Réseau International Schistosomoses, Environnement, Aménagement et Lutte (RISEAL-Niger), Niamey, Niger
| | - Amina A Hamidou
- Réseau International Schistosomoses, Environnement, Aménagement et Lutte (RISEAL-Niger), Niamey, Niger
| | - Shaali M Ame
- Public Health Laboratory - Ivo de Carneri, Pemba, United Republic of Tanzania
| | - Joanne P Webster
- London Centre for Neglected Tropical Disease Research (LCNTDR), Imperial College London, St Mary’s Campus, London, United Kingdom
- Centre for Emerging, Endemic and Exotic Diseases, Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, London, United Kingdom
| | - David Rollinson
- Department of Life Sciences, The Natural History Museum, London, United Kingdom
- London Centre for Neglected Tropical Disease Research (LCNTDR), Imperial College London, St Mary’s Campus, London, United Kingdom
| | - Bonnie L Webster
- Department of Life Sciences, The Natural History Museum, London, United Kingdom
- London Centre for Neglected Tropical Disease Research (LCNTDR), Imperial College London, St Mary’s Campus, London, United Kingdom
| | - Timothy J C Anderson
- Disease Intervention and Prevention, Texas Biomedical Research Institute, San Antonio, TX
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100
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Lund AJ, Sam MM, Sy AB, Sow OW, Ali S, Sokolow SH, Bereknyei Merrell S, Bruce J, Jouanard N, Senghor S, Riveau G, Lopez-Carr D, De Leo GA. Unavoidable Risks: Local Perspectives on Water Contact Behavior and Implications for Schistosomiasis Control in an Agricultural Region of Northern Senegal. Am J Trop Med Hyg 2019; 101:837-847. [PMID: 31452497 PMCID: PMC6779182 DOI: 10.4269/ajtmh.19-0099] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 06/24/2019] [Indexed: 12/31/2022] Open
Abstract
Human schistosomiasis is a snail-borne parasitic disease affecting more than 200 million people worldwide. Direct contact with snail-infested freshwater is the primary route of exposure. Water management infrastructure, including dams and irrigation schemes, expands snail habitat, increasing the risk across the landscape. The Diama Dam, built on the lower basin of the Senegal River to prevent saltwater intrusion and promote year-round agriculture in the drought-prone Sahel, is a paradigmatic case. Since dam completion in 1986, the rural population-whose livelihoods rely mostly on agriculture-has suffered high rates of schistosome infection. The region remains one of the most hyperendemic regions in the world. Because of the convergence between livelihoods and environmental conditions favorable to transmission, schistosomiasis is considered an illustrative case of a disease-driven poverty trap (DDPT). The literature to date on the topic, however, remains largely theoretical. With qualitative data generated from 12 focus groups in four villages, we conducted team-based theme analysis to investigate how perception of schistosomiasis risk and reported preventive behaviors may suggest the presence of a DDPT. Our analysis reveals three key findings: 1) rural villagers understand schistosomiasis risk (i.e., where and when infections occur), 2) accordingly, they adopt some preventive behaviors, but ultimately, 3) exposure persists, because of circumstances characteristic of rural livelihoods. These findings highlight the capacity of local populations to participate actively in schistosomiasis control programs and the limitations of widespread drug treatment campaigns. Interventions that target the environmental reservoir of disease may provide opportunities to reduce exposure while maintaining resource-dependent livelihoods.
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Affiliation(s)
- Andrea J. Lund
- Emmett Interdisciplinary Program in Environment and Resources, Stanford University, Stanford, California
| | | | - Alioune Badara Sy
- Centre de Recherche Biomédicale – Espoir Pour la Santé, Saint Louis, Sénégal
| | | | - Sofia Ali
- Stanford University, Stanford, California
| | | | - Sylvia Bereknyei Merrell
- Department of Surgery, Stanford Surgery Policy Improvement Research & Education Center (S-SPIRE), School of Medicine, Stanford University, Stanford, California
| | - Janine Bruce
- Pediatric Advocacy Program, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - Nicolas Jouanard
- Centre de Recherche Biomédicale – Espoir Pour la Santé, Saint Louis, Sénégal
- Station d’Innovation Aquacole, Saint Louis, Senegal
| | - Simon Senghor
- Centre de Recherche Biomédicale – Espoir Pour la Santé, Saint Louis, Sénégal
| | - Gilles Riveau
- Centre de Recherche Biomédicale – Espoir Pour la Santé, Saint Louis, Sénégal
| | - David Lopez-Carr
- Department of Geography, University of California, Santa Barbara, Santa Barbara, California
| | - Giulio A. De Leo
- Hopkins Marine Station, Stanford University, Pacific Grove, California
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