1
|
Alderton DL, Ackley C, Trueba ML. The psychosocial impacts of skin-neglected tropical diseases (SNTDs) as perceived by the affected persons: A systematic review. PLoS Negl Trop Dis 2024; 18:e0012391. [PMID: 39093848 DOI: 10.1371/journal.pntd.0012391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/21/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Neglected Tropical Diseases (NTDs) disproportionately affect marginalised groups within impoverished communities, conferring devastating physical, financial and psychosocial effects. Skin-NTDs (SNTDs) are uniquely stigmatising due to their visible nature, rendering affected individuals vulnerable to psychosocial risk and the associated decline in social participation, quality of life and mental health. In response to knowledge gaps identified by current global efforts for integrated control of SNTDs this review gathers existing evidence on the psychosocial effects of SNTDs, with consideration given to the influence of gender. METHODS The study protocol is registered with PROSPERO (CRD42022336676). Data was collected from Embase, Global Health, Medline and Web of Science, with additional articles identified through Google Scholar and bibliography tracking. Qualitative studies published in English between 2005 and 2024 reporting men's and women's experiences with SNTDs were searched. Appropriate data from each included study were inputted into NVivo software to facilitate thematic synthesis. Descriptive and analytic themes were generated through line-by-line coding using an inductive approach. RESULTS 27 articles of high and moderate quality were included. They pertained to buruli ulcer, cutaneous leishmaniasis, leprosy, lymphatic filariasis, tungiasis, onchocerciasis, schistosomiasis and podoconiosis. Men and women across SNTDs and contexts reported debilitating physical symptoms which impaired their ability to work, socialise and carry out usual daily activities. Some felt (at least initially) well supported by partners and relatives, whereas most experienced avoidance, abandonment and even violence, with women incurring worse SNTD-related social consequences. Many men and most women experienced stigma, with discriminatory behaviours largely attributed to fear of infection, decreased ability to perform gender-specific daily activities, and the perceived association between SNTDs and sinfulness. Self-reported impacts of SNTDs on men's and women's mental wellbeing included low mood, anxiety, low self-esteem, and suicidal ideation. Disease-specific knowledge, early treatment, social support, and disease acceptance were mentioned as protective factors. CONCLUSION SNTDs cause significant psychosocial harms, particularly for women. Implementing myth-busting and contact-based educational campaigns and improving access to treatment and to livelihood opportunities and social protection schemes for men and women with a SNTD will help prevent and mitigate these.
Collapse
Affiliation(s)
- Dasha L Alderton
- Brighton and Sussex Medical School (BSMS), University of Sussex, Brighton, United Kingdom
| | - Caroline Ackley
- Brighton and Sussex Medical School (BSMS), University of Sussex, Brighton, United Kingdom
| | - Mei L Trueba
- Brighton and Sussex Medical School (BSMS), University of Sussex, Brighton, United Kingdom
| |
Collapse
|
2
|
Okyere D, Ocloo EK, Owusu L, Amoako YA, Tuwor RD, Koka E, Novignon J, Asante-Poku A, Siam IM, Afreh EK, Agbanyo A, Akuffo RA, Gyabaah S, Oppong MN, Halliday KE, Simpson H, Timothy J, Marks M, Zuurmond M, Walker SL, Pullan RL, Ahorlu CS, Phillips RO, Yeboah-Manu D, Pitt C, Palmer J. Improving experiences of neglected tropical diseases of the skin: Mixed methods formative research for development of a complex intervention in Atwima Mponua District, Ghana. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002833. [PMID: 38870111 PMCID: PMC11175470 DOI: 10.1371/journal.pgph.0002833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 05/21/2024] [Indexed: 06/15/2024]
Abstract
Integrated approaches to managing co-endemic neglected tropical diseases (NTDs) of the skin within primary healthcare services are complex and require tailoring to local contexts. We describe formative research in Atwima Mponua District in Ghana's Ashanti Region designed to inform the development of a sustainable intervention to improve access to skin NTD care. We employed a convergent, parallel, mixed-methods design, collecting data from February 2021 to February 2022. We quantitatively assessed service readiness using a standardised checklist and reviewed outpatient department registers and condition-specific case records in all government health facilities in the district. Alongside a review of policy documents, we conducted 49 interviews and 7 focus group discussions with purposively selected affected persons, caregivers, community members, health workers, and policy-makers to understand skin NTD care-seeking practices and the policy landscape. Outside the district hospital, skin NTD reporting rates in the surveyed facilities were low; supply chains for skin NTD diagnostics, consumables, and medicines had gaps; and health worker knowledge of skin NTDs was limited. Affected people described fragmented care, provided mostly by hospitals (often outside the district) or traditional healers, resulting in challenges obtaining timely diagnosis and treatment and high care-seeking costs. Affected people experienced stigma, although the extent to which stigma influenced care-seeking behaviour was unclear. National actors were more optimistic than district-level actors about local resource availability for skin NTD care and were sceptical of including traditional healers in interventions. Our findings indicate that improvement of the care cascade for affected individuals to reduce the clinical, economic, and psychosocial impact of skin NTDs is likely to require a complementary set of interventions. These findings have informed the design of a strategy to support high-quality, integrated, decentralised care for skin NTDs in Atwima Mponua, which will be assessed through a multidisciplinary evaluation.
Collapse
Affiliation(s)
- Daniel Okyere
- Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana
| | - Edmond Kwaku Ocloo
- Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana
- Department of Sociology and Anthropology, University of Cape Coast, Cape Coast, Ghana
| | - Lucy Owusu
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Yaw Ampem Amoako
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Ruth Dede Tuwor
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Eric Koka
- Department of Sociology and Anthropology, University of Cape Coast, Cape Coast, Ghana
| | - Jacob Novignon
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
- Department of Economics, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Adwoa Asante-Poku
- Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana
| | - Ishaque Mintah Siam
- Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana
| | - Emmanuel Kyei Afreh
- Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana
| | - Abigail Agbanyo
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Richard Adjei Akuffo
- Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana
| | - Solomon Gyabaah
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Michael Ntiamoah Oppong
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Katherine E. Halliday
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hope Simpson
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joseph Timothy
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Michael Marks
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospital, London, United Kingdom
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Maria Zuurmond
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Stephen L. Walker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rachel L. Pullan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Richard Odame Phillips
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Dorothy Yeboah-Manu
- Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana
| | - Catherine Pitt
- Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana
| | - Jennifer Palmer
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | |
Collapse
|
3
|
Agbanyo A, Agbavor B, Gyabaah S, Oppong MN, Dornu O, Antwi PB, Loglo AD, Abass KM, Amofa G, Kotey NK, Quao B, Frimpong M, Asiedu K, Amoako YA, Phillips RO. Implementation of an integrated control programme for neglected tropical diseases of the skin in Ghana: The essential role of the laboratory. J Clin Tuberc Other Mycobact Dis 2024; 35:100442. [PMID: 38680788 PMCID: PMC11046218 DOI: 10.1016/j.jctube.2024.100442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024] Open
Abstract
Introduction In this study, we report on findings from approaches used, the outcomes and the lessons learnt from the laboratory support provided for integrated control of skin NTDs including Buruli ulcer (BU), and yaws in seven selected districts in Ghana. Methods Actions implemented from July 2018 to October 2022 included; training district-level health workers on specimen collection, storage, and transport to laboratories, integrated case searches, continual monitoring and supervision for trained health workers, laboratory confirmation of BU and yaws samples and providing results of the analysed samples to guide decision making. Descriptive analysis of data was performed. Results A total of 18,683 (including suspected BU 976; suspected yaws 10,995) individuals were screened for BU and yaws. Of 976 suspected BU cases, 16.8% [median (IQR) age 24 (12.0-37.8) years] were confirmed positive by IS2404 PCR; BU mostly presented as ulcers (78.7%); category I (37.2%) and category II (36%). 480 individuals (4.4%) had DPP positive yaws. Multiplex PCR analysis of 75 selected DPP positive cases identified; 7 DPP positive yaws cases as Treponema pallidum, 28 as Haemophilus ducreyi and 7 as Treponema pallidum/Haemophilus ducreyi coinfection. Laboratory results were sent to the districts within a median (IQR) of 5 (3 - 9) days. Conclusion The implementation of integrated diagnostic confirmation for skin NTDs is feasible with provision of timely results within a week. Multiplex diagnostic tools differentiated Treponema pallidum and Haemophilus ducreyi. There is a need to sustain active case search activities, enhance health worker training, and improve laboratory confirmation of cases as part of the overall strategy for the integrated control of skin neglected tropical diseases.
Collapse
Affiliation(s)
- Abigail Agbanyo
- Kumasi Centre for Collaborative Research into Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bernadette Agbavor
- Kumasi Centre for Collaborative Research into Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Solomon Gyabaah
- Kumasi Centre for Collaborative Research into Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Michael Ntiamoah Oppong
- Kumasi Centre for Collaborative Research into Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Olivia Dornu
- Kumasi Centre for Collaborative Research into Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Philemon Boasiako Antwi
- Kumasi Centre for Collaborative Research into Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Aloysius Dzigbordi Loglo
- Kumasi Centre for Collaborative Research into Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | | | | | - Michael Frimpong
- Kumasi Centre for Collaborative Research into Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kingsley Asiedu
- Department for Control of Neglected Tropical Diseases, World Health Organisation, Geneva, Switzerland
| | - Yaw Ampem Amoako
- Kumasi Centre for Collaborative Research into Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Richard Odame Phillips
- Kumasi Centre for Collaborative Research into Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| |
Collapse
|
4
|
Romanini T, Hart J. Fundamental dermatology education of medical doctors at a regional hospital in Johannesburg, South Africa. Pan Afr Med J 2024; 47:178. [PMID: 39036029 PMCID: PMC11260053 DOI: 10.11604/pamj.2024.47.178.40779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 04/01/2024] [Indexed: 07/23/2024] Open
Abstract
Introduction dermatology is a prevalent field of global health and dermatological conditions are amongst the most frequent complaints affecting communities, yet dermatology has become an overlooked aspect of the medical school curricula and many medical schools have failed to provide doctors with training to manage these conditions confidently and adequately. This study aimed to determine the baseline dermatological knowledge of medical doctors and determine the influence of fundamental dermatology education on hospital medical staff at a regional hospital in Johannesburg, South Africa. Methods the knowledge and confidence of 33 medical doctors were tested using a pre-test and post-test quasi-experimental design. Participants completed an online questionnaire followed by an image-based test consisting of 20 questions to determine their level of confidence in diagnosing and managing common dermatological conditions. The participants then attended a sixty-minute educational session based on common dermatological conditions. Following this, their level of confidence and knowledge on the subject was re-assessed using the same online test. Pre and post-intervention confidence and test scores were compared. Results the pre-intervention test mean score was 67.11%. The post-intervention mean score was 92.50%. The difference between means (post-intervention - pre-intervention) ± SEM was 25.39 ± 4.81. The intervention significantly improved overall test scores (p-value < 0.0001). Many participants felt that their undergraduate training was insufficient in preparing them for the management of common dermatological conditions. Conclusion the baseline knowledge and confidence of medical doctors in managing common dermatological conditions was poor and such educational interventions have significant value in improving the ability of medical doctors in managing common dermatological conditions. More time should be dedicated to dermatology training at an undergraduate level.
Collapse
Affiliation(s)
- Tamara Romanini
- Emergency Department, Thelle Mogoerane Regional Hospital, Johannesburg, South Africa
| | - Jedd Hart
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
5
|
Wadagni ACA, Yao TAK, Diez G, Balle FH, Koffi AP, Aoulou P, Zahiri MH, Djossou P, Barogui YT, Assé H, Houezo JG, Sopoh GE, Nichter M, Johnson RC. Community based integrated wound care: Results of a pilot formative research conducted in Benin and Côte d'Ivoire, West Africa. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002889. [PMID: 38335227 PMCID: PMC10857723 DOI: 10.1371/journal.pgph.0002889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 01/16/2024] [Indexed: 02/12/2024]
Abstract
Appropriate treatment of chronic wounds is priority in the management of Neglected Tropical Skin Diseases (NTSDs) and non-communicable diseases. We describe an integrated, community-based wound care pilot project carried out in Benin and Cote d'Ivoire that entailed both outreach education and evidence based wound care training for nurses staffing rural clinics. This research was carried out by a transdisciplinary research. Following the collection of baseline data on wound care at home and in clinics, an innovative pilot project was developed based on a critical assessment of baseline data in three parts: a pragmatic nurse training program; mass community cultural sensitive outreach programs and a mobile consultation. It came out from our investigation that several dangerous homecare and inappropriate wound treatment practices in clinics, gaps in knowledge about Neglected Tropical Skin Diseases (NTSDs), and little health staff communication with patients about appropriate wound care. Nurse training covered 11 modules including general principles of wound management and advice specific to endemic NTSDs. Nurse pre-post training knowledge scores increased substantially. Eight mass community outreach programs were conducted, followed by mobile clinics at which 850 people with skin conditions were screened. Three hundred and three (35.65%) of these people presented with wounds of which 64% were simple, 20% moderate, and 16% severe cases. Patients were followed for ten weeks to assess adherence with wound hygiene messages presented in outreach programs and repeated by nurses during screening. Over 90% of simple and moderate cases were managed appropriately at home and 98% of wounds were healed. Of the 47 cases referred to the health center, 87% came for and adhered to wound care advice. In 90% of cases, wounds healed. This pilot study provides a model for introducing integrated community based wound care in Africa.
Collapse
Affiliation(s)
| | - Théodore Ange Kouakou Yao
- National Buruli Ulcer Control Programs, Ministry of Health and Public Hygiene, Abidjan, Côte d’Ivoire
| | | | | | - Aboa Paul Koffi
- National Buruli Ulcer Control Programs, Ministry of Health and Public Hygiene, Abidjan, Côte d’Ivoire
| | - Paulin Aoulou
- National Buruli Ulcer and Leprosy Control Programs, Ministry of Health, Cotonou, Bénin
| | - Marie-Hélène Zahiri
- National Leprosy Elimination Program, Ministry of Health and Public Hygiene, Abidjan, Côte d’Ivoire
| | - Parfait Djossou
- Centre Interfacultaire de Formation et de Recherche en Environnement pour le Développement Durable, Université d’Abomey-Calavi, Abomey-Calavi, Benin
| | - Yves Thierry Barogui
- National Buruli Ulcer and Leprosy Control Programs, Ministry of Health, Cotonou, Bénin
| | - Henry Assé
- National Buruli Ulcer Control Programs, Ministry of Health and Public Hygiene, Abidjan, Côte d’Ivoire
| | - Jean-Gabin Houezo
- National Buruli Ulcer and Leprosy Control Programs, Ministry of Health, Cotonou, Bénin
| | - Ghislain Emmanuel Sopoh
- Regional Institute of Public Health Comlan Alfred Quenum of Ouidah, University of Abomey-Calavi, Abomey-Calavi, Bénin
| | - Mark Nichter
- School of Anthropology, University of Arizona, Tucson, AZ, United States of America
| | - Roch Christian Johnson
- Centre Interfacultaire de Formation et de Recherche en Environnement pour le Développement Durable, Université d’Abomey-Calavi, Abomey-Calavi, Benin
| |
Collapse
|
6
|
Kollie KK, Theobald S, Jones L, Kpadeh O, Nallo G, Borbor D, Taylor M, Dean L, Phillip M, Godwin-Akpan TG, Mensah DF, Wickenden A, Kollie JT, Rogers E, Zaizay Z, Stewart M. Multimethod evaluation of health services integration for neglected tropical diseases requiring case management in Liberia. BMJ Glob Health 2024; 9:e012599. [PMID: 38238023 PMCID: PMC10806886 DOI: 10.1136/bmjgh-2023-012599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 12/13/2023] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION The WHO neglected tropical disease (NTD) roadmap stresses the importance of integrating NTDs requiring case management (CM) within the health system. The NTDs programme of Liberia is among the first to implement an integrated approach and evaluate its impact. METHODS A retrospective study of three of five CM-NTD-endemic counties that implemented the integrated approach was compared with cluster-matched counties with non-integrated CM-NTD. We compared trends in CM-NTD integrated versus non-integrated county clusters. We conducted a pre-post comparison of WHO high-level outcomes using data collected during intervention years compared with baseline in control counties. Changes in health outcomes, effect sizes for different diseases and rate ratios with statistically significant differences were determined. Complementary qualitative research explored CM-NTD stakeholders' perceptions, analysed through the framework approach, which is a transparent, multistage approach for qualitative thematic interdisciplinary data analysis. RESULTS The detection rates for all diseases combined improved significantly in the intervention compared with the control clusters. Besides leprosy, detection rates improved with large effects, over fourfold increase with statistically significant effects for individual diseases (p<0.000; 95% CI 3.5 to 5.4). Access to CM-NTD services increased in integrated counties by 71 facilities, compared with three facilities in non-integrated counties. Qualitative findings highlight training and supervision as inputs underpinning increases in case detection, but challenges with refresher training, medicine supply and incentives negatively impact quality, equity and access. CONCLUSIONS Integrating CM-NTDs improves case detection, accessibility and availability of CM-NTD services, promoting universal health coverage. Early case detection and the quality of care need further strengthening.
Collapse
Affiliation(s)
- Karsor K Kollie
- Health Services, Ministry of Health, Congo Town Back Road, Monrovia, Liberia
| | - Sally Theobald
- International Public Health, Liverpool School of Tropical Medicine, Pembroke Place Liverpool L3 5QA, UK
| | - Lent Jones
- The University of Liberia, Pacific Institute for Research Evaluation, Monrovia, Liberia
| | - Otis Kpadeh
- The University of Liberia, Pacific Institute for Research Evaluation, Monrovia, Liberia
| | - Gartee Nallo
- The University of Liberia, Pacific Institute for Research Evaluation, Monrovia, Liberia
| | - Darwosu Borbor
- Cuttington University Graduate School Research Student, Monrovia, Liberia
| | - Mark Taylor
- Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place Liverpool L3 5QA, UK
| | - Laura Dean
- International Public Health, Liverpool School of Tropical Medicine, Pembroke Place Liverpool L3 5QA, UK
| | - Maneesh Phillip
- Effect Hope, 90 Allstate Parkway Markham ON L3R 6H3, Ontario, Canada
| | | | | | - Anna Wickenden
- International Public Health, Liverpool School of Tropical Medicine, Pembroke Place Liverpool L3 5QA, UK
- Effect Hope, 90 Allstate Parkway Markham ON L3R 6H3, Ontario, Canada
| | - Jewel T Kollie
- A. M. Dogliotti School of Medicine, University of Liberia, Monrovia, Liberia
| | - Emerson Rogers
- Health Services, Ministry of Health, Congo Town Back Road, Monrovia, Liberia
| | - Zeela Zaizay
- Action Transforming Lives, Congo Town Back Road Monrovia, Liberia
| | - Martyn Stewart
- Education, Liverpool School of Tropical Medicine, Pembroke Place Liverpool L3 5QA, UK
| |
Collapse
|
7
|
Middleton J, Colthart G, Dem F, Elkins A, Fairhead J, Hazell RJ, Head MG, Inacio J, Jimbudo M, Jones CI, Laman M, MacGregor H, Novotny V, Peck M, Philip J, Paliau J, Pomat W, Stockdale JA, Sui S, Stewart AJ, Umari R, Walker SL, Cassell JA. Health service needs and perspectives of a rainforest conserving community in Papua New Guinea's Ramu lowlands: a combined clinical and rapid anthropological assessment with parallel treatment of urgent cases. BMJ Open 2023; 13:e075946. [PMID: 37802618 PMCID: PMC10565268 DOI: 10.1136/bmjopen-2023-075946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVES Determine community needs and perspectives as part of planning health service incorporation into Wanang Conservation Area, in support of locally driven sustainable development. DESIGN Clinical and rapid anthropological assessment (individual primary care assessments, key informant (KI) interviews, focus groups (FGs), ethnography) with treatment of urgent cases. SETTING Wanang (pop. c189), a rainforest community in Madang province, Papua New Guinea. PARTICIPANTS 129 villagers provided medical histories (54 females (f), 75 males (m); median 19 years, range 1 month to 73 years), 113 had clinical assessments (51f, 62m; median 18 years, range 1 month to 73 years). 26 ≥18 years participated in sex-stratified and age-stratified FGs (f<40 years; m<40 years; f>40 years; m>40 years). Five KIs were interviewed (1f, 4m). Daily ethnographic fieldnotes were recorded. RESULTS Of 113 examined, 11 were 'well' (a clinical impression based on declarations of no current illness, medical histories, conversation, no observed disease signs), 62 (30f, 32m) were treated urgently, 31 referred (15f, 16m), indicating considerable unmet need. FGs top-4 ranked health issues concorded with KI views, medical histories and clinical examinations. For example, ethnoclassifications of three ((A) 'malaria', (B) 'sotwin', (C) 'grile') translated to the five biomedical conditions diagnosed most ((A) malaria, 9 villagers; (B) upper respiratory infection, 25; lower respiratory infection, 10; tuberculosis, 9; (C) tinea imbricata, 15) and were highly represented in declared medical histories ((A) 75 participants, (B) 23, (C) 35). However, 29.2% of diagnoses (49/168) were limited to one or two people. Treatment approaches included plant medicines, stored pharmaceuticals, occasionally rituals. Travel to hospital/pharmacy was sometimes undertaken for severe/refractory disease. Service barriers included: no health patrols/accessible aid post, remote hospital, unfamiliarity with institutions and medicine costs. Service introduction priorities were: aid post, vaccinations, transport, perinatal/birth care and family planning. CONCLUSIONS This study enabled service planning and demonstrated a need sufficient to acquire funding to establish primary care. In doing so, it aided Wanang's community to develop sustainably, without sacrificing their forest home.
Collapse
Affiliation(s)
- Jo Middleton
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Watson Building, University of Brighton, Falmer, UK
| | - Gavin Colthart
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Watson Building, University of Brighton, Falmer, UK
| | - Francesca Dem
- New Guinea Binatang Research Centre, Madang, Papua New Guinea
| | - Alice Elkins
- Department of Ecology and Evolution, University of Sussex, Falmer, UK
| | - James Fairhead
- Department of Anthropology, University of Sussex, Falmer, UK
| | - Richard J Hazell
- Department of Ecology and Evolution, University of Sussex, Falmer, UK
| | - Michael G Head
- Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Joao Inacio
- School of Applied Sciences, Cockcroft Building, University of Brighton, Brighton, UK
| | - Mavis Jimbudo
- New Guinea Binatang Research Centre, Madang, Papua New Guinea
| | - Christopher Iain Jones
- Medical Statistics, Brighton and Sussex Medical School, Watson Building, University of Brighton, Falmer, UK
| | - Moses Laman
- Papua New Guinea Institute of Medical Research, Port Moresby, Papua New Guinea
| | - Hayley MacGregor
- Health and Nutrition Research Cluster, Institute of Development Studies, Falmer, UK
| | - Vojtech Novotny
- Department of Zoology, Faculty of Science, University of South Bohemia in Ceske Budejovice, Ceske Budejovice, Czech Republic
- Institute of Entomology, Biology Centre, Czech Academy of Sciences, Ceske Budejovice, Czech Republic
| | - Mika Peck
- Department of Ecology and Evolution, University of Sussex, Falmer, UK
| | - Jonah Philip
- New Guinea Binatang Research Centre, Madang, Papua New Guinea
- Wanang Conservation Area, Wanang, Papua New Guinea
| | - Jason Paliau
- New Guinea Binatang Research Centre, Madang, Papua New Guinea
- Department of Environmental Engineering & Renewable Energy, School of Environment and Climate Change, Papua New Guinea University of Natural Resources and Environment, Kokopo, Papua New Guinea
| | - William Pomat
- PNG Institute of Medical Research, Goroka, Papua New Guinea
| | - Jessica A Stockdale
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Watson Building, University of Brighton, Falmer, UK
| | - Shen Sui
- New Guinea Binatang Research Centre, Madang, Papua New Guinea
| | - Alan J Stewart
- Department of Ecology and Evolution, University of Sussex, Falmer, UK
| | - Ruma Umari
- New Guinea Binatang Research Centre, Madang, Papua New Guinea
- Wanang Conservation Area, Wanang, Papua New Guinea
| | - Stephen L Walker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Hospital for Tropical Diseases, and Department of Dermatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jackie A Cassell
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Watson Building, University of Brighton, Falmer, UK
| |
Collapse
|
8
|
Tran JT, Diaz MJ, Rodriguez D, Kleinberg G, Aflatooni S, Palreddy S, Abdi P, Taneja K, Batchu S, Forouzandeh M. Evidence-Based Utility of Adjunct Antioxidant Supplementation for the Prevention and Treatment of Dermatologic Diseases: A Comprehensive Systematic Review. Antioxidants (Basel) 2023; 12:1503. [PMID: 37627498 PMCID: PMC10451863 DOI: 10.3390/antiox12081503] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/07/2023] [Accepted: 07/14/2023] [Indexed: 08/27/2023] Open
Abstract
Skin conditions are a significant cause of fatal and nonfatal disease burdens globally, ranging from mild irritations to debilitating diseases. Oxidative stress, which is an imbalance between reactive oxygen species and the cells' ability to repair damage, is implicated in various skin diseases. Antioxidants have been studied for their potential benefits in dermatologic health, but the evidence is limited and conflicting. Herein, we conducted a systematic review of controlled trials, meta-analyses, and Cochrane review articles to evaluate the current evidence on the utility of antioxidant supplementation for adjunct prevention and treatment of skin disease and to provide a comprehensive assessment of their role in promoting dermatologic health. The Cochrane Library, PubMed, EMBASE, and Epistemonikos databases were queried. Eligibility criteria included (1) primary focus on nanoparticle utility for skin cancer; (2) includes measurable outcomes data with robust comparators; (3) includes a number of human subjects or cell-line types, where applicable; (4) English language; and (5) archived as full-text journal articles. A total of 55 articles met the eligibility criteria for the present review. Qualitative analysis revealed that topical and oral antioxidant supplementation has demonstrated preliminary efficacy in reducing sunburns, depigmentation, and photoaging. Dietary exogenous antioxidants (namely vitamins A, C, and E) have shown chemopreventive effects against skin cancer. Antioxidant supplementation has also shown efficacy in treating non-cancer dermatoses, including rosacea, psoriasis, atopic dermatitis, and acne vulgaris. While further studies are needed to validate these findings on a larger scale, antioxidant supplementation holds promise for improving skin health and preventing skin diseases.
Collapse
Affiliation(s)
| | | | - Daphnee Rodriguez
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA
| | - Giona Kleinberg
- College of Engineering, Northeastern University, Boston, MA 02115, USA
| | - Shaliz Aflatooni
- Morsani College of Medicine, University of South Florida, Tampa, FL 33602, USA
| | - Siri Palreddy
- Department of Biology, Amherst College, Amherst, MA 01002, USA
| | - Parsa Abdi
- Faculty of Medicine, Memorial University, St. Johns, NL A1B 3V6, Canada
| | - Kamil Taneja
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA;
| | - Sai Batchu
- Cooper Medical School, Rowan University, Camden, NJ 08103, USA
| | - Mahtab Forouzandeh
- Department of Dermatology, University of Florida, Gainesville, FL 32606, USA
| |
Collapse
|
9
|
Dean L, Tolhurst R, Nallo G, Kollie K, Bettee A, Theobald S. A health-systems journey towards more people-centred care: lessons from neglected tropical disease programme integration in Liberia. Health Res Policy Syst 2023; 21:29. [PMID: 37055758 PMCID: PMC10103472 DOI: 10.1186/s12961-023-00975-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/25/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Neglected tropical diseases (NTDs) are associated with high levels of morbidity and disability as a result of stigma and social exclusion. To date, the management of NTDs has been largely biomedical. Consequently, ongoing policy and programme reform within the NTD community is demanding the development of more holistic disease management, disability and inclusion (DMDI) approaches. Simultaneously, integrated, people-centred health systems are increasingly viewed as essential to ensure the efficient, effective and sustainable attainment of Universal Health Coverage. Currently, there has been minimal consideration of the extent to which the development of holistic DMDI strategies are aligned to and can support the development of people-centred health systems. The Liberian NTD programme is at the forefront of trying to establish a more integrated, person-centred approach to the management of NTDs and provides a unique learning site for health systems decision makers to consider how shifts in vertical programme delivery can support overarching systems strengthening efforts that are designed to promote the attainment of health equity. METHODS We use a qualitative case study approach to explore how policy and programme reform of the NTD programme in Liberia supports systems change to enable the development of integrated people-centred services. RESULTS A cumulation of factors, catalysed by the shock to the health system presented by the Ebola epidemic, created a window of opportunity for policy change. However, programmatic change aimed at achieving person-centred practice was more challenging. Deep reliance on donor funding for health service delivery in Liberia limits the availability of flexible funding, and the ongoing funding prioritization towards specific disease conditions limits flexibility in health systems design that can shape more person-centred care. CONCLUSION Sheikh et al.'s four key aspects of people centred health systems, that is, (1) putting peoples voices and needs first; (2) people centredness in service delivery; (3) relationships matter: health systems as social institutions; and (4) values drive people centred health systems, enable the illumination of varying push and pull factors that can facilitate or hinder the alignment of DMDI interventions with the development of people-centred health systems to support disease programme integration and the attainment of health equity.
Collapse
Affiliation(s)
- Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | - Rachel Tolhurst
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Gartee Nallo
- University of Liberia Pacific Institute for Research and Evaluation, Monrovia, Monsterrado, Liberia
| | - Karsor Kollie
- Neglected Tropical Disease Programme, Ministry of Health, Government of Liberia, Monrovia, Monsterrado, Liberia
| | - Anthony Bettee
- Neglected Tropical Disease Programme, Ministry of Health, Government of Liberia, Monrovia, Monsterrado, Liberia
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| |
Collapse
|
10
|
Alotaibi G, Alharthi S, Basu B, Ash D, Dutta S, Singh S, Prajapati BG, Bhattacharya S, Chidrawar VR, Chitme H. Nano-Gels: Recent Advancement in Fabrication Methods for Mitigation of Skin Cancer. Gels 2023; 9:gels9040331. [PMID: 37102943 PMCID: PMC10137892 DOI: 10.3390/gels9040331] [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: 03/19/2023] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 04/28/2023] Open
Abstract
In the 21st century, melanoma and non-melanoma skin cancers have become an epidemic outbreak worldwide. Therefore, the exploration of all potential preventative and therapeutic measures based on either physical or bio-chemical mechanisms is essential via understanding precise pathophysiological pathways (Mitogen-activated protein kinase, Phosphatidylinositol 3-kinase Pathway, and Notch signaling pathway) and other aspects of such skin malignancies. Nano-gel, a three-dimensional polymeric cross-linked porous hydrogel having a diameter of 20-200 nm, possesses dual properties of both hydrogel and nanoparticle. The capacity of high drug entrapment efficiency with greater thermodynamic stability, remarkable solubilization potential, and swelling behavior of nano-gel becomes a promising candidate as a targeted drug delivery system in the treatment of skin cancer. Nano-gel can be either synthetically or architectonically modified for responding to either internal or external stimuli, including radiation, ultrasound, enzyme, magnetic, pH, temperature, and oxidation-reduction to achieve controlled release of pharmaceuticals and several bio-active molecules such as proteins, peptides, genes via amplifying drug aggregation in the active targeted tissue and reducing adverse pharmacological effects. Several drugs, such as anti-neoplastic biomolecules having short biological half-lives and prompt enzyme degradability capacity, must be appropriate for administration employing either chemically bridged or physically constructed nano-gel frameworks. The comprehensive review summarizes the advancement in the preparation and characterization methods of targeted nano-gel with enhanced pharmacological potential and preserved intracellular safety limits for the mitigation of skin malignancies with a special emphasize on skin cancer inducing pathophysiological pathways and prospective research opportunities for skin malignancy targeted nano-gels.
Collapse
Affiliation(s)
- Ghallab Alotaibi
- Department of Pharmaceutical Sciences, College of Pharmacy, Shaqra University, Al-Dawadmi Campus, Al-Dawadmi 11961, Saudi Arabia
| | - Sitah Alharthi
- Department of Pharmaceutical Sciences, College of Pharmacy, Shaqra University, Al-Dawadmi Campus, Al-Dawadmi 11961, Saudi Arabia
| | - Biswajit Basu
- Department of Pharmaceutical Technology, Global College of Pharmaceutical Technology, Krishnagar 741102, West Bengal, India
| | - Dipanjana Ash
- Department of Pharmaceutics, BCDA College of Pharmacy & Technology, Kolkata 700127, West Bengal, India
| | - Swarnali Dutta
- Department of Pharmacology, Birla Institute of Technology, Ranchi 835215, Jharkhand, India
| | - Sudarshan Singh
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Bhupendra G Prajapati
- S. K. Patel College of Pharmaceutical Education and Research, Ganpat University, Mehsana 384012, Gujarat, India
| | - Sankha Bhattacharya
- Department of Pharmaceutics, School of Pharmacy and Technology Management, SVKM's NMIMS Deemed-to-Be University, Shirpur 425405, Maharashtra, India
| | - Vijay R Chidrawar
- Department of Pharmacology, Raghavendra Institute of Pharmaceutical Education and Research, Ananthapuramu 515721, Andhra Pradesh, India
| | - Havagiray Chitme
- Faculty of Pharmacy, DIT University, Dehradun 248009, Uttarakhand, India
| |
Collapse
|
11
|
One versus two doses of ivermectin-based mass drug administration for the control of scabies: A cluster randomised non-inferiority trial. PLoS Negl Trop Dis 2023; 17:e0011207. [PMID: 36930667 PMCID: PMC10058081 DOI: 10.1371/journal.pntd.0011207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/29/2023] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Mass drug administration (MDA) based on two doses of ivermectin, one week apart, substantially reduces prevalence of both scabies and impetigo. The Regimens of Ivermectin for Scabies Elimination (RISE) trial assessed whether one-dose ivermectin-based MDA would be as effective. METHODS RISE was a cluster-randomised trial in Solomon Islands. We assigned 20 villages in a 1:1 ratio to one- or two-dose ivermectin-based MDA. We planned to test whether the impact of one dose on scabies prevalence at 12 and 24 months was non-inferior to two, at a 5% non-inferiority margin. RESULTS We deferred endpoint assessment to 21 months due to COVID-19. We enrolled 5239 participants in 20 villages at baseline and 3369 at 21 months from an estimated population of 5500. At baseline scabies prevalence was similar in the two arms (one-dose 17·2%; two-dose 13·2%). At 21 months, there was no reduction in scabies prevalence (one-dose 18·7%; two-dose 13·4%), and the confidence interval around the difference included values substantially greater than 5%. There was however a reduction in prevalence among those who had been present at the baseline assessment (one-dose 15·9%; two-dose 10·8%). Additionally, we found a reduction in both scabies severity and impetigo prevalence in both arms, to a similar degree. CONCLUSIONS There was no indication of an overall decline in scabies prevalence in either arm. The reduction in scabies prevalence in those present at baseline suggests that the unexpectedly high influx of people into the trial villages, likely related to the COVID-19 pandemic, may have compromised the effectiveness of the MDA. Despite the lack of effect there are important lessons to be learnt from this trial about conducting MDA for scabies in high prevalence settings. TRIAL REGISTRATION Registered with Australian New Zealand Clinical Trials Registry ACTRN12618001086257.
Collapse
|
12
|
Saka B, Kassang P, Gnossike P, Head MG, Akakpo AS, Teclessou JN, Elegbede YM, Mouhari-Toure A, Mahamadou G, Tevi K, Katsou K, Kombaté K, Walker SL, Pitché P. Prevalence of skin Neglected Tropical Diseases and superficial fungal infections in two peri-urban schools and one rural community setting in Togo. PLoS Negl Trop Dis 2022; 16:e0010697. [PMID: 36534701 PMCID: PMC9810153 DOI: 10.1371/journal.pntd.0010697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/03/2023] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Skin neglected tropical diseases (NTDs), are endemic and under-diagnosed in many lower-income communities. The objective of this study was to determine the prevalence of skin NTDs and fungal infections in two primary schools and a community setting in rural Togo. METHOD This was a cross-sectional study that took place between June-October 2021. The two primary schools are located on the outskirts of Lomé, the capital city. The community setting was Ndjéi, in north-east Togo. Study sites were purposively selected. Dermatologists examined the skin of study participants. Diagnosis of skin NTDs were made clinically. RESULTS A total of 1401 individuals were examined, 954 (68.1%) from Ndjéi community, and 447 (31.9%) were children in the schools. Cutaneous skin infections were diagnosed in 438 (31.3%) participants, of whom 355 (81%) were in community settings. There were 105 observed skin NTDs (7.5%). Within the school setting, there were 20 individuals with NTDs (4.5% of 447 participants), and 85 NTDs (8.9%) from 954 community participants. Across all settings 68/1020 (6.7%) NTDs were in children, and 37/381 (9.7%) in adults. In addition, there were 333 observed mycoses (23.8% prevalence). The main cutaneous NTDs diagnosed were scabies (n = 86; 6.1%) and suspected yaws (n = 16, 1.1%). The prevalence of scabies in schools was 4.3%, and 7.0% in the rural community. One case of leprosy was diagnosed in each school and the rural community, and one suspected Buruli Ulcer case in the community. In the school setting, five (6%) children with a skin NTD reported being stigmatised, four of whom had refused to attend school because of their dermatosis. In Ndjéi, 44 (4.6%) individuals reported having experienced stigma and 41 (93.2%) of them missed at least one day of school or work. CONCLUSION This study shows that the burden of scabies and skin infections such as superficial mycoses is high in the school and rural community settings in Togo, with associated presence of stigma. Improved health promotion and education across institutional and community settings may reduce stigma and encourage early reporting of skin infection cases to a health facility.
Collapse
Affiliation(s)
- Bayaki Saka
- Service de dermatologie, CHU de Lomé, Lomé, Togo
| | | | | | - Michael G. Head
- Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- * E-mail:
| | | | | | | | | | | | - Kokoé Tevi
- Service de dermatologie, CHU de Lomé, Lomé, Togo
| | | | | | - Stephen L. Walker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | |
Collapse
|
13
|
Timothy JWS, Rogers E, Halliday KE, Mulbah T, Marks M, Zaizay Z, Giddings R, Kempf M, Marion E, Walker SL, Kollie KK, Pullan RL. Quantifying Population Burden and Effectiveness of Decentralized Surveillance Strategies for Skin-Presenting Neglected Tropical Diseases, Liberia. Emerg Infect Dis 2022; 28:1755-1764. [PMID: 35997318 PMCID: PMC9423900 DOI: 10.3201/eid2809.212126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We evaluated programmatic approaches for skin neglected tropical disease (NTD) surveillance and completed a robust estimation of the burden of skin NTDs endemic to West Africa (Buruli ulcer, leprosy, lymphatic filariasis morbidity, and yaws). In Maryland, Liberia, exhaustive case finding by community health workers of 56,285 persons across 92 clusters identified 3,241 suspected cases. A total of 236 skin NTDs (34.0 [95% CI 29.1–38.9]/10,000 persons) were confirmed by midlevel healthcare workers trained using a tailored program. Cases showed a focal and spatially heterogeneous distribution. This community health worker‒led approach showed a higher skin NTD burden than prevailing surveillance mechanisms, but also showed high (95.1%) and equitable population coverage. Specialized training and task-shifting of diagnoses to midlevel health workers led to reliable identification of skin NTDs, but reliability of individual diagnoses varied. This multifaceted evaluation of skin NTD surveillance strategies quantifies benefits and limitations of key approaches promoted by the 2030 NTD roadmap of the World Health Organization.
Collapse
|
14
|
Valentin J, Niemetzky F, Gaillet M, Michaud C, Carbunar A, Demar M, Couppie P, Blaizot R. Spectrum of skin diseases in Maroon villages of the Maroni area, French Guiana. Int J Dermatol 2022; 61:1137-1144. [PMID: 35767188 PMCID: PMC9543587 DOI: 10.1111/ijd.16324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/08/2022] [Accepted: 06/12/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Due to their genetic characteristics and their high exposure to infectious diseases, Maroons are likely to suffer from a specific spectrum of skin diseases. However, skin disorders have never been explored in this population. We aimed to describe all skin diseases in Maroon villages of the Maroni region in French Guiana. METHODS This retrospective study concerned all patients who consulted in the remote health centers of Apatou, Grand-Santi, Papaichton, and Maripasoula between October 5, 2017, and June 30, 2020. We included all patients registered with a skin disorder (International Classification of Diseases) in the medical database. We excluded patients whose diagnosis was invalidated after cross-checking by a dermatologist. RESULTS A total of 4741 patients presented at least one skin disease, for 6058 different disorders. Nonsexually transmitted infections represented 71.6% of all diagnoses, followed by inflammatory diseases (9.8%) and bites/envenomations (4.6%). The three most frequent conditions were scabies, abscesses, and impetigo. Besides scabies, neglected tropical diseases (NTDs) were still prevalent as we reported 13 cases of leprosy and 63 cutaneous leishmaniasis. Atopic dermatitis (AD) represented only 2.5% of our diagnoses. CONCLUSIONS With the exception of AD, which was less frequent among Maroons, these results are similar to those previously reported in Amerindians. Therefore, a common exposure to rainforest pathogens seems to induce a common spectrum of skin diseases dominated by infections. The high prevalence of NTDs requires specific public health actions.
Collapse
Affiliation(s)
- Julie Valentin
- Dermatology Department, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Florence Niemetzky
- Centres Délocalisés de Prévention et de Soins, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Melanie Gaillet
- Centres Délocalisés de Prévention et de Soins, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Celine Michaud
- Centres Délocalisés de Prévention et de Soins, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Aurel Carbunar
- Centres Délocalisés de Prévention et de Soins, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Magalie Demar
- Tropical Biome and Immunophysiopathology (TBIP), Université de Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, Centre Hospitalier de Cayenne, Université de Guyane, Cayenne, French Guiana.,Laboratory of Parasitology, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Pierre Couppie
- Dermatology Department, Centre Hospitalier de Cayenne, Cayenne, French Guiana.,Tropical Biome and Immunophysiopathology (TBIP), Université de Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, Centre Hospitalier de Cayenne, Université de Guyane, Cayenne, French Guiana
| | - Romain Blaizot
- Dermatology Department, Centre Hospitalier de Cayenne, Cayenne, French Guiana.,Tropical Biome and Immunophysiopathology (TBIP), Université de Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, Centre Hospitalier de Cayenne, Université de Guyane, Cayenne, French Guiana
| |
Collapse
|
15
|
Davies B, Kinfe M, Ali O, Mengiste A, Tesfaye A, Wondimeneh MT, Davey G, Semrau M. Stakeholder perspectives on an integrated package of care for lower limb disorders caused by podoconiosis, lymphatic filariasis or leprosy: A qualitative study. PLoS Negl Trop Dis 2022; 16:e0010132. [PMID: 35061673 PMCID: PMC8809619 DOI: 10.1371/journal.pntd.0010132] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 02/02/2022] [Accepted: 01/04/2022] [Indexed: 11/21/2022] Open
Abstract
Background Lower limb disorders including lymphoedema create a huge burden for affected persons in their physical and mental health, as well as socioeconomic and psychosocial consequences for them, their families and communities. As routine health services for the integrated management and prevention of lower limb disorders are still lacking, the ‘Excellence in Disability Prevention Integrated across Neglected Tropical Diseases’ (EnDPoINT) study was implemented to assess the development and delivery of an integrated package of holistic care–including physical health, mental health and psychosocial care–within routine health services for persons with lower limb disorders caused by podoconiosis, lymphatic filariasis and leprosy. Methodology/Principal findings This study was part of the first of three phases within EnDPoINT, involving the development of the integrated care package. Focus group discussions and key informant interviews were undertaken with 34 participants between January–February 2019 in Awi zone, Ethiopia, in order to assess the draft care package’s feasibility, acceptability and appropriateness. Persons affected by lower limb disorders such as lymphoedema experience stigma, exclusion from families, communities and work as well as physical and financial hardship. Beliefs in disease causation inhibit affected persons from accessing care. Ignorance was a barrier for health care providers as well as affected persons. Training and education of affected persons, communities and caregivers is important in improving care access. It also requires time, space, materials and financial resources. Both top-down and grass roots input into service development are key, as well as collaboration across stakeholders including charities, community leaders and “expert patients”. Conclusions/Significance This study highlighted the need for the EnDPoINT integrated care package and provided suggestions for solutions according to its three aspects of integrated care (integration into routine care; integration of mental health and psychosocial care; and integration of care across the three diseases), thereby giving support for its feasibility, acceptability and appropriateness. Lower limb disorders including lymphoedema are prevalent in Ethiopia as a common endpoint of varying causes such as podoconiosis, leprosy and lymphatic filariasis. This study involved the development of a comprehensive integrated and holistic care package for lower limb disorders into routine health care services. It used interviews and focus groups to assess feasibility, acceptability and appropriateness of the draft care package. We found that persons affected by lower limb disorders had many negative experiences due to their condition, especially related to stigma, that included physical, financial and psychological sequelae. Neglect was paramount, with financial neglect in central budgets, a lack of knowledge by care givers and a lack of awareness among affected persons and their communities, all contributing to inadequate care provision and access. Affected persons, communities and caregivers may benefit from provision of learning opportunities about the prevention and treatment of lower limb disorders; and resources are crucial in engendering change, including material goods, time to provide care, and collaborative work to create a culture shift and address stigma.
Collapse
Affiliation(s)
- Bethany Davies
- Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
- * E-mail: (BD); (MS)
| | - Mersha Kinfe
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Oumer Ali
- Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Asrat Mengiste
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Abraham Tesfaye
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Gail Davey
- Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Maya Semrau
- Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
- * E-mail: (BD); (MS)
| | - EnDPoINT Research Team and Consortium
- Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
16
|
Leishmanicidal activity of Morita-Baylis-Hillman adducts. Parasitol Res 2022; 121:751-762. [PMID: 34988671 DOI: 10.1007/s00436-021-07421-3] [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: 07/22/2021] [Accepted: 12/27/2021] [Indexed: 10/19/2022]
Abstract
Leishmaniasis is a neglected disease that affects millions of people, mostly in developing countries. Although this disease has a high impact on public health, there are few drug options to treat the different leishmaniasis forms. Additionally, these current therapies have various adverse effects, including gastrointestinal disturbances, headache, pancreatitis, and hepatotoxicity. Thus, it is essential to develop new drug prototypes to treat leishmaniasis. Accordingly, the present study aimed to evaluate the leishmanicidal activity of Morita-Baylis-Hillman adducts and their O-acetylates, carboxylic acid derivatives, and acid and ester derivatives of 2-methyl-phenylpropanoids against Leishmania chagasi. Initially, we evaluated the cytotoxicity of 16 derivatives (1-16G) against J774A.1 macrophages. Eight derivatives (2G, 4G, 5G, 7G, 9G, 10G, 13G, and 15G) showed no cytotoxicity at up to the maximum concentration tested (100 μM). When evaluated for antileishmanial effect against promastigote forms, 1G, 6G, 8G, 10G, 11G, 13G, 14G, 15G, and 16G displayed significant toxicity compared to the control (0.1% DMSO). Additionally, the compounds 1G, 5G, 7G, 9G, 11G, 13G, 14G, and 16G reduced macrophage infection by amastigotes. Thus, we conclude that these derivatives have antileishmanial effects, particularly 1G, which showed activity against promastigotes and amastigotes, and low toxicity against macrophages.
Collapse
|
17
|
Dean L, Theobald S, Nallo G, Bettee A, Kollie K, Tolhurst R. A syndemic born of war: Combining intersectionality and structural violence to explore the biosocial interactions of neglected tropical diseases, disability and mental distress in Liberia. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000551. [PMID: 36962440 PMCID: PMC10021464 DOI: 10.1371/journal.pgph.0000551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 05/09/2022] [Indexed: 11/19/2022]
Abstract
The intersections between NTDs, disability, and mental ill-health are increasingly recognised globally. Chronic morbidity resultant from many NTDs, particularly those affecting the skin-including lymphatic filariasis (LF), leprosy, Buruli ulcer (BU) and onchocerciasis-is well known and largely documented from a medicalised perspective. However less is known about the complex biosocial interaction shaping interconnected morbidities. We apply syndemic theory to explain the biosocial relationship between NTDs and mental distress in the context of structural violence in Liberia. By advancing syndemic theory to include intersectional thought, it is apparent that structural violence becomes embodied in different ways through interacting multi-level (macro, meso and micro) processes. Through the use of in-depth qualitative methods, we explore the syndemic interaction of NTDs and mental distress from the vantage point of the most vulnerable and suggest that: 1) the post-conflict environment in Liberia predisposes people to the chronic effects of NTDs as well as other 'generalised stressors' as a consequence of ongoing structural violence; 2) people affected by NTDs are additionally exposed to stigma and discrimination that cause additional stressors and synergistically produce negative health outcomes in relation to NTDs and mental distress; and 3) the impact and experience of consequential syndemic suffering is shaped by intersecting axes of inequity such as gender and generation which are themselves created by unequal power distribution across multiple systems levels. Bringing together health systems discourse, which is focused on service integration and centred around disease control, with syndemic discourse that considers the biosocial context of disease interaction offers new approaches. We suggest that taking a syndemic-informed approach to care in the development of people-centred health systems is key to alleviating the burden of syndemic suffering associated with NTDs and mental distress currently experienced by vulnerable populations in resource-limited settings.
Collapse
Affiliation(s)
- Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Gartee Nallo
- University of Liberia Pacific Institute for Research and Evaluation, Monrovia, Monsterrado, Liberia
| | - Anthony Bettee
- Neglected Tropical Disease Programme, Ministry of Health, Government of Liberia, Monrovia, Monsterrado, Liberia
| | - Karsor Kollie
- Neglected Tropical Disease Programme, Ministry of Health, Government of Liberia, Monrovia, Monsterrado, Liberia
| | - Rachel Tolhurst
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| |
Collapse
|
18
|
Timothy JWS, Pullan RL, Yotsu RR. Methods and Approaches for Buruli Ulcer Surveillance in Africa: Lessons Learnt and Future Directions. Methods Mol Biol 2022; 2387:87-102. [PMID: 34643905 DOI: 10.1007/978-1-0716-1779-3_10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Over 95% of the global burden of Buruli ulcer disease (BU) caused by Mycobacterium ulcerans occurs in equatorial Africa. National and sub-national programs have implemented various approaches to improve detection and reporting of incident cases over recent decades. Regional incidence rates are currently in decline; however, surveillance targets outlined in 2012 by WHO have been missed and detection bias may contribute to these trends. In light of the new 2030 NTD roadmap and disease-specific targets, BU programs are required to strengthen case detection and begin a transition towards integration with other skin-NTDs. This transition comes with new opportunities to enhance existing BU surveillance systems and develop novel approaches for implementation and evaluation.In this review, we present a breakdown and assessment of the methods and approaches that have been the pillars of BU surveillance systems in Africa: (1) Passive case detection, (2) Data systems, (3) Clinical training, (4) Active case finding, (5) Burden estimation, and (6) Laboratory confirmation pathways. We discuss successes, challenges, and relevant case studies before highlighting opportunities for future development and evaluation including novel data collection tools, risk-based surveillance, and integrated skin-NTD surveillance. We draw on both experience and available literature to critically evaluate methods of BU surveillance in Africa and highlight new approaches to help achieve 2030 roadmap targets.
Collapse
Affiliation(s)
- Joseph W S Timothy
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Rachel L Pullan
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Rie R Yotsu
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
- Department of Dermatology, National Center for Global Health and Medicine, Tokyo, Japan.
- Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, USA.
| |
Collapse
|
19
|
de Carvalho AG, Tiwari A, Luz JGG, Nieboer D, Steinmann P, Richardus JH, Ignotti E. Leprosy and cutaneous leishmaniasis affecting the same individuals: A retrospective cohort analysis in a hyperendemic area in Brazil. PLoS Negl Trop Dis 2021; 15:e0010035. [PMID: 34898634 PMCID: PMC8699965 DOI: 10.1371/journal.pntd.0010035] [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: 03/29/2021] [Revised: 12/23/2021] [Accepted: 11/28/2021] [Indexed: 12/15/2022] Open
Abstract
Background Leprosy and cutaneous leishmaniasis (CL) are neglected tropical diseases (NTDs) affecting the skin. Their control is challenging but the integration of skin NTDs control programs is recommended to improve timely detection and treatment. However, little is known about the occurrence of leprosy and CL in the same individuals, and what are the characteristics of such patients. This study aimed to identify and characterize patients diagnosed with both leprosy and CL (i.e., outcome) in the hyperendemic state of Mato Grosso, Brazil. Also, we investigated the demographic risk factors associated with the period between the diagnosis of both diseases. Methodology/principal findings A retrospective cohort study was conducted with patients diagnosed between 2008 and 2017. From the leprosy (n = 28,204) and CL (n = 24,771) databases of the national reporting system, 414 (0.8%; 414/52,561) patients presenting both diseases were identified through a probabilistic linkage procedure. This observed number was much higher than the number of patients that would be expected by chance alone (n = 22). The spatial distribution of patients presenting the outcome was concentrated in the North and Northeast mesoregions of the state. Through survival analysis, we detected that the probability of a patient developing both diseases increased over time from 0.2% in the first year to 1.0% within seven years. Further, using a Cox model we identified male sex (HR: 2.3; 95% CI: 1.7–2.9) and low schooling level (HR: 1.5; 95% CI: 1.2–1.9) as positively associated with the outcome. Furthermore, the hazard of developing the outcome was higher among individuals aged 40–55 years. Conclusions/significance Leprosy and CL are affecting the same individuals in the area. Integration of control policies for both diseases will help to efficiently cover such patients. Measures should be focused on timely diagnosis by following-up patients diagnosed with CL, active case detection, and training of health professionals. Leprosy and cutaneous leishmaniasis (CL) are neglected tropical diseases (NTDs) that usually affect poor populations in the same geographical areas. Both affect the skin and can cause physical disability and disfigurement resulting in discrimination. Both diseases occur at hyperendemic levels in several regions of Brazil. The integration of skin NTDs control programs may be a way to improve timely detection and treatment. However, little is known about the occurrence of leprosy and CL in the same individuals, and what are the characteristics of these patients. For the Brazilian state of Mato Grosso, we identified 414 patients diagnosed with leprosy and CL between 2008 and 2017, spatially concentrated mainly in the North and Northeast mesoregions. The individual probability of developing both diseases increased from 0.2% to 1.0% within seven years. Male sex, being in the 40–55 years age group, and low levels of schooling were the risk factors positively associated with the time interval between the diagnosis of both diseases. These findings may inform the implementation of integrated leprosy and CL control policies focused on timely diagnosis. A sustainable integration requires continuous measures, such as the follow-up of patients, active case detection, training of health professionals, besides financial and political support.
Collapse
Affiliation(s)
- Amanda Gabriela de Carvalho
- School of Medicine, Faculty of Health Sciences, Federal University of Rondonópolis, Rondonópolis, Mato Grosso, Brazil
- School of Medicine, Post-Graduation Program in Health Sciences, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
- * E-mail:
| | - Anuj Tiwari
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - João Gabriel Guimarães Luz
- School of Medicine, Faculty of Health Sciences, Federal University of Rondonópolis, Rondonópolis, Mato Grosso, Brazil
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eliane Ignotti
- School of Medicine, Post-Graduation Program in Health Sciences, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
- School of Health Sciences, Post-Graduation Program Environment Sciences, State University of Mato Grosso, Cáceres, Mato Grosso, Brazil
| |
Collapse
|
20
|
Ferreira MA, de Almeida Júnior RF, Onofre TS, Casadei BR, Farias KJS, Severino P, de Oliveira Franco CF, Raffin FN, de Lima e Moura TFA, de Melo Barbosa R. Annatto Oil Loaded Nanostructured Lipid Carriers: A Potential New Treatment for Cutaneous Leishmaniasis. Pharmaceutics 2021; 13:1912. [PMID: 34834327 PMCID: PMC8618414 DOI: 10.3390/pharmaceutics13111912] [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: 08/12/2021] [Revised: 10/14/2021] [Accepted: 10/25/2021] [Indexed: 11/18/2022] Open
Abstract
Annatto (Bixa orellana L.) is extensively used as food pigment worldwide. Recently, several studies have found it to have healing and antioxidant properties, as well as effective action against leishmaniasis. Therefore, the purpose of this study was to incorporate the oil obtained from annatto seeds into a nanostructured lipid carrier (NLC) and evaluate its physicochemical properties and biological activity against Leishmania major. Nanoparticles were prepared by the fusion-emulsification and ultrasonication method, with the components Synperonic™ PE (PL) as the surfactant, cetyl palmitate (CP) or myristyl myristate (MM) as solid lipids, annatto oil (AO) (2% and 4%, w/w) as liquid lipid and active ingredient, and ultra-pure water. Physicochemical and biological characterizations were carried out to describe the NLCs, including particle size, polydispersity index (PDI), and zeta potential (ZP) by dynamic light scattering (DLS), encapsulation efficiency (EE%), thermal behavior, X-ray diffraction (XRD), transmission electron microscopy (TEM), Electron Paramagnetic Resonance (EPR), cytotoxicity on BALB/c 3T3 fibroblasts and immortalized human keratinocyte cells, and anti-leishmaniasis activity in vitro. Nanoparticles presented an average diameter of ~200 nm (confirmed by TEM results), a PDI of less than 0.30, ZP between -12.6 and -31.2 mV, and more than 50% of AO encapsulated in NLCs. Thermal analyses demonstrated that the systems were stable at high temperatures with a decrease in crystalline structure due to the presence of AOs (confirmed by XRD). In vitro, the anti-leishmania test displayed good activity in encapsulating AO against L. major. The results indicate that the oily fraction of Bixa orellana L. in NLC systems should be evaluated as a potential therapeutic agent against leishmaniasis.
Collapse
Affiliation(s)
- Marianna Araújo Ferreira
- Laboratory of Drug Development, Department of Pharmacy, Federal University of Rio Grande do Norte, Natal 59012-570, Brazil; (M.A.F.); (F.N.R.)
| | | | - Thiago Souza Onofre
- Biochemistry and Molecular Biology Department, Federal University of Viçosa (UFV), Viçosa 36570-900, Brazil;
| | - Bruna Renata Casadei
- Institute of Physics, University of São Paulo, USP, São Paulo 05508-090, Brazil;
| | | | - Patricia Severino
- Institute of Technology and Research (ITP), Aracaju 49010-390, Brazil;
| | | | - Fernanda Nervo Raffin
- Laboratory of Drug Development, Department of Pharmacy, Federal University of Rio Grande do Norte, Natal 59012-570, Brazil; (M.A.F.); (F.N.R.)
| | | | - Raquel de Melo Barbosa
- Laboratory of Drug Development, Department of Pharmacy, Federal University of Rio Grande do Norte, Natal 59012-570, Brazil; (M.A.F.); (F.N.R.)
| |
Collapse
|
21
|
Tsoi SK, Lake SJ, Thean LJ, Matthews A, Sokana O, Kama M, Amaral S, Romani L, Whitfeld M, Francis JR, Vaz Nery S, Marks M, Kaldor JM, Steer AC, Engelman D. Estimation of scabies prevalence using simplified criteria and mapping procedures in three Pacific and southeast Asian countries. BMC Public Health 2021; 21:2060. [PMID: 34758806 PMCID: PMC8579609 DOI: 10.1186/s12889-021-12039-2] [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: 08/17/2021] [Accepted: 10/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Scabies causes considerable morbidity in disadvantaged populations. The International Alliance for the Control of Scabies (IACS) published consensus criteria in 2020 to standardize scabies diagnosis. However, these criteria are complex, and a WHO informal consultation proposed simplified criteria for mapping, to identify regions of high prevalence as targets for mass drug administration. We aimed to investigate the accuracy of simplified criteria in determining scabies prevalence, compared to the 2020 IACS criteria. Methods We obtained data relating to demographics, relevant history and skin lesions from all-age prevalence surveys from Fiji (n = 3365) and Solomon Islands (n = 5239), as well as school-aged children in Timor-Leste (n = 1043). We calculated prevalence using the 2020 IACS criteria and simplified criteria and compared these disease estimates. Results There was no significant difference in the pooled prevalence using the two methods (2020 IACS criteria: 16.6%; simplified criteria: 15.6%; difference = 0.9, [95% CI -0.1, 2.0]). In Timor-Leste, the prevalence using simplified criteria was lower (26.5% vs 33.8%). Simplified criteria had a sensitivity of 82.3% (95% CI 80.2, 84.2) and specificity of 97.6% (95% CI 97.2, 97.9) compared to the 2020 IACS criteria. Conclusions The scabies prevalence estimation using simplified criteria was similar to using the 2020 IACS criteria in high prevalence, tropical countries. The prevalence estimation was lower in the school-based survey in Timor-Leste. Mapping using simplified criteria may be a feasible and effective public health tool to identify priority regions for scabies control. Further work assessing use of simplified criteria for mapping in a field setting should be conducted. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12039-2.
Collapse
Affiliation(s)
- Shu Ki Tsoi
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Australia
| | - Susanna J Lake
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Melbourne Children's Global Health, Royal Children's Hospital, Melbourne, Australia
| | - Li Jun Thean
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | | | - Oliver Sokana
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Mike Kama
- Ministry of Health, Dinem House, Suva, Republic of Fiji
| | - Salvador Amaral
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Lucia Romani
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Margot Whitfeld
- St Vincent's Hospital, University of New South Wales, Sydney, Australia
| | - Joshua R Francis
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.,Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia
| | - Susana Vaz Nery
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.,Hospital for Tropical Diseases, University College London Hospital, London, UK
| | - John M Kaldor
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Andrew C Steer
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Melbourne Children's Global Health, Royal Children's Hospital, Melbourne, Australia
| | - Daniel Engelman
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Australia. .,Department of Paediatrics, University of Melbourne, Melbourne, Australia. .,Melbourne Children's Global Health, Royal Children's Hospital, Melbourne, Australia.
| |
Collapse
|
22
|
Skevaki C, Ngocho JS, Amour C, Schmid-Grendelmeier P, Mmbaga BT, Renz H. Epidemiology and management of asthma and atopic dermatitis in Sub-Saharan Africa. J Allergy Clin Immunol 2021; 148:1378-1386. [PMID: 34715154 DOI: 10.1016/j.jaci.2021.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/08/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022]
Abstract
Sub-Saharan Africa (SSA) is currently undergoing a transformation process of unprecedented magnitude owing to economic development and urbanization. This process is paralleled by a dramatic increase in prevalence and incidence of noncommunicable diseases. In this article we analyze the current situation with regard to 1 group of the earliest noncommunicable diseases in a person's life, namely, allergies and asthma. This article provides an update on the epidemiology, availability, and access to management strategies by patients experiencing bronchial asthma or atopic dermatitis in SSA. Despite all of the progress, there is still a tremendous need to support education and training, transfer of resources, and cooperation with pharmaceutical and diagnostic companies to achieve adequate treatment and sustainability in SSA with regard to allergy, asthma, and eczema management.
Collapse
Affiliation(s)
- Chrysanthi Skevaki
- Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Center, Philipps Universität Marburg, Member of the German Center for Lung Research, Marburg, Germany
| | - James S Ngocho
- Department of Epidemiology and Applied Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Caroline Amour
- Department of Epidemiology and Applied Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Blandina T Mmbaga
- Department of Pediatric and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania; Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Harald Renz
- Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Center, Philipps Universität Marburg, Member of the German Center for Lung Research, Marburg, Germany; Department of Epidemiology and Applied Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania; Department of Clinical Immunology and Allergology, Laboratory of Immunopathology, Sechenov University, Moscow, Russia.
| |
Collapse
|
23
|
Prasad S, Bassett IV, Freeman EE. Dermatology on the Global Stage: The role of dermatologists in international health advocacy and COVID-19 research. Int J Womens Dermatol 2021; 7:653-659. [PMID: 34722850 PMCID: PMC8539819 DOI: 10.1016/j.ijwd.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 11/24/2022] Open
Abstract
Background Over the last decade, there has been a surge in interest and funding for global health dermatology. Skin conditions are now recognized as the fourth leading cause of nonfatal disease burden worldwide in disability-adjusted life years. Dermatologists are uniquely positioned within global health because skin conditions are often the presenting sign of severe illnesses, such as neglected tropical diseases and COVID-19. Methods We review four major areas of work by dermatologists within global health: i) characterization of global burden of skin disease, ii) advocacy for dermatologic therapies on the World Health Organization's Model List of Essential Medicines, iii) advancements in global programming for skin-related tropical diseases, and iv) the role of dermatologists during the COVID-19 pandemic. For each area of work, the significance and impact on the health of women and girls is briefly highlighted. Results Dermatologists have led the efforts to quantify and evaluate the global burden of skin disease, the burden of which is disproportionately shared by women. The dermatology community has also championed global efforts to eliminate skin-related neglected tropical diseases, such as scabies. Through national and international policy advocacy, dermatologists have pushed for more dermatologic therapies in the World Health Organization's Model List of Essential Medicines, helping to secure better care for patients with skin disease throughout the world. Since 2020, the dermatology community has worked collaboratively in the fight against COVID-19, establishing a worldwide registry for cutaneous manifestations of SARS-CoV-2 and pursuing research that has allowed colleagues in the house of medicine to better understand this landmark disease. Conclusion Through the study and promotion of global health, dermatologists have an important role in the house of medicine.
Collapse
Affiliation(s)
- Sonya Prasad
- Icahn School of Medicine, The Mount Sinai Hospital, New York, New York, United States of America.,Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Ingrid V Bassett
- Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Esther E Freeman
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, United States of America.,Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| |
Collapse
|
24
|
Eze CC, Ekeke N, Alphonsus C, Lehman L, Chukwu JN, Nwafor CC, Stillwaggon E, Meka AO, Sawers L, Ikebudu J, Anyim MC, Ukwaja KN. Effectiveness of self-care interventions for integrated morbidity management of skin neglected tropical diseases in Anambra State, Nigeria. BMC Public Health 2021; 21:1748. [PMID: 34563162 PMCID: PMC8465703 DOI: 10.1186/s12889-021-11729-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 09/03/2021] [Indexed: 12/03/2022] Open
Abstract
Background Lymphatic filariasis (LF), Buruli ulcer (BU) and leprosy are neglected tropical diseases (NTDs) of the skin co-endemic in some communities in Nigeria. Not enough is known about the effectiveness of integrated morbidity management and disability prevention in people with these conditions. An integrated self-care intervention was carried out for people with these skin NTDs in two endemic communities of Anambra state, Nigeria. The objective of the study was to assess the effectiveness of self-care practices on costs of care, disability status and health-related quality of life. Methods This study utilised a quasi-experimental pre-test/post-test design to assess the effectiveness of the self-care interventions for people affected by NTDs to care for these impairments at home. Data were collected using questionnaires administered at the beginning and at the end of the intervention on monthly cost of morbidity care, and on participants’ disability status and their quality of life (QoL). Focus group discussions (FGDs) were held with both the participants and healthcare workers at follow-up. Results Forty-eight participants were recruited. Thirty participants (62.5%) continued the self-care interventions until the end of the project. Of those, 25 (83%) demonstrated improvement from their baseline impairment status. The mean household costs of morbidity care per participant decreased by 66% after the intervention, falling from US$157.50 at baseline to US$53.24 after 6 months of self-care (p = 0.004). The mean disability score at baseline was 22.3; this decreased to 12.5 after 6 months of self-care (p < 0.001). Among the 30 participants who continued the interventions until the end of the project, 26 (86.7%) had severe disability score (i.e. a score of 10–46) at baseline, and the number with severe disability fell to 18 (60%) of the 30 after the intervention. The mean QoL score increased from 45.7 at baseline to 57.5 at the end of the intervention (p = 0.004). Conclusions The 6-month self-care intervention for participants affected by BU, leprosy, or LF led to lower costs of care (including out-of-pocket costs and lost earnings due to morbidity), improved QoL scores, and reduced disability status. Trial registration ISRCTN Registry: ISRCTN20317241; 27/08/2021, Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11729-1.
Collapse
Affiliation(s)
- Chinwe C Eze
- Medical Department, German Leprosy and TB Relief Association, Enugu, Enugu State, Nigeria
| | - Ngozi Ekeke
- Medical Department, German Leprosy and TB Relief Association, Enugu, Enugu State, Nigeria
| | - Chukwuka Alphonsus
- Medical Department, German Leprosy and TB Relief Association, Enugu, Enugu State, Nigeria
| | - Linda Lehman
- American Leprosy Missions, 120 Broadus Ave, Greenville, SC, 29601, USA
| | - Joseph N Chukwu
- Medical Department, German Leprosy and TB Relief Association, Enugu, Enugu State, Nigeria
| | - Charles C Nwafor
- Medical Department, German Leprosy and TB Relief Association, Enugu, Enugu State, Nigeria
| | | | - Anthony O Meka
- Medical Department, German Leprosy and TB Relief Association, Enugu, Enugu State, Nigeria
| | - Larry Sawers
- Department of Economics, American University, Washington, DC, 20016-8029, USA
| | - Joy Ikebudu
- Medical Department, German Leprosy and TB Relief Association, Enugu, Enugu State, Nigeria
| | - Moses C Anyim
- Medical Department, German Leprosy and TB Relief Association, Enugu, Enugu State, Nigeria
| | - Kingsley N Ukwaja
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.
| |
Collapse
|
25
|
Hannah C, Williams V, Fuller LC, Forrestel A. The Impact of the COVID-19 Pandemic on Global Health Dermatology. Dermatol Clin 2021; 39:619-625. [PMID: 34556251 PMCID: PMC8165086 DOI: 10.1016/j.det.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Claire Hannah
- Department of Dermatology, Hospital of the University of Pennsylvania, 3600 Spruce Street, 2 Maloney, Philadelphia, PA 19104, USA; Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Victoria Williams
- Department of Dermatology, Hospital of the University of Pennsylvania, 3600 Spruce Street, 2 Maloney, Philadelphia, PA 19104, USA; Merck & Co, Inc, Upper Gwynedd, PA, USA
| | - Lucinda Claire Fuller
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; International Foundation for Dermatology, London, UK
| | - Amy Forrestel
- Department of Dermatology, Hospital of the University of Pennsylvania, 3600 Spruce Street, 2 Maloney, Philadelphia, PA 19104, USA.
| |
Collapse
|
26
|
Engelman D, Marks M, Steer AC, Beshah A, Biswas G, Chosidow O, Coffeng LE, Lardizabal Dofitas B, Enbiale W, Fallah M, Gasimov E, Hopkins A, Jacobson J, Kaldor JM, Ly F, Mackenzie CD, McVernon J, Parnaby M, Rainima-Qaniuci M, Sokana O, Sankara D, Yotsu R, Yajima A, Cantey PT. A framework for scabies control. PLoS Negl Trop Dis 2021; 15:e0009661. [PMID: 34473725 PMCID: PMC8412357 DOI: 10.1371/journal.pntd.0009661] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Scabies is a neglected tropical disease (NTD) that causes a significant health burden, particularly in disadvantaged communities and where there is overcrowding. There is emerging evidence that ivermectin-based mass drug administration (MDA) can reduce the prevalence of scabies in some settings, but evidence remains limited, and there are no formal guidelines to inform control efforts. An informal World Health Organization (WHO) consultation was organized to find agreement on strategies for global control. The consultation resulted in a framework for scabies control and recommendations for mapping of disease burden, delivery of interventions, and establishing monitoring and evaluation. Key operational research priorities were identified. This framework will allow countries to set control targets for scabies as part of national NTD strategic plans and develop control strategies using MDA for high-prevalence regions and outbreak situations. As further evidence and experience are collected and strategies are refined over time, formal guidelines can be developed. The control of scabies and the reduction of the health burden of scabies and associated conditions will be vital to achieving the targets set in WHO Roadmap for NTDs for 2021 to 2030 and the Sustainable Development Goals.
Collapse
Affiliation(s)
- Daniel Engelman
- Tropical Diseases, Murdoch Children’s Research Institute, Melbourne, Australia
- Melbourne Children’s Global Health, Royal Children’s Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- * E-mail:
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, London, United Kingdom
| | - Andrew C. Steer
- Tropical Diseases, Murdoch Children’s Research Institute, Melbourne, Australia
- Melbourne Children’s Global Health, Royal Children’s Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Abate Beshah
- Communicable Diseases, Neglected Tropical Diseases, WHO Regional Office for Africa, Brazzaville, Congo
| | - Gautam Biswas
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Olivier Chosidow
- Faculté de Santé de Créteil et Service de Dermatologie, APHP, Hôpital Henri-Mondor, Université Paris-Est, Créteil, France
- Research Group Dynamic, EA7380, Faculté de Santé de Créteil, Ecole Nationale Vétérinaire d’Alfort, USC ANSES, Université Paris-Est Créteil, Créteil, France
| | - Luc E. Coffeng
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Belen Lardizabal Dofitas
- College of Medicine, University of the Philippines, Manila, Philippines
- Philippine Leprosy Mission, Inc., Manila, Philippines
| | - Wendemagegn Enbiale
- Department of Dermatovenerology, Bahir Dar University, Medicine and Health Science College, Addis Ababa, Ethiopia
- Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Mosoka Fallah
- University of Liberia, Monrovia, Liberia
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Elkhan Gasimov
- Division of Country Health Programmes, Malaria, Neglected Tropical Diseases and Other Vector-borne Diseases, WHO Regional Office for Europe, Copenhagen, Denmark
| | | | - Julie Jacobson
- Bridges to Development, Seattle, Washington, United States of America
| | - John M. Kaldor
- Public Health Interventions Research Group, Kirby Institute University of New South Wales, Sydney, Australia
| | - Fatimata Ly
- Dermatology Unit, EPS Institut d’Hygiéne Sociale de Dakar, Dakar, Senegal
- University Cheikh Anta Diop of Dakar, Dakar, Senegal
| | | | - Jodie McVernon
- Peter Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Infection Modelling, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Matthew Parnaby
- Tropical Diseases, Murdoch Children’s Research Institute, Melbourne, Australia
- Melbourne Children’s Global Health, Royal Children’s Hospital, Melbourne, Australia
| | | | | | - Dieudonne Sankara
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Rie Yotsu
- Tulane School of Public Health and Tropical Medicine, New Orleans, United States of America
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Dermatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Aya Yajima
- Division of Communicable Diseases, Medicines, Vaccines and Pharmaceuticals, WHO Regional Office for the Western Pacific, Manila, Philippines
| | - Paul T. Cantey
- Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Former Medical Officer, Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| |
Collapse
|
27
|
Schoenmakers A, Hambridge T, van Wijk R, Kasang C, Richardus JH, Bobosha K, Mitano F, Mshana SE, Mamo E, Marega A, Mwageni N, Letta T, Muloliwa AM, Kamara DV, Eman AM, Raimundo L, Njako B, Mieras L. PEP4LEP study protocol: integrated skin screening and SDR-PEP administration for leprosy prevention: comparing the effectiveness and feasibility of a community-based intervention to a health centre-based intervention in Ethiopia, Mozambique and Tanzania. BMJ Open 2021; 11:e046125. [PMID: 34446483 PMCID: PMC8395349 DOI: 10.1136/bmjopen-2020-046125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 08/02/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Leprosy, or Hansen's disease, remains a cause of preventable disability. Early detection, treatment and prevention are key to reducing transmission. Post-exposure prophylaxis with single-dose rifampicin (SDR-PEP) reduces the risk of developing leprosy when administered to screened contacts of patients. This has been adopted in the WHO leprosy guidelines. The PEP4LEP study aims to determine the most effective and feasible method of screening people at risk of developing leprosy and administering chemoprophylaxis to contribute to interrupting transmission. METHODS AND ANALYSIS PEP4LEP is a cluster-randomised implementation trial comparing two interventions of integrated skin screening combined with SDR-PEP distribution to contacts of patients with leprosy in Ethiopia, Mozambique and Tanzania. One intervention is community-based, using skin camps to screen approximately 100 community contacts per leprosy patient, and to administer SDR-PEP when eligible. The other intervention is health centre-based, inviting household contacts of leprosy patients to be screened in a local health centre and subsequently receive SDR-PEP when eligible. The mobile health (mHealth) tool SkinApp will support health workers' capacity in integrated skin screening. The effectiveness of both interventions will be compared by assessing the rate of patients with leprosy detected and case detection delay in months, as well as feasibility in terms of cost-effectiveness and acceptability. ETHICS AND DISSEMINATION Ethical approval was obtained from the national ethical committees of Ethiopia (MoSHE), Mozambique (CNBS) and Tanzania (NIMR/MoHCDEC). Study results will be published open access in peer-reviewed journals, providing evidence for the implementation of innovative leprosy screening methods and chemoprophylaxis to policymakers. TRIAL REGISTRATION NUMBER NL7294 (NTR7503).
Collapse
Affiliation(s)
| | - Thomas Hambridge
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robin van Wijk
- Medical Technical Department, NLR, Amsterdam, The Netherlands
| | - Christa Kasang
- Deutsche Lepra- und Tuberkulosehilfe e.V, Wuerzburg, Germany
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Kidist Bobosha
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Fernando Mitano
- Lúrio University, Nampula, Mozambique
- Nampula Provincial Health Directorate, Ministry of Health Mozambique, Maputo, Mozambique
| | - Stephen E Mshana
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, United Republic of Tanzania
| | - Ephrem Mamo
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | - Nelly Mwageni
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, United Republic of Tanzania
| | - Taye Letta
- Ministry of Health Ethiopia, Addis Ababa, Ethiopia
| | - Artur Manuel Muloliwa
- Lúrio University, Nampula, Mozambique
- Nampula Provincial Health Directorate, Ministry of Health Mozambique, Maputo, Mozambique
| | | | | | | | - Blasdus Njako
- Deutsche Lepra- und Tuberkulosehilfe e.V. Tanzania, Dar es Salaam, United Republic of Tanzania
| | - Liesbeth Mieras
- Medical Technical Department, NLR, Amsterdam, The Netherlands
| |
Collapse
|
28
|
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.
Collapse
Affiliation(s)
- Amal A El-Moamly
- Department of Medical Parasitology, Faculty of Medicine, Suez Canal University, Round Road, Ismailia, Postal Code 41522, Egypt.
| |
Collapse
|
29
|
Asiedu K, Marks M, Hay R. Podoconiosis, skin-NTDs and global health. Trans R Soc Trop Med Hyg 2021; 114:887-888. [PMID: 33169171 DOI: 10.1093/trstmh/traa069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/23/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kingsley Asiedu
- Department of Control of Neglected Tropical Diseases, World Health Organisation, Geneva, Switzerland
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Roderick Hay
- Kings College London and the International Foundation for Dermatology, London, United Kingdom
| |
Collapse
|
30
|
Carrion C, Robles N, Sola-Morales O, Aymerich M, Ruiz Postigo JA. Mobile Health Strategies to Tackle Skin Neglected Tropical Diseases With Recommendations From Innovative Experiences: Systematic Review. JMIR Mhealth Uhealth 2020; 8:e22478. [PMID: 33382382 PMCID: PMC7808891 DOI: 10.2196/22478] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/28/2020] [Accepted: 11/20/2020] [Indexed: 12/12/2022] Open
Abstract
Background Neglected tropical diseases (NTDs) represent a diverse group of 20 communicable diseases that occur in tropical and subtropical areas in 149 countries, affecting over 1 billion people and costing developing economies billions of dollars every year. Within these diseases, those that present lesions on the skin surface are classified as skin NTDs (sNTDs). Mobile health interventions are currently being used worldwide to manage skin diseases and can be a good strategy in the epidemiological and clinical management of sNTDs. Objective We aimed to analyze existing evidence about mobile health interventions to control and manage sNTDs in low- and middle-income countries (LMICs) and make recommendations for what should be considered in future interventions. Methods A systematic review was conducted of the MEDLINE, Embase, and Scopus databases over 10 years up to April 30, 2020. All types of clinical studies were considered. Data were synthesized into evidence tables. Apps were selected through a comprehensive systematic search in the Google Play Store and Apple App Store conducted between March 20 and April 15, 2020. Results From 133 potentially relevant publications, 13 studies met our criteria (9.8%). These analyzed eight different interventions (three SMS text messaging interventions and five app interventions). Six of the 13 (46%) studies were community-based cross-sectional studies intended to epidemiologically map a specific disease, mainly lymphatic filariasis, but also cutaneous leishmaniasis, leprosy, and NTDs, as well as sNTDs in general. Most of the studies were considered to have a high (5/13, 39%) or moderate (4/13, 31%) risk of bias. Fifteen apps were identified in the Google Play Store, of which three were also in the Apple App Store. Most of the apps (11/15, 73%) were targeted at health care professionals, with only four targeted at patients. The apps focused on scabies (3/15, 20%), lymphatic filariasis (3/15, 20%), cutaneous leishmaniasis (1/15, 7%), leprosy (1/15, 7%), yaws and Buruli ulcer (1/15, 7%), tropical diseases including more than one sNTDs (3/15, 20%), and NTDs including sNTDs (2/15, 13%). Only 1 (7%) app focused on the clinical management of sNTDs. Conclusions All mobile health interventions that were identified face technological, legal, final user, and organizational issues. There was a remarkable heterogeneity among studies, and the majority had methodological limitations that leave considerable room for improvement. Based on existing evidence, eight recommendations have been made for future interventions.
Collapse
Affiliation(s)
- Carme Carrion
- eHealth Lab Research Group, School of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.,eHealth Center, Universitat Oberta de Catalunya, Barcelona, Spain.,Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Barcelona, Spain
| | - Noemí Robles
- eHealth Lab Research Group, School of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.,eHealth Center, Universitat Oberta de Catalunya, Barcelona, Spain.,Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Barcelona, Spain
| | | | - Marta Aymerich
- eHealth Lab Research Group, School of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.,eHealth Center, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Jose Antonio Ruiz Postigo
- Prevention, Treatment and Care Unit, Department of Control of Neglected Tropical Diseases, World Health Organization, Geneve, Switzerland
| |
Collapse
|
31
|
De Carvalho AG, Guimarães Luz JG, Leite Dias JV, Tiwari A, Steinmann P, Ignotti E. Hyperendemicity, heterogeneity and spatial overlap of leprosy and cutaneous leishmaniasis in the southern Amazon region of Brazil. GEOSPATIAL HEALTH 2020; 15. [PMID: 33461274 DOI: 10.4081/gh.2020.892] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 07/13/2020] [Indexed: 06/12/2023]
Abstract
Neglected tropical diseases characterized by skin lesions are highly endemic in the state of Mato Grosso, Brazil. We analyzed the spatial distribution of leprosy and Cutaneous Leishmaniasis (CL) and identified the degree of overlap in their distribution. All new cases of leprosy and CL reported between 2008 and 2017 through the national reporting system were included in the study. Scan statistics together with univariate Global and Local Moran's I were employed to identify clusters and spatial autocorrelation for each disease, with the spatial correlation between leprosy and CL measured by bivariate Global and Local Moran's I. Finally, we evaluated the demographic characteristics of the patients. The number of leprosy (N = 28,204) and CL (N = 24,771) cases in Mato Grosso and the highly smoothed detection coefficients indicated hyperendemicity and spatial distribution heterogeneity. Scan statistics demonstrated overlap of high-risk clusters for leprosy (RR = 2.0; P <0.001) and CL (RR = 4.0; P <0.001) in the North and Northeast mesoregions. Global Moran's I revealed a spatial autocorrelation for leprosy (0.228; P = 0.001) and CL (0.311; P = 0.001) and a correlation between them (0.164; P = 0.001). Both diseases were found to be concentrated in urban areas among men aged 31-60 years, of brown-skinned ethnicity and with a low educational level. Our findings indicate a need for developing integrated and spatially as well as socio-demographically targeted public health policies.
Collapse
Affiliation(s)
- Amanda Gabriela De Carvalho
- School of Medicine, Institute of Exact and Natural Sciences, Federal University of Rondonópolis, Rondonópolis; School of Medicine, Post-Graduation Program in Health Sciences, Federal University of Mato Grosso, Cuiabá, Mato Grosso.
| | - João Gabriel Guimarães Luz
- School of Medicine, Institute of Exact and Natural Sciences, Federal University of Rondonópolis, Rondonópolis, Brazil; Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - João Victor Leite Dias
- School of Medicine, Federal University of Jequitinhonha and Mucuri Valleys, Teófilo Otoni, Minas Gerais, Brazil.
| | - Anuj Tiwari
- Department of Public Health, Erasmus University Medical Center, Rotterdam.
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel.
| | - Eliane Ignotti
- School of Medicine, Post-Graduation Program in Health Sciences, Federal University of Mato Grosso, Cuiabá, Mato Grosso; School of Health Sciences, Post-Graduation Program Environment Sciences, State University of Mato Grosso, Cáceres, Mato Grosso.
| |
Collapse
|
32
|
A scabies outbreak in the North East Region of Ghana: The necessity for prompt intervention. PLoS Negl Trop Dis 2020; 14:e0008902. [PMID: 33351803 PMCID: PMC7787682 DOI: 10.1371/journal.pntd.0008902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 01/06/2021] [Accepted: 10/19/2020] [Indexed: 02/05/2023] Open
Abstract
Background There is a dearth of data on scabies from Ghana. In September 2019, local health authorities in the East Mamprusi district of northern Ghana received reports of scabies from many parts of the district. Due to on-going reports of more cases, an assessment team visited the communities to assess the effect of the earlier individual treatment on the outbreak. The assessment team furthermore aimed to contribute to the data on scabies burden in Ghana and to demonstrate the use of the International Alliance for the Control of Scabies (IACS) diagnostic tool in a field survey in a resource limited setting. Methodology/Principal findings This was a cross sectional study. Demographic information and medical history was collected on all participants using a REDCap questionnaire. A standardised skin examination of exposed regions of the body was performed on all participants. Scabies was diagnosed based on the criteria of the International Alliance for the Control of Scabies (IACS). Participants were mostly female (61.5%) and had a median age of 18.8 years (IQR 13–25). Two hundred out of 283 (71%) of participants had scabies with most (47%) presenting with moderate disease. Impetigo was found in 22% of participants with scabies and 10.8% of those without scabies [RR 2.27 (95% CI 1.21–4.27)]. 119 participants who received scabies treatment in the past months still had clinical evidence of the disease. 97% of participants reported a recent scabies contact. Scabies was commoner in participants ≤16 years compared to those >16 years [RR 3.06 (95% CI 1.73–5.45)]. Conclusion/Significance The prevalence of scabies was extremely high. The lack of a systematic approach to scabies treatment led to recurrence and ongoing community spread. The IACS criteria was useful in this outbreak assessment in Ghana. Alternative strategies such as Mass drug administration may be required to contain outbreaks early in such settings. Scabies, recently categorised as a Neglected Tropical Disease by the WHO is caused by infestation with Sarcoptes scabiei and is characterised by intense pruritus and rash that typically involves the genitalia and the web spaces of the fingers and toes. It has a large global burden and is associated with significant morbidity and socio-economic burden. Secondary bacterial infections following scabies can lead to significant complications including chronic kidney disease from glomerulonephritis and possibly rheumatic heart disease. An outbreak of scabies was reported in Ghana’s East Mamprusi district in September 2019. Despite earlier treatment of individual cases, scabies prevalence was 71%. About 19% of participants had impetigo which was mostly mild in severity. Absence of a systematic approach to treat scabies led to recurrence and ongoing community spread. The recently published IACS criteria for diagnosing scabies proved useful in this outbreak assessment in Ghana. Alternative strategies such as Mass drug administration may be required to contain outbreaks in such settings.
Collapse
|
33
|
Engelman D, Yoshizumi J, Hay R, Osti M, Micali G, Norton S, Walton S, Boralevi F, Bernigaud C, Bowen A, Chang A, Chosidow O, Estrada‐Chavez G, Feldmeier H, Ishii N, Lacarrubba F, Mahé A, Maurer T, Mahdi M, Murdoch M, Pariser D, Nair P, Rehmus W, Romani L, Tilakaratne D, Tuicakau M, Walker S, Wanat K, Whitfeld M, Yotsu R, Steer A, Fuller L. The 2020 International Alliance for the Control of Scabies Consensus Criteria for the Diagnosis of Scabies. Br J Dermatol 2020; 183:808-820. [PMID: 32034956 PMCID: PMC7687112 DOI: 10.1111/bjd.18943] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Scabies is a common parasitic skin condition that causes considerable morbidity globally. Clinical and epidemiological research for scabies has been limited by a lack of standardization of diagnostic methods. OBJECTIVES To develop consensus criteria for the diagnosis of common scabies that could be implemented in a variety of settings. METHODS Consensus diagnostic criteria were developed through a Delphi study with international experts. Detailed recommendations were collected from the expert panel to define the criteria features and guide their implementation. These comments were then combined with a comprehensive review of the available literature and the opinion of an expanded group of international experts to develop detailed, evidence-based definitions and diagnostic methods. RESULTS The 2020 International Alliance for the Control of Scabies (IACS) Consensus Criteria for the Diagnosis of Scabies include three levels of diagnostic certainty and eight subcategories. Confirmed scabies (level A) requires direct visualization of the mite or its products. Clinical scabies (level B) and suspected scabies (level C) rely on clinical assessment of signs and symptoms. Evidence-based, consensus methods for microscopy, visualization and clinical symptoms and signs were developed, along with a media library. CONCLUSIONS The 2020 IACS Criteria represent a pragmatic yet robust set of diagnostic features and methods. The criteria may be implemented in a range of research, public health and clinical settings by selecting the appropriate diagnostic levels and subcategories. These criteria may provide greater consistency and standardization for scabies diagnosis. Validation studies, development of training materials and development of survey methods are now required. What is already known about this topic? The diagnosis of scabies is limited by the lack of accurate, objective tests. Microscopy of skin scrapings can confirm the diagnosis, but it is insensitive, invasive and often impractical. Diagnosis usually relies on clinical assessment, although visualization using dermoscopy is becoming increasingly common. These diagnostic methods have not been standardized, hampering the interpretation of findings from clinical research and epidemiological surveys, and the development of scabies control strategies. What does this study add? International consensus diagnostic criteria for common scabies were developed through a Delphi study with global experts. The 2020 International Alliance for the Control of Scabies (IACS) Criteria categorize diagnosis at three levels of diagnostic certainty (confirmed, clinical and suspected scabies) and eight subcategories, and can be adapted to a range of research and public health settings. Detailed definitions and figures are included to aid training and implementation. The 2020 IACS Criteria may facilitate the standardization of scabies diagnosis.
Collapse
|
34
|
Fuller LC, Asiedu KB, Hay RJ. Integration of Management Strategies for Skin-Related Neglected Tropical Diseases. Dermatol Clin 2020; 39:147-152. [PMID: 33228857 DOI: 10.1016/j.det.2020.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The concept of skin neglected tropical diseases has been widely adopted into the policy and strategy of various organizations, governments, nongovernmental organizations, and health agencies. By pooling information and resources across different diseases, whose primary manifestations affect the skin, it is possible to deliver integrated surveillance and control programs and promote advocacy and reduction of disability and stigma. A further key part of the skin neglected tropical diseases program is the development and validation of training methods for front-line health workers. Networks that allow those involved in this work to share and compare expertise are being developed through various organizations.
Collapse
Affiliation(s)
- Lucinda Claire Fuller
- Chelsea and Westminster NHS Foundation Trust, London SW10 9NH, UK; The International Foundation for Dermatology, London W1P 5HQ, UK.
| | - Kingsley B Asiedu
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva 1202, Switzerland
| | - Roderick J Hay
- The International Foundation for Dermatology, London W1P 5HQ, UK; The St John's Institute of Dermatology, King's College London, London SE1 9RT. UK
| |
Collapse
|
35
|
Cox V, Fuller LC, Engelman D, Steer A, Hay RJ. Estimating the global burden of scabies: what else do we need? Br J Dermatol 2020; 184:237-242. [PMID: 32358799 DOI: 10.1111/bjd.19170] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2020] [Indexed: 02/06/2023]
Abstract
Scabies is one of the most common disorders identified in any estimate of global skin disease prevalence. Furthermore, quantifying its impact on individuals and societies has been problematic. There has been a lack of clear case definitions and laboratory tests. There have been few epidemiological studies, particularly those focusing on low-income countries, variation in prevalence within high-income countries, or estimates of the effect of scabies on health beyond the skin, such as renal disease or mental wellbeing. Economic studies are also lacking. However, the new strategy of integrating surveillance for skin Neglected Tropical Diseases may well produce advancements on these issues, in addition to providing an overarching structure for health improvement and disease control.
Collapse
Affiliation(s)
- V Cox
- Royal Darwin Hospital, Darwin, Australia
| | - L C Fuller
- International Foundation for Dermatology, London, UK.,Chelsea and Westminster NHS Foundation Trust, London, UK
| | - D Engelman
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Melbourne Children's Global Health, Melbourne, Australia
| | - A Steer
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Melbourne Children's Global Health, Melbourne, Australia
| | - R J Hay
- International Foundation for Dermatology, London, UK.,St John's Institute of Dermatology, King's College London, London, UK
| |
Collapse
|
36
|
Padovese V, Dassoni F, Morrone A. Scabies coexisting with other dermatoses: the importance of recognizing multiple pathologies in resource‐poor settings. Int J Dermatol 2020; 59:1502-1505. [DOI: 10.1111/ijd.15023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/15/2020] [Accepted: 05/28/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Valeska Padovese
- Department of Dematology and Venerology Genito‐Urinary Clinic Mater Dei Hospital Msida Malta
- Ayder Referral Hospital Mekelle Ethiopia
| | | | - Aldo Morrone
- San Gallicano Dermatological Institute Rome Italy
| |
Collapse
|
37
|
Chandler DJ, Grijsen ML, Fuller LC. With Bare Feet in the Soil: Podoconiosis, a Neglected Cause of Tropical Lymphoedema. Dermatology 2020; 237:236-247. [PMID: 32101870 DOI: 10.1159/000506045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/19/2020] [Indexed: 11/19/2022] Open
Abstract
Podoconiosis is a form of lymphoedema that occurs in tropical highland areas in genetically susceptible individuals who are exposed to irritant volcanic soils. The disease is preventable through consistent use of footwear and attention to foot hygiene; however, in endemic areas there is a strong barefoot tradition, and many cannot afford shoes. Patients with podoconiosis face significant physical disability, psychological comorbidity, reduced quality of life and experience frequent episodes of systemic illness due to acute dermatolymphangioadenitis. This review provides an overview of this important and neglected tropical skin disease and summarizes the latest research findings.
Collapse
Affiliation(s)
- David J Chandler
- Dermatology Department, Brighton General Hospital, Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom,
| | - Marlous L Grijsen
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | - Lucinda C Fuller
- Department of Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom.,International Foundation for Dermatology, London, United Kingdom
| |
Collapse
|
38
|
Prochazka M, Timothy J, Pullan R, Kollie K, Rogers E, Wright A, Palmer J. "Buruli ulcer and leprosy, they are intertwined": Patient experiences of integrated case management of skin neglected tropical diseases in Liberia. PLoS Negl Trop Dis 2020; 14:e0008030. [PMID: 32023242 PMCID: PMC7001903 DOI: 10.1371/journal.pntd.0008030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 01/06/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Skin neglected tropical diseases (NTDs) such as Buruli ulcer (BU) and leprosy produce significant stigma and disability. Shared clinical presentations and needs for care present opportunities for integrated case management in co-endemic areas. As global policies are translated into local integrated services, there remains a need to monitor what new configurations of care emerge and how individuals experience them. METHODS To explore patient experiences of integrated case management for skin NTDs, in 2018, we conducted a field-based qualitative case series in a leprosy rehabilitation centre in Ganta, Liberia where BU services were recently introduced. Twenty patients with BU (n = 10) and leprosy (n = 10) participated in in-depth interviews that incorporated photography methods. We contextualised our findings with field observations and unstructured interviews with health workers. FINDINGS The integration of care for BU and leprosy prompted new conceptualisations of these diseases and experiences of NTD stigma. Some patients felt anxiety about using services because they feared being infected with the other disease. Other patients viewed the two diseases as 'intertwined': related manifestations of the same condition. Configurations of inter-disease stigma due to fear of transmission were buffered by joint health education sessions which also appeared to facilitate social support between patients in the facility. For both diseases, medication and wound care were viewed as the cornerstones of care and appreciated as interventions that led to rehabilitation of the whole patient group through shared experiences of healing, avoidance of physical deformities and stigma reduction. Patient accounts of intense pain during wound care for BU and inability of staff to manage severe complications, however, exposed some shortcomings of medical care for the newly integrated service, as did patient fears of long-lasting disability due to lack of physiotherapy services. SIGNIFICANCE Under integrated care policies, the possibility of new discourses about skin NTD identities emerging along with new configurations of stigma may have unanticipated consequences for patients' experiences of case management. The social experience of integrated medication and wound dressing has the potential to link patients within a single, supportive patient community. Control programmes with resource constraints should anticipate potential challenges of integrating care, including the need to ameliorate lasting disability and provide adequate clinical management of severe BU cases.
Collapse
Affiliation(s)
- Mateo Prochazka
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joseph Timothy
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rachel Pullan
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Karsor Kollie
- Liberia Ministry of Health and Social Welfare, Monrovia, Liberia
| | - Emerson Rogers
- Liberia Ministry of Health and Social Welfare, Monrovia, Liberia
| | - Abednego Wright
- Liberia Ministry of Health and Social Welfare, Monrovia, Liberia
| | - Jennifer Palmer
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
39
|
Handley BL, Butcher R, Taoaba R, Roberts CH, Cama A, Müeller A, Solomon AW, Tekeraoi R, Marks M. Absence of Serological Evidence of Exposure to Treponema pallidum among Children Suggests Yaws Is No Longer Endemic in Kiribati. Am J Trop Med Hyg 2020; 100:940-942. [PMID: 30719964 PMCID: PMC6447131 DOI: 10.4269/ajtmh.18-0799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Yaws is a neglected tropical disease targeted for eradication by 2020. Kiribati, a Pacific Island nation, was previously endemic for yaws but lacks recent data from which its current endemicity status could be determined. This study tested antibody responses to Treponema pallidum to determine if transmission of yaws is taking place among children in Kiribati. Using a commercially available T. pallidum particle agglutination kit (Serodia®, Fujirebio Inc., Tokyo, Japan), we tested dried blood spots, collected during population-based trachoma prevalence surveys on Tarawa Atoll and Kiritimati Island, for long-lived treponemal antibodies. Dried blood spots from 1,420 children aged 1-9 years were tested. Only two were positive, suggesting T. pallidum is not being widely transmitted among children in the settings sampled. These data require support from additional surveys to demonstrate the absence of clinical signs of disease and molecular evidence of infection, to confirm that yaws is no longer endemic in Kiribati.
Collapse
Affiliation(s)
- Becca L Handley
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Robert Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Raebwebwe Taoaba
- Eye Department, Ministry of Health and Medical Services, South Tarawa, Kiribati
| | - Chrissy H Roberts
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anasaini Cama
- The International Agency for the Prevention of Blindness, Melbourne, Australia.,The Fred Hollows Foundation, Sydney, Australia
| | - Andreas Müeller
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.,Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.,Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rabebe Tekeraoi
- Eye Department, Ministry of Health and Medical Services, South Tarawa, Kiribati
| | - Michael Marks
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
40
|
Lopes MJ, da Silva ET, Ca J, Gonçalves A, Rodrigues A, Mandjuba C, Nakutum J, D'Alessandro U, Achan J, Logan J, Bailey R, Last A, Walker S, Marks M. Perceptions, attitudes and practices towards scabies in communities on the Bijagós Islands, Guinea-Bissau. Trans R Soc Trop Med Hyg 2020; 114:49-56. [PMID: 31722016 PMCID: PMC6974396 DOI: 10.1093/trstmh/trz102] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Scabies is highly endemic among impoverished populations and has been recently included in the WHO's list of neglected tropical diseases (NTDs). Community support and behavioural changes are essential for the success of control interventions. This study aimed to explore beliefs, prevention attitudes and healthcare-seeking behaviours towards scabies in the Bijagós Archipelago of Guinea-Bissau. METHODS Data were collected through two methods. Community key informants (community members, community health workers, healthcare workers and traditional healers) were interviewed using snowball sampling. A questionnaire covering perceptions, attitudes and practices was administered to community members using random cluster sampling. Thematic analysis of qualitative data was applied to identify themes. Descriptive statistics were used for quantitative data analysis. RESULTS There was a satisfactory awareness about scabies, but perceptions about disease causation and transmission were imprecise. Misconceptions about personal hygiene as the primary measure for scabies prevention were recurrent. Some participants recognised the importance of early treatment to interrupt transmission. Treatment of close contacts was not considered important. Costs were the main determining factor for treatment choice between traditional healer and the local health centre. Late presentation and delayed treatment were common and associated with poverty and stigmatisation. Scabies impaired quality of life by affecting social interactions, health, fitness to work and school attendance. CONCLUSIONS There is a need to improve education, recognition, management and affordable access to treatment. Community education, healthcare workers' training and skin NTD integrated control programmes should address the challenges highlighted in this study.
Collapse
Affiliation(s)
- Maria João Lopes
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Infectious Diseases Department, Hospital Prof. Doutor Fernando Fonseca, IC 19, 2720-276 Amadora, Portugal
| | | | - Janete Ca
- Region Sanitaria Bolama-Bijagós, Bubaque, Guinea-Bissau
| | - Adriana Gonçalves
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | | | - Cristóvão Mandjuba
- Ministry of Public Health, Avenida Unidade Africana, 26, Bissau, Guinea-Bissau
| | - Jose Nakutum
- Region Sanitaria Bolama-Bijagós, Bubaque, Guinea-Bissau
| | - Umberto D'Alessandro
- MRC Unit The Gambia at London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara P.O. Box 273, Banjul, The Gambia
| | - Jane Achan
- MRC Unit The Gambia at London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Fajara P.O. Box 273, Banjul, The Gambia
| | - James Logan
- Disease Control Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Robin Bailey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK
| | - Anna Last
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK
| | - Steve Walker
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, UK
| |
Collapse
|
41
|
Schmid‐Grendelmeier P, Takaoka R, Ahogo K, Belachew W, Brown S, Correia J, Correia M, Degboe B, Dorizy‐Vuong V, Faye O, Fuller L, Grando K, Hsu C, Kayitenkore K, Lunjani N, Ly F, Mahamadou G, Manuel R, Kebe Dia M, Masenga E, Muteba Baseke C, Ouedraogo A, Rapelanoro Rabenja F, Su J, Teclessou J, Todd G, Taïeb A. Position Statement on Atopic Dermatitis in Sub-Saharan Africa: current status and roadmap. J Eur Acad Dermatol Venereol 2019; 33:2019-2028. [PMID: 31713914 PMCID: PMC6899619 DOI: 10.1111/jdv.15972] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/05/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The first International Society of Atopic Dermatitis (ISAD) global meeting dedicated to atopic dermatitis (AD) in Sub-Saharan Africa (SSA) was held in Geneva, Switzerland in April 2019. A total of 30 participants were present at the meeting, including those from 17 SSA countries, representatives of the World Health Organization (WHO), the International Foundation for Dermatology (IFD) (a committee of the International League of Dermatological Societies, ILDS www.ilds.org), the Fondation pour la Dermatite Atopique, as well as specialists in telemedicine, artificial intelligence and therapeutic patient education (TPE). RESULTS AD is one of the most prevalent chronic inflammatory skin diseases in SSA. Besides neglected tropical diseases (NTDs) with a dermatological presentation, AD requires closer attention from the WHO and national Departments of Health. CONCLUSIONS A roadmap has been defined with top priorities such as access to essential medicines and devices for AD care, in particular emollients, better education of primary healthcare workers for adequate triage (e.g. better educational materials for skin diseases in pigmented skin generally and AD in particular, especially targeted to Africa), involvement of traditional healers and to a certain extent also patient education, bearing in mind the barriers to effective healthcare faced in SSA countries such as travel distances to health facilities, limited resources and the lack of dermatological expertise. In addition, several initiatives concerning AD research in SSA were discussed and should be implemented in close collaboration with the WHO and assessed at follow-up meetings, in particular, at the next ISAD meeting in Seoul, South Korea and African Society of Dermatology and Venereology (ASDV) meeting in Nairobi, Kenya, both in 2020.
Collapse
Affiliation(s)
| | - R. Takaoka
- Department of DermatologyUniversity of São Paulo Medical SchoolSão PauloBrazil
| | - K.C. Ahogo
- Département de médecine et Spécialités MédicalesDermatologie et VénérologieCHU TreichvilleUniversité Félix Houphouët‐Boigny UFR Sciences MédicalesAbidjanCôte d'Ivoire
| | - W.A. Belachew
- College of Health ScienceAyder Comprehensive Specialized Teaching HospitalMekelle UniversityMekelleEthiopia
| | - S.J. Brown
- Skin Research GroupSchool of MedicineNinewells Hospital & Medical SchoolUniversity of DundeeDundeeUK
| | - J.C. Correia
- Division of Therapeutic Education for Chronic DiseasesWHO Collaborating CenterDepartment of First Aid MedecineGeneva University HospitalsGenevaSwitzerland
| | - M. Correia
- Department of DermatologyHospital Cuf Descobertas and Hospital Cuf Torres VedrasTorres VedrasPortugal
| | - B. Degboe
- Department of DermatologyFaculty of Health SciencesNational and Teaching Hospital HKM of CotonouUniversity of Abomey‐CalaviCotonouBenin
| | - V. Dorizy‐Vuong
- Department of Adult and Pediatric DermatologyCHU BordeauxBordeauxFrance
- INSERM U 1035University of BordeauxBordeauxFrance
| | - O. Faye
- Department of DermatologyFaculty of MedicineCNAMBamakoMali
| | - L.C. Fuller
- Chair of International Foundation for DermatologyChelsea and Westminster HospitalLondonUK
| | - K. Grando
- Allergy UnitDepartment of DermatologyUniversity HospitalZurichSwitzerland
| | - C. Hsu
- Department of DermatologyTeledermatology and AIUniversity Hospital of BaselBaselSwitzerland
| | - K. Kayitenkore
- Kigali Dermatology CenterUniversity of RwandaKigaliRwanda
| | - N. Lunjani
- University of Cape TownCape TownSouth Africa
| | - F. Ly
- Université Cheikh Anta DiopDakarSenegal
| | - G. Mahamadou
- Department of Adult and Pediatric DermatologyCHU BordeauxBordeauxFrance
- Service de Dermatologie‐VénéréologieCHU Sylvanus OlympioLoméTogo
| | - R.C.F. Manuel
- Department of DermatologyMinistry of HealthHospital Central de MaputoMaputoMozambique
| | | | - E.J. Masenga
- Regional Dermatology Training CenterKilimanjaro Christian Medical University CollegeMoshiTanzania
| | | | - A.N. Ouedraogo
- University Hospital Yalgado Ouedraogo of OuagadougouUniversity Ouaga I Pr Joseph Ki‐Zerbo OuagadougouOuagadougouBurkina Faso
| | - F. Rapelanoro Rabenja
- Department of DermatologyUniversity Hospital Joseph Raseta BefelatananaAntananarivoMadagascar
| | - J. Su
- Department of PaediatricsMurdoch Children's Research InstituteRoyal Children's HospitalThe University of MelbourneParkvilleVictoriaAustralia
| | - J.N. Teclessou
- Service dermatologie et ISTCHU Sylvanus OlympioUniversité de LoméLoméTogo
| | - G. Todd
- Department of MedicineUniversity of Cape TownCape TownSouth Africa
| | - A. Taïeb
- Department of Adult and Pediatric DermatologyCHU BordeauxBordeauxFrance
- INSERM U 1035University of BordeauxBordeauxFrance
| |
Collapse
|
42
|
Hay R, Denning DW, Bonifaz A, Queiroz-Telles F, Beer K, Bustamante B, Chakrabarti A, Chavez-Lopez MDG, Chiller T, Cornet M, Estrada R, Estrada-Chavez G, Fahal A, Gomez BL, Li R, Mahabeer Y, Mosam A, Soavina Ramarozatovo L, Rakoto Andrianarivelo M, Rapelanoro Rabenja F, van de Sande W, Zijlstra EE. The Diagnosis of Fungal Neglected Tropical Diseases (Fungal NTDs) and the Role of Investigation and Laboratory Tests: An Expert Consensus Report. Trop Med Infect Dis 2019; 4:E122. [PMID: 31554262 PMCID: PMC6958312 DOI: 10.3390/tropicalmed4040122] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/18/2019] [Accepted: 09/06/2019] [Indexed: 02/07/2023] Open
Abstract
The diagnosis of fungal Neglected Tropical Diseases (NTD) is primarily based on initial visual recognition of a suspected case followed by confirmatory laboratory testing, which is often limited to specialized facilities. Although molecular and serodiagnostic tools have advanced, a substantial gap remains between the desirable and the practical in endemic settings. To explore this issue further, we conducted a survey of subject matter experts on the optimal diagnostic methods sufficient to initiate treatment in well-equipped versus basic healthcare settings, as well as optimal sampling methods, for three fungal NTDs: mycetoma, chromoblastomycosis, and sporotrichosis. A survey of 23 centres found consensus on the key role of semi-invasive sampling methods such as biopsy diagnosis as compared with swabs or impression smears, and on the importance of histopathology, direct microscopy, and culture for mycetoma and chromoblastomycosis confirmation in well-equipped laboratories. In basic healthcare settings, direct microscopy combined with clinical signs were reported to be the most useful diagnostic indicators to prompt referral for treatment. The survey identified that the diagnosis of sporotrichosis is the most problematic with poor sensitivity across the most widely available laboratory tests except fungal culture, highlighting the need to improve mycological diagnostic capacity and to develop innovative diagnostic solutions. Fungal microscopy and culture are now recognized as WHO essential diagnostic tests and better training in their application will help improve the situation. For mycetoma and sporotrichosis, in particular, advances in identifying specific marker antigens or genomic sequences may pave the way for new laboratory-based or point-of-care tests, although this is a formidable task given the large number of different organisms that can cause fungal NTDs.
Collapse
Affiliation(s)
- Roderick Hay
- The International Foundation for Dermatology, London W1T 5HQ, UK.
| | - David W Denning
- The Global Fund for Fungal Infections, 1208 Geneva, Switzerland, and the University of Manchester, Manchester M13 9PL, UK.
| | - Alexandro Bonifaz
- Hospital General de México, "Dr. Eduardo Liceaga", CP 06720, Mexico.
| | - Flavio Queiroz-Telles
- Department of Public Health, Hospital de Clinicas, Federal University of Parana, 80060-900 Curriba, Parana, Brazil.
| | - Karlyn Beer
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
| | - Beatriz Bustamante
- Tropical Medicine, Infectious Diseases and Dermatology Department at the Hospital Cayetano Heredia, Lima 15102, Peru.
| | | | | | - Tom Chiller
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
| | - Muriel Cornet
- Laboratoire de Parasitologie-Mycologie, Grenoble Alpes University, CNRS, Grenoble INP, CHU Grenoble Alpes, F-38000, France.
| | - Roberto Estrada
- Community Dermatology Mexico C.A., Acapulco 39850, Guerrero, Mexico.
| | | | - Ahmed Fahal
- The Mycetoma Research Centre, Khartoum, Soba University Hospital, P.O. Box 102, Sudan.
| | - Beatriz L Gomez
- School of Medicine and Health Sciences, Universidad del Rosario, Bogota 111211, Colombia.
| | - Ruoyu Li
- Peking University First Hospital, Research Centre for Medical Mycology, Peking University, Beijing 100034, China.
| | - Yesholata Mahabeer
- Department of Medical Microbiology, National Health Laboratory Services and School of Laboratory Medicine and Medical Sciences, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Berea, Durban 4001, South Africa.
| | - Anisa Mosam
- Nelson R Mandela School of Medicine, University of Kwazulu Natal, Berea, Durban 4001, South Africa.
| | | | | | | | - Wendy van de Sande
- Erasmus MC, Department of Medical Microbiology and Infectious Diseases, 3000 CA Rotterdam, The Netherlands.
| | | |
Collapse
|
43
|
Dean L, Tolhurst R, Nallo G, Kollie K, Bettee A, Theobald S. Neglected tropical disease as a 'biographical disruption': Listening to the narratives of affected persons to develop integrated people centred care in Liberia. PLoS Negl Trop Dis 2019; 13:e0007710. [PMID: 31490931 PMCID: PMC6750611 DOI: 10.1371/journal.pntd.0007710] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 09/18/2019] [Accepted: 08/15/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Integrated disease management, disability and inclusion (DMDI) for NTDs is increasingly prioritised. There is limited evidence on the effectiveness of integrated DMDI from the perspective of affected individuals and how this varies by differing axes of inequality such as age, gender, and disability. We used narrative methods to consider how individuals' unique positions of power and privilege shaped their illness experience, to elucidate what practical and feasible steps could support integrated DMDI in Liberia and beyond. METHODS We purposively selected 27 participants affected by the clinical manifestations of lymphatic filariasis, leprosy, Buruli Ulcer, and onchocerciasis from three counties in Liberia to take part in illness narrative interviews. Participants were selected to ensure maximum variation in age, gender and clinical manifestation. Narrative analysis was grounded within feminist intersectional theory. FINDINGS For all participants, chronic illness, morbidity and disability associated with NTDs represented a key moment of 'biographical disruption' triggering the commencement of a restitution narrative. Complex health seeking pathways, aetiologies and medical syncretism meant that adoption of the 'sick role' was initially acceptable, but when the reality of permanency of condition was identified, a transition to periods of chaos and significant psycho-social difficulty occurred. An intersectional lens emphasises how biographical disruption is mediated by intersecting social processes. Gender, generation, and disability were all dominant axes of social inequity shaping experience. SIGNIFICANCE This is one of the first studies to use narrative approaches to interrogate experience of chronic disabling conditions within LMICs and is the only study to apply such an analysis to NTDs. The emotive power of narrative should be utilised to influence the value base of policy makers to ensure that DMDI strategies respond holistically to the needs of the most marginalised, thus contributing to more equitable people-centred care.
Collapse
Affiliation(s)
- Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
- * E-mail:
| | - Rachel Tolhurst
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Gartee Nallo
- University of Liberia, Pacific Institute for Research and Evaluation, Monrovia, Monsterrado, Liberia
| | - Karsor Kollie
- Neglected Tropical Disease Programme, Ministry of Health, Government of Liberia, Monrovia, Monsterrado, Liberia
| | - Anthony Bettee
- Neglected Tropical Disease Programme, Ministry of Health, Government of Liberia, Monrovia, Monsterrado, Liberia
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| |
Collapse
|
44
|
Bernigaud C, Samarawickrama GR, Jones MK, Gasser RB, Fischer K. The Challenge of Developing a Single-Dose Treatment for Scabies. Trends Parasitol 2019; 35:931-943. [PMID: 31474559 DOI: 10.1016/j.pt.2019.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/02/2019] [Accepted: 08/04/2019] [Indexed: 11/29/2022]
Abstract
Scabies is a common skin disease with an estimated worldwide incidence of 200 million people infected per year. Its morbidity and mortality is principally due to secondary bacterial infections, a link now well recognized and prompting the recent inclusion of this disease-complex in the WHO list of neglected tropical diseases. The few treatments available are poorly effective against Sarcoptes scabiei eggs and appear to induce resistance in the parasite. An ideal alternative would be a single-dose regimen that kills all developmental stages, including eggs. Drugs used in the veterinary field and applied to other arthropods could be tested experimentally in an established pig-scabies model. Moreover, functional genomics combined with target validation through biochemical research should assist in identifying new drugs.
Collapse
Affiliation(s)
- Charlotte Bernigaud
- QIMR Berghofer Medical Research Institute, Infectious Diseases Program, 300 Herston Road, Herston, Brisbane 4006, Australia; Dermatology Department, AP-HP, Hôpital Henri Mondor, Université Paris-Est, Créteil, France; Research group Dynamyc, EA7380, Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, Université Paris-Est Créteil, Créteil, France
| | - Gangi R Samarawickrama
- QIMR Berghofer Medical Research Institute, Infectious Diseases Program, 300 Herston Road, Herston, Brisbane 4006, Australia
| | - Malcolm K Jones
- School of Veterinary Science, The University of Queensland, Gatton Campus, Gatton, Australia
| | - Robin B Gasser
- Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Melbourne, Australia
| | - Katja Fischer
- QIMR Berghofer Medical Research Institute, Infectious Diseases Program, 300 Herston Road, Herston, Brisbane 4006, Australia.
| |
Collapse
|
45
|
Engelman D, Cantey PT, Marks M, Solomon AW, Chang AY, Chosidow O, Enbiale W, Engels D, Hay RJ, Hendrickx D, Hotez PJ, Kaldor JM, Kama M, Mackenzie CD, McCarthy JS, Martin DL, Mengistu B, Maurer T, Negussu N, Romani L, Sokana O, Whitfeld MJ, Fuller LC, Steer AC. The public health control of scabies: priorities for research and action. Lancet 2019; 394:81-92. [PMID: 31178154 PMCID: PMC11257500 DOI: 10.1016/s0140-6736(19)31136-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/14/2019] [Accepted: 04/25/2019] [Indexed: 12/16/2022]
Abstract
Scabies is a parasitic disease of the skin that disproportionately affects disadvantaged populations. The disease causes considerable morbidity and leads to severe bacterial infection and immune-mediated disease. Scientific advances from the past 5 years suggest that scabies is amenable to population-level control, particularly through mass drug administration. In recognition of these issues, WHO added scabies to the list of neglected tropical diseases in 2017. To develop a global control programme, key operational research questions must now be addressed. Standardised approaches to diagnosis and methods for mapping are required to further understand the burden of disease. The safety of treatments for young children, including with ivermectin and moxidectin, should be investigated. Studies are needed to inform optimum implementation of mass treatment, including the threshold for intervention, target, dosing, and frequency. Frameworks for surveillance, monitoring, and evaluation of control strategies are also necessary.
Collapse
Affiliation(s)
- Daniel Engelman
- Tropical Diseases Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Department of General Medicine, Royal Children's Hospital, Melbourne, VIC, Australia.
| | - Paul T Cantey
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Aileen Y Chang
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Olivier Chosidow
- Department of Dermatology, Hôpital Henri-Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France; Université Paris-Est Créteil Val-de-Marne, Créteil, France
| | - Wendemagegn Enbiale
- Department of Dermatovenerology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Dirk Engels
- Uniting to Combat Neglected Tropical Diseases, Switzerland
| | - Roderick J Hay
- Department of Dermatology, King's College London, London, UK
| | - David Hendrickx
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Peter J Hotez
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - John M Kaldor
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mike Kama
- Ministry of Health and Medical Services, Suva, Fiji
| | | | - James S McCarthy
- QIMR Berghoefer Medical Research Institute, Brisbane, QLD, Australia
| | - Diana L Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Toby Maurer
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | | | - Lucia Romani
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Oliver Sokana
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Margot J Whitfeld
- Department of Dermatology, St Vincent's Hospital, University of New South Wales, Sydney, NSW, Australia
| | - L Claire Fuller
- Chelsea and Westminster Healthcare National Health Service Foundation Trust, London, UK; International Foundation for Dermatology, London, UK
| | - Andrew C Steer
- Tropical Diseases Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Department of General Medicine, Royal Children's Hospital, Melbourne, VIC, Australia
| |
Collapse
|
46
|
Health-Related Quality of Life Impairment among Patients with Different Skin Diseases in Vietnam: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030305. [PMID: 30678097 PMCID: PMC6388287 DOI: 10.3390/ijerph16030305] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 12/11/2022]
Abstract
Skin diseases have caused a heavy burden on the infected population worldwide. This study aimed to examine the health-related quality of life (HRQOL) among patients with different skin diseases and identify associated factors. A cross-sectional study with 430 participants was conducted at the Vietnam National Hospital of Dermatology and Venereology (NHD) from September to November 2018. The EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) instrument was employed, which measures the EQ-5D index from five domains including mobility, self-care, usual activity, pain/discomfort, and anxiety/depression. Multivariate Tobit regression was adopted to determine factors that were associated with HRQOL (EQ-5D index). The rate of atopic dermatitis was the highest with 28.8%, following by contact dermatitis (17.0%) and skin fungal infections (13.0%). Regarding HRQOL, anxiety/depression was the most common health problem in patients with skin diseases (71.8%), following by pain/discomfort (63.6%). The mean EQ-5D index score was 0.73 (SD = 0.19). The lowest EQ-5D index scores were obtained for females with skin infections (mean = 0.52) and for males with psoriasis (mean = 0.59). Females had significantly lower scores compared to males (Coef. = −0.06; 95% CI = −0.11 to −0.01). Higher income and living in rural areas were also negatively correlated with the EQ-5D index. This study demonstrated the low HRQOL among patients with skin diseases in Vietnam and emphasized the vulnerability of patients with different socioeconomic statuses to their HRQOL.
Collapse
|
47
|
Hay RJ, Asiedu K. Skin-Related Neglected Tropical Diseases (Skin NTDs)-A New Challenge. Trop Med Infect Dis 2018; 4:tropicalmed4010004. [PMID: 30585179 PMCID: PMC6473730 DOI: 10.3390/tropicalmed4010004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 12/22/2018] [Indexed: 11/16/2022] Open
Affiliation(s)
- Roderick J Hay
- The International Foundation for Dermatology, London W1P 5HQ, UK.
| | - Kingsley Asiedu
- Department of Control of Neglected Tropical Diseases, World Health Organization, 1202 Geneva, Switzerland.
| |
Collapse
|
48
|
Neglected Tropical Diseases and Mental Health: Progress, Partnerships, and Integration. Trends Parasitol 2018; 35:23-31. [PMID: 30578149 DOI: 10.1016/j.pt.2018.11.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/30/2018] [Accepted: 11/01/2018] [Indexed: 02/01/2023]
Abstract
Neglected tropical diseases (NTDs) are increasingly recognised as major drivers of psychosocial morbidity in affected individuals and their caregivers. Nevertheless, there has remained a lack of prioritisation at the policy level of some of the most stigmatising and chronic NTDs, with subsequent under-representation within NTD programmes. In response, the Neglected Tropical Disease/Non-Governmental Organization/Network (NNN) has established a Mental Wellbeing and Stigma Task Group (MWS) to address these issues through a comprehensive research agenda. In our article, we highlight the progress in understanding the scope of the mental health impact of NTDs and the innovative practice emerging in this area. Finally, we examine opportunities for integration of mental and physical health for individuals with NTDs.
Collapse
|
49
|
Chandler D, Fuller L. A Review of Scabies: An Infestation More than Skin Deep. Dermatology 2018; 235:79-90. [DOI: 10.1159/000495290] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/12/2018] [Indexed: 11/19/2022] Open
Abstract
Human scabies, a common infestation, has a worldwide distribution with a variable impact and presentation depending on the clinical situation. In developed, high-income settings, health institution and residential home outbreaks challenge health and social care services. In resource-poor settings, it is the downstream sequelae of staphylococcal and streptococcal bacteraemia, induced by scratching, which have a significant impact on the long-term health of communities. Over the past decade scabies has been recognised as a “neglected tropical disease” (NTD) by the World Health Organisation, has an accepted practical system of global diagnostic criteria and is being adopted into integrated programmes of mass drug administration for NTDs in field settings. This review seeks to summarise the recent advances in the understanding of scabies and highlight the advocacy and research headlines with their implication for diagnosis and management of outbreaks and individuals. In addition, it will indicate the priorities and questions that remain.
Collapse
|
50
|
Yotsu RR. Integrated Management of Skin NTDs-Lessons Learned from Existing Practice and Field Research. Trop Med Infect Dis 2018; 3:E120. [PMID: 30441754 PMCID: PMC6306929 DOI: 10.3390/tropicalmed3040120] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/10/2018] [Accepted: 11/11/2018] [Indexed: 12/18/2022] Open
Abstract
Integration of neglected tropical diseases (NTDs) into the public health agenda has been a priority in global health for the last decade. Because a number of these diseases share not only the geographical distribution, but also a common feature which is skin involvement, bringing together a sub-group of 'skin NTDs' is one way forward to promote further integration among NTDs. With these diseases, which include leprosy, Buruli ulcer, yaws, mycetoma, lymphatic filariasis, and leishmaniasis, patients may be left with life-long deformities and disabilities when diagnosis and treatment are delayed. Stigma is another serious consequence of skin NTDs as it places a large barrier on the economic activities and social life of a patient. As a result, this creates a vicious cycle and obstructs a key goal of society, the elimination of poverty. Enhancement in surveillance systems as well as the further development of diagnostic methods, improvement in treatment and management, and identification of preventative measures for skin NTDs are therefore urgently needed. This article summarizes the existing practices and field research on skin NTDs and identifies potential synergies that could be achieved by adopting this integrated approach.
Collapse
Affiliation(s)
- Rie R Yotsu
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki 852-8102, Japan.
- Department of Dermatology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
| |
Collapse
|