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Broad J, Robertson RC, Evans C, Perussolo J, Lum G, Piper JD, Loucaides E, Ziruma A, Chasekwa B, Ntozini R, Bourke CD, Prendergast AJ. Maternal inflammatory and microbial drivers of low birthweight in low- and middle-income countries. Paediatr Int Child Health 2024; 44:79-93. [PMID: 39066726 DOI: 10.1080/20469047.2024.2380974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 07/10/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Low birthweight (LBW) is when an infant is born too soon or too small, and it affects one in seven infants in low- and middle-income countries. LBW has a significant impact on short-term morbidity and mortality, and it impairs long-term health and human capital. Antenatal microbial and inflammatory exposure may contribute to LBW. METHODS Ovid-Medline, Embase and Cochrane databases were searched for English-language articles evaluating inflammatory, microbial or infective causes of LBW, small-for-gestational age, intra-uterine growth restriction or prematurity. Inclusion criteria were human studies including published data; conference abstracts and grey literature were excluded. A narrative synthesis of the literature was conducted. RESULTS Local infections may drive the underlying causes of LBW: for example, vaginitis and placental infection are associated with a greater risk of prematurity. Distal infection and inflammatory pathways are also associated with LBW, with an association between periodontitis and preterm delivery and environmental enteric dysfunction and reduced intra-uterine growth. Systemic maternal infections such as malaria and HIV are associated with LBW, even when infants are exposed to HIV but not infected. This latter association may be driven by chronic inflammation, co-infections and socio-economic confounders. Antimicrobial prophylaxis against other bacteria in pregnancy has shown minimal impact in most trials, though positive effects on birthweight have been found in some settings with a high infectious disease burden. CONCLUSION Maternal inflammatory and infective processes underlie LBW, and provide treatable pathways for interventions. However, an improved understanding of the mechanisms and pathways underlying LBW is needed, given the impact of LBW on life-course.
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Affiliation(s)
- Jonathan Broad
- Maternal and Child Health Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
- Paediatrics Department, Croydon University Hospital, London, UK
| | - Ruairi C Robertson
- Maternal and Child Health Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
| | - Ceri Evans
- Maternal and Child Health Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
- Institute of Infection, Veterinary and Ecological Sciences, Liverpool, UK
| | - Jeniffer Perussolo
- Maternal and Child Health Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
| | - Gina Lum
- Centre for Genomics and Child Health, Barts and The London School of Medicine and Dentistry, London, UK
| | - Joe D Piper
- Maternal and Child Health Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
| | - Eva Loucaides
- Paediatrics Department, Croydon University Hospital, London, UK
| | - Asaph Ziruma
- Blizard Institute, Queen Mary University of London, London, UK
| | - Bernard Chasekwa
- Maternal and Child Health Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
| | - Robert Ntozini
- Maternal and Child Health Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
| | - Claire D Bourke
- Maternal and Child Health Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
| | - Andrew J Prendergast
- Maternal and Child Health Research Department, Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Blizard Institute, Queen Mary University of London, London, UK
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Gerstenberg J, Mishra S, Holtfreter M, Richter J, Davi SD, Okwu DG, Ramharter M, Mischlinger J, Schleenvoigt BT. Human Placental Schistosomiasis-A Systematic Review of the Literature. Pathogens 2024; 13:470. [PMID: 38921768 PMCID: PMC11206619 DOI: 10.3390/pathogens13060470] [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: 04/10/2024] [Revised: 05/22/2024] [Accepted: 05/29/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Schistosome egg deposition in pregnant women may affect the placenta of infected mothers and cause placental schistosomiasis (PS). Histopathological examination of placental tissue is an inadequate detection method due to low sensitivity. So far, there has not been any systematic review on PS. METHODS We conducted a systematic literature search on PubMed, EMBASE, and Medline and included all publications that reported microscopically confirmed cases of PS, as well as the relevant secondary literature found in the citations of the primarily included publications. RESULTS Out of 113 abstracts screened we found a total of 8 publications describing PS with a total of 92 cases describing egg deposition of dead and/or viable eggs and worms of S. haematobium and S. mansoni in placental tissue. One cross-sectional study investigating the prevalence of PS and its association with adverse birth outcomes, found 22% of placentas to be infested using a maceration technique but only <1% using histologic examination. Additionally, no direct link to deleterious pregnancy outcomes could be shown. CONCLUSIONS PS is a highly unattended and underdiagnosed condition in endemic populations, due to a lack of awareness as well as low sensitivity of histopathological examinations. However, PS may play an important role in mediating or reinforcing adverse birth outcomes (ABO) such as fetal growth restriction (FGR) in maternal schistosomiasis, possibly by placental inflammation.
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Affiliation(s)
- Jacob Gerstenberg
- Institute for Tropical Medicine, Eberhard-Karls University Tübingen, 72074 Tübingen, Germany;
- Centre de Recherches Médicales de Lambaréné, Lambaréné 242, Gabon
| | - Sasmita Mishra
- Department of Obstetrics and Gynecology, Heidekreis Klinikum, 29664 Walsrode, Germany
| | - Martha Holtfreter
- Tropical Medicine Unit, Department of Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine, Heinrich-Heine-University, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Joachim Richter
- Institute of International Health, Global Health Center, Charité University Medicine, 13353 Berlin, Germany
- Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
| | - Saskia Dede Davi
- Center for Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20359 Hamburg, Germany
- German Centre for Infection Research (DZIF), Partner Site Hamburg-Luebeck-Borstel, 20359 Hamburg, Germany
| | | | - Michael Ramharter
- Center for Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20359 Hamburg, Germany
- German Centre for Infection Research (DZIF), Partner Site Hamburg-Luebeck-Borstel, 20359 Hamburg, Germany
| | - Johannes Mischlinger
- Center for Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20359 Hamburg, Germany
- German Centre for Infection Research (DZIF), Partner Site Hamburg-Luebeck-Borstel, 20359 Hamburg, Germany
| | - Benjamin T. Schleenvoigt
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University, 07747 Jena, Germany
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Beitze DE, Kavira Malengera C, Barhwamire Kabesha T, Frank J, Scherbaum V. Disparities in health and nutrition between semi-urban and rural mothers and birth outcomes of their newborns in Bukavu, DR Congo: a baseline assessment. Prim Health Care Res Dev 2023; 24:e61. [PMID: 37870120 PMCID: PMC10594532 DOI: 10.1017/s1463423623000518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 03/29/2023] [Accepted: 08/28/2023] [Indexed: 10/24/2023] Open
Abstract
AIM This research aimed to evaluate health and nutritional practices of mothers during pregnancy and birth outcomes of their newborns in Bukavu, Democratic Republic of the Congo (DRC), comparing semi-urban and rural areas. BACKGROUND Health and nutrition during pregnancy are crucial for adequate development of the fetus. Health care plays an important role but is often poor in rural areas of developing countries. METHODS A baseline survey of a nutritional follow-up study was conducted in two semi-urban and one rural hospital in the vicinity of Bukavu, DRC. In total, 471 mother-child pairs were recruited after delivery. Data collection included socio-demographic parameters, nutrition and health measures during pregnancy, and anthropometric parameters. Semi-urban and rural study locations were compared and predictors of birth weight evaluated. FINDINGS Semi-urban and rural mothers differed significantly in nutrition and health practices during pregnancy, as well as birth outcomes. In the rural area, there was a higher rate of newborns with low birth weight (10.7%) and lower rates of antimalarial medication (80.8%), deworming (24.6%), consumption of nutritional supplements (81.5%), and being informed about nutrition by medical staff (32.8%) during pregnancy as well as practicing family planning (3.1%) than in the semi-urban areas (2.7%, 88.6%, 88.3%; 89.3%, 46.5%, and 17.1%, respectively). Birth weight was positively predicted by increasing maternal MUAC, age, and gestational age and negatively by rural location, being primipara, being a farmer, and female newborn sex. CONCLUSION The findings highlight the importance of strengthening antenatal care activities especially in rural areas in order to ameliorate both maternal and infantile health and ensure appropriate development.
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Affiliation(s)
| | - Céline Kavira Malengera
- School of Public Health, Faculty of Medicine, Université de Goma, Goma, DR Congo
- School of Medicine and Public Health, Université Evangélique en Afrique, Bukavu, DR Congo
- Département de Nutrition, Centre de Recherche en Sciences Naturelles/Lwiro, D.S. Bukavu, DR Congo
| | - Theophile Barhwamire Kabesha
- School of Medicine and Public Health, Université Evangélique en Afrique, Bukavu, DR Congo
- Faculty of Medicine, Official University of Bukavu, Bukavu, DR Congo
| | - Jan Frank
- Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany
- Food Security Center, University of Hohenheim, Stuttgart, Germany
| | - Veronika Scherbaum
- Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany
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Clark J, Davis EL, Prada JM, Gass K, Krentel A, Hollingsworth TD. How correlations between treatment access and surveillance inclusion impact neglected tropical disease monitoring and evaluation-A simulated study. PLoS Negl Trop Dis 2023; 17:e0011582. [PMID: 37672518 PMCID: PMC10506705 DOI: 10.1371/journal.pntd.0011582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/18/2023] [Accepted: 08/09/2023] [Indexed: 09/08/2023] Open
Abstract
Neglected tropical diseases (NTDs) largely impact marginalised communities living in tropical and subtropical regions. Mass drug administration is the leading intervention method for five NTDs; however, it is known that there is lack of access to treatment for some populations and demographic groups. It is also likely that those individuals without access to treatment are excluded from surveillance. It is important to consider the impacts of this on the overall success, and monitoring and evaluation (M&E) of intervention programmes. We use a detailed individual-based model of the infection dynamics of lymphatic filariasis to investigate the impact of excluded, untreated, and therefore unobserved groups on the true versus observed infection dynamics and subsequent intervention success. We simulate surveillance in four groups-the whole population eligible to receive treatment, the whole eligible population with access to treatment, the TAS focus of six- and seven-year-olds, and finally in >20-year-olds. We show that the surveillance group under observation has a significant impact on perceived dynamics. Exclusion to treatment and surveillance negatively impacts the probability of reaching public health goals, though in populations that do reach these goals there are no signals to indicate excluded groups. Increasingly restricted surveillance groups over-estimate the efficacy of MDA. The presence of non-treated groups cannot be inferred when surveillance is only occurring in the group receiving treatment.
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Affiliation(s)
- Jessica Clark
- School of Biodiversity, One Health & Veterinary Medicine, University of Glasgow, Glasgow, Scotland
- Big Data Institute, Neglected Tropical Disease Modelling Consortium, University of Oxford, Oxford, England
| | - Emma L. Davis
- Big Data Institute, Neglected Tropical Disease Modelling Consortium, University of Oxford, Oxford, England
| | - Joaquin M. Prada
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, England
| | - Katherine Gass
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, Georgia, United States of America
| | - Alison Krentel
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Bruyère Research Institute, Ottawa, Canada
| | - T. Déirdre Hollingsworth
- Big Data Institute, Neglected Tropical Disease Modelling Consortium, University of Oxford, Oxford, England
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Holtfreter MC, Mischlinger J, Davi SD, Schleenvoigt BT. Investigation on birth weight outcomes in schistosomiasis and praziquantel research: a correspondence. Eur J Med Res 2023; 28:231. [PMID: 37434209 DOI: 10.1186/s40001-023-01202-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/27/2023] [Indexed: 07/13/2023] Open
Abstract
Infection with Schistosoma sp. during pregnancy can cause low birth weight of the newborn. To allow a better differentiation between newborns with low birth weight and those with normal weight, the terms of intrauterine growth restriction (IUGR), small for gestational age (SGA) or fetal growth restriction (FGR) should be used. FGR describes the relationship between birth weight and gestational age and is defined as the incapability of a fetus to achieve expected growth with birth weight below the 10th percentile for gestational age. Additional investigations of the proportion of newborns with FGR should obtain more certainty about the effect of praziquantel and schistosomiasis on fetal growth.
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Affiliation(s)
- Martha C Holtfreter
- Tropical Medicine Unit, Department of Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Johannes Mischlinger
- Centre of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Infection Research (DZIF), partner site Hamburg-Luebeck-Borstel, Hamburg, Germany
| | - Saskia Dede Davi
- Centre of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Infection Research (DZIF), partner site Hamburg-Luebeck-Borstel, Hamburg, Germany
| | - Benjamin T Schleenvoigt
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
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Atagozli T, Elliott DE, Ince MN. Helminth Lessons in Inflammatory Bowel Diseases (IBD). Biomedicines 2023; 11:1200. [PMID: 37189818 PMCID: PMC10135676 DOI: 10.3390/biomedicines11041200] [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: 03/20/2023] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
Helminths are multicellular invertebrates that colonize the gut of many vertebrate animals including humans. This colonization can result in pathology, which requires treatment. It can also lead to a commensal and possibly even a symbiotic relationship where the helminth and the host benefit from each other's presence. Epidemiological data have linked helminth exposure to protection from immune disorders that include a wide range of diseases, such as allergies, autoimmune illnesses, and idiopathic inflammatory disorders of the gut, which are grouped as inflammatory bowel diseases (IBD). Treatment of moderate to severe IBD involves the use of immune modulators and biologics, which can cause life-threatening complications. In this setting, their safety profile makes helminths or helminth products attractive as novel therapeutic approaches to treat IBD or other immune disorders. Helminths stimulate T helper-2 (Th2) and immune regulatory pathways, which are targeted in IBD treatment. Epidemiological explorations, basic science studies, and clinical research on helminths can lead to the development of safe, potent, and novel therapeutic approaches to prevent or treat IBD in addition to other immune disorders.
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Affiliation(s)
- Tyler Atagozli
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Iowa Carver College of Medicine, Iowa City, IA 52246, USA
| | - David E. Elliott
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Iowa Carver College of Medicine, Iowa City, IA 52246, USA
- Iowa City Veterans Affairs Medical Center, Iowa City, IA 52246, USA
| | - Mirac Nedim Ince
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Iowa Carver College of Medicine, Iowa City, IA 52246, USA
- Iowa City Veterans Affairs Medical Center, Iowa City, IA 52246, USA
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Cando LFT, Perias GAS, Tantengco OAG, Dispo MD, Ceriales JA, Girasol MJG, Leonardo LR, Tabios IKB. The Global Prevalence of Schistosoma mansoni, S. japonicum, and S. haematobium in Pregnant Women: A Systematic Review and Meta-Analysis. Trop Med Infect Dis 2022; 7:354. [PMID: 36355896 PMCID: PMC9693339 DOI: 10.3390/tropicalmed7110354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 10/10/2023] Open
Abstract
Schistosomiasis is a neglected tropical disease affecting 40 million women of childbearing age worldwide. Its global disease prevalence among pregnant women is still unknown. This meta-analysis determined the pooled prevalence of schistosomiasis among pregnant women globally. Additionally, this study also determined the pooled prevalence based on infection intensity based on eggs per gram. Observational studies on the prevalence of schistosomiasis among pregnant patients were obtained from Medline, Scopus, and CINAHL from January 2001 until August 2020. A review of titles and abstracts was done independently by six reviewers. The quality of the included studies was assessed using the Newcastle-Ottawa Scale for case-control, cohort, and cross-sectional studies. A total of 27 studies were included in the meta-analysis and meta-regression. The pooled prevalence of S. haematobium was 13.44 (CI: 8.90-19.80) per 100 observations, while the pooled prevalence of S. mansoni was 12.18 (CI: 4.47-29.12) per 100 observations. The prevalence of S. japonicum infection in one study was 53.54 (CI: 43.23-63.62) per 100 observations. Our results showed a prevailing health problem of schistosomiasis during pregnancy in various countries worldwide. This strengthens the need to conduct more schistosomiasis research, prevention, and control programs in pregnant women.
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Affiliation(s)
- Leslie Faye T. Cando
- College of Medicine, University of the Philippines Manila, Manila 1000, Philippines
| | | | | | - Micah D. Dispo
- Department of Epidemiology and Biostatistics, College of Public Health, University of the Philippines Manila, Manila 1000, Philippines
| | - Jeremy A. Ceriales
- College of Medicine, University of the Philippines Manila, Manila 1000, Philippines
| | - Mark John G. Girasol
- College of Medicine, University of the Philippines Manila, Manila 1000, Philippines
| | - Lydia R. Leonardo
- Office of Research Coordination, University of the East, Manila 1008, Philippines
- Institute of Biology, College of Science, University of the Philippines Diliman, Manila 1101, Philippines
| | - Ian Kim B. Tabios
- Institute of Biology, College of Science, University of the Philippines Diliman, Manila 1101, Philippines
- Institute of Human Genetics, National Institutes of Health, University of the Philippines Manila, Manila 1000, Philippines
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Raj E, Calvo-Urbano B, Heffernan C, Halder J, Webster JP. Systematic review to evaluate a potential association between helminth infection and physical stunting in children. Parasit Vectors 2022; 15:135. [PMID: 35443698 PMCID: PMC9022337 DOI: 10.1186/s13071-022-05235-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/10/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Despite considerable public health efforts over the past 20 years, childhood stunting (physical and/or cognitive) levels globally remain unacceptably high-at 22% amongst children under 5 years old in 2020. The aetiology of stunting is complex and still largely unknown. Helminths can cause significant mortality and morbidity and have often been cited as major causative agents for stunting, although their actual role in childhood stunting remains unclear. Our aim was to systematically review the current evidence to help support or refute the hypothesis that helminths cause physical stunting in children. METHODS Inclusion criteria were as follows: infected with (and/or exposed to) helminths (soil-transmitted helminths, schistosomes or food-borne trematodes), children, pregnant or breastfeeding women as study participants (children included infants 0-1 year old, preschool-age children 1-5 years and school-age children > 5 years old), anthelmintic treatment intervention, stunting-related variables reported (e.g. height, height-for-age z-score, birth weight), helminth infection reported in relation to stunting, any geographic location, any date, peer-reviewed literature only. Exclusion criteria were: non-primary research, study protocols, studies with no new data, non-English language papers and animal (non-human) helminth studies. Seven databases were searched on 28 May 2021. Risk of bias was assessed for included studies and GRADE was used for studies included in RCT subgroup meta-analyses (in preschool-age children and pregnant women). This systematic review was registered with PROSPERO (CRD42021256201). RESULTS Eighty studies were included in the analyses. No significant overall evidence was found in support of the hypothesis that helminths cause physical stunting in children, although there was some association with wasting. CONCLUSIONS Whilst analyses of the available literature to date failed to support a direct association between helminth infection and childhood stunting, there was significant heterogeneity between studies, and many had follow-up periods which may have been too short to detect impacts on growth. Most apparent was a lack of available data from key demographic groups wherein one may predict the greatest association of helminth infection with stunting-notably that of infants, preschool-age children, and pregnant or nursing women. Thus this review highlights the urgent need for further targeted empirical research amongst these potentially most vulnerable demographic groups.
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Affiliation(s)
- E Raj
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hertfordshire, AL9 7TA, UK.
| | - B Calvo-Urbano
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hertfordshire, AL9 7TA, UK
- London Centre for Neglected Tropical Disease Research, Imperial College Faculty of Medicine, W2 1PG, London, UK
| | - C Heffernan
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hertfordshire, AL9 7TA, UK
- London International Development Centre, London, WC1A 2NS, UK
| | - J Halder
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hertfordshire, AL9 7TA, UK
- London Centre for Neglected Tropical Disease Research, Imperial College Faculty of Medicine, W2 1PG, London, UK
| | - J P Webster
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hertfordshire, AL9 7TA, UK.
- London Centre for Neglected Tropical Disease Research, Imperial College Faculty of Medicine, W2 1PG, London, UK.
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Verdecia J, Martinez A, Ravi M. Strongyloidiasis Infection As the Cause of Pancreatitis. Cureus 2022; 14:e24097. [PMID: 35573535 PMCID: PMC9106552 DOI: 10.7759/cureus.24097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/05/2022] Open
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Bustinduy AL, Randriansolo B, Sturt AS, Kayuni SA, Leustcher PDC, Webster BL, Van Lieshout L, Stothard JR, Feldmeier H, Gyapong M. An update on female and male genital schistosomiasis and a call to integrate efforts to escalate diagnosis, treatment and awareness in endemic and non-endemic settings: The time is now. ADVANCES IN PARASITOLOGY 2022; 115:1-44. [PMID: 35249661 DOI: 10.1016/bs.apar.2021.12.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The last decades have brought important insight and updates in the diagnosis, management and immunopathology of female genital schistosomiasis (FGS) and male genital schistosomiasis (MGS). Despite sharing a common parasitic aetiological agent, FGS and MGS have typically been studied separately. Infection with Schistosoma haematobium manifests with gender-specific clinical manifestations and consequences of infection, albeit having a similar pathogenesis within the human genital tract. Schistosoma haematobium is a known urinary bladder carcinogen, but its potential causative role in other types of neoplasia, such as cervical cancer, is not fully understood. Furthermore, the impact of praziquantel treatment on clinical outcomes remains largely underexplored, as is the interplay of FGS/MGS with relevant reproductive tract infections such as HIV and Human Papillomavirus. In non-endemic settings, travel and immigrant health clinics need better guidance to correctly identify and treat FGS and MGS. Our review outlines the latest advances and remaining knowledge gaps in FGS and MGS research. We aim to pave a way forward to formulate more effective control measures and discuss elimination targets. With a growing community awareness in health practitioners, scientists and epidemiologists, alongside the sufferers from these diseases, we aspire to witness a new generation of young women and men free from the downstream disabling manifestations of disease.
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Affiliation(s)
- Amaya L Bustinduy
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | | | - Amy S Sturt
- Section of Infectious Diseases, Veterans Affairs Palo Alto Health Care System, Palo Alto, United States
| | - Seke A Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; MASM Medi Clinics Limited, Blantyre, Malawi
| | - Peter D C Leustcher
- Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Lisette Van Lieshout
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Hermann Feldmeier
- Charité University Medicine Berlin, Institute of Microbiology, Infectious Diseases and Immunology, Berlin, Germany
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
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Bankanie V, Moshi FV. Factors associated with the use of deworming drugs during pregnancy in Tanzania; an analysis from the 2015–16 Tanzanian HIV and malaria indicators survey. BMC Pregnancy Childbirth 2022; 22:60. [PMID: 35065622 PMCID: PMC8783498 DOI: 10.1186/s12884-021-04291-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 11/25/2021] [Indexed: 11/29/2022] Open
Abstract
Background The use of deworming drugs is one of the important antenatal strategies in preventing anaemia in pregnancy. Little is known about the factors associated with the use of deworming drugs, which accounts for the aim of this study. Method The study used data from the 2015–16 Tanzania HIV Demographic and Health Survey and Malaria Indicators Survey (2015–16 TDHS-MIS). A total of 6924 women of active reproductive age from 15 to 49 were included in the analysis. Both univariate and multiple logistic regression analyses were used. Results The majority of interviewed women 3864(60.1%) took deworming drugs. In a weighed multiple logistic regression, women residing in urban areas reported greater use of deworming drugs than women residing in rural areas [AOR = 1.73, p = 0.01, 95% CI (1.26–2.38)]. In the four areas of residence, compared to women residing in mainland rural areas, women residing in mainland urban areas and Pemba islands reported greater use of deworming drugs [mainland urban (AOR = 2.56 p < 0.001,95% CI(1.78–3.75), and Pemba Island (AOR = 1.18, p < 0.001, 95% CI(1.17–1.20)]. However, women residing in Zanzibar Island (Unguja) were less likely to use deworming drugs compared to women in mainland rural women (AOR = 0.5, p < 0.001, 95% CI (0.45–0.55). Similarly, compared to women under 20 years of age, women between 20 to 34 years reported significantly greater use of deworming drugs [20 to 34 years (AOR = 1.30, p = 0.03, 95% CI(1.02–1.65). Likewise, greater use of deworming drugs was reported in women with a higher level of education compared to no education [higher education level (AOR = 3.25, p = 0.01,95% CI(1.94–7.92)], rich women compared to poor [rich (AOR = 1.43, p = 0.003, 95% CI (1.13–1.80)] and in women who initiated antenatal care on their first trimester of pregnancy compared to those who initiated later [AOR = 1.37, p < 0.001, 95% CI (1.17–1.61)]. Conclusion Women who were more likely to use the deworming drugs were those residing in urban compared to rural areas, aged between 20 and 34 years, those with a higher level of formal education, wealthier, and women who book the antenatal clinic (ANC) within their first trimester of pregnancy. Considering the outcomes of anaemia in pregnancy, a well-directed effort is needed to improve the use of deworming drugs.
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The Role of the Intestinal Epithelium in the "Weep and Sweep" Response during Gastro-Intestinal Helminth Infections. Animals (Basel) 2022; 12:ani12020175. [PMID: 35049796 PMCID: PMC8772803 DOI: 10.3390/ani12020175] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/25/2021] [Accepted: 01/10/2022] [Indexed: 02/08/2023] Open
Abstract
Simple Summary The immune system actively combats intruders such as bacteria, viruses, fungi, and protozoan and metazoan parasites using leukocytes. During an infection white blood cells are activated to internalize bacteria or viruses and release a number of molecules to kill pathogens. Unfortunately, those mechanisms are ineffective against larger intruders like helminths, which are too large to be killed by a single immune cell. To eliminate gastro-intestinal helminths an integrated response involving the nervous, endocrine, and immune systems are used to expel the parasites. This is achieved through increased gut hydration and muscle contractions which detach worms from the gut and lead to release outside the body in a “weep and sweep” response. Epithelial cells of the intestine are significant players in this process, being responsible for detecting the presence of helminths in the gut and participating in the regulation of parasite expulsion. This paper describes the role of the gut epithelium in detecting and eliminating helminths from the intestine. Abstract Helminths are metazoan parasites infecting around 1.5 billion people all over the world. During coevolution with hosts, worms have developed numerous ways to trick and evade the host immune response, and because of their size, they cannot be internalized and killed by immune cells in the same way as bacteria or viruses. During infection, a substantial Th2 component to the immune response is evoked which helps restrain Th1-mediated tissue damage. Although an enhanced Th2 response is often not enough to kill the parasite and terminate an infection in itself, when tightly coordinated with the nervous, endocrine, and motor systems it can dislodge parasites from tissues and expel them from the gut. A significant role in this “weep and seep” response is attributed to intestinal epithelial cells (IEC). This review highlights the role of various IEC lineages (enterocytes, tuft cells, Paneth cells, microfold cells, goblet cells, and intestine stem cells) during the course of helminth infections and summarizes their roles in regulating gut architecture and permeability, and muscle contractions and interactions with the immune and nervous system.
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Walker M, Freitas LT, Halder JB, Brack M, Keiser J, King CH, Levecke B, Ai-Lian Lim Y, Pieri O, Sow D, Stothard JR, Webster JP, Zhou XN, Terry RF, Guérin PJ, Basáñez MG. Improving anthelmintic treatment for schistosomiasis and soil-transmitted helminthiases through sharing and reuse of individual participant data. Wellcome Open Res 2022; 7:5. [PMID: 35493199 PMCID: PMC9020536 DOI: 10.12688/wellcomeopenres.17468.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 01/13/2023] Open
Abstract
The Infectious Diseases Data Observatory (IDDO, https://www.iddo.org) has launched a clinical data platform for the collation, curation, standardisation and reuse of individual participant data (IPD) on treatments for two of the most globally important neglected tropical diseases (NTDs), schistosomiasis (SCH) and soil-transmitted helminthiases (STHs). This initiative aims to harness the power of data-sharing by facilitating collaborative joint analyses of pooled datasets to generate robust evidence on the efficacy and safety of anthelminthic treatment regimens. A crucial component of this endeavour has been the development of a Research Agenda to promote engagement with the SCH and STH research and disease control communities by highlighting key questions that could be tackled using data shared through the IDDO platform. Here, we give a contextual overview of the priority research themes articulated in the Research Agenda-a 'living' document hosted on the IDDO website-and describe the three-stage consultation process behind its development. We also discuss the sustainability and future directions of the platform, emphasising throughout the power and promise of ethical and equitable sharing and reuse of clinical data to support the elimination of NTDs.
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Affiliation(s)
- Martin Walker
- Department of Pathobiology and Population Sciences, Royal Veterinary College, London, Hatfield, UK
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis and London Centre for Neglected Tropical Disease Research, Imperial College London, London, UK
- Infectious Diseases Data Observatory, University of Oxford, Oxford, UK
| | - Luzia T. Freitas
- Department of Pathobiology and Population Sciences, Royal Veterinary College, London, Hatfield, UK
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis and London Centre for Neglected Tropical Disease Research, Imperial College London, London, UK
- Infectious Diseases Data Observatory, University of Oxford, Oxford, UK
| | - Julia B. Halder
- Department of Pathobiology and Population Sciences, Royal Veterinary College, London, Hatfield, UK
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis and London Centre for Neglected Tropical Disease Research, Imperial College London, London, UK
- Infectious Diseases Data Observatory, University of Oxford, Oxford, UK
| | - Matthew Brack
- Infectious Diseases Data Observatory, University of Oxford, Oxford, UK
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Charles H. King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio, USA
| | - Bruno Levecke
- Department of Translational Physiology, Ghent University, Merelbeke, Belgium
| | - Yvonne Ai-Lian Lim
- Department of Parasitology, University of Malaya, Kuala Lumpur, Malaysia
| | - Otavio Pieri
- Laboratory of Health and Environment Education, Oswaldo Cruz Institute, Fiocruz, Rio de Janiero, Brazil
| | - Doudou Sow
- Service de Parasitologie, Université Gaston Berger de Saint Louis, Saint Louis, Senegal
| | - J. Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Joanne P. Webster
- Department of Pathobiology and Population Sciences, Royal Veterinary College, London, Hatfield, UK
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis and London Centre for Neglected Tropical Disease Research, Imperial College London, London, UK
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, China Center for Disease Control and Prevention, Shanghai, China
| | - Robert F. Terry
- Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | | | - Maria-Gloria Basáñez
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis and London Centre for Neglected Tropical Disease Research, Imperial College London, London, UK
- Infectious Diseases Data Observatory, University of Oxford, Oxford, UK
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A descriptive qualitative case study of the experiences, perceptions and attitudes of pregnant women on Unguja island, Zanzibar, towards antischistosomal treatment. Acta Trop 2022; 225:106143. [PMID: 34562430 PMCID: PMC8646856 DOI: 10.1016/j.actatropica.2021.106143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/17/2021] [Accepted: 09/12/2021] [Indexed: 11/23/2022]
Abstract
Women were enthusiastic about keeping healthy during pregnancy. Women strongly valued high quality antenatal care and were encouraged to attend clinics by their families and community members. Women demonstrated poor retention of knowledge about schistosomiasis from school. The majority of women interviewed had missed mass drug administration rounds of praziquantel due to pregnancy or concerns about side effects. Women were unanimously agreeable to taking praziquantel during pregnancy if advised to do so by a healthcare professional.
Many countries exclude pregnant and lactating women from mass drug administration (MDA) programmes with praziquantel against schistosomiasis due to historic safety concerns over drug use during gestation and breast feeding. More than 10 years of empirical evidence from the field and a growing body of dedicated research has prompted the World Health Organisation and schistosomiasis control initiatives to advocate the inclusion of this vulnerable group into MDA. This qualitative descriptive case study explored, over a five-week period, the subjective experiences, perceptions, opinions, and attitudes of pregnant women attending government supported clinics on Unguja island, United Republic of Tanzania, towards praziquantel use during pregnancy in MDA programmes. The aim of the study was to identify and determine how to overcome potential barriers to effective use of MDA medications during pregnancy. Additionally, it was to determine trusted communication channels for future messaging and discover behavioural and community opportunities to increase participation of pregnant women in future MDA efforts. A 60 min, semi-structured qualitative interview was undertaken with 25 pregnant women recruited from 4 health centres on Unguja along with testing for Schistosoma haematobium infection. Using a modified-grounded theory approach, narrative data were transcribed, coded and analysed using a thematic analysis of the emergent themes. Women reported that they rely on traditional home remedies to stay healthy during pregnancy. Influenced by their mothers, husbands and neighbours, women predominately made medication choices during pregnancy and breastfeeding based on what they heard at home. Most women had been excluded from government MDA programmes in the past due to pregnancy. Women valued healthcare services for antenatal education and pregnancy advice. Women reported they would trust and follow direction from healthcare providers about taking praziquantel during pregnancy. Antenatal clinics offer an excellent opportunity to educate and expand praziquantel treatment to this cohort. Efforts should be augmented with training for providers and behavioural education for the community as a whole and family members of pregnant women.
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Wastnedge E, Waters D, Murray SR, McGowan B, Chipeta E, Nyondo-Mipando AL, Gadama L, Gadama G, Masamba M, Malata M, Taulo F, Dube Q, Kawaza K, Khomani PM, Whyte S, Crampin M, Freyne B, Norman JE, Reynolds RM. Interventions to reduce preterm birth and stillbirth, and improve outcomes for babies born preterm in low- and middle-income countries: A systematic review. J Glob Health 2021; 11:04050. [PMID: 35003711 PMCID: PMC8709903 DOI: 10.7189/jogh.11.04050] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Reducing preterm birth and stillbirth and improving outcomes for babies born too soon is essential to reduce under-5 mortality globally. In the context of a rapidly evolving evidence base and problems with extrapolating efficacy data from high- to low-income settings, an assessment of the evidence for maternal and newborn interventions specific to low- and middle-income countries (LMICs) is required. METHODS A systematic review of the literature was done. We included all studies performed in LMICs since the Every Newborn Action Plan, between 2013 - 2018, which reported on interventions where the outcome assessed was reduction in preterm birth or stillbirth incidence and/or a reduction in preterm infant neonatal mortality. Evidence was categorised according to maternal or neonatal intervention groups and a narrative synthesis conducted. RESULTS 179 studies (147 primary evidence studies and 32 systematic reviews) were identified in 82 LMICs. 81 studies reported on maternal interventions and 98 reported on neonatal interventions. Interventions in pregnant mothers which resulted in significant reductions in preterm birth and stillbirth were (i) multiple micronutrient supplementation and (ii) enhanced quality of antenatal care. Routine antenatal ultrasound in LMICs increased identification of fetal antenatal conditions but did not reduce stillbirth or preterm birth due to the absence of services to manage these diagnoses. Interventions in pre-term neonates which improved their survival included (i) feeding support including probiotics and (ii) thermal regulation. Improved provision of neonatal resuscitation did not improve pre-term mortality rates, highlighting the importance of post-resuscitation care. Community mobilisation, for example through community education packages, was found to be an effective way of delivering interventions. CONCLUSIONS Evidence supports the implementation of several low-cost interventions with the potential to deliver reductions in preterm birth and stillbirth and improve outcomes for preterm babies in LMICs. These, however, must be complemented by overall health systems strengthening to be effective. Quality improvement methodology and learning health systems approaches can provide important means of understanding and tackling implementation challenges within local contexts. Further pragmatic efficacy trials of interventions in LMICs are essential, particularly for interventions not previously tested in these contexts.
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Affiliation(s)
- Elizabeth Wastnedge
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Donald Waters
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Sarah R Murray
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Brian McGowan
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Effie Chipeta
- Centre for Reproductive Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Alinane Linda Nyondo-Mipando
- Department of Health Systems & Policy, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Luis Gadama
- Department of Obstetrics & Gynaecology, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Gladys Gadama
- Department of Obstetrics & Gynaecology, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Martha Masamba
- Department of Obstetrics & Gynaecology, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Monica Malata
- Centre for Reproductive Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Frank Taulo
- Department of Obstetrics & Gynaecology, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Queen Dube
- Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Kondwani Kawaza
- Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Sonia Whyte
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
| | - Mia Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Bridget Freyne
- Malawi-Liverpool Wellcome Trust Research Program, Blantyre, Malawi
- Institute of Infection & Global Health, University of Liverpool, Liverpool, UK
| | - Jane E Norman
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Rebecca M Reynolds
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
- Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK
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Wikman-Jorgensen P, Requena-Méndez A, Llenas-García J. A Review on Strongyloidiasis in Pregnant Women. Res Rep Trop Med 2021; 12:219-225. [PMID: 34584485 PMCID: PMC8464358 DOI: 10.2147/rrtm.s282268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/07/2021] [Indexed: 12/21/2022] Open
Abstract
Strongyloidiasis is a parasitic infection distributed worldwide, with an estimated 614 million people infected. Strongyloidiasis usually presents asymptomatically or with aspecific and mild clinical symptoms, mainly cutaneous, respiratory, or gastrointestinal. Disseminated disease and hyperinfection syndrome are the most serious complications, have a high mortality rate, usually occur in immunosuppressed patients, and are particularly associated with the use of corticosteroids. Strongyloidiasis is the most neglected of the neglected diseases, and its occurrence in pregnancy has been neglected and understudied. In this review, we focus on the effects of strongyloidiasis during pregnancy and highlight the knowledge shortage and the need for more research on the subject. There are few studies addressing strongyloidiasis prevalence during pregnancy and hyperinfection incidence during pregnancy is practically unknown, with only isolated case reports published. Although data are scarce, the infection has been associated with developmental disabilities and anemia during pregnancy, while hyperinfection may cause both maternal and neonatal death. Data on the best screening and diagnostic strategies during pregnancy are lacking. There is insufficient evidence on ivermectin safety in pregnancy, complicating treatment recommendations.
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Affiliation(s)
- Philip Wikman-Jorgensen
- Internal Medicine Department, Hospital Universitario San Juan de Alicante-FISABIO, San Juan de Alicante, Alicante, Spain
| | - Ana Requena-Méndez
- Barcelona Institute for Global Health (ISGlobal, Hospital Clinic-Universitat de Barcelona), Barcelona, Spain.,Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jara Llenas-García
- Internal Medicine and Infectious Diseases Department, Hospital Vega Baja-FISABIO, Alicante, Spain.,Clinical Medicine Department, Universidad Miguel Hernández de Elche, Elche, Spain
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The determinants of lipid profiles in early adolescence in a Ugandan birth cohort. Sci Rep 2021; 11:16503. [PMID: 34389769 PMCID: PMC8363641 DOI: 10.1038/s41598-021-96035-x] [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: 07/31/2020] [Accepted: 08/02/2021] [Indexed: 12/04/2022] Open
Abstract
Dyslipidaemia in adolescence tracks into adulthood and is an important risk factor for cardiovascular disease. Little is known about the effects of environmental exposures and early-life exposure to infectious diseases common to tropical regions on lipids. In 1119 early adolescent participants in the Entebbe Mother and Baby Study, we used linear regression to examine whether prenatal, childhood or adolescent factors are associated with lipid levels. Reduced high-density lipoprotein (HDL) and elevated triglyceride levels were common (prevalence 31% and 14%, respectively), but elevated low-density lipoprotein (LDL) or total cholesterol (TC) were rare. Current malaria infection was associated with lower mean LDL (adjusted ß − 0.51; 95% CI − 0.81, − 0.21), HDL (adjusted ß − 0.40; 95% CI − 0.56, − 0.23), and TC levels (adjusted ß − 0.62; 95% CI − 0.97, − 0.27), but higher mean triglyceride levels (geometric mean ratio (GMR) 1.47; 95% CI 1.18–1.84). Early-life asymptomatic malaria was associated with modest reductions in HDL and TC. Body mass index (BMI) was positively associated with LDL, TC, and triglycerides. No associations with helminth infection were found. Our findings suggest that early-life factors have only marginal effects on the lipid profile. Current malaria infection and BMI are strongly associated with lipids and important to consider when trying to improve the lipid profile.
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Chelkeba L, Melaku T, Lemma D, Mekonnen Z. Burden of intestinal parasitic infections among pregnant women in Ethiopia: a systematic review and meta-analysis. Infection 2021; 49:1091-1105. [PMID: 34110569 DOI: 10.1007/s15010-021-01635-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Comprehensive nationwide data on prevalence and distribution of intestinal parasites (IPIs) among pregnant women are lacking. Therefore, the aim of this study was to provide pooled prevalence estimate, prevalence in different regions and species-specific IPIs among pregnant women in Ethiopia. METHODS The search was carried out in Medline via PubMed, Scopus, Science Direct, Web of Science and Google Scholar on published and unpublished data between 2008 and Sep 2020 for studies describing rate of IPIs among pregnant women in Ethiopian. A random-effects model and forest plots to estimate pooled effect size and effect of each study with their confidence interval (CI) were used to provide a visual summary of the data. We conducted meta-regression to understand the source of heterogeneity and pooled the prevalence using 'metaprop' command using STATA software version 14. RESULTS A total of 3149 of the 9803 pregnant women were infected with one or more species of IPIs resulted in an overall prevalence of 29% (95% CI 22-37%). The prevalence estimate varied among studies with considerable heterogeneity (χ2 = 2069.19, p < 0.001 I2 = 98.84). The prevalence of IPIs was 36% (95% CI 22-50%) in Oromia region, 29% (95% CI 10-47%) in Amhara region, 24% (95% CI 17-32%) in southern nation, nationality and people region, 24% (95% CI 22-27%) in Tigray region and 24% (95% CI 20-29%) in Addis Ababa city. Hookworms with pooled prevalence estimate of 10% (95% CI 8-13%) followed by Ascaris lumbricoides 10% (95% CI 7-13%), and Entamoeba histolytica/dispar 6% (95% CI 4-8%) were the three common species of IPIs identified in this group of population. CONCLUSION The prevalence of IPIs among pregnant women is relatively high in comparison to other general population. Hookworms and Ascaris lumbricoides were the most dominant species of intestinal helminths, whereas Entamoeba histolytica/dispar was the dominant intestinal protozoa among pregnant women in Ethiopia.
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Affiliation(s)
- Legese Chelkeba
- Department of Pharmacology and Clinical Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tsegaye Melaku
- School of Pharmacy, Institute of Health, Jimma University, P.O. Box: 378, Jimma, Ethiopia.
| | - Dereje Lemma
- Department of Obstetrics and Gynecology, College Health Sciences, Ambo University, Ambo, Ethiopia
| | - Zeleke Mekonnen
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
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Braseth AL, Elliott DE, Ince MN. Parasitic Infections of the Gastrointestinal Track and Liver. Gastroenterol Clin North Am 2021; 50:361-381. [PMID: 34024446 PMCID: PMC11095845 DOI: 10.1016/j.gtc.2021.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Parasites have coevolved with humans. Several of them colonize the human body and establish a symbiotic relationship. Other parasites cause severe and lethal diseases. Prevalence of parasitic infections is decreased in highly industrialized countries, largely due to enforced hygienic practices. In contrast, parasites cause significant morbidity and mortality in parts of the world with barriers to effective public hygiene. Some parasites have emerged as potent pathogens in specific patient populations, such as immune suppressed individuals, regardless of sanitation. This article reviews common parasites encountered in clinical practice and, in the setting of host-parasite symbiosis, discusses their immune regulatory role.
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Affiliation(s)
- Annie L Braseth
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Iowa, Carver College of Medicine, Iowa City, IA 52242, USA
| | - David E Elliott
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Iowa, Carver College of Medicine, 4546 JCP, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - M Nedim Ince
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Iowa, Carver College of Medicine, 4546 JCP, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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Salam RA, Das JK, Bhutta ZA. Effect of mass deworming with antihelminthics for soil-transmitted helminths during pregnancy. Cochrane Database Syst Rev 2021; 5:CD005547. [PMID: 33998661 PMCID: PMC8127571 DOI: 10.1002/14651858.cd005547.pub4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Helminthiasis is an infestation of the human body with parasitic worms. It is estimated to affect 44 million pregnancies, globally, each year. Intestinal helminthiasis (hookworm infestation) is associated with blood loss and decreased supply of nutrients for erythropoiesis, resulting in iron-deficiency anaemia. Over 50% of the pregnant women in low- and middle-income countries (LMIC) suffer from iron-deficiency anaemia. Though iron-deficiency anaemia is multifactorial, hookworm infestation is a major contributory cause in women of reproductive age in endemic areas. Antihelminthics are highly efficacious, but evidence of their beneficial effect and safety when given during pregnancy has not been established. This is an update of a Cochrane Review last published in 2015. OBJECTIVES To determine the effects of mass deworming with antihelminthics for soil-transmitted helminths (STH) during the second or third trimester of pregnancy on maternal and pregnancy outcomes. SEARCH METHODS For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP) (8 March 2021) and reference lists of retrieved studies. SELECTION CRITERIA We included all prospective randomised controlled trials evaluating the effect of administration of antihelminthics versus placebo or no treatment during the second or third trimester of pregnancy; both individual-randomised and cluster-randomised trials were eligible. We excluded quasi-randomised trials and studies that were only available as abstracts with insufficient information. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data, checked accuracy and assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included a total of six trials (24 reports) that randomised 7873 pregnant women. All of the included trials were conducted in antenatal clinics within hospitals in LMICs (Uganda, Nigeria, Peru, India, Sierra Leone and Tanzania). Among primary outcomes, five trials reported maternal anaemia, one trial reported preterm birth and three trials reported perinatal mortality. Among secondary outcomes, included trials reported maternal worm prevalence, low birthweight (LBW) and birthweight. None of the included studies reported maternal anthropometric measures or infant survival at six months. Overall, we judged the included trials to be generally at low risk of bias for most domains, while the certainty of evidence ranged from low to moderate. Analysis suggests that administration of a single dose of antihelminthics in the second trimester of pregnancy may reduce maternal anaemia by 15% (average risk ratio (RR) 0.85, 95% confidence interval (CI) 0.72 to 1.00; I²= 86%; 5 trials, 5745 participants; low-certainty evidence). We are uncertain of the effect of antihelminthics during pregnancy on preterm birth (RR 0.84, 95% CI 0.38 to 1.86; 1 trial, 1042 participants; low-certainty evidence) or perinatal mortality (RR 1.01, 95% CI 0.67 to 1.52; 3 trials, 3356 participants; low-certainty evidence). We are uncertain of the effect of antihelminthics during pregnancy on hookworm (average RR 0.31, 95% CI 0.05 to 1.93; Tau² = 1.76, I² = 99%; 2 trials, 2488 participants; low-certainty evidence). Among other secondary outcomes, findings suggest that administration of antihelminthics during pregnancy may reduce the prevalence of trichuris (average RR 0.68, 95% CI 0.48 to 0.98; I²=75%; 2 trials, 2488 participants; low-certainty evidence) and ascaris (RR 0.24, 95% CI 0.19 to 0.29; I²= 0%; 2 trials, 2488 participants; moderate-certainty evidence). Antihelminthics during pregnancy probably make little or no difference to LBW (RR 0.89, 95% CI 0.69 to 1.16; 3 trials, 2960 participants; moderate-certainty evidence) and birthweight (mean difference 0.00 kg, 95% CI -0.03 kg to 0.04 kg; 3 trials, 2960 participants; moderate-certainty evidence). AUTHORS' CONCLUSIONS The evidence suggests that administration of a single dose of antihelminthics in the second trimester of pregnancy may reduce maternal anaemia and worm prevalence when used in settings with high prevalence of maternal helminthiasis. Further data is needed to establish the benefit of antihelminthic treatment on other maternal and pregnancy outcomes. Future research should focus on evaluating the effect of these antihelminthics among various subgroups in order to assess whether the effect varies. Future studies could also assess the effectiveness of co-interventions and health education along with antihelminthics for maternal and pregnancy outcomes.
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MESH Headings
- Female
- Humans
- Pregnancy
- Albendazole/administration & dosage
- Anemia, Iron-Deficiency/parasitology
- Anemia, Iron-Deficiency/prevention & control
- Anthelmintics/administration & dosage
- Bias
- Helminthiasis/drug therapy
- Helminthiasis/transmission
- Intestinal Diseases, Parasitic/drug therapy
- Iron Compounds/administration & dosage
- Perinatal Mortality
- Pregnancy Complications, Hematologic/parasitology
- Pregnancy Complications, Hematologic/prevention & control
- Pregnancy Complications, Parasitic/drug therapy
- Pregnancy Complications, Parasitic/etiology
- Pregnancy Outcome
- Pregnancy Trimester, Second
- Pregnancy Trimester, Third
- Randomized Controlled Trials as Topic
- Soil/parasitology
- Infant, Newborn
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Affiliation(s)
- Rehana A Salam
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Jai K Das
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
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21
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Demeke G, Mengistu G, Abebaw A, Toru M, Yigzaw M, Shiferaw A, Mengist HM, Dilnessa T. Effects of intestinal parasite infection on hematological profiles of pregnant women attending antenatal care at Debre Markos Referral Hospital, Northwest Ethiopia: Institution based prospective cohort study. PLoS One 2021; 16:e0250990. [PMID: 33970934 PMCID: PMC8109803 DOI: 10.1371/journal.pone.0250990] [Citation(s) in RCA: 3] [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: 11/21/2020] [Accepted: 04/16/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intestinal parasitosis is a common disease that causes misery and disability in poor populations. The number of individuals affected is staggering. From two billion peoples who harbor parasites worldwide, 300 million suffer severe morbidity and more than 25% of pregnant women are infected with hookworm, which causes intestinal bleeding and blood loss, and has been most commonly associated with anemia. Intestinal parasite infection during pregnancy has been associated with iron deficiency, maternal anemia, and impaired nutritional status, as well as decreased infant birth weight. OBJECTIVE This study aimed to assess the effects of intestinal parasite infection on hematological profiles of pregnant women attending antenatal care in Debre Markos Referral Hospital from December 2017 to February 2019. METHOD A prospective cohort study design was conducted among 94 intestinal parasite-infected pregnant women as an exposed group and 187 pregnant women free from intestinal parasite were used as a control group. The effect of intestinal parasites on hematological profiles of pregnant women was assessed at Debre Markos Referral Hospital antenatal care ward. Socio-demographic data and nutrition status were assessed by using structured questionnaires and mid-upper arm circumference (MUAC), respectively. Two ml of venous blood and 2 gm of stool samples were collected to analyze the hematological profiles and detect intestinal parasites, respectively. Wet mount and formol-ether concentration (FEC) techniques were used to detect intestinal parasites. Hematological profile was analyzed using Mind ray BC-3000 plus instrument. Data were double entered into EpiData version 3.1 software and exported to SPSS version 24 software for analysis. Results were presented using tables and graphs. Associations of hemoglobin levels with intestinal parasitic infections were determined using binary logistic regression models. P≤0.05 was considered statistically significant. The mean hematological profile difference between parasite-infected and parasite-free pregnant women was computed using independent t-test. RESULTS In the present study, the predominant parasites identified were Entamoeba histolytica, hookworm, Giardia lamblia, Schistosoma mansoni, and Ascaris lumbricoides. About 8.2% of intestinal parasite-infected pregnant women had mild anemia while 4% had moderate anemia. Only 1.2% of intestinal parasite-free pregnant women developed moderate anemia. The mean HGB, HCT, MCV, MCH, and MCHC values of intestinal parasite-infected pregnant women were 12.8g/dl, 38.2%, 94.7fl, 33.1pg and 34.7g/dl, respectively. But the mean HGB, HCT, MCV, MCH and MCHC values of pregnant women who were free from intestinal parasites were 14.4 g/dl, 39.8%, 94.9fl, 33.9pg and 35.5g/dl, respectively. Anemia was strongly associated with hookworm (AOR = 21.29, 95%CI: 8.28-54.75, P<0.001), S.mansoni (AOR = 63.73, 95% CI: 19.15-212, P<0.001) and A.lumbricoide (AOR = 14.12, 95% CI 3.28-60.65, P<0.001). CONCLUSION Intestinal parasitic infection in pregnant women caused adverse impact on hematological profiles and was an independent predictor of anemia. Intestinal parasitic infection significantly decreased pregnant the level of HGB, HCT, MCV, MCH, and MCHC values. To minimize maternal anemia deworming could be good before pregnancy.
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Affiliation(s)
- Gebreselassie Demeke
- Department of Medical Laboratory Science, College Health Science, Debre Markos University, Debre Markos, Ethiopia
- * E-mail:
| | - Getachew Mengistu
- Department of Medical Laboratory Science, College Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Abtie Abebaw
- Department of Medical Laboratory Science, College Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Milkiyas Toru
- Department of Medical Laboratory Science, College Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Molla Yigzaw
- Department of Medical Laboratory Science, College Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Aster Shiferaw
- Department of Midwifery, College Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Hylemariam Mihiretie Mengist
- Department of Medical Laboratory Science, College Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Tebelay Dilnessa
- Department of Medical Laboratory Science, College Health Science, Debre Markos University, Debre Markos, Ethiopia
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22
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Bongomin F, Olum R, Kyazze AP, Ninsiima S, Nattabi G, Nakyagaba L, Nabakka W, Kukunda R, Ssekamatte P, Kibirige D, Cose S, Nakimuli A, Baluku JB, Andia-Biraro I. Anemia in Ugandan pregnant women: a cross-sectional, systematic review and meta-analysis study. Trop Med Health 2021; 49:19. [PMID: 33648575 PMCID: PMC7919073 DOI: 10.1186/s41182-021-00309-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/19/2021] [Indexed: 12/26/2022] Open
Abstract
Background Anemia in pregnancy represents a global public health concern due to wide ranging maternal and neonatal adverse outcomes in all peripartum periods. We estimated the prevalence and factors associated with anemia in pregnancy at a national obstetrics and gynecology referral hospital in Uganda and in addition performed a systematic review and meta-analysis of the overall burden of anemia in pregnancy in Uganda. Methods We conducted a cross-sectional study among 263 pregnant women attending the antenatal care clinic of Kawempe National Referral Hospital, Kampala, Uganda, in September 2020. Anemia in pregnancy was defined as a hemoglobin level of < 11.0 g/dl and microcytosis as a mean corpuscular volume (MCV) of < 76 fL. We also performed a systematic review (PROSPERO Registration ID: CRD42020213001) and meta-analysis of studies indexed on MEDLINE, Embase, African Journal Online, ClinicalTrials.gov, ICTRP, and the Cochrane Library of systematic review between 1 January 2000 and 31 September 2020 reporting on the prevalence of anemia in pregnancy in Uganda. Results The prevalence of anemia was 14.1% (n= 37) (95%CI 10.4–18.8), of whom 21 (56.8%) had microcytic anemia. All cases of anemia occurred in the second or third trimester of pregnancy and none were severe. However, women with anemia had significantly lower MCV (75.1 vs. 80.2 fL, p<0.0001) and anthropometric measurements, such as weight (63.3 vs. 68.9kg; p=0.008), body mass index (25.2 vs. 27.3, p=0.013), hip (98.5 vs. 103.8 cm, p=0.002), and waist (91.1 vs. 95.1 cm, p=0.027) circumferences and mean systolic blood pressure (BP) (118 vs 125 mmHg, p=0.014). Additionally, most had BP within the normal range (59.5% vs. 34.1%, p=0.023). The comparison meta-analysis of pooled data from 17 published studies of anemia in pregnancy in Uganda, which had a total of 14,410 pregnant mothers, revealed a prevalence of 30% (95% CI 23–37). Conclusions Despite our study having a lower prevalence compared to other studies in Uganda, these findings further confirm that anemia in pregnancy is still of public health significance and is likely to have nutritional causes, requiring targeted interventions. A larger study would be necessary to demonstrate potential use of basic clinical parameters such as weight or blood pressure as screening predictors for anemia in pregnancy. Supplementary Information The online version contains supplementary material available at 10.1186/s41182-021-00309-z.
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Affiliation(s)
- Felix Bongomin
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda. .,Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda.
| | - Ronald Olum
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Andrew Peter Kyazze
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sandra Ninsiima
- Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Uganda
| | - Gloria Nattabi
- Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Uganda
| | - Lourita Nakyagaba
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Winnie Nabakka
- Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Uganda
| | - Rebecca Kukunda
- Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Uganda
| | - Phillip Ssekamatte
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Davis Kibirige
- Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Uganda.,Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Stephen Cose
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,Directorate of Programs, Mildmay Uganda, Wakiso, Uganda
| | - Annettee Nakimuli
- Department of Obstetrics & Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joseph Baruch Baluku
- Directorate of Programs, Mildmay Uganda, Wakiso, Uganda.,Department of Internal Medicine, Mulago National Referral Hospital, Kampala, Uganda
| | - Irene Andia-Biraro
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,Department of Clinical Research, Faculty of Infectious and Tropical Disease (ITD), London School of Hygiene and Tropical Medicine, London, UK
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23
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Aleem S, Bhutta ZA. Infection-related stillbirth: an update on current knowledge and strategies for prevention. Expert Rev Anti Infect Ther 2021; 19:1117-1124. [PMID: 33517816 DOI: 10.1080/14787210.2021.1882849] [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: 10/22/2022]
Abstract
Introduction: Infections during pregnancy are a preventable public health concern globally, with the highest burden occurring in low- and middle-income countries. Despite clear interventions to reduce these infections, their impact on preventing stillbirths is unclear, with conflicting evidence.Areas covered: The purpose of this review is to discuss data regarding infectious causes of stillbirths, and interventions for the prevention and/or treatment of these infections. We discuss the limitations in evaluating the true effect of the interventions on stillbirths, and highlight the importance of preventing infections in the grand scheme of improving maternal and infant pregnancy outcomes. We used PubMed to identify relevant studies, reviews, and meta-analysis until January 2021.Expert opinion: Maternal infections during pregnancy, especially malaria and syphilis, are notable causes of stillbirth in low- and middle-income countries. Despite considerable global advocacy, there is scant recognition of the potential to reduce the burden of antepartum stillbirths related to infections. Reducing stillbirths overall must become an important indicator for quality of care and accountability, and progress must also be assessed by coverage of key interventions that impact stillbirths, which includes population-based screening, prevention and timely treatment of infections during pregnancy.
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Affiliation(s)
- Samia Aleem
- Department of Pediatrics, Duke University, Durham, North Carolina, United States
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Centre of Excellence in Women, and Child Health, Aga Khan University, Karachi, Pakistan.,Epidemiology Division, Dalla Lana School of Public Health University of Toronto, Health Sciences Building, Toronto, Ontario, Canada
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24
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Chetty A, Omondi MA, Butters C, Smith KA, Katawa G, Ritter M, Layland L, Horsnell W. Impact of Helminth Infections on Female Reproductive Health and Associated Diseases. Front Immunol 2020; 11:577516. [PMID: 33329545 PMCID: PMC7719634 DOI: 10.3389/fimmu.2020.577516] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/27/2020] [Indexed: 12/25/2022] Open
Abstract
A growing body of knowledge exists on the influence of helminth infections on allergies and unrelated infections in the lung and gastrointestinal (GI) mucosa. However, the bystander effects of helminth infections on the female genital mucosa and reproductive health is understudied but important considering the high prevalence of helminth exposure and sexually transmitted infections in low- and middle-income countries (LMICs). In this review, we explore current knowledge about the direct and systemic effects of helminth infections on unrelated diseases. We summarize host disease-controlling immunity of important sexually transmitted infections and introduce the limited knowledge of how helminths infections directly cause pathology to female reproductive tract (FRT), alter susceptibility to sexually transmitted infections and reproduction. We also review work by others on type 2 immunity in the FRT and hypothesize how these insights may guide future work to help understand how helminths alter FRT health.
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Affiliation(s)
- Alisha Chetty
- Institute of Infectious Disease and Molecular Medicine and Division of Immunology, University of Cape Town, Cape Town, South Africa
| | - Millicent A Omondi
- Institute of Infectious Disease and Molecular Medicine and Division of Immunology, University of Cape Town, Cape Town, South Africa
| | - Claire Butters
- Institute of Infectious Disease and Molecular Medicine and Division of Immunology, University of Cape Town, Cape Town, South Africa
| | - Katherine Ann Smith
- Institute of Infectious Disease and Molecular Medicine and Division of Immunology, University of Cape Town, Cape Town, South Africa.,School of Biosciences, Cardiff University, Cardiff, United Kingdom
| | - Gnatoulma Katawa
- Ecole Supérieure des Techniques Biologiques et Alimentaires, Université de Lomé, Lomé, Togo
| | - Manuel Ritter
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), Bonn, Germany
| | - Laura Layland
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), Bonn, Germany
| | - William Horsnell
- Institute of Infectious Disease and Molecular Medicine and Division of Immunology, University of Cape Town, Cape Town, South Africa.,Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
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25
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Patel P, Rose CE, Kjetland EF, Downs JA, Mbabazi PS, Sabin K, Chege W, Watts DH, Secor WE. Association of schistosomiasis and HIV infections: A systematic review and meta-analysis. Int J Infect Dis 2020; 102:544-553. [PMID: 33157296 PMCID: PMC8883428 DOI: 10.1016/j.ijid.2020.10.088] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
Abstract
Background: Female genital schistosomiasis (FGS) affects up to 56 million women in sub-Saharan Africa and may increase risk of HIV infection. Methods: To assess the association of schistosomiasis with HIV infection, peer-reviewed literature published until 31 December 2018 was examined and a pooled estimate for the odds ratio was generated using Bayesian random effects models. Results: Of the 364 abstracts that were identified, 26 were included in the summary. Eight reported odds ratios of the association between schistosomiasis and HIV; one reported a transmission hazard ratio of 1.8 (95% CI, 1.2–2.6) among women and 1.4 (95% CI, 1.0–1.9) among men; 11 described the prevalence of schistosomiasis among HIV-positive people (range, 1.5–36.6%); and six reported the prevalence of HIV among people with schistosomiasis (range, 5.8–57.3%). Six studies were selected for quantitative analysis. The pooled estimate for the odds ratio of HIV among people with schistosomiasis was 2.3 (95% CI, 1.2–4.3). Conclusions: A significant association of schistosomiasis with HIV was found. However, a specific summary estimate for FGS could not be generated. A research agenda was provided to determine the effect of FGS on HIV infection. The WHO’s policy on mass drug administration for schistosomiasis may prevent HIV.
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Affiliation(s)
- Pragna Patel
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Charles E Rose
- Deputy Director for Non-Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eyrun F Kjetland
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway; Discipline of Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Jennifer A Downs
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Pamela Sabina Mbabazi
- World Health Organization, Department of Control of Neglected Tropical Diseases, Geneva, Switzerland
| | | | - Wairimu Chege
- National Institutes of Health, National Institutes of Allergy and Infectious Diseases, Division of AIDS, Rockville, MD, USA
| | - D Heather Watts
- Office of the Global AIDS Coordinator, Department of State, Washington, DC, USA
| | - W Evan Secor
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
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26
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Hoekstra PT, Schwarz NG, Adegnika AA, Andrianarivelo MR, Corstjens PLAM, Rakotoarivelo RA, Rakotozandrindrainy R, Sicuri E, Kreidenweiss A, van Dam GJ. Fast and reliable easy-to-use diagnostics for eliminating bilharzia in young children and mothers: An introduction to the freeBILy project. Acta Trop 2020; 211:105631. [PMID: 32679109 DOI: 10.1016/j.actatropica.2020.105631] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 06/24/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023]
Abstract
Schistosoma antigen detection tests have a large potential for schistosomiasis control programs due to their ability to detect active and ongoing Schistosoma infections, their much higher sensitivity compared to microscopical methods, and the possibility to use non-invasive urine samples. Pregnant women and young children could especially benefit from affordable and easy-to-use antigen tests as inclusion of these vulnerable groups in mass drug administration campaigns will always require higher justification hurdles, especially in low to middle endemic regions with a higher proportion of individuals who are not infected and thus unnecessarily exposed to praziquantel. The overall objective of the 'fast and reliable easy-to-use diagnostics for eliminating bilharzia in young children and mothers' (freeBILy, www.freeBILy.eu) project is to thoroughly evaluate the point-of-care circulating cathodic antigen (POC-CCA) and the up-converting phosphor reporter particle, lateral flow circulating anodic antigen (UCP-LF CAA) urine strip tests to diagnose Schistosoma infections in pregnant women and young children and to assess their potential as a schistosomiasis control tool in test-and-treat strategies. The freeBILy project will generate valuable, evidence-based findings on improved tools and test-and-treat strategies to reduce the burden of schistosomiasis in pregnant women and young children.
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Affiliation(s)
- Pytsje T Hoekstra
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Norbert G Schwarz
- Bernhard-Nocht-Institut für Tropenmedizin, Hamburg, Germany; German Center for Infection Research, Germany
| | - Ayola A Adegnika
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands; German Center for Infection Research, Germany; Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon; Eberhard Karls Universität Tübingen, Tübingen, Germany
| | | | - Paul L A M Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Elisa Sicuri
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Health Economics Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Andrea Kreidenweiss
- German Center for Infection Research, Germany; Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Govert J van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
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27
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Honkpehedji YJ, Adegnika AA, Dejon-Agobe JC, Zinsou JF, Mba RB, Gerstenberg J, Rakotozandrindrainy R, Rakotoarivelo RA, Rasamoelina T, Sicuri E, Schwarz NG, Corstjens PLAM, Hoekstra PT, van Dam GJ, Kreidenweiss A. Prospective, observational study to assess the performance of CAA measurement as a diagnostic tool for the detection of Schistosoma haematobium infections in pregnant women and their child in Lambaréné, Gabon: study protocol of the freeBILy clinical trial in Gabon. BMC Infect Dis 2020; 20:718. [PMID: 32993559 PMCID: PMC7523491 DOI: 10.1186/s12879-020-05445-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Schistosoma antigen detection in urine is a valuable diagnostic approach for schistosomiasis control programmes because of the higher sensitivity compared to parasitological methods and preferred sampling of urine over stool. Highly accurate diagnostics are important in low Schistosoma transmission areas. Pregnant women and young children could particularly benefit from antigen testing as praziquantel (PZQ) can be given to only confirmed Schistosoma cases. This prevents the unborn baby from unnecessary exposure to PZQ. We present here the protocol of a diagnostic study that forms part of the freeBILy project. The aim is to evaluate the accuracy of circulating anodic antigen (CAA) detection for diagnosis of Schistosoma haematobium infections in pregnant women and to validate CAA as an endpoint measure for anti-Schistosoma drug efficacy. The study will also investigate Schistosoma infections in infants. METHODS A set of three interlinked prospective, observational studies is conducted in Gabon. The upconverting phosphor lateral flow (UCP-LF) CAA test is the index diagnostic test that will be evaluated. The core trial, sub-study A, comprehensively evaluates the accuracy of the UCP-LF CAA urine test against a set of other Schistosoma diagnostics in a cross-sectional trial design. Women positive for S. haematobium will proceed with sub-study B and will be randomised to receive PZQ treatment immediately or after delivery followed by weekly sample collection. This approach includes comparative monitoring of CAA levels following PZQ intake and will also contribute further data for safety of PZQ administration during pregnancy. Sub-study C is a longitudinal study to determine the incidence of S. haematobium infection as well as the age for first infection in life-time. DISCUSSION The freeBILy trial in Gabon will generate a comprehensive set of data on the accuracy of the UCP-LF CAA test for the detection of S. haematobium infection in pregnant women and newborn babies and for the use of CAA as a marker to determine PZQ efficacy. Furthermore, incidence of Schistosoma infection in infants will be reported. Using the ultrasensitive diagnostics, this information will be highly relevant for Schistosoma prevalence monitoring by national control programs as well as for the development of medicaments and vaccines. TRIAL REGISTRATION The registration number of this study is NCT03779347 ( clinicaltrials.gov , date of registration: 19 December 2018).
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Affiliation(s)
- Yabo Josiane Honkpehedji
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ayôla Akim Adegnika
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
- German Center for Infection Research (DZIF), Tübingen, Germany
| | - Jean Claude Dejon-Agobe
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
- Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jeannot Fréjus Zinsou
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Romuald Beh Mba
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Jacob Gerstenberg
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | | | | | | | - Elisa Sicuri
- Fundación Privada Instituto de Salud Global Barcelona, Barcelona, Spain
| | | | - Paul L A M Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - Pytsje T Hoekstra
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Govert J van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Andrea Kreidenweiss
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands.
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Bengu MD, Dorsamy V, Moodley J. Schistosomiasis infections in South African pregnant women: A review. S Afr J Infect Dis 2020; 35:171. [PMID: 39380900 PMCID: PMC11459292 DOI: 10.4102/sajid.v35i1.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 06/24/2020] [Indexed: 10/10/2024] Open
Abstract
Background Schistosomiasis, a chronic parasitic disease caused by Schistosoma species, has a negative impact on pregnancy outcomes and child development. The disease affects over 230 million people worldwide, and in South Africa an estimated 5.2 million people are thought to be infected. However, there is scant data on the impact of schistosomiasis in pregnancy in South Africa and globally. The aim of this review was to analyse the current knowledge of schistosomiasis in pregnancy, particularly in South Africa, focusing on maternal and neonatal complications linked directly to the disease or its treatment. Methods An electronic search of online databases was used to identify and collect relevant research articles related to schistosomiasis in pregnancy, with a focus on South Africa. Results Schistosomiasis can cause severe organ damage when left untreated and influences maternal and foetal morbidity and mortality. Although South Africa's first helminth control programme was established in 1997, there is currently no ongoing treatment strategy programme, and little information is available on prevalence rates in pregnant women for the last 20 years. There is also an absence of data from well-controlled clinical trials that focus on the efficacy and safety of treatment during pregnancy, which has led to this vulnerable group being neglected. Conclusion This review highlights the dearth of information on the impact of schistosomiasis in pregnant women in South Africa and the need for high-quality evidence-based studies.
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Affiliation(s)
- Melissa D Bengu
- Department of Obstetrics and Gynaecology, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Vinogrin Dorsamy
- Department of Laboratory Medicine and Medical Sciences, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Jagidesa Moodley
- Department of Obstetrics and Gynaecology, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Rabiu OR, Dada-Adegbola H, Kosoko AM, Falade CO, Arinola OG, Odaibo AB, Ademowo OG. Contributions of malaria, helminths, HIV and iron deficiency to anaemia in pregnant women attending ante-natal clinic in SouthWest Nigeria. Afr Health Sci 2020; 20:1035-1044. [PMID: 33402949 PMCID: PMC7751510 DOI: 10.4314/ahs.v20i3.6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Iron deficiency is a dominant source of anaemia in many settings. To evaluate the key cause of anaemia in the study area, the prevalence of anaemia due to major public health diseases was compared with anaemia due to iron deficiency. METHODS Pregnant women were recruited from ante-natal (n=490) and HIV clinics (n=217) with their personal data documented using a questionnaire. Microscopy of Giemsa-stained thick smears was used for detection of malaria parasites while helminths in stools were detected using direct smear method. Haematocrit values were determined by capillary method. Serum ferritin levels were determined using enzyme-linked immunosorbent assay. Data was analysed using SPSS version 22.0. RESULTS The mean age of the recruited women was 28.6±5.4 years old. There were 68.1% cases of anaemia of which 35.5% was due to infections only predominantly HIV and malaria, 14.9% from unknown sources while anaemia due to iron deficiency only was 7.1%. CONCLUSION It can safely be inferred that malaria and HIV predispose to anaemia than iron deficiency in the study area. Although pregnant women are dewormed and given IPTp for helminths and malaria treatment respectively, there should be complementary routine malaria screening at ANC visits for those with HCT values <33% and those infected with HIV.
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Affiliation(s)
- Olawunmi R Rabiu
- Department of Zoology, University of Ibadan, Ibadan, Nigeria
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Biological Sciences, Mountain Top University, Km 12, Lagos-Ibadan Expressway, Ogun State, Nigeria
| | - Hannah Dada-Adegbola
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ayokulehin M Kosoko
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Biochemistry, University of Ibadan, Ibadan, Nigeria
- Department of Biochemistry, Federal University of Agriculture, Abeokuta, Ogun State, Nigeria
| | - Catherine O Falade
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Olatunbosun G Arinola
- Immunology Unit, Department of Chemical Pathology, College of Medicine, University of Ibadan, Nigeria
| | | | - Olusegun G Ademowo
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
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Population Pharmacokinetics of Praziquantel in Pregnant and Lactating Filipino Women Infected with Schistosoma japonicum. Antimicrob Agents Chemother 2020; 64:AAC.00566-20. [PMID: 32631820 PMCID: PMC7449211 DOI: 10.1128/aac.00566-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/08/2020] [Indexed: 01/16/2023] Open
Abstract
An estimated 40 million women of reproductive age are infected with one of three species of the waterborne parasite Schistosoma spp. Treatment with praziquantel (PZQ) via mass drug administration (MDA) campaigns is the mainstay of schistosomiasis control for populations living in areas of endemicity. The World Health Organization recommends that pregnant and lactating women be included in schistosomiasis MDA programs, and several recent studies have evaluated the safety and efficacy of PZQ use during pregnancy. To date, there are no data describing PZQ pharmacokinetics (PK) during pregnancy or among lactating postpartum women. As part of a randomized controlled trial investigating the safety and efficacy of PZQ during human pregnancy, we examined the PK of this therapeutic drug among three distinct cohorts of women infected with S. japonicum in Leyte, Philippines. Specifically, we studied the PK properties of PZQ among early- and late-gestation pregnant women (n = 15 each) and lactating postpartum women (n = 15) with schistosomiasis. We found that women in early pregnancy had increased apparent clearance and lower area-under-the-curve (AUC0-24) values that may be related to physiological changes in drug clearance and/or changes in oral bioavailability. There was no relationship between body weight and apparent clearance. The mean ± standard deviation partition ratio of plasma to breast milk was 0.36. ± 0.13. The estimated median infant PZQ daily dose would be 0.037 mg/kg of body weight ingested from breast milk, which is significantly lower than the dosage required for antischistosomal activity and not known to be harmful to the infant. Our PK data do not support the suggestion to delay breastfeeding 72 h after taking PZQ. Results can help inform future drug efficacy studies in pregnant and lactating women with schistosomiasis.
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Hookworm Infection among Pregnant Women at First Antenatal Visit in Lira, Uganda: A Cross-Sectional Study. Int J Reprod Med 2020; 2020:8053939. [PMID: 32685438 PMCID: PMC7341405 DOI: 10.1155/2020/8053939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/09/2020] [Indexed: 11/17/2022] Open
Abstract
Background Hookworm infection in expectant mothers has adverse health effects on both the mothers and their unborn babies. Foetal effects are known to include intrauterine growth retardation and physical and mental growth retardation, while the mothers may develop anemia which could potentially result in death. Unfortunately, little is known about factors that may predispose a pregnant woman to infection by hookworm. In this study, we strived to determine not only the prevalence of hookworm infection among pregnant women attending their first antenatal visit during the current pregnancy in a local health center in northern Uganda but also factors that might predispose them to hookworm infection. Method This cross-sectional study was conducted among 346 pregnant women from Ogur Health Center IV located in Lira district, northern Uganda. Stool samples were collected from each study participant and analyzed for hookworms. The independent variables listed in this study (participant's sociodemographic characteristics, preconception care, and sanitation factors) were obtained using a structured questionnaire. Data analysis, including calculation of adjusted ratios, was performed using STATA software (version 14). Results Prevalence of hookworm infection among pregnant women who attended their first antenatal visit at Ogur Health Center IV was 11% (n = 38). After controlling for confounders, factors found to be significantly associated with this infection among pregnant women here were gardening barefooted (adjusted odds ratio (AOR), 3.4; 95% confidence interval (CI), 1.6 to 7.5; P < 0.001) and fetching unsafe water shared with animals for domestic uses (AOR, 2.8; 95% CI, 1.3 to 6.2; P value of 0.002). Conclusion Hookworm infection among pregnant women at Ogur Health Center IV in Lira district, at 11%, is a public health concern and significantly associated with barefoot gardening and fetching water from unsafe sources shared with animals. We, therefore, recommend that special emphasis during routine prenatal health education be placed on the use of protective footwear during farming and fetching water for domestic use from protected safe sources. Author Summary. Hookworm infection is a parasitic condition that more often goes unnoticed, yet it presents immense detrimental effects, especially to pregnant women and their unborn children. It is a chronic disease with accruing effects of blood depletion resulting in anemia. Anemia is, by far, one of the major causes of maternal morbidity and mortality in Uganda. Pregnant women are more prone to hookworm infection by virtue of their compromised immunity, secondary to the physiological process of pregnancy. We demonstrated here that hookworm infection still exists among pregnant women in Uganda. We also showed that gardening barefooted and fetching water for domestic uses from unsafe sources shared with animals were major factors associated with this helminthic infection. This study provides evidence necessary to influence decision making on prevention of hookworm infection in the study area.
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Hemida M, Vuori KA, Salin S, Moore R, Anturaniemi J, Hielm-Björkman A. Identification of modifiable pre- and postnatal dietary and environmental exposures associated with owner-reported canine atopic dermatitis in Finland using a web-based questionnaire. PLoS One 2020; 15:e0225675. [PMID: 32469869 PMCID: PMC7259748 DOI: 10.1371/journal.pone.0225675] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 05/11/2020] [Indexed: 02/06/2023] Open
Abstract
A cross-sectional hypothesis generating study was performed to investigate modifiable exposures such as whether feeding pattern (a non-processed meat based diet, NPMD, or an ultra-processed carbohydrate based diet, UPCD), certain environmental factors and their timing of exposure might be associated with the development of canine atopic dermatitis (CAD). Also, genetic and demographic factors were tested for associations with CAD. The data was collected from the validated internet-based DogRisk food frequency questionnaire in Finland. A total of 2236 dogs were eligible for the study (the owners reported 406 cases and 1830 controls). Our main interest was to analyze modifiable early risk factors of CAD, focusing on nutritional and environmental factors. We tested four early life periods; prenatal, neonatal, early postnatal and late postnatal periods. Twenty-two variables were tested for associations with CAD using logistic regression analysis. From the final models we identified novel dietary associations with CAD: the NPMD during the prenatal and early postnatal periods had a significant negative association with the incidence of CAD in adult dogs (age above 1 year). Oppositely, UPCD was associated with a significantly higher risk for CAD incidence. Other variables that were associated with a significantly lower risk for CAD were maternal deworming during pregnancy, sunlight exposure during early postnatal period, normal body condition score during the early postnatal period, the puppy being born within the same family that it would stay in, and spending time on a dirt or grass surface from 2 to 6 months. Also, the genetic factors regarding maternal history of CAD, allergy-prone breeds and more than 50% white-colored coat all showed a significant positive association with CAD incidence in agreement with previous findings. Although no causality can be established, feeding NPMD early in life seemed to be protective against CAD, while UPCD could be considered a risk factor. Prospective intervention studies are needed to establish the causal effects of the protective role of NPMD on prevalence of CAD during the fetal and early postnatal life.
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Affiliation(s)
- Manal Hemida
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
- Department of Nutrition and Clinical Nutrition, Faculty of Veterinary Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Kristiina A. Vuori
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Siru Salin
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Robin Moore
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Johanna Anturaniemi
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Anna Hielm-Björkman
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
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Faust CL, Osakunor DNM, Downs JA, Kayuni S, Stothard JR, Lamberton PHL, Reinhard-Rupp J, Rollinson D. Schistosomiasis Control: Leave No Age Group Behind. Trends Parasitol 2020; 36:582-591. [PMID: 32430274 DOI: 10.1016/j.pt.2020.04.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 01/11/2023]
Abstract
Despite accelerating progress towards schistosomiasis control in sub-Saharan Africa, several age groups have been eclipsed by current treatment and monitoring strategies that mainly focus on school-aged children. As schistosomiasis poses a threat to people of all ages, unfortunate gaps exist in current treatment coverage and associated monitoring efforts, preventing subsequent health benefits to preschool-aged children as well as certain adolescents and adults. Expanding access to younger ages through the forthcoming pediatric praziquantel formulation and improving treatment coverage in older ages is essential. This should occur alongside formal inclusion of these groups in large-scale monitoring and evaluation activities. Current omission of these age groups from treatment and monitoring exacerbates health inequities and has long-term consequences for sustainable schistosomiasis control.
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Affiliation(s)
- Christina L Faust
- Wellcome Centre for Integrative Parasitology, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, UK.
| | - Derick N M Osakunor
- Institute of Immunology and Infection Research, University of Edinburgh, Ashworth Laboratories, King's Buildings, Charlotte Auerbach Road, Edinburgh EH9 3FL, UK
| | - Jennifer A Downs
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Sekeleghe Kayuni
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; MASM Medi Clinics Limited, Medical Aid Society of Malawi (MASM), Blantyre, Malawi
| | - J Russell Stothard
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Poppy H L Lamberton
- Wellcome Centre for Integrative Parasitology, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow G12 8QQ, UK
| | | | - David Rollinson
- Global Schistosomiasis Alliance, Natural History Museum, London SW7 5BD, UK
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Abstract
BACKGROUND Ascaris lumbricoides is a common infection, and mainly affects children living in low-income areas. Water and sanitation improvement, health education, and drug treatment may help break the cycle of transmission, and effective drugs will reduce morbidity. OBJECTIVES To compare the efficacy and safety of anthelmintic drugs (albendazole, mebendazole, ivermectin) for treating people with Ascaris infection. SEARCH METHODS We searched the Cochrane Infectious Disease Group Specialized Register, CENTRAL, MEDLINE, Embase, LILACS, three other databases, and reference lists of included studies, without language restrictions, up to 4 July 2019. SELECTION CRITERIA Randomized controlled trials (RCT) that compared albendazole, mebendazole, and ivermectin in children and adults with confirmed Ascaris infection. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion, assessed risk of bias, and extracted data from the included trials. A third review author checked the quality of data extraction. We used the Cochrane 'Risk of bias' assessment tool to determine the risk of bias in included trials. We used risk ratios (RRs) with 95% confidence intervals (CIs) to compare dichotomous outcomes in treatment and control groups. We used the fixed-effect model for studies with low heterogeneity and the random-effects model for studies with moderate to high heterogeneity. We assessed the certainty of the evidence using the GRADE approach. We used the control rate average to provide illustrative cure rates in the comparison groups. MAIN RESULTS We included 30 parallel-group RCTs, which enrolled 6442 participants from 17 countries across Africa, Asia, Central America and the Caribbean, and South America. Participants were from 28 days to 82 years of age, recruited from school, communities, and health facilities. Twenty studies were funded or co-funded by manufacturers, while 10 studies were independent of manufacturer funding. Twenty-two trials had a high risk of bias for one or two domains (blinding, incomplete outcome data, selective reporting). Single dose of albendazole (four trials), mebendazole (three trials) or ivermectin (one trial) was compared to placebo. Parasitological cure at 14 to 60 days was high in all the studies (illustrative cure of 93.0% in the anthelmintic group and 16.1% in the placebo group; RR 6.29, 95% CI 3.91 to 10.12; 8 trials, 1578 participants; moderate-certainty evidence). Single dose of albendazole is as effective as multiple doses of albendazole (illustrative cure of 93.2% with single dose, 94.3% with multiple doses; RR 0.98, 95% CI 0.92 to 1.05; 3 trials, 307 participants; high-certainty evidence); or as single dose of mebendazole (illustrative cure of 98.0% with albendazole, 96.9% with mebendazole; RR 1.01, 95% CI 1.00 to 1.02; 6 trials, 2131 participants; high-certainty evidence). Studies did not detect a difference between a single dose of albendazole and a single dose of ivermectin (cure rates of 87.8% with albendazole, 90.2% with ivermectin; RR 0.99, 95% CI 0.91 to 1.08; 3 trials, 519 participants; moderate-certainty evidence). Across all the studies, failure after single dose of albendazole ranged from 0.0% to 30.3%, mebendazole from 0.0% to 22.2%, and ivermectin from 0.0% to 21.6%. The egg reduction rate (ERR) measured up to 60 days after the treatment was high in all treated groups, regardless of the anthelmintic used (range 96% to 100%). It was not possible to evaluate parasitological cure by classes of infection intensity. No included trials reported complication or serious adverse events. Other adverse events were apparently similar among the compared anthelmintic groups (moderate- to low-certainty evidence). The most commonly reported other adverse events were nausea, vomiting, abdominal pain, diarrhoea, headache, and fever. AUTHORS' CONCLUSIONS Single-dose of albendazole, mebendazole, and ivermectin all appeared effective against Ascaris lumbricoides infection, yielding high parasitological cure and large reductions in eggs excreted, with no differences detected between them. The drugs appear to be safe to treat children and adults with confirmed Ascaris infection. There is little to choose between drugs and regimens in terms of cure or adverse events.
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Affiliation(s)
- Lucieni O Conterno
- State University of Campinas (UNICAMP)Medical School, Department of Internal Medicine, Infectious Diseases DivisionRua Tessália Vieira de Camargo, 126Cidade Universitária "Zeferino Vaz"CampinasSão PauloBrazil13083‐887
| | - Marilia D Turchi
- Federal University of GoiasDepartment of Public Health, Institute of Tropical Pathology and Public HealthRua Amorinopolis QdR2 Lt13 Residencial GoiasAlphaville FlamboyantGoianiaGoiasBrazil74884‐540
| | - Ione Corrêa
- Botucatu Medical School, UNESP ‐ Univ Estadual PaulistaDepartment of NursingDistrito de Rubião Júnior, s/nBotucatuSão PauloBrazil18603‐970
| | - Ricardo Augusto Monteiro de Barros Almeida
- Botucatu Medical School, UNESP ‐ Univ Estadual PaulistaDepartment of Tropical Diseases and Imaging DiagnosisAv. Prof. Montenegro, s/nDistrito de Rubiao JrBotucatuSao PauloBrazil18618‐970
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Lule SA, Namara B, Akurut H, Muhangi L, Lubyayi L, Nampijja M, Akello F, Tumusiime J, Aujo JC, Oduru G, Smeeth L, Elliott AM, Webb EL. Are birthweight and postnatal weight gain in childhood associated with blood pressure in early adolescence? Results from a Ugandan birth cohort. Int J Epidemiol 2020; 48:148-156. [PMID: 29982658 PMCID: PMC6380421 DOI: 10.1093/ije/dyy118] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 05/25/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In Africa, where low birthweight (LBW), malnutrition and high blood pressure (BP) are prevalent, the relationships between birthweight (BW), weight gain and BP later in life remain uncertain. We examined the effects of early life growth on BP among Ugandan adolescents. METHODS Data were collected prenatally from women and their offspring were followed from birth, with BP measured following standard protocols in early adolescence. Weight-for-age Z-scores (WAZ) were computed using World Health Organization references. Linear regression was used to relate BW, and changes in WAZ between birth and 5 years, to adolescents' BP, adjusting for confounders. RESULTS Among 2345 live offspring, BP was measured in 1119 (47.7%) adolescents, with mean systolic BP 105.9 mmHg and mean diastolic BP 65.2 mmHg. There was little evidence of association between BW and systolic [regression coefficient β = 0.14, 95% confidence interval (CI) (-1.00, 1.27)] or diastolic [β = 0.43, 95% CI (-0.57, 1.43)] BP. Accelerated weight gain between birth and 5 years was associated with increased BP: systolic β = 1.17, 95% CI (0.69, 1.66) and diastolic β = 1.03, 95% CI (0.59, 1.47). Between birth and 6 months of age, effects of accelerated weight gain on adolescent BP were strongest among the LBW (both premature and small-for-gestational-age) children [BW < 2.5 kg: β = 2.64, 95% CI (0.91, 4.37), BW≥2.5 kg: β = 0.58, 95% CI (0.01, 1.14), interaction P-value = 0.024]. CONCLUSIONS Findings from this large tropical birth cohort in Uganda suggest that postnatal weight gain rather than BW is important in the developmental programming of BP, with fast-growing LBW children at particular risk. Efforts to control BP should adopt a life course approach.
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Affiliation(s)
- Swaib A Lule
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Endemic, Neglected, Emerging and Re-emerging Infections Programme, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | - Benigna Namara
- Endemic, Neglected, Emerging and Re-emerging Infections Programme, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | - Helen Akurut
- Endemic, Neglected, Emerging and Re-emerging Infections Programme, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | - Lawrence Muhangi
- Endemic, Neglected, Emerging and Re-emerging Infections Programme, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | - Lawrence Lubyayi
- Endemic, Neglected, Emerging and Re-emerging Infections Programme, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | - Margaret Nampijja
- Endemic, Neglected, Emerging and Re-emerging Infections Programme, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | - Florence Akello
- Endemic, Neglected, Emerging and Re-emerging Infections Programme, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | | | - Judith C Aujo
- Department of Paediatrics, Mulago Hospital, Kampala, Uganda
| | - Gloria Oduru
- Endemic, Neglected, Emerging and Re-emerging Infections Programme, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | - Liam Smeeth
- Department of Non-communicable Disease Epidemiology
| | - Alison M Elliott
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Emily L Webb
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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St-Denis K, Blouin B, Rahme E, Casapia M, Montresor A, Mupfasoni D, Mbabazi PS, Gyorkos TW. Ruling out early trimester pregnancy when implementing community-based deworming programs. PLoS Negl Trop Dis 2020; 14:e0007901. [PMID: 31999690 PMCID: PMC6991962 DOI: 10.1371/journal.pntd.0007901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 11/03/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Large-scale deworming programs have, to date, mostly targeted preschool- and school-age children. As community-based deworming programs become more common, deworming will be offered to women of reproductive age. The World Health Organization recommends preventive chemotherapy be administered to pregnant women only after the first trimester. It is therefore important for deworming programs to be able to identify women in early pregnancy. Our objective was to validate a short questionnaire which could be used by deworming program managers to identify and screen out women in early pregnancy. METHODOLOGY/PRINCIPAL FINDINGS In May and June 2018, interviewers administered a questionnaire, followed by a pregnancy test, to 1,203 adult women living in the Peruvian Amazon. Regression analyses were performed to identify questions with high predictive properties (using the pregnancy test as the gold standard). Test parameters were computed at different decision tree nodes (where nodes represented questions). With 106 women confirmed to be pregnant, the positive predictive value of asking the single question 'Are you pregnant?' was 100%, at a 'cost' of a false negative rate of 1.9% (i.e. 21 women were incorrectly identified as not pregnant when they were truly pregnant). Additional questions reduced the false negative rate, but increased the false positive rate. Rates were dependent on both the combination and the order of questions. CONCLUSIONS/SIGNIFICANCE To identify women in early pregnancy when deworming programs are community-based, both the number and order of questions are important. The local context and cultural acceptability of different questions should inform this decision. When numbers are manageable and resources are available, pregnancy tests can be considered at different decision tree nodes to confirm pregnancy status. Trade-offs in terms of efficiency and misclassification rates will need to be considered to optimize deworming coverage in women of reproductive age.
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Affiliation(s)
- Kariane St-Denis
- WHO Collaborating Centre for Research and Training in Parasite Epidemiology and Control, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Brittany Blouin
- WHO Collaborating Centre for Research and Training in Parasite Epidemiology and Control, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Elham Rahme
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Martin Casapia
- Asociación Civil Selva Amazoníca, Iquitos, Peru
- Facultad de Medicina Humana, Universidad Nacional de la Amazonía Peruana, Iquitos, Peru
| | - Antonio Montresor
- Department of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Denise Mupfasoni
- Department of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Pamela Sabina Mbabazi
- Department of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Theresa W. Gyorkos
- WHO Collaborating Centre for Research and Training in Parasite Epidemiology and Control, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
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Nankinga O, Aguta D. Determinants of Anemia among women in Uganda: further analysis of the Uganda demographic and health surveys. BMC Public Health 2019; 19:1757. [PMID: 31888579 PMCID: PMC6937990 DOI: 10.1186/s12889-019-8114-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 12/19/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Anemia is a public health problem in many developing countries. It affects a sizable proportion of women of reproductive age. Anemia increases the risk of morbidity and mortality from infectious diseases, and can lead to poor fetal outcomes, and low productivity. This study examined the trends and determinants of anemia among women of reproductive age in Uganda. METHODS This study analyzed data from the Uganda Demographic and Health Surveys conducted in 2006, 2011, and 2016. The study was based on 10,956 weighted cases of women age 15-49. Bivariate analysis and multiple logistic regression analysis examined the association between the outcome variable and the determinants. Potential determinants of anemia in women were selected based on literature. RESULTS The results of the analysis show that anemia decreased in Uganda between 2006 and 2016, but with an increase between 2011 and 2016. The overall prevalence of anemia among women was 50, 23, and 32% respectively in 2006, 2011, and 2016. Women who were pregnant at the time of the survey had higher odds of being anemic across the surveys (OR 2.00, 95% CI 1.49-2.67; OR 1.47, 95% CI 1.02-2.10; OR 1.33, 95% CI 1.07-1.65). Women in households with nonimproved sources of drinking water also had higher odds for anemia (OR 1.32, 95% CI 1.09-1.61) in 2016. Wealth index, region and age were also significantly associated with anemia in women. CONCLUSION In order to reduce anemia in women, there is need to target pregnant women during antenatal and postpartum visits, and ensure that nutrition education during such visits is supported. There is also need to ensure sustainable household access to safe water. This should be combined with interventions aimed at enhancing household wealth.
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Affiliation(s)
- Olivia Nankinga
- Department of Population Studies, School of Statistics and Planning, College of Business and Management Sciences, Makerere University, Kampala, Uganda.
| | - Danstan Aguta
- Uganda Bureau of Statistics, Statistics House, Kampala, Uganda
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Murenjekwa W, Makasi R, Ntozini R, Chasekwa B, Mutasa K, Moulton LH, Tielsch JM, Humphrey JH, Smith LE, Prendergast AJ, Bourke CD. Determinants of Urogenital Schistosomiasis Among Pregnant Women and its Association With Pregnancy Outcomes, Neonatal Deaths, and Child Growth. J Infect Dis 2019; 223:1433-1444. [PMID: 31832636 PMCID: PMC8064048 DOI: 10.1093/infdis/jiz664] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/11/2019] [Indexed: 11/28/2022] Open
Abstract
Background Schistosoma haematobium is a parasitic helminth that causes urogenital pathology. The impact of urogenital schistosomiasis during pregnancy on birth outcomes and child growth is poorly understood. Methods Risk factors for urogenital schistosomiasis were characterized among 4437 pregnant women enrolled in a cluster-randomized community-based trial in rural Zimbabwe. Infection was defined via urine microscopy (≥1 S. haematobium egg) and urinalysis (hematuria). Associations between infection and pregnancy outcomes were assessed in case-control analyses using conditional logistic regression. The association of maternal infection with birthweight and length-for-age Z scores (LAZ) at 1 and 18 months of age were assessed using generalized estimating equations. Results Urogenital schistosomiasis (egg positive and/or hematuria positive) was detected in 26.8% of pregnant women. Risk factors significantly associated with infection were maternal age, education, marital status, and religion; household drinking water source and latrine; study region; and season. Urogenital schistosomiasis was not significantly associated with adverse pregnancy outcomes (miscarriage, stillbirth, preterm, and small-for-gestational age), birthweight, neonatal death, or LAZ. Conclusions Including pregnant women in antihelminthic treatment programs would benefit a large number of women in rural Zimbabwe. However, clearance of the low-intensity infections that predominate in this context is unlikely to have additive benefits for pregnancy outcomes or child growth. Clinical Trials Registration NCT01824940.
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Affiliation(s)
| | - Rachel Makasi
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Kuda Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Lawrence H Moulton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - James M Tielsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Jean H Humphrey
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Laura E Smith
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.,Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Andrew J Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.,Blizard Institute, Queen Mary University of London, London, UK
| | - Claire D Bourke
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.,Blizard Institute, Queen Mary University of London, London, UK
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Salam RA, Cousens S, Welch V, Gaffey M, Middleton P, Makrides M, Arora P, Bhutta ZA. Mass deworming for soil-transmitted helminths and schistosomiasis among pregnant women: A systematic review and individual participant data meta-analysis. CAMPBELL SYSTEMATIC REVIEWS 2019; 15:e1052. [PMID: 37131518 PMCID: PMC8356523 DOI: 10.1002/cl2.1052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The objective of the review is to use individual participant data (IPD) meta-analysis to explore the effect of mass deworming during pregnancy. We developed a search strategy and searched the databases till March 2018. We included individually randomised controlled trials; cluster randomised controlled trials and quasi randomised studies providing preventive or therapeutic deworming drugs for soil transmitted helminthiases and schistosomiasis during pregnancy. All IPD were assessed for completeness, compared to published reports and entered into a common data spreadsheet. Out of the seven trials elgible for IPD, we received data from three trials; out of 8,515 potential IPD participants; data were captured for 5,957 participants. Findings from this IPD suggest that mass deworming during pregnancy reduces maternal anaemia by 23% (Risk ratio [RR]: 0.77, 95% confidence intreval [CI]: 0.73-0.81; three trials; 5,216 participants; moderate quality evidence). We did not find any evidence of an effect of mass deworming during pregnancy on any of the other outcomes. There was no evidence of effect modification; however these findings should be interpreted with caution due to small sample sizes. The quality of evidence was rated as moderate for our findings. Our analyses suggest that mass deworming during pregnancy is associated with reducing anaemia with no evidence of impact on any other maternal or pregnancy outcomes. Our analyses were limited by the availability of data for the impact by subgroups and effect modification. There is also a need to support and promote open data for future IPDs.
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Affiliation(s)
- R. A. Salam
- Healthy Mother, Babies and Children ThemeSouth Australian Health and MedicalResearch InstituteAdelaideAustralia
- Paediatrics and Reproductive HealthUniversity of AdelaideAdelaideAustralia
| | - S. Cousens
- Maternal Adolescent Reproductive & Child Health (MARCH) CentreLondon School of Hygiene and Tropical MedicineLondonUK
| | - V. Welch
- School of Epidemiology, Public Health and Preventive MedicineUniversity of OttawaOttawaCanada
| | - M. Gaffey
- Centre for Global Child HealthThe Hospital for Sick ChildrenTorontoCanada
| | - P. Middleton
- Healthy Mother, Babies and Children ThemeSouth Australian Health and MedicalResearch InstituteAdelaideAustralia
- Robinson Research InstituteUniversity of AdelaideAdelaideAustralia
| | - M. Makrides
- Healthy Mother, Babies and Children ThemeSouth Australian Health and MedicalResearch InstituteAdelaideAustralia
| | - P. Arora
- Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
| | - Z. A. Bhutta
- Centre for Global Child HealthThe Hospital for Sick ChildrenTorontoCanada
- Centre of Excellence in Women and Child HealthThe Aga Khan UniversityKarachiPakistan
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40
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Gyorkos TW, St-Denis K. Systematic review of exposure to albendazole or mebendazole during pregnancy and effects on maternal and child outcomes, with particular reference to exposure in the first trimester. Int J Parasitol 2019; 49:541-554. [DOI: 10.1016/j.ijpara.2019.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/08/2019] [Accepted: 02/12/2019] [Indexed: 12/18/2022]
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41
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McKittrick ND, Malhotra IJ, Vu DM, Boothroyd DB, Lee J, Krystosik AR, Mutuku FM, King CH, LaBeaud AD. Parasitic infections during pregnancy need not affect infant antibody responses to early vaccination against Streptococcus pneumoniae, diphtheria, or Haemophilus influenzae type B. PLoS Negl Trop Dis 2019; 13:e0007172. [PMID: 30818339 PMCID: PMC6413956 DOI: 10.1371/journal.pntd.0007172] [Citation(s) in RCA: 5] [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: 08/21/2018] [Revised: 03/12/2019] [Accepted: 01/18/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Globally, vaccine-preventable diseases remain a significant cause of early childhood mortality despite concerted efforts to improve vaccine coverage. One reason for impaired protection may be the influence of prenatal exposure to parasitic antigens on the developing immune system. Prior research had shown a decrease in infant vaccine response after in utero parasite exposure among a maternal cohort without aggressive preventive treatment. This study investigated the effect of maternal parasitic infections on infant vaccination in a more recent setting of active anti-parasitic therapy. METHODOLOGY/PRINCIPAL FINDINGS From 2013-2015, 576 Kenyan women were tested in pregnancy for malaria, soil-transmitted helminths, filaria, and S. haematobium, with both acute and prophylactic antiparasitic therapies given. After birth, 567 infants received 10-valent S. pneumoniae conjugate vaccine and pentavalent vaccine for hepatitis B, pertussis, tetanus, H. influenzae type B (Hib) and C. diphtheriae toxoid (Dp-t) at 6, 10, and 14 weeks. Infant serum samples from birth, 10 and 14 weeks, and every six months until age three years, were analyzed using a multiplex bead assay to quantify IgG for Hib, Dp-t, and the ten pneumococcal serotypes. Antenatal parasitic prevalence was high; 461 women (80%) had at least one and 252 (43.6%) had two or more infections during their pregnancy, with the most common being malaria (44.6%), S. haematobium (43.9%), and hookworm (29.2%). Mixed models comparing influence of infection on antibody concentration revealed no effect of prenatal infection status for most vaccine outcomes. Prevalences of protective antibody concentrations after vaccination were similar among the prenatal exposure groups. CONCLUSIONS/SIGNIFICANCE These findings are in contrast with results from our prior cohort study performed when preventive anti-parasite treatment was less frequently given. The results suggest that the treatment of maternal infections in pregnancy may be able to moderate the previously observed effect of antenatal maternal infections on infant vaccine responses.
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Affiliation(s)
- Noah D. McKittrick
- Division of Infectious Diseases, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Indu J. Malhotra
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - David M. Vu
- Division of Infectious Diseases, Department of Pediatrics, Lucille Packard Children’s Hospital at Stanford School of Medicine, Stanford, California, United States of America
| | - Derek B. Boothroyd
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Justin Lee
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Amy R. Krystosik
- Division of Infectious Diseases, Department of Pediatrics, Lucille Packard Children’s Hospital at Stanford School of Medicine, Stanford, California, United States of America
| | - Francis M. Mutuku
- Department of Environment and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
| | - Charles H. King
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
- * E-mail:
| | - A. Desirée LaBeaud
- Division of Infectious Diseases, Department of Pediatrics, Lucille Packard Children’s Hospital at Stanford School of Medicine, Stanford, California, United States of America
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Dewals BG, Layland LE, Prazeres da Costa C, Horsnell WG. Maternal helminth infections and the shaping of offspring immunity. Parasite Immunol 2018; 41:e12599. [PMID: 30372527 DOI: 10.1111/pim.12599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 09/21/2018] [Accepted: 10/23/2018] [Indexed: 12/23/2022]
Abstract
Helminth infections leave a long-lasting immunological footprint on their hosts. Clinical studies have provided first evidence that maternal helminth infections can result in an altered immune profile in their offspring which can potentially shape how they respond to conditions throughout life. This can relate to changes in offspring induction of immune responses against other diseases. However, whether these changes result in actual changes in offspring ability to control disease is unclear. Our understanding of which immune mechanisms are altered and how they are changed is limited. In this review, we highlight what we know from human and mouse studies about this important context of helminth exposure. Moreover, we discuss how mechanisms such as antibody transfer, antigen exposure, maternal cell uptake, chimerism and epigenetics are all likely to be functional contributors to the striking changes that are seen in offspring born or nursed by helminth exposed mothers.
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Affiliation(s)
- Benjamin G Dewals
- Immunology-Vaccinology, Department of Infectious and Parasitic Diseases, Faculty of Veterinary Medicine-FARAH, University of Liège, Liège, Belgium
| | - Laura E Layland
- Institute of Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital of Bonn, Bonn, Germany.,German Centre for Infection Research (DZIF), Partner Site, Bonn-Cologne, Bonn, Germany
| | - Clarissa Prazeres da Costa
- Institute of Medical Microbiology, Immunology and Hygiene, Technische Universität München, Munich, Germany
| | - William G Horsnell
- Division of Immunology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK.,Laboratory of Molecular and Experimental Immunology and Neurogenetics, UMR 7355, CNRS-University of Orleans and Le Studium Institute for Advanced Studies, Orléans, France
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Boitel E, Desoubeaux G. Antiparasitic treatments in pregnant women: Update and recommendations. Med Mal Infect 2018; 50:3-15. [PMID: 30361033 DOI: 10.1016/j.medmal.2018.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 09/20/2018] [Indexed: 11/25/2022]
Abstract
Parasitoses are a major cause of morbidity and mortality worldwide, especially in resource-poor countries where the prevalence of such infections is very high. Their consequences for pregnant women are a public health issue. It is very challenging to successfully control parasitic infections with the dedicated drugs, while protecting the fetus from the harmful effects of these medications. However, in both temperate and tropical regions, true antiparasitic innovations are rare, and the therapeutic armamentarium remains limited. Scientific data is incomplete as only a few clinical studies have included pregnant women so far. Therefore, physicians have to learn how to thoroughly handle the antiparasitic molecules available. They also need to know the embryo- and fetotoxic effects of each of them. Medical practices must be adapted to the trimester of pregnancy.
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Affiliation(s)
- E Boitel
- Service de parasitologie, mycologie, médecine tropicale, CHU de Tours, 37044 Tours, France
| | - G Desoubeaux
- Service de parasitologie, mycologie, médecine tropicale, CHU de Tours, 37044 Tours, France.
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Panic G, Keiser J. Acting beyond 2020: better characterization of praziquantel and promising antischistosomal leads. Curr Opin Pharmacol 2018; 42:27-33. [DOI: 10.1016/j.coph.2018.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/01/2018] [Accepted: 06/06/2018] [Indexed: 12/01/2022]
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Feleke BE, Jember TH. Prevalence of helminthic infections and determinant factors among pregnant women in Mecha district, Northwest Ethiopia: a cross sectional study. BMC Infect Dis 2018; 18:373. [PMID: 30081837 PMCID: PMC6080381 DOI: 10.1186/s12879-018-3291-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 08/01/2018] [Indexed: 11/10/2022] Open
Abstract
Background Intestinal parasites are the most common infections in developing countries. Prevalence and impacts of these parasites are high in pregnant women. The aims of this study were to determine prevalence of helminthic infection and evaluate the determinant factors during pregnancy. Methods A cross-sectional study was conducted in Mecha district from November 2015 to January 2016. The data were collected by interview technique and collecting the stool sample from each pregnant woman. Descriptive statistics and binary logistic regression were used. Results A total of 783 pregnant women were included. The prevalence of intestinal parasite among pregnant women was 70.6% [95% CI 67 -74%]. Ascaris lumbricoides (32.7%) was the predominant intestinal parasite species. Intestinal parasitic infection were 2.94 folds higher in the absence of latrine (AOR: 2.94 [95% CI: 1.5–5.8]). Absence of regular hand washing habit increase the odds of infection by 3.33 folds higher (AOR: 3.33 [95% CI: 1.54–7.14]). Not wearing shoe increased the odds of helminthic infection by 6.87 folds higher (AOR: 6.87 [95% CI: 3.67–12.9]). Illiteracy increases the odds of intestinal parasitic infection by 2.32 folds higher (AOR: 2.32 [95% CI: 1.04–5.26]). Ingestion of raw vegetables increases the odds of intestinal parasitic infection by 2.65 folds higher (AOR: 2.65 [95% CI: 3.23–9.9]). The odds of intestinal parasitic infection were higher in rural areas (AOR: 2 [95% CI: 5–10]). Intestinal parasitic infection was higher in women aged less than 21 years (AOR: 6.48 [95% CI: 2.91–14.4]). Conclusion The prevalence of helminthic infection is high in this study. Latrine utilization, hand washing habit, eating raw vegetables and bare foot were the major determinant factors for the high prevalence. Therefore, health education and improvements in sanitary infrastructure could achieve long-term and sustainable reductions in helminth prevalence.
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Affiliation(s)
- Berhanu Elfu Feleke
- Department of Epidemiology and Biostatistics, University of Bahir Dar, Bahir Dar, Ethiopia.
| | - Tadesse Hailu Jember
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Freer JB, Bourke CD, Durhuus GH, Kjetland EF, Prendergast AJ. Schistosomiasis in the first 1000 days. THE LANCET. INFECTIOUS DISEASES 2018; 18:e193-e203. [PMID: 29170089 DOI: 10.1016/s1473-3099(17)30490-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 07/02/2017] [Accepted: 07/13/2017] [Indexed: 12/29/2022]
Abstract
Infections during the first 1000 days-the period from conception to a child's second birthday-can have lifelong effects on health, because this is a crucial phase of growth and development. There is increasing recognition of the burden and potential effects of schistosomiasis in women of reproductive age and young children. Exposure to schistosomes during pregnancy can modulate infant immune development and schistosomiasis can occur from early infancy, such that the high disease burden found in adolescents is often due to accumulation of infections with long-lived schistosomes from early life. Women of reproductive age and young children are largely neglected in mass drug administration programmes, but early treatment could avert subsequent disease. We evaluate the evidence that early schistosomiasis has adverse effects on birth, growth, and development. We also discuss the case for expanding public health interventions for schistosomiasis in women of reproductive age and preschool-age children, and the need for further research to evaluate the potential of treating women pre-conception to maximise health across the life course.
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Affiliation(s)
- Joseph B Freer
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; Blizard Institute, Queen Mary University of London, London, UK.
| | - Claire D Bourke
- Blizard Institute, Queen Mary University of London, London, UK
| | - Gunn H Durhuus
- Department of Internal Medicine, Sorlandet Hospital, Kristiansand, Norway
| | - Eyrun F Kjetland
- Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway; Discipline of Public Health Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Andrew J Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; Blizard Institute, Queen Mary University of London, London, UK
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Sanya RE, Nkurunungi G, Andia Biraro I, Mpairwe H, Elliott AM. A life without worms. Trans R Soc Trop Med Hyg 2018; 111:3-11. [PMID: 28340138 PMCID: PMC5412073 DOI: 10.1093/trstmh/trx010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 02/27/2017] [Indexed: 12/14/2022] Open
Abstract
Worms have co-evolved with humans over millions of years. To survive, they manipulate host systems by modulating immune responses so that they cause (in the majority of hosts) relatively subtle harm. Anthelminthic treatment has been promoted as a measure for averting worm specific pathology and to mitigate subtle morbidities which may include effects on anaemia, growth, cognitive function and economic activity. With our changing environment marked by rapid population growth, urbanisation, better hygiene practices and anthelminthic treatment, there has been a decline in worm infections and other infectious diseases and a rise in non-communicable diseases such as allergy, diabetes and cardiovascular disease. This review reflects upon our age-old interaction with worms, and the broader ramifications of life without worms for vaccine responses and susceptibility to other infections, and for allergy-related and metabolic disease. We touch upon the controversy around the benefits of mass drug administration for the more-subtle morbidities that have been associated with worm infections and then focus our attention on broader, additional aspects of life without worms, which may be either beneficial or detrimental.
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Affiliation(s)
- Richard E Sanya
- MRC/UVRI Uganda Research Unit, Uganda Virus Research Institute, P.O. Box 49, Entebbe, Uganda.,College of Health Sciences, Makerere University, Kampala, Uganda
| | - Gyaviira Nkurunungi
- MRC/UVRI Uganda Research Unit, Uganda Virus Research Institute, P.O. Box 49, Entebbe, Uganda.,Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | | | - Harriet Mpairwe
- MRC/UVRI Uganda Research Unit, Uganda Virus Research Institute, P.O. Box 49, Entebbe, Uganda
| | - Alison M Elliott
- MRC/UVRI Uganda Research Unit, Uganda Virus Research Institute, P.O. Box 49, Entebbe, Uganda.,Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Akpan UB, Asibong U, Okpara HC, Monjok E, Etuk S. Antenatal Deworming and Materno-Perinatal Outcomes in Calabar, Nigeria. Open Access Maced J Med Sci 2018; 6:901-907. [PMID: 29875869 PMCID: PMC5985893 DOI: 10.3889/oamjms.2018.143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/20/2018] [Accepted: 02/22/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Studies have shown that administration of anthelmintic drugs in pregnancy can reduce the incidence of maternal anaemia; however, data on other maternal and perinatal outcomes are limited. AIM This study was therefore conducted to evaluate the direct impact of mass deworming on delivery and perinatal outcome. MATERIAL AND METHODS A total of 560 healthy pregnant women in their second trimester were randomised to receive a single dose of oral mebendazole (500 mg) and placebo. Each participant received the standard dose of iron supplement and malaria prophylaxis. They were followed up to delivery and immediate postpartum period to document the possible impact on maternal and perinatal outcomes. RESULTS The prevalence of anaemia at term, 37 weeks gestation and above, among the treatment arm was 12.6% compared with 29.9% in the placebo arm (p < 0.001). Caesarean section rates was higher in the treated group and the placebo (p = 0.047). There were no statistically significant differences in incidences of postpartum haemorrhage (p = 0.119), Puerperal, pyrexia (p = 0.943), low birth weight (p = 0.556) asphyxia (p = 0.706) and perinatal death (p = 0.621). CONCLUSION Presumptive deworming during the antenatal period can significantly reduce the incidence of peripartum anaemia. However, more studies may be needed to prove any positive perinatal outcome.
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Affiliation(s)
- Ubong Bassey Akpan
- Department of Obstetrics and Gynaecology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Udeme Asibong
- Department of Family Medicine, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Henry Chima Okpara
- Department of Chemical Pathology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Emmanuel Monjok
- Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Saturday Etuk
- Department of Obstetrics and Gynaecology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
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Htun NSN, Odermatt P, Müller I, Yap P, Steinmann P, Schindler C, Gerber M, Du Randt R, Walter C, Pühse U, Utzinger J, Probst-Hensch N. Association between gastrointestinal tract infections and glycated hemoglobin in school children of poor neighborhoods in Port Elizabeth, South Africa. PLoS Negl Trop Dis 2018; 12:e0006332. [PMID: 29543807 PMCID: PMC5871004 DOI: 10.1371/journal.pntd.0006332] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 03/27/2018] [Accepted: 02/21/2018] [Indexed: 12/11/2022] Open
Abstract
Background Low- and middle-income countries are facing a dual disease burden with infectious diseases (e.g., gastrointestinal tract infections) and non-communicable diseases (e.g., diabetes) being common. For instance, chronic parasite infections lead to altered immune regulatory networks, anemia, malnutrition, and diarrhea with an associated shift in the gut microbiome. These can all be pathways of potential relevance for insulin resistance and diabetes. The aim of this study was to investigate the association between common gastrointestinal tract infections and glycemia in children from non-fee paying schools in South Africa. Methodology We conducted a cross-sectional survey among 9- to 14-year-old school children in Port Elizabeth. Stool and urine samples were collected to assess infection status with parasitic worms (e.g., Ascaris lumbricoides, Enterobius vermicularis, and Trichuris trichiura), intestinal protozoa (e.g., Cryptosporidium parvum and Giardia intestinalis), and the bacterium Helicobacter pylori. Glycated hemoglobin (HbA1c) was measured in finger prick derived capillary blood. All children at schools with a high prevalence of helminth infections and only infected children at the schools with low infection rates were treated with albendazole. The association of anthelmintic treatment with changes in HbA1c 6 months after the drug intervention was also investigated. Findings A high prevalence of 71.8% of prediabetes was measured in this group of children, with only 27.8% having HbA1c in the normal range. H. pylori was the predominant infectious agent and showed an independent positive association with HbA1c in a multivariable regression analysis (β = 0.040, 95% confidence interval (CI) 0.006–0.073, p<0.05). No association of HbA1c with either any other infectious agent or albendazole administration was found. Conclusion The role of H. pylori in diabetes needs confirmation in the context of longitudinal treatment interventions. The specific effect of other gastrointestinal tract infections on glycemia remains unclear. Future studies should integrate the measurement of biomarkers, including immunological parameters, to shed light on the potential mediating mechanisms between parasite infections and diabetes. Parasitic worms (e.g., pinworm, roundworm, and whipworm), intestinal protozoa (e.g., Cryptosporidium parvum and Giardia intestinalis), and the bacterium Helicobacter pylori persist at high rates in the gastrointestinal tract of people from low- and middle-income countries. These infectious agents are increasingly paralleled by high rates of non-communicable diseases, such as diabetes. We studied the association of glycemia, measured as HbA1c with common gastrointestinal tract infections among school children aged 9–14 years from disadvantaged neighborhoods in Port Elizabeth, South Africa. Our goal was to deepen the understanding of whether specific gastrointestinal tract infections might be early life determinants of elevated HbA1c levels that might lead to diabetes. We found that the bacterium H. pylori was very common among our group of children with a positive association with hyperglycemia. None of the other infectious agents showed such an association. Additional, longitudinal studies are needed to determine whether there is causality for the observed association between H. pylori and hyperglycemia. The integration of biomarkers will allow studying mediating mechanisms.
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Affiliation(s)
- Nan Shwe Nwe Htun
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Peter Odermatt
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Ivan Müller
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Peiling Yap
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Peter Steinmann
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Christian Schindler
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Rosa Du Randt
- Department of Human Movement Science, Nelson Mandela University, Port Elizabeth, South Africa
| | - Cheryl Walter
- Department of Human Movement Science, Nelson Mandela University, Port Elizabeth, South Africa
| | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Jürg Utzinger
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
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Is birth weight associated with blood pressure among African children and adolescents? A systematic review. J Dev Orig Health Dis 2018; 9:270-280. [PMID: 29353561 DOI: 10.1017/s2040174417001039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
There is substantial evidence of an inverse association between birth weight and later blood pressure (BP) in populations from high-income countries, but whether this applies in low-income countries, where causes of low birth weight are different, is not certain. OBJECTIVE We conducted a review of the evidence on the relationship between birth weight and BP among African children and adolescents. Medline, EMBASE, Global Health and Web of Science databases were searched for publications to October 2016. Papers reporting the relationship between birth weight and BP among African children and adolescents were assessed. Bibliographies were searched for further relevant publications. Selected papers were summarized following the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. In total, 16 papers from 13 studies conducted in nine African countries (Nigeria, Republic of Seychelles, Gambia, Democratic Republic of Congo, Cameroon, South Africa, Algeria, Zimbabwe and Angola) were reviewed. Eight studies were cohorts, while five were cross-sectional. The relationship between birth weight and later BP varied with age of the participants. Studies in neonates showed a consistently positive association, while predominantly inverse associations were seen among children, and studies in adolescents were inconsistent. Based on the limited number of studies identified, the relationship between birth weight and later BP may vary with age in African children and adolescents. Not all studies adequately controlled for confounding, notably gender or age. Whether the inverse relationship between birth weight and BP in later life observed in Western settings is also seen in Africa remains unclear.
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