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Ofori B, Agoha RK, Bokoe EK, Armah ENA, Misita Morang'a C, Sarpong KAN. Leveraging wastewater-based epidemiology to monitor the spread of neglected tropical diseases in African communities. Infect Dis (Lond) 2024:1-15. [PMID: 38922811 DOI: 10.1080/23744235.2024.2369177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
Neglected tropical diseases continue to cause a significant burden worldwide, with Africa accounting for more than one-third of the global burden. Over the past decade, progress has been made in eliminating, controlling, and eradicating these diseases in Africa. By December 2022, 47 out of 54 African countries had eliminated at least one neglected tropical disease, and more countries were close to achieving this milestone. Between 2020 and 2021, there was an 80 million reduction in people requiring intervention. However, continued efforts are needed to manage neglected tropical diseases and address their social and economic burden, as they deepen marginalisation and stigmatisation. Wastewater-based epidemiology involves analyzing wastewater to detect and quantify biomarkers of disease-causing pathogens. This approach can complement current disease surveillance systems in Africa and provide an additional layer of information for monitoring disease spread and detecting outbreaks. This is particularly important in Africa due to limited traditional surveillance methods. Wastewater-based epidemiology also provides a tsunami-like warning system for neglected tropical disease outbreaks and can facilitate timely intervention and optimised resource allocation, providing an unbiased reflection of the community's health compared to traditional surveillance systems. In this review, we highlight the potential of wastewater-based epidemiology as an innovative approach for monitoring neglected tropical disease transmission within African communities and improving existing surveillance systems. Our analysis shows that wastewater-based epidemiology can enhance surveillance of neglected tropical diseases in Africa, improving early detection and management of Buruli ulcers, hookworm infections, ascariasis, schistosomiasis, dengue, chikungunya, echinococcosis, rabies, and cysticercosis for better disease control.
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Affiliation(s)
- Benedict Ofori
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Accra, Ghana
| | - Righteous Kwaku Agoha
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Accra, Ghana
| | - Edem Kwame Bokoe
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Accra, Ghana
| | | | - Collins Misita Morang'a
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Accra, Ghana
| | - Kwabena Amofa Nketia Sarpong
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), University of Ghana, Accra, Ghana
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Accra, Ghana
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Rickman HM, Phiri MD, Feasey HRA, Mbale H, Nliwasa M, Semphere R, Chagaluka G, Fielding K, Mwandumba HC, Horton KC, Nightingale ES, Henrion MYR, Mbendera K, Mpunga JA, Corbett EL, MacPherson P. Tuberculosis Immunoreactivity Surveillance in Malawi (Timasamala)-A protocol for a cross-sectional Mycobacterium tuberculosis immunoreactivity survey in Blantyre, Malawi. PLoS One 2024; 19:e0291215. [PMID: 38787869 PMCID: PMC11125513 DOI: 10.1371/journal.pone.0291215] [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: 09/04/2023] [Accepted: 02/28/2024] [Indexed: 05/26/2024] Open
Abstract
Tuberculosis (TB) transmission and prevalence are dynamic over time, and heterogeneous within populations. Public health programmes therefore require up-to-date, accurate epidemiological data to appropriately allocate resources, target interventions, and track progress towards End TB goals. Current methods of TB surveillance often rely on case notifications, which are biased by access to healthcare, and TB disease prevalence surveys, which are highly resource-intensive, requiring many tens of thousands of people to be tested to identify high-risk groups or capture trends. Surveys of "latent TB infection", or immunoreactivity to Mycobacterium tuberculosis (Mtb), using tests such as interferon-gamma release assays (IGRAs) could provide a way to identify TB transmission hotspots, supplementing information from disease notifications, and with greater spatial and temporal resolution than is possible to achieve in disease prevalence surveys. This cross-sectional survey will investigate the prevalence of Mtb immunoreactivity amongst young children, adolescents and adults in Blantyre, Malawi, a high HIV-prevalence city in southern Africa. Through this study we will estimate the annual risk of TB infection (ARTI) in Blantyre and explore individual- and area-level risk factors for infection, as well as investigating geospatial heterogeneity of Mtb infection (and its determinants), and comparing these to the distribution of TB disease case-notifications. We will also evaluate novel diagnostics for Mtb infection (QIAreach QFT) and sampling methodologies (convenience sampling in healthcare settings and community sampling based on satellite imagery), which may increase the feasibility of measuring Mtb infection at large scale. The overall aim is to provide high-resolution epidemiological data and provide new insights into methodologies which may be used by TB programmes globally.
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Affiliation(s)
- Hannah M. Rickman
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
| | - Mphatso D. Phiri
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Helena R. A. Feasey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
| | - Hannah Mbale
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
| | - Marriott Nliwasa
- Helse Nord TB Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Robina Semphere
- Helse Nord TB Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
- School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - George Chagaluka
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Katherine Fielding
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Henry C. Mwandumba
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Katherine C. Horton
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Emily S. Nightingale
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Marc Y. R. Henrion
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Kuzani Mbendera
- Malawi National Tuberculosis and Leprosy Control Programme, Lilongwe, Malawi
| | - James A. Mpunga
- Malawi National Tuberculosis and Leprosy Control Programme, Lilongwe, Malawi
| | - Elizabeth L. Corbett
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
| | - Peter MacPherson
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Maddren R, Anderson RM. Measuring heterogeneities in soil-transmitted helminth transmission and control. Trends Parasitol 2024; 40:45-59. [PMID: 38087679 DOI: 10.1016/j.pt.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/08/2023] [Accepted: 11/08/2023] [Indexed: 01/06/2024]
Abstract
The global effort over the past decade to control soil-transmitted helminths (STH) has resulted in communities with endemic infection reaching low prevalence levels suitable for the validation of elimination as a public health problem (EPHP), defined by the World Health Organisation (WHO) as <2% of infections classified as moderate or heavy intensity. The spatial scale in which this is validated is currently undefined. As the burden of STH infection decreases, the degree of aggregation of infection within individuals in a population increases. Identifying these remaining pockets of infection requires fine-scale monitoring and evaluation (M&E) programmes that are rarely implemented within current national neglected tropical disease (NTD) control. This review examines various heterogeneities that characterise the epidemiology of STH infections, and discusses their impact on control policy formulation.
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Affiliation(s)
- Rosie Maddren
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, UK.
| | - Roy M Anderson
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
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Shomuyiwa DO, George NS, Sunday BA, Omotayo FO, Mwaba M, David SC, Nabiryo M, Yangaza Y. Addressing neglected tropical diseases in Africa: A gender perspective. Health Sci Rep 2023; 6:e1726. [PMID: 38028711 PMCID: PMC10654375 DOI: 10.1002/hsr2.1726] [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: 09/03/2023] [Revised: 10/25/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
This article delves into the interplay of neglected tropical diseases (NTDs) and Sustainable Development Goals (SDGs) within Africa, spotlighting gender disparities in NTD programs. NTDs, impacting marginalized communities, impose considerable physical, mental, and social burdens. The article underscores NTDs as equity markers for SDGs, spotlighting gender-based imbalances in disease susceptibility, treatment accessibility, and health-seeking tendencies. Gender's influence on NTD risks is elucidated, emphasizing the heightened susceptibility of women due to socioeconomic constraints, cultural dynamics, and gender norms. The article also highlights the absence of gender considerations in NTD programs, advocating for gender-integrated strategies, enhanced data collection, and collaborative partnerships to rectify these inequities. By embracing a gender-equity approach, the article underscores the necessity of gender-balanced NTD efforts for comprehensive health, sustainable development, and gender parity, demanding cohesive actions across sectors.
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Affiliation(s)
| | - Nsikakabasi S. George
- School of Heath and Related ResearchThe University of SheffieldSheffieldUK
- École des hautes études en santé publiqueRennesFrance
| | | | - Faith O. Omotayo
- Faculty of Pharmaceutical SciencesUniversity of NigeriaNsukkaEnuguNigeria
- Department of Public and Community Health ScienceUniversity of the PeopleCaliforniaUSA
| | | | - Success C. David
- Faculty of Pharmaceutical SciencesUniversity of NigeriaNsukkaEnuguNigeria
| | - Maxencia Nabiryo
- Integrated Community Health Initiative OrganizationKampalaUganda
- Makerere University School of Public HealthKampalaUganda
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Ghosh P, Chowdhury R, Rahat MA, Hossain F, Arpha NE, Kristan M, Higgins M, El Wahed AA, Goto Y, Islam MMT, Campino S, Cameron M, Duthie MS, Haque R, Mondal D. Dried Blood Spots (DBS): A suitable alternative to using whole blood samples for diagnostic testing of visceral leishmaniasis in the post-elimination era. PLoS Negl Trop Dis 2023; 17:e0011680. [PMID: 37862287 PMCID: PMC10588855 DOI: 10.1371/journal.pntd.0011680] [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: 04/05/2023] [Accepted: 09/25/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Serum or whole blood collection, processing, transport and storage still present significant challenges in low resource settings where mass surveillance is required to sustain disease elimination. Therefore, in this study, we explored the diagnostic efficacy of dried blood spots (DBS) as a minimally invasive and potentially cost-effective alternative sampling technique to whole blood sampling procedures for subsequent detection of Leishmania donovani antibodies or DNA. METHODOLOGY AND PRINCIPAL FINDINGS Archived serum, DNA samples from whole blood of visceral leishmaniasis (VL) cases and healthy controls, and DBS from corresponding cases and controls, were used. Both molecular and serological assays were optimized to detect L. donovani antibodies or DNA in DBS elute and results were compared against those obtained with whole blood. Serological assays (both rK28 ELISA and rK39 ELISA) of DBS samples showed sensitivity and specificity of 100% and had excellent agreement with results from whole blood samples (kappa value ranged from 0.98-1). Bland-Altman analysis of OD values from rK28-ELISA with DBS elute and patients' serum showed an excellent agreement (ICC = 0.9) whereas a good agreement (ICC = 0.8) was observed in the case of rK39-ELISA. However, qPCR and RPA of DBS samples had a diminished sensitivity of 76% and 68%, respectively, and poor agreement was observed with the whole blood samples. CONCLUSION Our results demonstrate that DBS offer excellent diagnostic efficiency for serological assays and represent a viable alternative to whole blood sampling procedures.
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Affiliation(s)
- Prakash Ghosh
- Nutirition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Banladesh, Dhaka, Bangladesh
| | - Rajashree Chowdhury
- Nutirition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Banladesh, Dhaka, Bangladesh
| | - Md. Abu Rahat
- Nutirition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Banladesh, Dhaka, Bangladesh
| | - Faria Hossain
- Nutirition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Banladesh, Dhaka, Bangladesh
| | - Nur E Arpha
- Genetic Engineering and Biotechnology, BRAC University, Dhaka, Bangladesh
| | - Mojca Kristan
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Matthew Higgins
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Ahmed Abd El Wahed
- Institute of Animal Hygiene and Veterinary Public Health, University of Leipzig, Leipzig, Germany
| | - Yasuyuki Goto
- Laboratory of Molecular Immunology, Department of Animal Resource Sciences, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - M. M. Towhidul Islam
- Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, Bangladesh
| | - Susana Campino
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Mary Cameron
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | | | - Rashidul Haque
- Emerging Infections and Parasitology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Dinesh Mondal
- Nutirition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Banladesh, Dhaka, Bangladesh
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Huang F, Cui Y, Huang Z, Wang S, Li S, Guo X, Guo X, Xia ZG. Serological surveillance on potential Plasmodium vivax exposure risk in a post-elimination setting. Front Cell Infect Microbiol 2023; 13:1132917. [PMID: 36968112 PMCID: PMC10034364 DOI: 10.3389/fcimb.2023.1132917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/23/2023] [Indexed: 03/11/2023] Open
Abstract
China was declared malaria free in June of 2021. In the post-elimination setting, vigilant surveillance is essential to sustain malaria free status. Serological surveillance has been recognized as an efficient tool for assessing the immunity levels and exposure risk in a population. In this study, a cross-sectional serological survey was conducted in Yingjiang County, China, in August–September, 2021. The study sites were villages along the borders with Myanmar, which have no local transmission since the last indigenous case registered in 2016. A total of 923 participants from six villages were enrolled. The majority was aged > 36 years (56.12%) and 12.46% (115/923) participants had experienced malaria infection at least once. A magnetic- bead-based assay was used to test antibodies against Plasmodium vivax antigen PvMSP-119 to evaluate the prevalence of antibody positive subjects. A reversible catalytic model was used to assess the risk of exposure. The prevalence of anti-PvMSP-119 IgG was 12.84% [95% confidence interval (CI): 9.22%–16.47%], 13.93% (95% CI: 10.11%–17.74%), and 3.57% (95% CI: 1.40%–5.75%) in three different line-of-defense areas, which differed significantly (P < 0.0001). The prevalence of anti-PvMSP-119 IgG increased with age and no statistically significant difference was detected between the sexes. The reversible catalytic model indicated that the seropositive conversion rate and seronegative reversion rate were 0.0042, 0.0034, 0.0032 and 0.0024, 0.0004, 0.0065 in the first-, second-line-of-defense area and total areas, respectively, and the fitted value did not differ significantly from the observed value (P > 0.1). Although this study found the prevalence of antibody-positive subjects and the seroconversion rate in this post-elimination setting were lower than that in transmission setting, the population still had an exposure risk. Serological surveillance should be considered in post-elimination settings to provide valuable information with which to evaluate the risk of malaria re-establishment.
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Affiliation(s)
- Fang Huang
- Institute of Immunization, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Yanwen Cui
- Division of Tuberculosis Control and Prevention, Shanghai Pudong Center for Disease Control and Prevention, Shanghai, China
| | - Zhuoying Huang
- Institute of Immunization, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Siqi Wang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China
- Department of Malaria, Chinese Center for Tropical Diseases Research, Shanghai, China
- NHC Key Laboratory of Parasite and Vector Biology, National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China
- WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, China
| | - Shigang Li
- Division of Endemic Disease Control and Prevention, Yingjiang County Center for Disease Control and Prevention, Yingjiang, China
| | - Xiangrui Guo
- Division of Endemic Disease Control and Prevention, Yingjiang County Center for Disease Control and Prevention, Yingjiang, China
| | - Xiang Guo
- Institute of Immunization, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
- *Correspondence: Xiang Guo, ; Zhi-Gui Xia,
| | - Zhi-Gui Xia
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China
- Department of Malaria, Chinese Center for Tropical Diseases Research, Shanghai, China
- NHC Key Laboratory of Parasite and Vector Biology, National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China
- WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, China
- *Correspondence: Xiang Guo, ; Zhi-Gui Xia,
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Melo GBT, Angulo-Tuesta A, da Silva EN, Santos TDS, Uchimura LYT, Obara MT. Evolution of research funding for neglected tropical diseases in Brazil, 2004-2020. PLoS Negl Trop Dis 2023; 17:e0011134. [PMID: 36928796 PMCID: PMC10019684 DOI: 10.1371/journal.pntd.0011134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/01/2023] [Indexed: 03/18/2023] Open
Abstract
Neglected tropical diseases are a global public health problem. Although Brazil is largely responsible for their occurrence in Latin America, research funding on the subject does not meet the population's health needs. The present study analyzed the evolution of research funding for neglected tropical diseases by the Ministry of Health and its partners in Brazil, from 2004 to 2020. This is a retrospective study of data from investigations registered on Health Research (Pesquisa Saúde in Portuguese), a public repository for research funded by the Ministry of Health's Department of Science and Technology. The temporal trend of funding and the influence of federal government changes on funding were analyzed using Prais-Winster generalized linear regression. From 2004 to 2020, 1,158 studies were financed (purchasing power parity (PPP$) 230.9 million), with most funding aimed at biomedical research (81.6%) and topics involving dengue, leishmaniasis and tuberculosis (60.2%). Funding was stationary (annual percent change of -5.7%; 95%CI -54.0 to 45.0) and influenced by changes to the federal government. Research funding was lacking for chikungunya, Chagas disease, schistosomiasis, malaria and taeniasis/cysticercosis, diseases with a high prevalence, burden or mortality rates in Brazil. Although the Ministry of Health had several budgetary partners, it was the main funder, with 69.8% of investments. The study revealed that research funding for neglected tropical diseases has stagnated over the years and that diseases with a high prevalence, burden and mortality rate receive little funding. These findings demonstrate the need to strengthen the health research system by providing sustainable funding for research on neglected tropical diseases that is consistent with the population's health needs.
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Affiliation(s)
- Gabriela Bardelini Tavares Melo
- Graduate Program in Health Sciences and Technologies, Faculty of Ceilândia - University of Brasilia, Federal District, Brasilia, Brazil
- Department of Science and Technology, Ministry of Health, Federal District, Brasilia, Brazil
- * E-mail:
| | - Antonia Angulo-Tuesta
- Graduate Program in Health Sciences and Technologies, Faculty of Ceilândia - University of Brasilia, Federal District, Brasilia, Brazil
| | - Everton Nunes da Silva
- Graduate Program in Health Sciences and Technologies, Faculty of Ceilândia - University of Brasilia, Federal District, Brasilia, Brazil
| | - Thaís da Silva Santos
- Graduate Program in Health Sciences and Technologies, Faculty of Ceilândia - University of Brasilia, Federal District, Brasilia, Brazil
| | | | - Marcos Takashi Obara
- Graduate Program in Health Sciences and Technologies, Faculty of Ceilândia - University of Brasilia, Federal District, Brasilia, Brazil
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Building an integrated serosurveillance platform to inform public health interventions: Insights from an experts' meeting on serum biomarkers. PLoS Negl Trop Dis 2022; 16:e0010657. [PMID: 36201428 PMCID: PMC9536637 DOI: 10.1371/journal.pntd.0010657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The use of biomarkers to measure immune responses in serum is crucial for understanding population-level exposure and susceptibility to human pathogens. Advances in sample collection, multiplex testing, and computational modeling are transforming serosurveillance into a powerful tool for public health program design and response to infectious threats. In July 2018, 70 scientists from 16 countries met to perform a landscape analysis of approaches that support an integrated serosurveillance platform, including the consideration of issues for successful implementation. Here, we summarize the group's insights and proposed roadmap for implementation, including objectives, technical requirements, ethical issues, logistical considerations, and monitoring and evaluation.
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Handley BL, Tchatchouang S, Grout L, Johnson RC, Tabah EN, Boua B, Boock AU, Koffi AP, Phanzu DM, Kotey NK, Rogers E, Dofitas B, Jung Y, Maweke T, Beiras CG, Maman I, Basing LA, Ngazoa SK, Houezo JG, Togbey K, Telan EF, Sarmento N, Marion E, Addo KK, Mitjà O, Asiedu K, Harding-Esch E, Marks M. Evaluating the yaws diagnostic gap: A survey to determine the capacity of and barriers to improving diagnostics in all yaws-endemic countries. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.969219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BackgroundYaws, caused by Treponema pallidum subsp. pertenue, is a skin neglected tropical disease. It is targeted for eradication by 2030, primarily using mass drug administration (MDA) with azithromycin. Traditionally, diagnosis of yaws has relied on clinical examination and serological testing. However, these approaches have poor diagnostic performance. To achieve eradication, more accurate diagnostics are required to determine whether MDA should be initiated or continued as well as for post-elimination surveillance. Molecular tools will be crucial for detecting antimicrobial resistant cases, which have the potential to derail eradication efforts. In order to determine the feasibility of introducing novel, more accurate, diagnostics for yaws surveillance purposes, it is necessary to understand current in-country diagnostic capacity. This study therefore aimed to understand the current capacity of, and challenges to, improving diagnostics for yaws in all yaws-endemic countries worldwide.Methodology/principal findingsAn online survey was sent to all 15 yaws-endemic countries in July 2021. The survey asked about past prevalence estimates, the availability of different diagnostic tools, and perceived barriers to enhancing capacity. Fourteen countries responded to the survey, four of which did not have a current National Policy for yaws eradication in place. Over 95% of reported that yaws cases from the past five years had not been confirmed with serological or molecular tools, largely due to the limited supply of rapid serological tests. Only four countries reported having operational laboratories for molecular yaws diagnosis, with only one of these having a validated assay to detect azithromycin resistance.Conclusions and significanceThis study highlights the diagnostic capacity constraints across all respondent countries. Countries are in need of access to a sustainable supply of serological tests, and development of molecular testing facilities. Sufficient sustainable funding should be made available to ensure that appropriate diagnostic tools are available and utilised.
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Trippler L, Ali MN, Ame SM, Ali SM, Kabole F, Hattendorf J, Knopp S. GPS-based fine-scale mapping surveys for schistosomiasis assessment: a practical introduction and documentation of field implementation. Infect Dis Poverty 2022; 11:8. [PMID: 35033202 PMCID: PMC8761264 DOI: 10.1186/s40249-021-00928-y] [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: 11/02/2021] [Accepted: 12/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fine-scale mapping of schistosomiasis to guide micro-targeting of interventions will gain importance in elimination settings, where the heterogeneity of transmission is often pronounced. Novel mobile applications offer new opportunities for disease mapping. We provide a practical introduction and documentation of the strengths and shortcomings of GPS-based household identification and participant recruitment using tablet-based applications for fine-scale schistosomiasis mapping at sub-district level in a remote area in Pemba, Tanzania. METHODS A community-based household survey for urogenital schistosomiasis assessment was conducted from November 2020 until February 2021 in 20 small administrative areas in Pemba. For the survey, 1400 housing structures were prospectively and randomly selected from shapefile data. To identify pre-selected structures and collect survey-related data, field enumerators searched for the houses' geolocation using the mobile applications Open Data Kit (ODK) and MAPS.ME. The number of inhabited and uninhabited structures, the median distance between the pre-selected and recorded locations, and the dropout rates due to non-participation or non-submission of urine samples of sufficient volume for schistosomiasis testing was assessed. RESULTS Among the 1400 randomly selected housing structures, 1396 (99.7%) were identified by the enumerators. The median distance between the pre-selected and recorded structures was 5.4 m. A total of 1098 (78.7%) were residential houses. Among them, 99 (9.0%) were dropped due to continuous absence of residents and 40 (3.6%) households refused to participate. In 797 (83.1%) among the 959 participating households, all eligible household members or all but one provided a urine sample of sufficient volume. CONCLUSIONS The fine-scale mapping approach using a combination of ODK and an offline navigation application installed on tablet computers allows a very precise identification of housing structures. Dropouts due to non-residential housing structures, absence, non-participation and lack of urine need to be considered in survey designs. Our findings can guide the planning and implementation of future household-based mapping or longitudinal surveys and thus support micro-targeting and follow-up of interventions for schistosomiasis control and elimination in remote areas. Trial registration ISRCTN, ISCRCTN91431493. Registered 11 February 2020, https://www.isrctn.com/ISRCTN91431493.
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Affiliation(s)
- Lydia Trippler
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland.,University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - Mohammed Nassor Ali
- Public Health Laboratory-Ivo de Carneri, Wawi, P.O. Box 122, Chake-Chake, Pemba, United Republic of Tanzania
| | - Shaali Makame Ame
- Public Health Laboratory-Ivo de Carneri, Wawi, P.O. Box 122, Chake-Chake, Pemba, United Republic of Tanzania
| | - Said Mohammed Ali
- Public Health Laboratory-Ivo de Carneri, Wawi, P.O. Box 122, Chake-Chake, Pemba, United Republic of Tanzania
| | - Fatma Kabole
- Neglected Diseases Program, Zanzibar Ministry of Health, Social Welfare, Elderly, Gender and Children, P.O. Box 236, Unguja, United Republic of Tanzania
| | - Jan Hattendorf
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland.,University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - Stefanie Knopp
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123, Allschwil, Switzerland. .,University of Basel, Petersplatz 1, 4001, Basel, Switzerland.
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Minter A, Pellis L, Medley GF, Hollingsworth TD. What Can Modeling Tell Us About Sustainable End Points for Neglected Tropical Diseases? Clin Infect Dis 2021; 72:S129-S133. [PMID: 33905477 PMCID: PMC8201563 DOI: 10.1093/cid/ciab188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
As programs move closer toward the World Health Organization (WHO) goals of reduction in morbidity, elimination as a public health problem or elimination of transmission, countries will be faced with planning the next stages of surveillance and control in low prevalence settings. Mathematical models of neglected tropical diseases (NTDs) will need to go beyond predicting the effect of different treatment programs on these goals and on to predicting whether the gains can be sustained. One of the most important challenges will be identifying the policy goal and the right constraints on interventions and surveillance over the long term, as a single policy option will not achieve all aims—for example, minimizing morbidity and minimizing costs cannot both be achieved. As NTDs move toward 2030 and beyond, more nuanced intervention choices will be informed by quantitative analyses which are adapted to national context.
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Affiliation(s)
- Amanda Minter
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Lorenzo Pellis
- Department of Mathematics, University of Manchester, Manchester, United Kingdom.,The Alan Turing Institute, London, United Kingdom
| | - Graham F Medley
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - T Déirdre Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
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