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Wardle MT, Allen SE, Gamboa R, Vilchez P, O'Neal SE, Muro C, Lescano AG, Moyano LM, Gonzalvez GE, González AE, Gilman RH, García HH. Mass chemotherapy with niclosamide for the control of Taenia solium: population-based safety profile and treatment effectiveness. LANCET REGIONAL HEALTH. AMERICAS 2024; 38:100876. [PMID: 39280880 PMCID: PMC11402444 DOI: 10.1016/j.lana.2024.100876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 08/06/2024] [Accepted: 08/13/2024] [Indexed: 09/18/2024]
Abstract
Background Mass drug administration (MDA) with niclosamide (NSM) can be used to control taeniasis, the cause of neurocysticercosis. NSM is 84.3% effective against taeniasis and is considered safe as it is not absorbed from the intestinal tract. However, information on its safety and effectiveness during MDA is limited. We evaluated the effectiveness of NSM and reported adverse events (AEs) during a cysticercosis elimination program in Tumbes, Peru. Methods Three rounds of NSM at 4-month intervals were offered to 77,397 eligible residents. We revisited all participants in their homes 72 h after each round to collect information regarding AEs. We also collected post-treatment stool samples to diagnose taeniasis after the first round, followed by a second sample at 30 days from those infected to evaluate NSM's effectiveness. Findings During implementation, 68,751 individuals were administered at least one dose of NSM (mean age 29 years, SD 20; 52% male), and 65,551 (95.3%) were visited post-treatment. 988 (1.5%) reported experiencing at least one AE. Almost all AEs (99.2%) were of mild intensity, with no severe AEs recorded. Of 211 participants diagnosed with taeniasis, 188 provided a follow-up stool sample 30-days after treatment and 141 were cured (treatment effectiveness 75.0%). Older age and higher coproantigen levels were significantly associated with treatment failure. Interpretation MDA with NSM is safe in Taenia solium endemic settings. However, the effectiveness following one dose is lower than expected, which suggests additional treatment may be necessary to enhance the infection control efforts. Funding The Bill and Melinda Gates Foundation.
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Affiliation(s)
- Melissa T Wardle
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR, USA
| | - Samantha E Allen
- Department of Neurology, School of Medicine, University of California, Davis, Sacramento, CA, USA
| | - Ricardo Gamboa
- Centro de Salud Global, Tumbes, Universidad Peruana Cayetano Heredia, Lima and Tumbes, Perú
| | - Percy Vilchez
- Centro de Salud Global, Tumbes, Universidad Peruana Cayetano Heredia, Lima and Tumbes, Perú
| | - Seth E O'Neal
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR, USA
- Centro de Salud Global, Tumbes, Universidad Peruana Cayetano Heredia, Lima and Tumbes, Perú
| | - Claudio Muro
- Centro de Salud Global, Tumbes, Universidad Peruana Cayetano Heredia, Lima and Tumbes, Perú
| | - Andrés G Lescano
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Luz M Moyano
- Centro de Salud Global, Tumbes, Universidad Peruana Cayetano Heredia, Lima and Tumbes, Perú
- School of Human Medicine, Universidad Nacional de Tumbes, Tumbes, Perú
| | - Guillermo E Gonzalvez
- Enfermedades Transmisibles y Análisis de Salud, Organización Panamericana de la Salud OPS/OMS, Bogotá, Colombia
| | - Armando E González
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Robert H Gilman
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Héctor H García
- Centro de Salud Global, Tumbes, Universidad Peruana Cayetano Heredia, Lima and Tumbes, Perú
- Instituto Nacional de Ciencias Neurológicas, Lima, Perú
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Arroyo G, Lescano AG, Gavidia CM, Lopez-Urbina T, Ara-Gomez M, Gomez-Puerta LA, Bustos JA, Jayashi CM, O’Neal SE, Gonzalez AE, Garcia HH. Antibody Banding Patterns on the Enzyme-Linked Immunoelectrotransfer Blot (EITB) Assay Clearly Discriminate Viable Cysticercosis in Naturally Infected Pigs. Pathogens 2023; 13:15. [PMID: 38251323 PMCID: PMC10820179 DOI: 10.3390/pathogens13010015] [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: 10/27/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
Enzyme-linked immunoelectrotransfer blot (EITB) detects antibodies against seven Taenia solium larvae antigens in three protein families (GP50, T24/42, and 8-kDa) with different structures and functions. EITB banding patterns against these antigens in pigs provide information about the course of infection and may discriminate viable cysticercosis. We analyzed the banding patterns and infection outcomes (presence of viable cysts, degenerated cysts, and any cysts) of 512 rural pigs. Banding patterns were grouped into homogenous classes using latent class analysis, and relationships with infection outcomes were assessed. Four classes were identified: 1 (n = 308, EITB-negative or positive for the GP50 family), 2 (n = 127, positive for GP50 (GP50 family), GP42-39 and GP24 (T24/42 family), but negative for 8-kDa antigens), 3 (n = 22, positive for GP50 and T24/42 antigens (GP42-39 and GP24), as well as to 8-kDa bands GP13, GP14, and GP18, but negative for GP21), and 4 (n = 55, positive for GP50 and T24/42 antigens, as well as to 8-kDa antigens GP21 and GP18 in combination). Pigs in classes 3 and 4 were more likely to have viable cysts (72.6% and 96.4%, respectively) than pigs in classes 1 and 2 (0.7% and 27.6%, respectively; p < 0.001). The number of infections with any cysts was higher in classes 3 and 4 (77.3% and 98.2%, respectively) and lower in classes 2 and 1 (34.7% and 4.9%, respectively; p < 0.001). Pigs with viable cysts represented >90% of pigs with any cysts in classes 3 and 4 (94.1% and 98.2%, respectively), while degenerated cysts were frequent among pigs with any cysts in classes 1, 3, and 2 (86.7%, 47.1%, and 43.2%, respectively; p < 0.001). EITB banding patterns strongly correlate with cysticercosis infection status in rural pigs, with classes 3 and 4 being more predictive of viable infections.
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Affiliation(s)
- Gianfranco Arroyo
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima 15021, Peru; (C.M.G.); (T.L.-U.); (M.A.-G.); (L.A.G.-P.); (C.M.J.); (A.E.G.)
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (J.A.B.); (S.E.O.); (H.H.G.)
| | - Andres G. Lescano
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima 15202, Peru;
| | - Cesar M. Gavidia
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima 15021, Peru; (C.M.G.); (T.L.-U.); (M.A.-G.); (L.A.G.-P.); (C.M.J.); (A.E.G.)
| | - Teresa Lopez-Urbina
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima 15021, Peru; (C.M.G.); (T.L.-U.); (M.A.-G.); (L.A.G.-P.); (C.M.J.); (A.E.G.)
| | - Miguel Ara-Gomez
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima 15021, Peru; (C.M.G.); (T.L.-U.); (M.A.-G.); (L.A.G.-P.); (C.M.J.); (A.E.G.)
| | - Luis A. Gomez-Puerta
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima 15021, Peru; (C.M.G.); (T.L.-U.); (M.A.-G.); (L.A.G.-P.); (C.M.J.); (A.E.G.)
| | - Javier A. Bustos
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (J.A.B.); (S.E.O.); (H.H.G.)
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima 15030, Peru
| | - Cesar M. Jayashi
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima 15021, Peru; (C.M.G.); (T.L.-U.); (M.A.-G.); (L.A.G.-P.); (C.M.J.); (A.E.G.)
| | - Seth E. O’Neal
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (J.A.B.); (S.E.O.); (H.H.G.)
- School of Public Health, Oregon Health & Sciences University-Portland State University, Portland, OR 97207, USA
| | - Armando E. Gonzalez
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima 15021, Peru; (C.M.G.); (T.L.-U.); (M.A.-G.); (L.A.G.-P.); (C.M.J.); (A.E.G.)
| | - Hector H. Garcia
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima 15202, Peru; (J.A.B.); (S.E.O.); (H.H.G.)
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurologicas, Lima 15030, Peru
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Pizzitutti F, Bonnet G, Gonzales-Gustavson E, Gabriël S, Pan WK, Gonzalez AE, Garcia HH, O'Neal SE. Spatial transferability of an agent-based model to simulate Taenia solium control interventions. Parasit Vectors 2023; 16:410. [PMID: 37941062 PMCID: PMC10634186 DOI: 10.1186/s13071-023-06003-9] [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: 08/21/2023] [Accepted: 10/06/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Models can be used to study and predict the impact of interventions aimed at controlling the spread of infectious agents, such as Taenia solium, a zoonotic parasite whose larval stage causes epilepsy and economic loss in many rural areas of the developing nations. To enhance the credibility of model estimates, calibration against observed data is necessary. However, this process may lead to a paradoxical dependence of model parameters on location-specific data, thus limiting the model's geographic transferability. METHODS In this study, we adopted a non-local model calibration approach to assess whether it can improve the spatial transferability of CystiAgent, our agent-based model of local-scale T. solium transmission. The calibration dataset for CystiAgent consisted of cross-sectional data on human taeniasis, pig cysticercosis and pig serology collected in eight villages in Northwest Peru. After calibration, the model was transferred to a second group of 21 destination villages in the same area without recalibrating its parameters. Model outputs were compared to pig serology data collected over a period of 2 years in the destination villages during a trial of T. solium control interventions, based on mass and spatially targeted human and pig treatments. RESULTS Considering the uncertainties associated with empirical data, the model produced simulated pre-intervention pig seroprevalences that were successfully validated against data collected in 81% of destination villages. Furthermore, the model outputs were able to reproduce validated pig seroincidence values in 76% of destination villages when compared to the data obtained after the interventions. The results demonstrate that the CystiAgent model, when calibrated using a non-local approach, can be successfully transferred without requiring additional calibration. CONCLUSIONS This feature allows the model to simulate both baseline pre-intervention transmission conditions and the outcomes of control interventions across villages that form geographically homogeneous regions, providing a basis for developing large-scale models representing T. solium transmission at a regional level.
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Affiliation(s)
| | - Gabrielle Bonnet
- Centre for Mathematical Modelling of Infectious Disease (CMMID), Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Eloy Gonzales-Gustavson
- Tropical and Highlands Veterinary Research Institute, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Sarah Gabriël
- Department of Veterinary Public Health and Food Safety, Ghent University, Ghent, Belgium
| | - William K Pan
- Nicholas School of Environment and Duke Global Health Institute, Duke University, Durham, USA
| | - Armando E Gonzalez
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Hector H Garcia
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- Cysticercosis Unit, National Institute of Neurological Sciences, Lima, Peru
| | - Seth E O'Neal
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, USA
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Pizzitutti F, Bonnet G, Gonzales-Gustavson E, Gabriël S, Pan WK, Pray IW, Gonzalez AE, Garcia HH, O’Neal SE. Non-local validated parametrization of an agent-based model of local-scale Taenia solium transmission in North-West Peru. PLoS One 2022; 17:e0275247. [PMID: 36166462 PMCID: PMC9514638 DOI: 10.1371/journal.pone.0275247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/13/2022] [Indexed: 12/01/2022] Open
Abstract
The pork tapeworm, Taenia solium, is the cause of a preventable zoonotic disease, cysticercosis, affecting both pigs and humans. Continued endemic transmission of T. solium is a major contributor of epilepsy and other neurologic morbidity, and the source of important economic losses, in many rural areas of developing countries. Simulation modelling can play an important role in aiding the design and evaluation of strategies to control or even eliminate transmission of the parasite. In this paper, we present a new agent based model of local-scale T. solium transmission and a new, non-local, approach to the model calibration to fit model outputs to observed human taeniasis and pig cysticercosis prevalence simultaneously for several endemic villages. The model fully describes all relevant aspects of T. solium transmission, including the processes of pig and human infection, the spatial distribution of human and pig populations, the production of pork for human consumption, and the movement of humans and pigs in and out in several endemic villages of the northwest of Peru. Despite the high level of uncertainty associated with the empirical measurements of epidemiological data associated with T. solium, the non-local calibrated model parametrization reproduces the observed prevalences with an acceptable precision. It does so not only for the villages used to calibrate the model, but also for villages not included in the calibration process. This important finding demonstrates that the model, including its calibrated parametrization, can be successfully transferred within an endemic region. This will enable future studies to inform the design and optimization of T. solium control interventions in villages where the calibration may be prevented by the limited amount of empirical data, expanding the possible applications to a wider range of settings compared to previous models.
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Affiliation(s)
| | - Gabrielle Bonnet
- Centre for the Mathematical Modelling of Infectious Diseases (CMMID), London School of Hygiene & Tropical Diseases, London, United Kingdom
| | - Eloy Gonzales-Gustavson
- Tropical and Highlands Veterinary Research Institute, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Sarah Gabriël
- Department of Veterinary Public Health and Food Safety, Ghent University, Ghent, Belgium
| | - William K. Pan
- Nicholas School of Environment Durham, Duke University, Durham, NC, United States of America
- Duke Global Health Institute, Durham, Duke University, Durham, NC, United States of America
| | - Ian W. Pray
- School of Public Health, Oregon Health and Science University Portland State University, Portland, OR, United States of America
| | - Armando E. Gonzalez
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Hector H. Garcia
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Lima Peru
- Cysticercosis Unit, National Institute of Neurological Sciences, Lima, Peru
| | - Seth E. O’Neal
- School of Public Health, Oregon Health and Science University Portland State University, Portland, OR, United States of America
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Lima Peru
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Ahmed S, Chase LE, Wagnild J, Akhter N, Sturridge S, Clarke A, Chowdhary P, Mukami D, Kasim A, Hampshire K. Community health workers and health equity in low- and middle-income countries: systematic review and recommendations for policy and practice. Int J Equity Health 2022; 21:49. [PMID: 35410258 PMCID: PMC8996551 DOI: 10.1186/s12939-021-01615-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/27/2021] [Indexed: 01/06/2023] Open
Abstract
Background The deployment of Community Health Workers (CHWs) is widely promoted as a strategy for reducing health inequities in low- and middle-income countries (LMIC). Yet there is limited evidence on whether and how CHW programmes achieve this. This systematic review aimed to synthesise research findings on the following questions: (1) How effective are CHW interventions at reaching the most disadvantaged groups in LMIC contexts? and (2) What evidence exists on whether and how these programmes reduce health inequities in the populations they serve? Methods We searched six academic databases for recent (2014–2020) studies reporting on CHW programme access, utilisation, quality, and effects on health outcomes/behaviours in relation to potential stratifiers of health opportunities and outcomes (e.g., gender, socioeconomic status, place of residence). Quantitative data were extracted, tabulated, and subjected to meta-analysis where appropriate. Qualitative findings were synthesised using thematic analysis. Results One hundred sixty-seven studies met the search criteria, reporting on CHW interventions in 33 LMIC. Quantitative synthesis showed that CHW programmes successfully reach many (although not all) marginalized groups, but that health inequalities often persist in the populations they serve. Qualitative findings suggest that disadvantaged groups experienced barriers to taking up CHW health advice and referrals and point to a range of strategies for improving the reach and impact of CHW programmes in these groups. Ensuring fair working conditions for CHWs and expanding opportunities for advocacy were also revealed as being important for bridging health equity gaps. Conclusion In order to optimise the equity impacts of CHW programmes, we need to move beyond seeing CHWs as a temporary sticking plaster, and instead build meaningful partnerships between CHWs, communities and policy-makers to confront and address the underlying structures of inequity. Trial registration PROSPERO registration number CRD42020177333. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01615-y.
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O'Neal SE, Pray IW, Vilchez P, Gamboa R, Muro C, Moyano LM, Ayvar V, Gavidia CM, Gilman RH, Gonzalez AE, Garcia HH. Geographically Targeted Interventions versus Mass Drug Administration to Control Taenia solium Cysticercosis, Peru. Emerg Infect Dis 2021; 27:2389-2398. [PMID: 34424165 PMCID: PMC8386790 DOI: 10.3201/eid2709.203349] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Optimal control strategies for Taenia solium taeniasis and cysticercosis have not been determined. We conducted a 2-year cluster randomized trial in Peru by assigning 23 villages to 1 of 3 geographically targeted intervention approaches. For ring screening (RS), participants living near pigs with cysticercosis were screened for taeniasis; identified cases were treated with niclosamide. In ring treatment (RT), participants living near pigs with cysticercosis received presumptive treatment with niclosamide. In mass treatment (MT), participants received niclosamide treatment every 6 months regardless of location. In each approach, half the villages received targeted or mass oxfendazole for pigs (6 total study arms). We noted significant reductions in seroincidence among pigs in all approaches (67.1% decrease in RS, 69.3% in RT, 64.7% in MT; p<0.001), despite a smaller proportion of population treated by targeted approaches (RS 1.4%, RT 19.3%, MT 88.5%). Our findings suggest multiple approaches can achieve rapid control of T. solium transmission.
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Dixon MA, Braae UC, Winskill P, Devleesschauwer B, Trevisan C, Van Damme I, Walker M, Hamley JID, Ramiandrasoa SN, Schmidt V, Gabriël S, Harrison W, Basáñez MG. Modelling for Taenia solium control strategies beyond 2020. Bull World Health Organ 2020; 98:198-205. [PMID: 32132754 PMCID: PMC7047036 DOI: 10.2471/blt.19.238485] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 12/15/2019] [Accepted: 12/27/2019] [Indexed: 01/06/2023] Open
Abstract
The cestode Taenia solium is responsible for a considerable cross-sectoral health and economic burden due to human neurocysticercosis and porcine cysticercosis. The 2012 World Health Organization (WHO) roadmap for neglected tropical diseases called for the development of a validated strategy for control of T. solium; however, such a strategy is not yet available. In 2019, WHO launched a global consultation aimed at refining the post-2020 targets for control of T. solium for a new roadmap for neglected tropical diseases. In response, two groups working on taeniasis and cysticercosis mathematical models (cystiSim and EPICYST models), together with a range of other stakeholders organized a workshop to provide technical input to the WHO consultation and develop a research plan to support efforts to achieve the post-2020 targets. The workshop led to the formation of a collaboration, CystiTeam, which aims to tackle the population biology, transmission dynamics, epidemiology and control of T. solium through mathematical modelling approaches. In this paper, we outline developments in T. solium control and in particular the use of modelling to help achieve post-2020 targets for control of T. solium. We discuss the steps involved in improving confidence in the predictive capacities of existing mathematical and computational models on T. solium transmission, including model comparison, refinement, calibration and validation. Expanding the CystiTeam partnership to other research groups and stakeholders, particularly those operating in different geographical and endemic areas, will enhance the prospects of improving the applicability of T. solium transmission models to inform taeniasis and cysticercosis control strategies.
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Affiliation(s)
- Matthew A Dixon
- Department of Infectious Disease Epidemiology, London Centre for Neglected Tropical Disease Research and MRC Centre for Global Infectious Disease Analysis, Imperial College London, London W2 1PG, England
| | - Uffe C Braae
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Peter Winskill
- Department of Infectious Disease Epidemiology, London Centre for Neglected Tropical Disease Research and MRC Centre for Global Infectious Disease Analysis, Imperial College London, London W2 1PG, England
| | | | - Chiara Trevisan
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Inge Van Damme
- Department of Veterinary Public Health and Food Safety, Ghent University, Merelbeke, Belgium
| | - Martin Walker
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, England
| | - Jonathan I D Hamley
- Department of Infectious Disease Epidemiology, London Centre for Neglected Tropical Disease Research and MRC Centre for Global Infectious Disease Analysis, Imperial College London, London W2 1PG, England
| | - Sylvia N Ramiandrasoa
- Service de Lutte contre les Maladies Endémiques et Négligées, Ministry of Public Health, Antananarivo, Madagascar
| | - Veronika Schmidt
- Department of Neurology, Technical University Munich, Munich, Germany
| | - Sarah Gabriël
- Department of Veterinary Public Health and Food Safety, Ghent University, Merelbeke, Belgium
| | - Wendy Harrison
- Schistosomiasis Control Initiative Foundation, London, England
| | - Maria-Gloria Basáñez
- Department of Infectious Disease Epidemiology, London Centre for Neglected Tropical Disease Research and MRC Centre for Global Infectious Disease Analysis, Imperial College London, London W2 1PG, England
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Beam M, Spencer AG, Atto R, Camizan R, Vilchez P, Muro C, Gamboa R, Pray I, Garvey B, Fernandez L, Garcia HH, O'Neal SE, For The Cysticercosis Working Group In Peru. To Really Know the Disease: Creating a Participatory Community Education Workshop about Taenia solium Focused on Physical, Economic, and Epidemiologic Evidence. Am J Trop Med Hyg 2020; 100:1490-1493. [PMID: 30938282 DOI: 10.4269/ajtmh.18-0939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Cysticercosis, caused by Taenia solium, is a neglected disease that causes preventable epilepsy. We conducted an experiential learning workshop in northern Peru to educate community members on T. solium transmission and motivate participation in community-led prevention and control. The workshop included presentation of local economic and epidemiologic data, followed by hands-on participation in pig dissection, group discussion of the T. solium life cycle, and viewing of eggs and nascent tapeworms with light microscopes. Among heads of household, we used community survey data to compare knowledge of the three-stage parasite life cycle at baseline and 2 months postworkshop. Knowledge of the life cycle increased significantly after the workshop, with greater gains for workshop attendees than non-attendees. Prior knowledge and workshop attendance were significant predictors of postworkshop knowledge. The use of local evidence and experiential learning positively affected knowledge of T. solium transmission, laying the foundation for subsequent community-engaged control efforts.
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Affiliation(s)
- Michelle Beam
- School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Angela G Spencer
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon
| | - Ruth Atto
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Roberto Camizan
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Percy Vilchez
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Claudio Muro
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ricardo Gamboa
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ian Pray
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon
| | - Brian Garvey
- School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Lauralee Fernandez
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon
| | - Hector H Garcia
- Department of Microbiology, Universidad Peruana Cayetano Heredia, Lima, Peru.,Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Seth E O'Neal
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Lima, Peru.,School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon
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Pray IW, Muro C, Gamboa R, Vilchez P, Wakeland W, Pan W, Lambert WE, Garcia HH, O'Neal SE. Seasonal patterns in risk factors for Taenia solium transmission: a GPS tracking study of pigs and open human defecation in northern Peru. Parasit Vectors 2019; 12:352. [PMID: 31311596 PMCID: PMC6636017 DOI: 10.1186/s13071-019-3614-5] [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: 02/26/2019] [Accepted: 07/10/2019] [Indexed: 11/17/2022] Open
Abstract
Background Taenia solium (cysticercosis) is a parasitic cestode that is endemic in rural populations where open defecation is common and free-roaming pigs have access to human feces. The purpose of this study was to examine the roaming patterns of free-range pigs, and identify areas where T. solium transmission could occur via contact with human feces. We did this by using GPS trackers to log the movement of 108 pigs in three villages of northern Peru. Pigs were tracked for approximately six days each and tracking was repeated in the rainy and dry seasons. Maps of pig ranges were analyzed for size, distance from home, land type and contact with human defecation sites, which were assessed in a community-wide defecation survey. Results Consistent with prior GPS studies and spatial analyses, we found that the majority of pigs remained close to home during the tracking period and had contact with human feces in their home areas: pigs spent a median of 79% (IQR: 61–90%) of their active roaming time within 50 m of their homes and a median of 60% of their contact with open defecation within 100 m of home. Extended away-from-home roaming was predominately observed during the rainy season; overall, home range areas were 61% larger during the rainy season compared to the dry season (95% CI: 41–73%). Both home range size and contact with open defecation sites showed substantial variation between villages, and contact with open defecation sites was more frequent among pigs with larger home ranges and pigs living in higher density areas of their village. Conclusions Our study builds upon prior work showing that pigs predominately roam and have contact with human feces within 50–100 m of the home, and that T. solium transmission is most likely to occur in these concentrated areas of contact. This finding, therefore, supports control strategies that target treatment resources to these areas of increased transmission. Our finding of a seasonal trend in roaming ranges may be useful for control programs relying on pig interventions, and in the field of transmission modeling, which require precise estimates of pig behavior and risk. Electronic supplementary material The online version of this article (10.1186/s13071-019-3614-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ian W Pray
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, Oregon, USA.
| | - Claudio Muro
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Tumbes, Peru
| | - Ricardo Gamboa
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Tumbes, Peru
| | - Percy Vilchez
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Tumbes, Peru
| | - Wayne Wakeland
- Systems Science Program, Portland State University, Portland, Oregon, USA
| | - William Pan
- Global Health Institute, Duke University, Durham, North Carolina, USA
| | - William E Lambert
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, Oregon, USA
| | - Hector H Garcia
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Tumbes, Peru.,School of Sciences, Department of Microbiology, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Seth E O'Neal
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, Oregon, USA.,Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Tumbes, Peru
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