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Alene KA, Hertzog L, Gilmour B, Clements ACA, Murray MB. Interventions to prevent post-tuberculosis sequelae: a systematic review and meta-analysis. EClinicalMedicine 2024; 70:102511. [PMID: 38434448 PMCID: PMC10907188 DOI: 10.1016/j.eclinm.2024.102511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/07/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024] Open
Abstract
Background Tuberculosis (TB) remains a global public health challenge, causing substantial mortality and morbidity. While TB treatment has made significant progress, it often leaves survivors with post-TB sequelae, resulting in long-term health issues. Current healthcare systems and guidelines lack comprehensive strategies to address post-TB sequelae, primarily due to insufficient evidence. This systematic review and meta-analysis aimed to identify effective interventions for preventing post-TB sequelae. Methods A systematic search was conducted across four databases including PubMed, SCOPUS, Web of Science, and Cochrane Central Register of Controlled Trials from inception to September 22, 2023. Eligible studies reported interventions designed to prevent post-TB sequelae were included. A random effect meta-analysis was conducted where applicable, and heterogeneity between studies was evaluated visually using forest plots and quantitatively using an index of heterogeneity (I2). This study is registered with PROSPERO (CRD42023464392). Findings From the 2525 unique records screened, 25 studies involving 10,592 participants were included. Different interventions were evaluated for different outcomes. However, only a few interventions were effective in preventing post-TB sequelae. Rehabilitation programs significantly improved lung function (Hedges's g = 0.21; 95% confidence interval (CI): 0.03, 0.39) and prevented neurological sequelae (relative risk (RR) = 0.10; 95% CI: 0.02, 0.42). Comprehensive interventions and cognitive-behavioural therapy significantly reduced the risk of mental health disorders among TB survivors (Hedges's g = -1.89; 95% CI: -3.77, -0.01). In contrast, interventions targeting post-TB liver sequelae, such as vitamin A and vitamin D supplementation and hepatoprotective agents, did not show significant reductions in sequelae (RR = 0.90; 95% CI: 0.52, 1.57). Moreover, adjunctive therapies did not show a significant effect in preventing post-TB neurological sequelae (RR = 0.62, 95% CI: 0.31, 1.24). Interpretation Rehabilitation programs prevented post-TB lung, neurologic and mental health sequelae, while adjuvant therapies and other interventions require further investigation. Funding Healy Medical Research Raine Foundation, Curtin School of Population Health and the Australian National Health and Medical Research Council.
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Affiliation(s)
- Kefyalew Addis Alene
- School of Population Health, Faculty of Health Sciences, Curtin University, Australia
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Australia
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Lucas Hertzog
- School of Population Health, Faculty of Health Sciences, Curtin University, Australia
| | - Beth Gilmour
- School of Population Health, Faculty of Health Sciences, Curtin University, Australia
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Australia
| | | | - Megan B Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Gebreyohannes EA, Wolde HF, Akalu TY, Clements ACA, Alene KA. Impacts of armed conflicts on tuberculosis burden and treatment outcomes: a systematic review. BMJ Open 2024; 14:e080978. [PMID: 38453196 PMCID: PMC10921481 DOI: 10.1136/bmjopen-2023-080978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/26/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVES This systematic review aimed to summarise existing literature on the impacts of armed conflicts on tuberculosis burden and treatment outcomes. DESIGN A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature Plus, Scopus, ScienceDirect, Embase and medRxiv. DATA EXTRACTION AND SYNTHESIS Three reviewers independently screened, selected eligible studies and extracted data. A narrative review was undertaken to summarise the findings qualitatively. RESULTS Eleven studies were included in this review, reporting on tuberculosis incidence rates, prevalence and treatment outcomes, including mortality. Overall, the impact of armed conflicts on case notifications was variable. Six studies reported overall increases in tuberculosis case notifications following the onset of conflicts, while three studies reported overall decreases in tuberculosis case notifications. Factors, including limited access to healthcare services, challenges in surveillance and laboratory confirmation, the destruction of health systems and incapacitating the healthcare workforce, contributed to a decrease in the number of notified cases. The higher tuberculosis notification in some of the studies could be attributed to the disruption of tuberculosis prevention and control programmes as well as increased socioeconomic deprivation, including malnutrition, mass migration, poor living conditions and overcrowding that are worsened during conflicts. Armed conflicts without effective interventions were associated with worse tuberculosis treatment outcomes, including lower proportions of people with treatment success and higher proportions of people with loss to follow-up, mortality and treatment failure. However, implementing various interventions in conflict settings (such as establishing a National Tuberculosis Control Programme) led to higher tuberculosis notification rates and treatment success. CONCLUSION The impact of armed conflicts on tuberculosis notification is complex and is influenced by multiple factors. The findings of this review underscore the importance of concerted efforts to control tuberculosis in conflict settings using available resources.
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Affiliation(s)
- Eyob Alemayehu Gebreyohannes
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Haileab Fekadu Wolde
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Temesgen Yihunie Akalu
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara, Ethiopia
| | - Archie C A Clements
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- Penninsula Medical School, University of Plymouth, Playmouth, UK
| | - Kefyalew Addis Alene
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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Awasthi KR, Jancey J, Clements ACA, Rai R, Leavy JE. Community engagement approaches for malaria prevention, control and elimination: a scoping review. BMJ Open 2024; 14:e081982. [PMID: 38365295 PMCID: PMC10875526 DOI: 10.1136/bmjopen-2023-081982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/25/2024] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION Globally malaria programmes have adopted approaches to community engagement (ACE) to design and deliver malaria interventions. This scoping review aimed to understand, map, and synthesise intervention activities guided by ACE and implemented by countries worldwide for the prevention, control and elimination of malaria. METHODS Three databases (Web of Science, Proquest, and Medline) were searched for peer-reviewed, primary studies, published in English between 1 January 2000 and 31 December 2022. Advanced Google was used to search for grey literature. The five levels of the International Association for Public Participation were used to categorise ACE - (1) Inform, (2) Consult, (3) involve, (4) Collaborate, and (5) Co-lead. Intervention activities were categorised as health education (HE), and/or health services (HS), and/or environmental management (EM). Outcomes were collected as knowledge, attitude, behaviour, help-seeking, health and HS and environment. Enablers and barriers were identified. Malaria intervention phases were categorised as (1) prevention (P), or (2) control (C), or (3) prevention and control (PC) or prevention, control and elimination (PCE). RESULTS Seventy-five studies were included in the review. Based on ACE levels, most studies were at the inform (n=37) and involve (n=26) level. HE (n=66) and HS (n=43) were the common intervention activities. HE informed communities about malaria, its prevention and vector control. EM activities were effective when complemented by HE. Community-based HS using locally recruited health workers was well-accepted by the community. Involvement of local leaders and collaboration with local stakeholders can be enablers for malaria intervention activities. CONCLUSION Involving local leaders and community groups in all stages of malaria prevention programmes is vital for successful interventions. Key elements of successful ACE, that is, consult, collaborate, and co-lead were under-represented in the literature and require attention. National programes must consult and collaborate with community stakeholders to develop ownership of the interventions and eventually co-lead them.
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Affiliation(s)
- Kiran Raj Awasthi
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Jonine Jancey
- Western Australian Centre for Health Promotion Research, School of Public Health, Curtin University, Perth, Western Australia, Australia
| | | | - Rajni Rai
- School of Population Health, Curtin University, Perth, Western Australia, Australia
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Akalu TY, Clements ACA, Xu Z, Bai L, Alene KA. Determinants of drug-resistant tuberculosis in Hunan province, China: a case-control study. BMC Infect Dis 2024; 24:198. [PMID: 38350860 PMCID: PMC10863170 DOI: 10.1186/s12879-024-09106-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 02/06/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Drug-resistant tuberculosis (DR-TB) is a major public health threat in Hunan Province, with an increasing clinical burden in recent years. This study aimed to identify socio-demographic and clinical factors associated with DR-TB in Hunan province, China. METHODS A case-control study was conducted in Hunan province. Cases were all DR-TB patients who were confirmed by culture and Drug susceptibility testing (DST) and enrolled at the DR-TB treatment center of Hunan Chest Hospital from 2013 to 2018. Controls were all Drug Susceptible TB (DS-TB) patients confirmed by DST and enrolled at the same hospital during the same period. A multivariable logistic regression model was fitted to identify factors significantly associated with DR-TB. RESULTS A total of 17,808 patients (15,534 DS-TB controls and 2274 DR-TB cases) were included in the study, with a mean age of 42.5 years (standard deviation (SD) ± 17.5 years) for cases and 46.1 years (SD ± 19.1 years) for controls. Age 15-64 years (Adjusted odds ratio (AOR = 1.5, 95% CI; 1.4, 1.8)), ethnic minorities (AOR = 1.5; 95% CI; 1.4, 1.8), and a history of previous TB treatment (AOR) = 1.84; 95% CI: 1.57, 2.15) was significantly associated with DR-TB. Being resident in a province outside Hunan was also a significant risk factor (AOR = 1.67; 1.27, 2.21) for DR-TB. CONCLUSION AND RECOMMENDATIONS To prevent the occurrence of DR-TB in Hunan Province, interventions should be targeted at high-risk demographic groups such as ethnic minorities, individuals of productive age, and residents living outside the province. Interventions must also be targeted to previously treated cases, suggesting the appropriateness of diagnosis, treatment, and follow-up. Understanding the risk factors at the province level helps design strategies for controlling DR-TB due to variations by socioeconomic differences, quality of health care, and healthcare access.
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Affiliation(s)
- Temesgen Yihunie Akalu
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia.
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Archie C A Clements
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- Penninsula Medical School, University of Plymouth, Plymouth, UK
| | - Zuhui Xu
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Liqiong Bai
- TB Control Institute of Hunan Province, Changsha, China
| | - Kefyalew Addis Alene
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
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Yang SK, Zhang W, Zhu N, McManus DP, Gray DJ, Clements ACA, Cadavid Restrepo AM, Williams GM, Zhang T, Ma GR, Yang YH, Yang YR. Serological Comparison of Native Antigen ELISAs with Rapid ICT Test Kits for the Diagnosis of Human Alveolar and Cystic Echinococcosis in China. Trop Med Infect Dis 2024; 9:44. [PMID: 38393133 PMCID: PMC10893119 DOI: 10.3390/tropicalmed9020044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The aim of this study was to compare the diagnostic performance of native antigen ELISAs and ADAMU-AE/CE commercial ICT test kits in subjects either exposed to Echinococcus infection or with clinically diagnosed alveolar (AE) or cystic (CE) echinococcosis. METHODS A total of 370 subjects with a previous clinical confirmation of CE or AE from northwestern China were recruited. Serum samples were also obtained from 3923 children/teenagers during a community survey. All sera were tested using native antigen ELISAs. The ADAMU-AE/CE test kits were subsequently used for the serology of the 370 clinically confirmed individuals and of 251 children/teenagers that were ELISA antibody-positive for both Echinococcus species but ultrasound-negative during baseline survey. An analysis of the association between the serological tests and ultrasound classification was carried out amongst 89 AE and 164 CE cases. A Kappa consistency analysis was undertaken to compare the diagnostic performance of the native antigen ELISAs and the ADAMU kits and the ultrasound imaging results. The χ² test was also used for a comparison of the different seropositivity rates between the groups. FINDINGS There was poor consistency (Kappa = 0.26 and 0.28 for AE and CE respectively) between the native antigen ELISAs and the ADAMU kits for the diagnosis of AE and CE among the cases and the surveyed children/teenagers, but a relatively good consistency (Kappa = 0.63) between the ADAMU-AE kit and ultrasound observations for the AE cases. Additionally, of the 251 teenagers co-positive for both AE and CE antibodies by the native antigen ELISAs, only one was found positive by the ADAMU-AE kit, verified as a new AE case on subsequent ultrasound follow-up. The remainder (N = 250) were negative by serology using the ADAMU-AE/CE kits and by ultrasound examination. The two native antigen ELISAs did not discriminate well between cases of clinically diagnosed AE and CE. In contrast, ADAMU-AE and ADAMU-CE commercial ICT test kits readily differentiated cases of AE from CE with specificities of 99% for AE and 100% for CE. CONCLUSIONS The ADAMU-AE/CE kits proved reliable, accurate, and amenable diagnostic tools in the clinical setting for confirmation of suspected AE/CE cases. The native antigen ELISAs tests can provide useful information on the level of human exposure to Echinococcus infection.
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Affiliation(s)
- Shu-Kun Yang
- Department of Radiology, The Second Affiliated Hospital of Ningxia Medical University, The First People’s Hospital of Yinchuan City, Yinchuan 750001, China;
| | - Wei Zhang
- Department of Pathogenic Biology & Medical Immunology, School of Basic Medical Science, Ningxia Medical University, Yinchuan 750004, China; (W.Z.); (N.Z.); (G.-R.M.); (Y.-H.Y.)
| | - Na Zhu
- Department of Pathogenic Biology & Medical Immunology, School of Basic Medical Science, Ningxia Medical University, Yinchuan 750004, China; (W.Z.); (N.Z.); (G.-R.M.); (Y.-H.Y.)
| | - Donald P. McManus
- Molecular Parasitology Laboratory, Global Health & Tropical Medicine, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia (D.J.G.)
| | - Darren J. Gray
- Molecular Parasitology Laboratory, Global Health & Tropical Medicine, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia (D.J.G.)
- Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT 2600, Australia;
- Infectious Disease Epidemiology Unit, School of Public Health, University of Queensland, Brisbane, QLD 4006, Australia; (A.M.C.R.); (G.M.W.)
| | - Archie C. A. Clements
- Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT 2600, Australia;
- Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
| | - Angela M. Cadavid Restrepo
- Infectious Disease Epidemiology Unit, School of Public Health, University of Queensland, Brisbane, QLD 4006, Australia; (A.M.C.R.); (G.M.W.)
| | - Gail M. Williams
- Infectious Disease Epidemiology Unit, School of Public Health, University of Queensland, Brisbane, QLD 4006, Australia; (A.M.C.R.); (G.M.W.)
| | - Ting Zhang
- NHC Key Laboratory of Parasite and Vector Biology, National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), Shanghai 200025, China
| | - Guo-Rong Ma
- Department of Pathogenic Biology & Medical Immunology, School of Basic Medical Science, Ningxia Medical University, Yinchuan 750004, China; (W.Z.); (N.Z.); (G.-R.M.); (Y.-H.Y.)
| | - Yan-Hui Yang
- Department of Pathogenic Biology & Medical Immunology, School of Basic Medical Science, Ningxia Medical University, Yinchuan 750004, China; (W.Z.); (N.Z.); (G.-R.M.); (Y.-H.Y.)
| | - Yu-Rong Yang
- Department of Pathogenic Biology & Medical Immunology, School of Basic Medical Science, Ningxia Medical University, Yinchuan 750004, China; (W.Z.); (N.Z.); (G.-R.M.); (Y.-H.Y.)
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Akalu TY, Clements ACA, Gebreyohannes EA, Xu Z, Bai L, Alene KA. Risk factors for diagnosis and treatment delay among patients with multidrug-resistant tuberculosis in Hunan Province, China. BMC Infect Dis 2024; 24:159. [PMID: 38308252 PMCID: PMC10835895 DOI: 10.1186/s12879-024-09036-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/19/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Multidrug-resistant tuberculosis (MDR-TB) is a global health threat associated with high morbidity and mortality rates. Diagnosis and treatment delays are associated with poor treatment outcomes in patients with MDR-TB. However, the risk factors associated with these delays are not robustly investigated, particularly in high TB burden countries such as China. Therefore, this study aimed to measure the length of diagnosis and treatment delays and identify their risk factors among patients with MDR-TB in Hunan province. METHODS A retrospective cohort study was conducted using MDR-TB data from Hunan province between 2013 and 2018. The main outcomes of the study were diagnosis and treatment delay, defined as more than 14 days from the date of symptom to diagnosis confirmation (i.e., diagnosis delay) and from diagnosis to treatment commencement (i.e., treatment delay). A multivariable logistic regression model was fitted, and an adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to identify factors associated with diagnosis and treatment delay. RESULTS In total, 1,248 MDR-TB patients were included in this study. The median length of diagnosis delays was 27 days, and treatment delays were one day. The proportion of MDR-TB patients who experienced diagnosis and treatment delay was 62.82% (95% CI: 60.09-65.46) and 30.77% (95% CI: 28.27-33.39), respectively. The odds of experiencing MDR-TB diagnosis delay among patients coming through referral and tracing was reduced by 41% (AOR = 0.59, 95% CI: 0.45-0.76) relative to patients identified through consultations due to symptoms. The odds of experiencing diagnosis delay among ≥ 65 years were 65% (AOR = 0.35, 0.14-0.91) lower than under-15 children. The odds of developing treatment delay among foreign nationalities and people from other provinces were double (AOR = 2.00, 95% CI: 1.31-3.06) compared to the local populations. Similarly, the odds of experiencing treatment delay among severely ill patients were nearly 2.5 times higher (AOR = 2.49, 95% CI: 1.41-4.42) compared to patients who were not severely ill. On the other hand, previously treated TB cases had nearly 40% (AOR = 0.59, 95% CI: 0.42-0.85) lower odds of developing treatment delay compared with new MDR-TB cases. Similarly, other ethnic minority groups had nearly 40% (AOR = 0.57, 95% CI: 0.34-0.96) lower odds of experiencing treatment delay than the Han majority. CONCLUSIONS Many MDR-TB patients experience long diagnosis and treatment delays in Hunan province. Strengthening active case detection can significantly reduce diagnosis delays among MDR-TB patients. Moreover, giving attention to patients who are new to MDR-TB treatment, are severely ill, or are from areas outside Hunan province will potentially reduce the burden of treatment delay among MDR-TB patients.
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Affiliation(s)
- Temesgen Yihunie Akalu
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA, 6102, Australia.
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, WA, Australia.
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Archie C A Clements
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, WA, Australia
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Eyob Alemayehu Gebreyohannes
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, WA, Australia
- School of Allied Health, University of Western Australia, Perth, WA, Australia
| | - Zuhui Xu
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Liqiong Bai
- TB Control Institute of Hunan Province, Changsha, China
| | - Kefyalew Addis Alene
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA, 6102, Australia
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, WA, Australia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Akalu TY, Clements ACA, Gebreyohannes EA, Wolde HF, Shiferaw FW, Alene KA. Burden of drug-resistant tuberculosis among contacts of index cases: a protocol for a systematic review. BMJ Open 2024; 14:e074364. [PMID: 38195168 PMCID: PMC10806946 DOI: 10.1136/bmjopen-2023-074364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 11/07/2023] [Indexed: 01/11/2024] Open
Abstract
INTRODUCTION People having close contact with drug-resistant tuberculosis (DR-TB) patients are at increased risk of contracting and developing the disease. However, no comprehensive review has been undertaken to estimate the burden of DR-TB among contacts of DR-TB patients. Therefore, the current systematic review will quantify the prevalence and incidence of DR-TB among contacts of DR-TB patients. METHOD AND ANALYSIS Systematic searches will be conducted in Medline, Embase, Web of Science, Scopus, Cochrane Central Register of Controlled trials (CENTRAL) and Cumulative Index to Nursing and Allied Health Literature (CINHAL) databases. The search will be conducted without restrictions on time, language and geography. A random-effects meta-analysis will be conducted for effect estimates. The pooled prevalence and incidence of DR-TB will be compared between people with and without contact with DR-TB patients. The presence of heterogeneity between studies will be assessed by Higgins I2 statistics. Subgroup analysis will be conducted to determine the source of heterogeneity. The risk of bias will be assessed using a visual inspection of the funnel plot and Egger's regression test statistics. Trim and fill analysis will be done in the presence of publication bias. A sensitivity analysis will be conducted by trimming low-quality studies. The systematic review will be reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol guidelines. ETHICS AND DISSEMINATION Ethical approval will not be required for this study as it will be a systematic review and meta-analysis based on previously published evidence. The findings of the systematic review will be presented at scientific conferences and published in scientific journals. PROTOCOL REGISTRATION The protocol is published in PROSPERO with registration number CRD42023390339.
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Affiliation(s)
- Temesgen Yihunie Akalu
- Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
- Curtin University Faculty of Health Sciences, Perth, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Archie C A Clements
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Eyob Alemayehu Gebreyohannes
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia
| | - Haileab Fekadu Wolde
- Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
- Curtin University Faculty of Health Sciences, Perth, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | | | - Kefyalew Addis Alene
- Curtin University Faculty of Health Sciences, Perth, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
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Akalu TY, Clements ACA, Wolde HF, Alene KA. Economic burden of multidrug-resistant tuberculosis on patients and households: a global systematic review and meta-analysis. Sci Rep 2023; 13:22361. [PMID: 38102144 PMCID: PMC10724290 DOI: 10.1038/s41598-023-47094-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 11/09/2023] [Indexed: 12/17/2023] Open
Abstract
Multidrug-resistant tuberculosis (MDR-TB) is a major health threat worldwide, causing a significant economic burden to patients and their families. Due to the longer duration of treatment and expensive second-line medicine, the economic burden of MDR-TB is assumed to be higher than drug-susceptible TB. However, the costs associated with MDR-TB are yet to be comprehensively quantified. We conducted this systematic review and meta-analysis to determine the global burden of catastrophic costs associated with MDR-TB on patients and their households. We systematically searched five databases (CINHAL, MEDLINE, Embase, Scopus, and Web of Science) from inception to 2 September 2022 for studies reporting catastrophic costs on patients and affected families of MDR-TB. The primary outcome of our study was the proportion of patients and households with catastrophic costs. Costs were considered catastrophic when a patient spends 20% or more of their annual household income on their MDR-TB diagnosis and care. The pooled proportion of catastrophic cost was determined using a random-effects meta-analysis. Publication bias was assessed using visualization of the funnel plots and the Egger regression test. Heterogeneity was assessed using I2, and sub-group analysis was conducted using study covariates as stratification variables. Finally, we used the Preferred Reporting Items for Reporting Systematic Review and Meta-Analysis-20 (PRISMA-20). The research protocol was registered in PROSPERO (CRD42021250909). Our search identified 6635 studies, of which 11 were included after the screening. MDR-TB patients incurred total costs ranging from $USD 650 to $USD 8266 during treatment. The mean direct cost and indirect cost incurred by MDR-TB patients were $USD 1936.25 (SD ± $USD 1897.03) and $USD 1200.35 (SD ± $USD 489.76), respectively. The overall burden of catastrophic cost among MDR-TB patients and households was 81.58% (95% Confidence Interval (CI) 74.13-89.04%). The catastrophic costs incurred by MDR-TB patients were significantly higher than previously reported for DS-TB patients. MDR-TB patients incurred more expenditure for direct costs than indirect costs. Social protection and financial support for patients and affected families are needed to mitigate the catastrophic economic consequences of MDR-TB.
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Affiliation(s)
- Temesgen Yihunie Akalu
- Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
- Geospital and Tuberculosis Research Team, Telethon Kids Institute, Perth, WA, Australia.
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Archie C A Clements
- Geospital and Tuberculosis Research Team, Telethon Kids Institute, Perth, WA, Australia
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Haileab Fekadu Wolde
- Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Geospital and Tuberculosis Research Team, Telethon Kids Institute, Perth, WA, Australia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kefyalew Addis Alene
- Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Geospital and Tuberculosis Research Team, Telethon Kids Institute, Perth, WA, Australia
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9
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Wolde HF, Clements ACA, Alene KA. Development and validation of a risk prediction model for pulmonary tuberculosis among presumptive tuberculosis cases in Ethiopia. BMJ Open 2023; 13:e076587. [PMID: 38101842 PMCID: PMC10729072 DOI: 10.1136/bmjopen-2023-076587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/22/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Early diagnosis and treatment of tuberculosis (TB) is one of the key strategies to achieve the WHO End TB targets. This study aimed to develop and validate a simple, convenient risk score to diagnose pulmonary TB among presumptive TB cases. METHODS This prediction model used Ethiopian national TB prevalence survey data and included 5459 presumptive TB cases from all regions of Ethiopia. Logistic regression was used to determine which variables are predictive of pulmonary TB. A risk prediction model was developed, incorporating significant variables (p<0.05). The Youden Index method was used to choose the optimal cut-off point to separate the risk score of the patients as high and low. Model performance was assessed using discrimination power and calibration. Internal validation of the model was assessed using Efron's enhanced bootstrap method, and the clinical utility of the risk score was assessed using decision curve analysis. RESULTS Of total participants, 94 (1.7%) were confirmed to have TB. The final prediction model included three factors with different scores: (1) TB contact history, (2) chest X-ray (CXR) abnormality and (3) two or more symptoms of TB. The optimal cut-off point for the risk score was 6 and was found to have a good discrimination accuracy (c-statistic=0.70, 95% CI: 0.65 to 0.75). The risk score has sensitivity of 51.1%, specificity of 79.9%, positive predictive value of 4.3% and negative predictive value of 98.9%. After internal validation, the optimism coefficient was 0.003, which indicates the model is internally valid. CONCLUSION We developed a risk score that combines TB contact, number of TB symptoms and CXR abnormality to estimate individual risk of pulmonary TB among presumptive TB cases. Though the score is easy to calculate and internally validated, it needs external validation before widespread implementation in a new setting.
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Affiliation(s)
- Haileab Fekadu Wolde
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Kefyalew Addis Alene
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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10
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Law HD, Randall DA, Armstrong BK, D’este C, Lazarevic N, Hosking R, Smurthwaite KS, Trevenar SM, Lucas RM, Clements ACA, Kirk MD, Korda RJ. Relative Risks of Adverse Perinatal Outcomes in Three Australian Communities Exposed to Per- and Polyfluoroalkyl Substances: Data Linkage Study. Int J Environ Res Public Health 2023; 20:6886. [PMID: 37835156 PMCID: PMC10572760 DOI: 10.3390/ijerph20196886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/08/2023] [Accepted: 09/15/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION Firefighting foams containing per- and polyfluoroalkyl substances (PFAS) have caused environmental contamination in several Australian residential areas, including Katherine in the Northern Territory (NT), Oakey in Queensland (Qld), and Williamtown in New South Wales (NSW). We examined whether the risks of adverse perinatal outcomes were higher in mothers living in these exposure areas than in selected comparison areas without known contamination. METHODS We linked residential addresses in exposure areas to addresses collected in the jurisdictional Perinatal Data Collections of the NT (1986-2017), Qld (2007-2018), and NSW (1994-2018) to select all pregnancies from mothers who gave birth while living in these areas. We also identified one comparison group for each exposure area by selecting pregnancies where the maternal address was in selected comparison areas. We examined 12 binary perinatal outcomes and three growth measurements. For each exposure area, we estimated relative risks (RRs) of adverse outcomes and differences in means of growth measures, adjusting for sociodemographic characteristics and other potential confounders. RESULTS We included 16,970 pregnancies from the NT, 4654 from Qld, and 7475 from NSW. We observed elevated risks of stillbirth in Oakey (RR = 2.59, 95% confidence interval (CI) 1.25 to 5.39) and of postpartum haemorrhage (RR = 1.94, 95% CI 1.13 to 3.33) and pregnancy-induced hypertension (RR = 1.88, 95% CI 1.30 to 2.73) in Williamtown. The risks of other perinatal outcomes were not materially different from those in the relevant comparison areas or were uncertain due to small numbers of events. CONCLUSIONS There was limited evidence for increased risks of adverse perinatal outcomes in mothers living in areas with PFAS contamination from firefighting foams. We found higher risks of some outcomes in individual areas, but these were not consistent across all areas under study and could have been due to chance, bias, or confounding.
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Affiliation(s)
- Hsei Di Law
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Deborah A. Randall
- Women and Babies Research, Northern Clinical School, The University of Sydney, St Leonards, NSW 2050, Australia
| | - Bruce K. Armstrong
- School of Population and Global Health, The University of Western Australia, Perth, WA 6009, Australia
| | - Catherine D’este
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Nina Lazarevic
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Rose Hosking
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Kayla S. Smurthwaite
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Susan M. Trevenar
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Robyn M. Lucas
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2601, Australia
| | | | - Martyn D. Kirk
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Rosemary J. Korda
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2601, Australia
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Wagnew F, Gray D, Tsheten T, Kelly M, Clements ACA, Alene KA. Effectiveness of nutritional support to improve treatment adherence in patients with tuberculosis: a systematic review. Nutr Rev 2023:nuad120. [PMID: 37759339 DOI: 10.1093/nutrit/nuad120] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Abstract
CONTEXT Nutritional interventions substantially improve tuberculosis (TB) treatment outcomes and prevent complications. However, there is limited evidence about the connections between having nutritional support and TB treatment adherence. OBJECTIVE The aim of this study was to determine the effectiveness of nutritional support in improving treatment adherence among patients with TB. DATA SOURCES Databases, including PubMed, Embase (Ovid), Web of Science, and Scopus, were comprehensively reviewed to identify relevant studies reporting the impacts of nutritional support on TB treatment adherence. DATA EXTRACTION Two authors independently screened the title, abstracts, and full article texts to identify eligible studies and assess the risk of bias. Observational and interventional studies were included. DATA ANALYSIS A narrative synthesis approach was used to summarize the findings qualitatively. RESULTS From the search, 3059 publications were identified; of these, 8 studies were included in this systematic review. Three types of nutritional interventions were identified: food baskets (eg, energy, micronutrient- or macronutrient-enriched food support), nutritional advice and guidance, and incentives for buying foods. Although 5 studies reported that nutritional support significantly improved treatment adherence in patients with TB, 3 studies showed that nutritional support had no effect on TB treatment adherence. CONCLUSIONS Providing nutritional support may improve adherence to TB treatment. However, more well-powered, high-quality trials are warranted to demonstrate the effect of nutrition support on cost-effectively improving adherence to TB treatment. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42023392162.
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Affiliation(s)
- Fasil Wagnew
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
- College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Darren Gray
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Tsheten Tsheten
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Matthew Kelly
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| | | | - Kefyalew Addis Alene
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Faculty of Health Sciences, School of Population Health, Curtin University, Bentley, Western Australia, Australia
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12
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Cadavid Restrepo AM, Martin BM, Fuimaono S, Clements ACA, Graves PM, Lau CL. Spatial predictive risk mapping of lymphatic filariasis residual hotspots in American Samoa using demographic and environmental factors. PLoS Negl Trop Dis 2023; 17:e0010840. [PMID: 37486947 PMCID: PMC10399813 DOI: 10.1371/journal.pntd.0010840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 06/26/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND American Samoa successfully completed seven rounds of mass drug administration (MDA) for lymphatic filariasis (LF) from 2000-2006. The territory passed the school-based transmission assessment surveys in 2011 and 2015 but failed in 2016. One of the key challenges after the implementation of MDA is the identification of any residual hotspots of transmission. METHOD Based on data collected in a 2016 community survey in persons aged ≥8 years, Bayesian geostatistical models were developed for LF antigen (Ag), and Wb123, Bm14, Bm33 antibodies (Abs) to predict spatial variation in infection markers using demographic and environmental factors (including land cover, elevation, rainfall, distance to the coastline and distance to streams). RESULTS In the Ag model, females had a 26.8% (95% CrI: 11.0-39.8%) lower risk of being Ag-positive than males. There was a 2.4% (95% CrI: 1.8-3.0%) increase in the odds of Ag positivity for every year of age. Also, the odds of Ag-positivity increased by 0.4% (95% CrI: 0.1-0.7%) for each 1% increase in tree cover. The models for Wb123, Bm14 and Bm33 Abs showed similar significant associations as the Ag model for sex, age and tree coverage. After accounting for the effect of covariates, the radii of the clusters were larger for Bm14 and Bm33 Abs compared to Ag and Wb123 Ab. The predictive maps showed that Ab-positivity was more widespread across the territory, while Ag-positivity was more confined to villages in the north-west of the main island. CONCLUSION The findings may facilitate more specific targeting of post-MDA surveillance activities by prioritising those areas at higher risk of ongoing transmission.
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Affiliation(s)
- Angela M Cadavid Restrepo
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Beatris M Martin
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Archie C A Clements
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Patricia M Graves
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
| | - Colleen L Lau
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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13
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Hughes A, Ng-Nguyen D, Clarke NE, Dyer CEF, Hii SF, Clements ACA, Anderson RM, Gray DJ, Coffeng LE, Kaldor JM, Traub RJ, Vaz Nery S. Epidemiology of soil-transmitted helminths using quantitative PCR and risk factors for hookworm and Necator americanus infection in school children in Dak Lak province, Vietnam. Parasit Vectors 2023; 16:213. [PMID: 37370075 DOI: 10.1186/s13071-023-05809-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 05/14/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Soil-transmitted helminth (STH) infection is driven by a complex interaction of demographic, socioeconomic and behavioural factors, including those related to water, sanitation and hygiene (WASH). Epidemiological studies that measure both infection and potential risk factors associated with infection help to understand the drivers of transmission in a population and therefore can provide information to optimise STH control programmes. METHODS During October and November 2019, we conducted a cross-sectional survey of the prevalence and intensity of STH infection and associated risk factors among 7710 primary-school-age children from 64 primary schools across 13 districts in Dak Lak province, Vietnam. Quantitative PCR (qPCR) was used to detect and quantify STH infections. RESULTS The predominant STH species was the hookworm Necator americanus (overall cluster-adjusted prevalence of 13.7%), and its prevalence was heterogeneously distributed across surveyed schools (0% to 56.3%). All other STH species had a prevalence of less than 1%. Using mixed-effects logistic regression, we found that the adjusted odds ratio (aOR) was significantly higher for both infection and moderate-to-heavy-intensity infection with N. americanus among children from multiple ethnic minority groups, compared to children from the majority group (Kinh). Adjusted odds of infection with N. americanus were also higher in children who reported practising open defecation at school (aOR 1.42, 95% CI 1.05, 1.93, P = 0.02) and in those who had an unimproved household water supply (aOR 1.28, 95% CI 1.04, 1.57, P = 0.02). Conversely, children with a flushing household toilet had a reduced risk of infection (aOR 0.58, 95% CI 0.47, 0.70, P < 0.01), as did those whose primary female carer attended secondary (aOR 0.65, 95% CI 0.51, 0.84, P < 0.01) or tertiary education (aOR 0.39, 95% CI 0.24, 0.63, P < 0.01). CONCLUSIONS This study is the largest reported prevalence survey of STH infections conducted using qPCR as a diagnostic technique. The findings of higher adjusted odds of infection amongst ethnic minority children highlight that STH control programmes may not be reaching certain population groups and that additional culturally appropriate approaches may be required. Additionally, the associations between specific WASH factors and infection indicate potential programmatic targets to complement preventive chemotherapy programmes.
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Affiliation(s)
- Angus Hughes
- School of Population Health, University of New South Wales, Sydney, Australia.
| | - Dinh Ng-Nguyen
- Faculty of Animal Sciences and Veterinary Medicine, Tay Nguyen University, Buon Ma Thuot, Dak Lak, Vietnam
| | - Naomi E Clarke
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | - Clare E F Dyer
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | - Sze Fui Hii
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Perth, Australia
- Telethon Kids Institute, Perth, Australia
| | - Roy M Anderson
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Darren J Gray
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Luc E Coffeng
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - John M Kaldor
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | - Rebecca J Traub
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Australia
| | - Susana Vaz Nery
- Faculty of Animal Sciences and Veterinary Medicine, Tay Nguyen University, Buon Ma Thuot, Dak Lak, Vietnam
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14
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Clements ACA. Spatial and Temporal Data Visualisation for Mass Dissemination: Advances in the Era of COVID-19. Trop Med Infect Dis 2023; 8:314. [PMID: 37368732 DOI: 10.3390/tropicalmed8060314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
The COVID-19 pandemic is the first major pandemic of the digital age and has been characterised by unprecedented public consumption of spatial and temporal disease data, which can enable greater transparency and accountability of governments to the public for their public health decisions. A variety of state and non-state actors have collated and presented maps, charts, and plots of data related to the pandemic in both static and dynamic formats. In particular, there has been a proliferation of online dashboards presenting data related to the pandemic. The sources and types of information displayed have evolved rapidly during the pandemic, with a general trend towards providing more specialised information pertinent to specific aspects of epidemiology or disease control, as opposed simply to disease and death notifications. Limited evaluation of the quality of COVID-19 data visualisation tools has been conducted and significant effort now needs to be spent on standardisation and quality improvement of national and international data visualisation systems including developing common indicators, data quality assurance mechanisms and visualisation approaches, and building compatible electronic systems for data collection and sharing. The increasing availability of disease data for public consumption presents challenges and opportunities for government, media organisations, academic research institutions, and the general public. A key challenge is ensuring consistency and effectiveness of public health messaging to ensure a coordinated response and public trust in intervention strategies. Capitalising on opportunities for greater government accountability for public health decision-making, and more effective mobilisation of public health interventions, is predicated on the provision of accurate and timely information.
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Affiliation(s)
- Archie C A Clements
- Peninsula Medical School, University of Plymouth, Plymouth PL4 8AA, UK
- Telethon Kids Institute, Nedlands, Perth, WA 6009, Australia
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15
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Lazarevic N, Smurthwaite KS, Batterham PJ, Lane J, Trevenar SM, D'Este C, Clements ACA, Joshy AL, Hosking R, Gad I, Lal A, Law HD, Banwell C, Randall DA, Miller A, Housen T, Korda RJ, Kirk MD. Psychological distress in three Australian communities living with environmental per- and polyfluoroalkyl substances contamination. Sci Total Environ 2023; 874:162503. [PMID: 36863595 DOI: 10.1016/j.scitotenv.2023.162503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/07/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Environmental chemical contamination is a recognised risk factor for psychological distress, but has been seldom studied in the context of per- and polyfluoroalkyl substances (PFAS) contamination. We examined psychological distress in a cross-sectional study of three Australian communities exposed to PFAS from the historical use of aqueous film-forming foam in firefighting activities, and three comparison communities without environmental contamination. METHODS Participation was voluntary following recruitment from a PFAS blood-testing program (exposed) or random selection (comparison). Participants provided blood samples and completed a survey on their exposure history, sociodemographic characteristics, and four measures of psychological distress (Kessler-6, Distress Questionnaire-5, Patient Health Questionnaire-15, and Generalised Anxiety Disorder-7). We estimated prevalence ratios (PR) of clinically-significant psychological distress scores, and differences in mean scores: (1) between exposed and comparison communities; (2) per doubling in PFAS serum concentrations in exposed communities; (3) for factors that affect the perceived risk of living in a community exposed to PFAS; and (4) in relation to self-reported health concerns. RESULTS We recruited 881 adults in exposed communities and 801 in comparison communities. We observed higher levels of self-reported psychological distress in exposed communities than in comparison communities (e.g., Katherine compared to Alice Springs, Northern Territory: clinically-significant anxiety scores, adjusted PR = 2.82, 95 % CI 1.16-6.89). We found little evidence to suggest that psychological distress was associated with PFAS serum concentrations (e.g., Katherine, PFOS and anxiety, adjusted PR = 0.85, 95 % CI 0.65-1.10). Psychological distress was higher among exposed participants who were occupationally exposed to firefighting foam, used bore water on their properties, or were concerned about their health. CONCLUSION Psychological distress was substantially more prevalent in exposed communities than in comparison communities. Our findings suggest that the perception of risks to health, rather than PFAS exposure, contribute to psychological distress in communities with PFAS contamination.
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Affiliation(s)
- Nina Lazarevic
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT 2600, Australia.
| | - Kayla S Smurthwaite
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT 2600, Australia
| | - Philip J Batterham
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT 2600, Australia
| | - Jo Lane
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT 2600, Australia
| | - Susan M Trevenar
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT 2600, Australia
| | - Catherine D'Este
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT 2600, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Bentley, WA 6102, Australia; Telethon Kids Institute, Nedlands, WA 6009, Australia
| | - Amelia L Joshy
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT 2600, Australia
| | - Rose Hosking
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT 2600, Australia
| | - Imogen Gad
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT 2600, Australia
| | - Aparna Lal
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT 2600, Australia
| | - Hsei Di Law
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT 2600, Australia
| | - Catherine Banwell
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT 2600, Australia
| | - Deborah A Randall
- The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, NSW, Australia
| | - Adrian Miller
- Central Queensland University, Townsville, Qld 4810, Australia
| | - Tambri Housen
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT 2600, Australia
| | - Rosemary J Korda
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT 2600, Australia
| | - Martyn D Kirk
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, ACT 2600, Australia
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16
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Alene KA, Python A, Weiss DJ, Elagali A, Wagaw ZA, Kumsa A, Gething PW, Clements ACA. Mapping tuberculosis prevalence in Ethiopia using geospatial meta-analysis. Int J Epidemiol 2023:7159696. [PMID: 37164625 DOI: 10.1093/ije/dyad052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/19/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Reliable and detailed data on the prevalence of tuberculosis (TB) with sub-national estimates are scarce in Ethiopia. We address this knowledge gap by spatially predicting the national, sub-national and local prevalence of TB, and identifying drivers of TB prevalence across the country. METHODS TB prevalence data were obtained from the Ethiopia national TB prevalence survey and from a comprehensive review of published reports. Geospatial covariates were obtained from publicly available sources. A random effects meta-analysis was used to estimate a pooled prevalence of TB at the national level, and model-based geostatistics were used to estimate the spatial variation of TB prevalence at sub-national and local levels. Within the MBG Plugin Framework, a logistic regression model was fitted to TB prevalence data using both fixed covariate effects and spatial random effects to identify drivers of TB and to predict the prevalence of TB. RESULTS The overall pooled prevalence of TB in Ethiopia was 0.19% [95% confidence intervals (CI): 0.12%-0.28%]. There was a high degree of heterogeneity in the prevalence of TB (I2 96.4%, P <0.001), which varied by geographical locations, data collection periods and diagnostic methods. The highest prevalence of TB was observed in Dire Dawa (0.96%), Gambela (0.88%), Somali (0.42%), Addis Ababa (0.28%) and Afar (0.24%) regions. Nationally, there was a decline in TB prevalence from 0.18% in 2001 to 0.04% in 2009. However, prevalence increased back to 0.29% in 2014. Substantial spatial variation of TB prevalence was observed at a regional level, with a higher prevalence observed in the border regions, and at a local level within regions. The spatial distribution of TB prevalence was positively associated with population density. CONCLUSION The results of this study showed that TB prevalence varied substantially at sub-national and local levels in Ethiopia. Spatial patterns were associated with population density. These results suggest that targeted interventions in high-risk areas may reduce the burden of TB in Ethiopia and additional data collection would be required to make further inferences on TB prevalence in areas that lack data.
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Affiliation(s)
- Kefyalew Addis Alene
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Andre Python
- Center for Data Science, Zhejiang University, Zhejiang Province, Hangzhou, China
| | - Daniel J Weiss
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Telethon Kids Institute, Nedlands, WA, Australia
| | | | | | - Andargachew Kumsa
- National TB Control Program, Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | - Peter W Gething
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Archie C A Clements
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Telethon Kids Institute, Nedlands, WA, Australia
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17
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Lee P, Kurscheid JM, Laksono B, Park MJ, Clements ACA, Lowe C, Stewart DE, Gray DJ. Model validation for a knowledge and practices survey towards prevention of soil-transmitted helminth infections in rural villages in Indonesia. Sci Rep 2023; 13:1444. [PMID: 36697451 PMCID: PMC9876981 DOI: 10.1038/s41598-023-27781-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
The rate of soil-transmitted helminth (STH) infection is estimated to be around 20% in Indonesia. Health promotion and health education are cost-effective strategies to supplement STH prevention and control programs. Existing studies suggest that quantitative tools for knowledge, attitudes and practices (KAP) are important to monitor effective community-based STH interventions. However, evidence is limited regarding the applicability of such tools. This study aims to identify the socio-demographic predictors for STH-related knowledge and practices and validate the quantitative tools in population use. A cross-sectional study design was conducted among residents of 16 villages in Central Java, Indonesia. Adult and child respondents were interviewed to assess general knowledge and practices in relation to STH. Two mixed effects models identified the significant factors in predicting knowledge and practice scores. The model predicted knowledge and practice scores were compared with the observed scores to validate the quantitative measurements developed in this study. Participants' socio-demographic variables were significant in predicting an individual's STH-related knowledge level and their hand washing and hygiene practices, taking into account household-level variability. Model validation results confirmed that the quantitative measurement tools were suitable for assessing STH associated knowledge and behaviour. The questionnaire developed in this study can be used to support school- and community-based health education interventions to maximize the effect of STH prevention and control programs.
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Affiliation(s)
- P Lee
- School of Medicine & Dentistry, Griffith University, Gold Coast, QLD, Australia.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - J M Kurscheid
- Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT, Australia.,Health Systems Support Unit, Swiss Centre for International Health, Swiss Tropical and Public Health Institute, 4051, Basel, Switzerland
| | - B Laksono
- Faculty of Medicine, Universitas Diponegoro, Semarang, 50275, Indonesia
| | - M J Park
- Department of Nursing, College of Nursing, Konyang University, Daejeon, South Korea
| | - A C A Clements
- Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT, Australia.,Faculty of Health Sciences, Curtin University, Perth, Australia
| | - C Lowe
- Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT, Australia.
| | - D E Stewart
- School of Medicine & Dentistry, Griffith University, Gold Coast, QLD, Australia.,Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT, Australia
| | - D J Gray
- Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT, Australia
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18
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Akalu TY, Clements ACA, Baraki AG, Alene KA. Protocol for a systematic review of long-term physical sequelae and financial burden of multidrug-resistant and extensively drug-resistant tuberculosis. PLoS One 2023; 18:e0285404. [PMID: 37186609 PMCID: PMC10184907 DOI: 10.1371/journal.pone.0285404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/31/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Multidrug resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) are major public health threats that are significant causes of physical sequelae and financial consequences for infected people. Treatment for MDR- and XDR-TB are more toxic and take longer duration than for drug-susceptible-TB. As a result, the long-term sequelae are thought to be more common among patients with MDR- and XDR-TB than drug-susceptible-TB, but this is yet to be quantified. Hence, the aim of this systematic review and meta-analysis is to quantify the global burden and types of long-term physical sequelae and financial burden associated with both MDR- and XDR-TB. METHOD AND ANALYSIS We will search CINHAL, MEDLINE, Embase, Scopus, and Web of science for studies that report physical and financial sequelae associated with rifampicin-resistant (RR), MDR- and XDR-TB or their treatments. The search will be conducted without time, language, and place restrictions. A random-effects meta-analysis will be conducted to estimate the pooled prevalence of each physical sequela. Heterogeneity will be measured using the Higgins I2 statistics. We will assess publication bias visually using the funnel plot and statistically using Egger's test. Adjustments for publication basis will be made using Tweedie's and Duval Trim and Fill analysis. ETHICS AND DISSEMINATION Since the study is based on published evidence, ethics approval is not required. The findings of the systematic review will be presented at various conferences and will be published in a peer-reviewed journal. PROTOCOL REGISTRATION The protocol is published in the PROSPERO with registration number CRD42021250909.
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Affiliation(s)
- Temesgen Yihunie Akalu
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Archie C A Clements
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom
| | | | - Kefyalew Addis Alene
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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19
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Awasthi KR, Jancey J, Clements ACA, Sah RK, Koirala MP, Chalise B, Leavy JE. Traditional Beliefs, Practices, and Migration: A Risk to Malaria Transmission in Rural Nepal. Int J Environ Res Public Health 2022; 19:16872. [PMID: 36554752 PMCID: PMC9779137 DOI: 10.3390/ijerph192416872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/02/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
The study aimed to explore sociocultural factors influencing the risk of malaria and practices and beliefs towards malaria prevention, transmission and treatment in a remote village in Khatyad Rural Municipality (KRM) of Nepal. A sequential exploratory mixed methods approach was used. Qualitative data were collected through 25 one-on-one, in-depth interviews followed by a face-to-face household survey (n = 218) among people from a village in KRM believed to have a high risk of malaria. Traditional practices such as Chhaupadi requiring the seclusion of women during menstruation and post-partum, transhumance, and reliance on traditional healers for the management of malaria were common practices in the village. The household survey found 98.1% of women faced menstrual exile either inside the house or in a separate hut, with 64.2% not having access to Long-lasting Insecticidal Nets (LLINs). Hardships and economic constraints compelled villagers to migrate seasonally for work to malaria-endemic areas in India, thereby exposing themselves to the risk of malaria. Persistent traditional beliefs and seasonal migration could threaten the elimination goals set by the national malaria program.
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Affiliation(s)
- Kiran Raj Awasthi
- Curtin School of Population Health, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
| | - Jonine Jancey
- Curtin School of Population Health, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
| | - Archie C. A. Clements
- Curtin School of Population Health, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
- Telethon Kids Institute, Perth, WA 6009, Australia
- Peninsula Medical School, University of Plymouth, Plymouth PL4 8AA, UK
| | - Rohit Kumar Sah
- National Malaria Program, Karnali Province Field Office, Nepalgunj 21900, Nepal
| | | | - Binaya Chalise
- Graduate School for International Development and Cooperation, Hiroshima University, Higasi-Hiroshima 739-8529, Japan
| | - Justine E. Leavy
- Curtin School of Population Health, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
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20
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Cleary E, Hetzel MW, Clements ACA. A review of malaria epidemiology and control in Papua New Guinea 1900 to 2021: Progress made and future directions. Front Epidemiol 2022; 2:980795. [PMID: 38455277 PMCID: PMC10910954 DOI: 10.3389/fepid.2022.980795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/29/2022] [Indexed: 03/09/2024]
Abstract
The research and control of malaria has a long history in Papua New Guinea, sometimes resulting in substantial changes to the distribution of infection and transmission dynamics in the country. There have been four major periods of malaria control in PNG, with the current control programme having commenced in 2004. Each previous control programme was successful in reducing malaria burden in the country, but multiple factors led to programme failures and eventual breakdown. A comprehensive review of the literature dating from 1900 to 2021 was undertaken to summarize control strategies, epidemiology, vector ecology and environmental drivers of malaria transmission in PNG. Evaluations of historical control programs reveal poor planning and communication, and difficulty in sustaining financial investment once malaria burden had decreased as common themes in the breakdown of previous programs. Success of current and future malaria control programs in PNG is contingent on adequate planning and management of control programs, effective communication and engagement with at-risk populations, and cohesive targeted approaches to sub-national and national control and elimination.
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Affiliation(s)
- Eimear Cleary
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Manuel W. Hetzel
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Archie C. A. Clements
- Curtin University, Perth, WA, Australia
- Telethon Kids Institute, Perth, WA, Australia
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21
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Alene KA, Gordon CA, Clements ACA, Williams GM, Gray DJ, Zhou XN, Li Y, Utzinger J, Kurscheid J, Forsyth S, Zhou J, Li Z, Li G, Lin D, Lou Z, Li S, Ge J, Xu J, Yu X, Hu F, Xie S, McManus DP. Spatial Analysis of Schistosomiasis in Hunan and Jiangxi Provinces in the People's Republic of China. Diseases 2022; 10:93. [PMID: 36278592 PMCID: PMC9590053 DOI: 10.3390/diseases10040093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/30/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2023] Open
Abstract
Understanding the spatial distribution of schistosome infection is critical for tailoring preventive measures to control and eliminate schistosomiasis. This study used spatial analysis to determine risk factors that may impact Schistosoma japonicum infection and predict risk in Hunan and Jiangxi Provinces in the People's Republic of China. The study employed survey data collected in Hunan and Jiangxi in 2016. Independent variable data were obtained from publicly available sources. Bayesian-based geostatistics was used to build models with covariate fixed effects and spatial random effects to identify factors associated with the spatial distribution of infection. Prevalence of schistosomiasis was higher in Hunan (12.8%) than Jiangxi (2.6%). Spatial distribution of schistosomiasis varied at pixel level (0.1 × 0.1 km), and was significantly associated with distance to nearest waterbody (km, β = -1.158; 95% credible interval [CrI]: -2.104, -0.116) in Hunan and temperature (°C, β = -4.359; 95% CrI: -9.641, -0.055) in Jiangxi. The spatial distribution of schistosomiasis in Hunan and Jiangxi varied substantially and was significantly associated with distance to nearest waterbody. Prevalence of schistosomiasis decreased with increasing distance to nearest waterbody in Hunan, indicating that schistosomiasis control should target individuals in close proximity to open water sources as they are at highest risk of infection.
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Affiliation(s)
| | - Catherine A. Gordon
- Infection and Inflammation Program, QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia
| | | | - Gail M. Williams
- School of Population Health, University of Queensland, Brisbane 4072, Australia
| | - Darren J. Gray
- Department of Global Health, Australian National University, Canberra 0200, Australia
| | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai 200025, China
| | - Yuesheng Li
- Infection and Inflammation Program, QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia
- Hunan Institute of Schistosomiasis Control, Yueyang 414000, China
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, CH-4051 Allschwil, Switzerland
- University of Basel, CH-4003 Basel, Switzerland
| | - Johanna Kurscheid
- School of Population Health, University of Queensland, Brisbane 4072, Australia
- Swiss Tropical and Public Health Institute, CH-4051 Allschwil, Switzerland
| | - Simon Forsyth
- School of Population Health, University of Queensland, Brisbane 4072, Australia
| | - Jie Zhou
- Hunan Institute of Schistosomiasis Control, Yueyang 414000, China
| | - Zhaojun Li
- Jiangxi Institute of Parasitic Diseases, Nanchang 330096, China
| | - Guangpin Li
- Hunan Institute of Schistosomiasis Control, Yueyang 414000, China
| | - Dandan Lin
- Jiangxi Institute of Parasitic Diseases, Nanchang 330096, China
| | - Zhihong Lou
- Hunan Institute of Schistosomiasis Control, Yueyang 414000, China
| | - Shengming Li
- Hunan Institute of Schistosomiasis Control, Yueyang 414000, China
| | - Jun Ge
- Jiangxi Institute of Parasitic Diseases, Nanchang 330096, China
| | - Jing Xu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai 200025, China
| | - Xinling Yu
- Hunan Institute of Schistosomiasis Control, Yueyang 414000, China
| | - Fei Hu
- Jiangxi Institute of Parasitic Diseases, Nanchang 330096, China
| | - Shuying Xie
- Jiangxi Institute of Parasitic Diseases, Nanchang 330096, China
| | - Donald P. McManus
- Infection and Inflammation Program, QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia
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22
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Assoum M, Ortu G, Basáñez MG, Lau C, Clements ACA, Halton K, Fenwick A, Magalhães RJS. Impact of a 5-Year Mass Drug Administration Programme for Soil-Transmitted Helminthiases on the Spatial Distribution of Childhood Anaemia in Burundi from 2007 to 2011. Trop Med Infect Dis 2022; 7:tropicalmed7100307. [PMID: 36288048 PMCID: PMC9611614 DOI: 10.3390/tropicalmed7100307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Childhood anaemia affects 1.8 billion people globally. Little is known about the long-term impact of mass drug administration (MDA) for the control of soil-transmitted helminthiases (STH) on the spatiotemporal variation of anaemia prevalence and severity. We describe the long-term spatiotemporal impact of a 5-year STH MDA programme (2007−2011) on the prevalence of anaemia and anaemia severity in school-aged children (SAC) in Burundi. Methodology/Principal Findings: We used annual haemoglobin concentration and STH data collected during 2007−2011 in 31 schools in Burundi. Spatial dependence in prevalence and severity of anaemia was assessed using semivariograms. Bayesian geostatistical models were developed to (a) quantify the role of STH (adjusted for other anaemia determinants) in the spatiotemporal distribution of anaemia prevalence/severity, and (b) predict the geographical variation of both outcomes across Burundi. Adjusted population data were used to estimate the geographical distribution of the number of SAC at risk of anaemia and with low and moderate/severe anaemia. Infections with Ascaris lumbricoides and Trichuris trichiura were positively and significantly associated with childhood anaemia; hookworm infections were not. A significant decrease in anaemia prevalence, from 40−50% (2008) to 10−20% (2011) was predicted in western areas. The predicted prevalence of low-severity anaemia decreased from 40−50% (2008) to <20% (2011) in southern and eastern areas. Moderate/high-severity anaemia was concentrated in western regions of Burundi, with pockets of moderate/high-severity anaemia in central and northern regions in 2008. The overall number of predicted anaemic children decreased from 443,657 (2008) to 232,304 (2011), with a resurgence after MDA disruption in 2010 (to 480,605). Prevalence of low- and moderate-severity anaemia was higher in boys than in girls. Conclusions/Significance: Despite ongoing MDA, the prevalence of anaemia in SAC remained high and increased in certain parts of the country. It is recommended that MDA programmes targeting STH are complemented with specific anaemia interventions.
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Affiliation(s)
- Mohamad Assoum
- Children’s Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, QLD 4101, Australia
- UQ Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Via Warrego Highway, Gatton, QLD 4343, Australia
- School of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia
- Correspondence:
| | - Giuseppina Ortu
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary’s Campus), Imperial College London, Norfolk Place, London W2 1PG, UK
| | - Maria-Gloria Basáñez
- London Centre for Neglected Tropical Disease Research and MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - Colleen Lau
- Children’s Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, QLD 4101, Australia
- Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Archie C. A. Clements
- Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Kate Halton
- Institute of Health and Biomedical Innovations, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Alan Fenwick
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary’s Campus), Imperial College London, Norfolk Place, London W2 1PG, UK
| | - Ricardo J. Soares Magalhães
- Children’s Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, QLD 4101, Australia
- UQ Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Via Warrego Highway, Gatton, QLD 4343, Australia
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23
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Sota P, Alene KA, Andityas M, Tangkawattana S, Sripa B, Clements ACA. Effectiveness of public health interventions in reducing the prevalence of Opisthorchis viverrini: a protocol for systematic review and network meta-analysis. BMJ Open 2022; 12:e064573. [PMID: 36691213 PMCID: PMC9462107 DOI: 10.1136/bmjopen-2022-064573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/19/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The carcinogenic liver fluke Opisthorchis viverrini is a major public health problem in the Mekong basin region. The liver flukes can induce cholangiocarcinoma, a bile duct cancer that causes a significant burden of mortality and economic loss. Various public health interventions have been conducted to reduce opisthorchiasis but the prevalence of O. viverrini remains high in endemic regions. The aim is to quantify the effectiveness of public health interventions in reducing the prevalence of O. viverrini infection. METHODS AND ANALYSIS Seven databases (including PubMed, SCOPUS, Web of Science, EMBASE, ScienceDirect, Thai thesis database and TCI (Thai journals online)) will be searched from initiation through to 2022 to identify studies of interventions to reduce the prevalence of O. viverrini infection. The prevalence, incidence or number of O. viverrini-infected people will be used as the source of O. viverrini prevalence data. A conventional meta-analysis and a Bayesian network meta-analysis will be conducted to undertake direct and indirect comparisons of different interventions. Meta-regression will be used to determine the effect of each intervention. The risk of bias will be assessed using the Cochrane Collaboration's risk of bias tool. Heterogeneity between studies will be determined by forest plots and I2 and publication bias investigated with funnel plots and the Egger's test. ETHICS AND DISSEMINATION Ethical approval will not be required because this study will only use published data. The final report of this review will be disseminated through publication in a peer-reviewed scientific journal and will also be presented at relevant conferences. PROSPERO REGISTRATION NUMBER CRD42022323066.
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Affiliation(s)
- Pornphutthachat Sota
- Graduate School, Khon Kaen University, Mueang Khon Kaen, Khon Kaen, Thailand
- WHO Collaborating Centre for Research and Control of Opisthorchiasis (Southeast Asian Liver Fluke Disease), Tropical Disease Research Center, Khon Kaen University, Mueang Khon Kaen, Khon Kaen, Thailand
| | - Kefyalew Addis Alene
- Geospatial Health and Development, Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Morsid Andityas
- WHO Collaborating Centre for Research and Control of Opisthorchiasis (Southeast Asian Liver Fluke Disease), Tropical Disease Research Center, Khon Kaen University, Mueang Khon Kaen, Khon Kaen, Thailand
- Faculty of Veterinary Medicine, Khon Kaen University, Mueang Khon Kaen, Khon Kaen, Thailand
| | - Sirikachorn Tangkawattana
- WHO Collaborating Centre for Research and Control of Opisthorchiasis (Southeast Asian Liver Fluke Disease), Tropical Disease Research Center, Khon Kaen University, Mueang Khon Kaen, Khon Kaen, Thailand
- Faculty of Veterinary Medicine, Khon Kaen University, Mueang Khon Kaen, Khon Kaen, Thailand
| | - Banchob Sripa
- WHO Collaborating Centre for Research and Control of Opisthorchiasis (Southeast Asian Liver Fluke Disease), Tropical Disease Research Center, Khon Kaen University, Mueang Khon Kaen, Khon Kaen, Thailand
- Department of Pathology, Faculty of Medicine, Khon Kaen University, Mueang Khon Kaen, Khon Kaen, Thailand
| | - Archie C A Clements
- Geospatial Health and Development, Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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Alene KA, Murray MB, van de Water BJ, Becerra MC, Atalell KA, Nicol MP, Clements ACA. Treatment Outcomes Among Pregnant Patients With Multidrug-Resistant Tuberculosis: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2216527. [PMID: 35687333 PMCID: PMC9187956 DOI: 10.1001/jamanetworkopen.2022.16527] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE The management of multidrug-resistant tuberculosis (MDR-TB) during pregnancy is challenging, yet no systematic synthesis of evidence has accurately measured treatment outcomes. OBJECTIVE To systematically synthesize treatment outcomes and adverse events among pregnant patients with MDR-TB. DATA SOURCES PubMed, Scopus, Web of Science, and ProQuest were searched from the inception of each database through August 31, 2021. STUDY SELECTION Studies containing cohorts of pregnant patients with a defined treatment outcome were eligible. DATA EXTRACTION AND SYNTHESIS Independent reviewers screened studies and assessed the risk of bias. The study followed the Preferring Reporting Items for Systematic Review and Meta-analyses reporting guideline. Meta-analysis was performed using random-effects models. The sources of heterogeneity were explored through metaregression. MAIN OUTCOMES AND MEASURES The primary outcome was the proportion of patients with each treatment outcome (including treatment success, death, loss to follow-up, and treatment failure), and the secondary outcomes included the proportion of patients experiencing adverse events during pregnancy. RESULTS In this systematic review and meta-analysis, 10 studies containing 275 pregnant patients with available data on treatment outcomes were included. The pooled estimate was 72.5% (95% CI, 63.3%-81.0%) for treatment success, 6.8% (95% CI, 2.6%-12.4%) for death, 18.4% (95% CI, 13.1%-24.2%) for loss to follow-up, and 0.6% (95% CI, 0.0%-2.9%) for treatment failure. Treatment success was significantly higher in studies in which the proportion of patients taking linezolid was greater than the median (20.1%) compared with studies in which this proportion was lower than the median (odds ratio, 1.22; 95% CI, 1.05-1.42). More than half of the pregnant patients (54.7%; 95% CI, 43.5%-65.4%) experienced at least 1 type of adverse event, most commonly liver function impairment (30.4%; 95% CI, 17.7%-45.7%), kidney function impairment (14.9%; 95% CI, 6.2%-28.3%), hypokalemia (11.9%; 95% CI, 3.9%-25.6%), hearing loss (11.8%; 95% CI, 5.5%-21.3%), gastrointestinal disorders (11.8%; 95% CI, 5.2%-21.8%), psychiatric disorders (9.1%; 95% CI, 2.5%-21.6%), or anemia (8.9%; 95% CI, 3.6%-17.4%). The pooled proportion of favorable pregnancy outcomes was 73.2% (95% CI, 49.4%-92.1%). The most common types of adverse pregnancy outcomes were preterm birth (9.5%; 95% CI, 0.0%-29.0%), pregnancy loss (6.0%; 95% CI, 1.3%-12.9%), low birth weight (3.9%; 95% CI, 0.0%-18.7%), and stillbirth (1.9%; 95% CI, 0.1%-5.1%). Most of the studies had low-quality (3 studies) or medium-quality (4 studies) scores. CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis, high treatment success and favorable pregnancy outcomes were reported among pregnant patients with MDR-TB. Further research is needed to design shorter, more effective, and safer treatment regimens for pregnant patients with MDR-TB.
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Affiliation(s)
- Kefyalew Addis Alene
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Megan B. Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | | | - Mercedes C. Becerra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | | | - Mark P. Nicol
- Institute for Infectious Diseases and Molecular Medicine, Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
- School of Biomedical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Archie C. A. Clements
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
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25
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Awasthi KR, Jancey J, Clements ACA, Leavy JE. A qualitative study of knowledge, attitudes and perceptions towards malaria prevention among people living in rural upper river valleys of Nepal. PLoS One 2022; 17:e0265561. [PMID: 35303022 PMCID: PMC8932613 DOI: 10.1371/journal.pone.0265561] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/03/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Nepal has made significant progress in decreasing the number of malaria cases over the last two decades. Prevention and timely management of malaria are critical for the National Malaria Program in its quest for elimination. The study aimed to explore the knowledge, attitudes and behaviour towards malaria prevention and treatment among people living in rural villages of Khatyad Rural Municipality in Nepal. METHODS This qualitative study collected information through virtual in-depth interviews (N = 25) with female and male participants aged between 15 and 72 years. RESULTS More than half of the participants knew about the causes of malaria, were aware of the complications of untreated malaria and knew that anti-malarial medicines were provided for free at the public health facilities. Participants indicated that their first choice of health care were public health facilities, however limited supply of medications and diagnostics deviated patients to the private sector. While tertiary care costs were not financially viable, participants opted against traditional care for malaria. Factors such as cost of treatment, distance to the health facility and the decision making authority in households influenced health related decisions in the family. Although long-lasting insecticidal nets were distributed and indoor residual spraying was done periodically, several barriers were identified. CONCLUSION Increased awareness of malaria prevention and treatment among people living in malaria risk areas is important for the National Malaria Program in its quest for malaria elimination in Nepal.
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Affiliation(s)
- Kiran Raj Awasthi
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Jonine Jancey
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | | | - Justine E. Leavy
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
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26
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Aung E, Han KT, Gordon CA, Hlaing NN, Aye MM, Htun MW, Wai KT, Myat SM, Thwe TL, Tun A, Wangdi K, Li Y, Williams GM, Clements ACA, Vaz Nery S, McManus DP, Gray DJ. High prevalence of soil-transmitted helminth infections in Myanmar schoolchildren. Infect Dis Poverty 2022; 11:28. [PMID: 35272701 PMCID: PMC8908594 DOI: 10.1186/s40249-022-00952-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Achieving the elimination of soil-transmitted helminth (STH) infections requires a sufficient understanding of the current epidemiological status of STH endemicity. We aimed to examine the status of STH in Myanmar – a country with the eighth highest STH prevalence in the world, 10 years after instigation of the national deworming programme. Methods In August 2016 we screened for STH infections using Kato Katz (KK) microscopy and real-time PCR (qPCR) in schoolchildren from the Bago Region township of Phyu, a STH sentinel site in Myanmar. Ten schools were randomly selected, and one stool sample each from a total of 264 students was examined. Prevalence and intensity of infection were calculated for each STH. Results High prevalence of STH was identified in the study area with 78.8% of the schoolchildren infected with at least one STH by qPCR, and 33.3% by KK. The most prevalent STH was Trichuris trichiura, diagnosed by both KK (26.1%) and qPCR (67.1%), followed by Ascaris lumbricoides (15.5% KK; 54.9% qPCR). No hookworm infections were identified by KK; however, the qPCR analysis showed a high prevalence of Ancylostoma sp. infection (29.6%) with few Necator americanus (1.1%) infections. Conclusions Despite bi-annual deworming of schoolchildren in the fourth-grade and below, STH prevalence remains stubbornly high. These results informed the expansion of the Myanmar National STH control programme to include all school-aged children by the Ministry of Health and Sports in 2017, however further expansion to the whole community should be considered along with improving sanitation and hygiene measures. This would be augmented by rigorous monitoring and evaluation, including national prevalence surveys.
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Affiliation(s)
- Eindra Aung
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Kay Thwe Han
- Parasitology Research Division, Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Catherine A Gordon
- Infectious Diseases Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | | | - Moe Moe Aye
- Department of Zoology, University of Yangon, Yangon, Myanmar
| | - Myo Win Htun
- Parasitology Research Division, Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Khin Thet Wai
- Parasitology Research Division, Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Su Mon Myat
- Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Thida Lay Thwe
- Department of Zoology, University of Yangon, Yangon, Myanmar
| | - Aung Tun
- Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Kinley Wangdi
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Yuesheng Li
- Infectious Diseases Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Hunan Institute of Parasitic Diseases, World Health Organization Collaborating Centre for Research and Control On Schistosomiasis in Lake Region, Yueyang, China
| | - Gail M Williams
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Archie C A Clements
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia.,Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Susana Vaz Nery
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia.,The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Donald P McManus
- Infectious Diseases Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Darren J Gray
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia.
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Alene KA, Elagali A, Barth DD, Rumisha SF, Amratia P, Weiss DJ, Atalell KA, Erena AK, Gething PW, Clements ACA. Spatial codistribution of HIV, tuberculosis and malaria in Ethiopia. BMJ Glob Health 2022; 7:bmjgh-2021-007599. [PMID: 35217531 PMCID: PMC8867247 DOI: 10.1136/bmjgh-2021-007599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/20/2022] [Indexed: 12/15/2022] Open
Abstract
Background HIV, tuberculosis (TB) and malaria are the three most important infectious diseases in Ethiopia, and sub-Saharan Africa. Understanding the spatial codistribution of these diseases is critical for designing geographically targeted and integrated disease control programmes. This study investigated the spatial overlap and drivers of HIV, TB and malaria prevalence in Ethiopia. Methods HIV, TB and malaria data were obtained from different nationwide prevalence surveys, and geospatial covariates were obtained from publicly available sources. A Bayesian model-based geostatistical framework was applied to each survey leveraging the strength of high-resolution spatial covariates to predict continuous disease-specific prevalence surfaces and their codistribution. Results The national prevalence was 1.54% (95% CI 1.40 to 1.70) for HIV, 0.39% (95% CI 0.34 to 0.45) for TB and 1.1% (95%CI 0.95 to 1.32) for malaria. Substantial subnational variation was predicted with the highest HIV prevalence estimated in Gambela (4.52%), Addis Ababa (3.52%) and Dire Dawa (2.67%) regions. TB prevalence was highest in Dire Dawa (0.96%) and Gambela (0.88%), while malaria was highest in Gambela (6.1%) and Benishangul-Gumuz (3.8%). Spatial overlap of their prevalence was observed in some parts of the country, mainly Gambela region. Spatial distribution of the diseases was significantly associated with healthcare access, demographic, and climatic factors. Conclusions The national distribution of HIV, TB and malaria was highly focal in Ethiopia, with substantial variation at subnational and local levels. Spatial distribution of the diseases was significantly associated with healthcare access, demographic and climatic factors. Spatial overlap of HIV, TB and malaria prevalence was observed in some parts of the country. Integrated control programmes for these diseases should be targeted to these areas with high levels of co-endemicity.
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Affiliation(s)
- Kefyalew Addis Alene
- Geospatial Health and Development, Telethon Kids Institute, Nedlands, Western Australia, Australia .,Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Ahmed Elagali
- Geospatial Health and Development, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Dylan D Barth
- University of Western Australia, Perth, Western Australia, Australia.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Susan F Rumisha
- Geospatial Health and Development, Telethon Kids Institute, Nedlands, Western Australia, Australia.,National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Punam Amratia
- Geospatial Health and Development, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Daniel J Weiss
- Geospatial Health and Development, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Kendalem Asmare Atalell
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Peter W Gething
- Geospatial Health and Development, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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Gordon CA, Williams GM, Gray DJ, Clements ACA, Zhou XN, Li Y, Utzinger J, Kurscheid J, Forsyth S, Addis Alene K, Zhou J, Li Z, Li G, Lin D, Lou Z, Li S, Ge J, Xu J, Yu X, Hu F, Xie S, Chen J, Shi T, Li C, Zheng H, McManus DP. Schistosomiasis in the People's Republic of China - down but not out. Parasitology 2022; 149:218-233. [PMID: 35234601 PMCID: PMC11010531 DOI: 10.1017/s0031182021001724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/06/2022]
Abstract
Schistosomiasis has been subjected to extensive control efforts in the People's Republic of China (China) which aims to eliminate the disease by 2030. We describe baseline results of a longitudinal cohort study undertaken in the Dongting and Poyang lakes areas of central China designed to determine the prevalence of Schistosoma japonicum in humans, animals (goats and bovines) and Oncomelania snails utilizing molecular diagnostics procedures. Data from the Chinese National Schistosomiasis Control Programme (CNSCP) were compared with the molecular results obtained.Sixteen villages from Hunan and Jiangxi provinces were surveyed; animals were only found in Hunan. The prevalence of schistosomiasis in humans was 1.8% in Jiangxi and 8.0% in Hunan determined by real-time polymerase chain reaction (PCR), while 18.3% of animals were positive by digital droplet PCR. The CNSCP data indicated that all villages harboured S. japonicum-infected individuals, detected serologically by indirect haemagglutination assay (IHA), but very few, if any, of these were subsequently positive by Kato-Katz (KK).Based on the outcome of the IHA and KK results, the CNSCP incorporates targeted human praziquantel chemotherapy but this approach can miss some infections as evidenced by the results reported here. Sensitive molecular diagnostics can play a key role in the elimination of schistosomiasis in China and inform control measures allowing for a more systematic approach to treatment.
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Affiliation(s)
- Catherine A. Gordon
- Department of Immunology, Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Gail M. Williams
- School of Population Health, Discipline of Epidemiology and Biostatistics, University of Queensland, Brisbane, Australia
| | - Darren J. Gray
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, Australia
| | | | - Xiao-Nong Zhou
- National Institute of Parasitic Diseases, Shanghai, People's Republic of China
| | - Yuesheng Li
- Department of Immunology, Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
- Hunan Institute of Schistosomiasis Control, Yueyang, Hunan, People's Republic of China
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Johanna Kurscheid
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, Australia
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Simon Forsyth
- School of Population Health, Discipline of Epidemiology and Biostatistics, University of Queensland, Brisbane, Australia
| | | | - Jie Zhou
- Hunan Institute of Schistosomiasis Control, Yueyang, Hunan, People's Republic of China
| | - Zhaojun Li
- Jiangxi Institute of Parasitic Diseases, Jiangxi, People's Republic of China
| | - Guangpin Li
- Hunan Institute of Schistosomiasis Control, Yueyang, Hunan, People's Republic of China
| | - Dandan Lin
- Jiangxi Institute of Parasitic Diseases, Jiangxi, People's Republic of China
| | - Zhihong Lou
- Hunan Institute of Schistosomiasis Control, Yueyang, Hunan, People's Republic of China
| | - Shengming Li
- Hunan Institute of Schistosomiasis Control, Yueyang, Hunan, People's Republic of China
| | - Jun Ge
- Jiangxi Institute of Parasitic Diseases, Jiangxi, People's Republic of China
| | - Jing Xu
- National Institute of Parasitic Diseases, Shanghai, People's Republic of China
| | - Xinling Yu
- Hunan Institute of Schistosomiasis Control, Yueyang, Hunan, People's Republic of China
| | - Fei Hu
- Jiangxi Institute of Parasitic Diseases, Jiangxi, People's Republic of China
| | - Shuying Xie
- Jiangxi Institute of Parasitic Diseases, Jiangxi, People's Republic of China
| | - Jie Chen
- Chinese National Human Genome Center, Shanghai, People's Republic of China
| | - Tao Shi
- Chinese National Human Genome Center, Shanghai, People's Republic of China
| | - Chong Li
- Chinese National Human Genome Center, Shanghai, People's Republic of China
| | - Huajun Zheng
- Chinese National Human Genome Center, Shanghai, People's Republic of China
| | - Donald P. McManus
- Department of Immunology, Molecular Parasitology Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
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Gilmour B, Xu Z, Bai L, Alene KA, Clements ACA. The impact of ethnic minority status on tuberculosis diagnosis and treatment delays in Hunan Province, China. BMC Infect Dis 2022; 22:90. [PMID: 35081919 PMCID: PMC8790941 DOI: 10.1186/s12879-022-07072-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 01/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) continues to be a major public health challenge in China. Understanding TB management delays within the context of China's unique ethnic diversity may be of value in tackling the disease. This study sought to evaluate the impact of ethnic minority status on TB diagnosis and treatment delays. METHODS This retrospective cohort study was conducted on patients diagnosed with TB in Hunan Province, China between 2013 and 2018. Diagnosis delay was defined as the time interval between the onset of symptoms and the date of diagnosis. Treatment delay was defined as the time interval between diagnosis and treatment commencement. Univariable and multivariable logistic regression models were used to identify factors associated with TB diagnosis and treatment delay, including ethnic minority status. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were calculated to assess the strength of association between the dependant and independent variables. RESULTS A total of 318,792 TB patients were included in the study with a mean age of 51.7 years (SD 17.7). The majority of patients were male (72.6%) and Han ethnicity (90.6%). The odds of experiencing diagnosis delay (> 21 days) were significantly higher for Tujia (AOR: 1.46, 95% CI: 1.41, 1.51), Miao (AOR: 1.31, 95% CI: 1.26, 1.37), Dong (AOR: 1.97, 95% CI: 1.85, 2.11), Yao (AOR: 1.27, 95% CI: 1.17, 1.37), and Bai (AOR: 1.45, 95% CI: 1.22, 1.74) ethnic minorities compared to the Han majority. The odds of experiencing treatment delay (> 15 days) were significantly lower for five of the seven ethnic minority groups relative to the Han majority: Tujia (AOR 0.92, 95% CI 0.88, 0.96), Miao (AOR 0.74, 95% CI 0.70, 0.79), Dong (AOR 0.87, 95% CI 0.81, 0.95), Yao (AOR 0.20, 95% CI 0.17, 0.24) and 'other' (ethnic minorities that individually represented < 0.1% of the patient population) (AOR 0.70, 955 CI 0.51, 0.97). CONCLUSIONS This study shows ethnic minority status to be a significant risk factor in diagnosis delay, but for it to reduce the odds of treatment delay. Further research is required to determine the underlying causes of diagnosis delay within ethnic minority populations.
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Affiliation(s)
- Beth Gilmour
- Faculty of Health Sciences, Curtin University, Western Australia, Kent St, Bentley, WA, 6102, Australia.
| | - Zuhui Xu
- Xiangya School of Public Health, Central South University, Changsha, China.,TB Control Institute of Hunan Province, Changsha, China
| | - Liqiong Bai
- TB Control Institute of Hunan Province, Changsha, China
| | - Kefyalew Addis Alene
- Faculty of Health Sciences, Curtin University, Western Australia, Kent St, Bentley, WA, 6102, Australia.,Telethon Kids Institute, Nedlands, WA, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Western Australia, Kent St, Bentley, WA, 6102, Australia.,Telethon Kids Institute, Nedlands, WA, Australia
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30
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Mationg MLS, Williams GM, Tallo VL, Olveda RM, Aung E, Alday P, Reñosa MD, Daga CM, Landicho J, Demonteverde MP, Santos ED, Bravo TA, Bieri FA, Bedford A, Li Y, Clements ACA, Steinmann P, Halton K, Stewart DE, McManus DP, Gray DJ. "The Magic Glasses Philippines": a cluster randomised controlled trial of a health education package for the prevention of intestinal worm infections in schoolchildren. Lancet Reg Health West Pac 2022; 18:100312. [PMID: 35024651 PMCID: PMC8671727 DOI: 10.1016/j.lanwpc.2021.100312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 11/01/2022]
Abstract
Background Soil-transmitted helminths (STH) cause substantial disease and disability globally. Health education has proven complementary to school-based drug administration programs for STH control. We determined the generalizability of the impact of "The Magic Glasses" health education package for STH prevention in schoolchildren in Laguna province, the Philippines, having previously shown its positive impact in China. Methods We conducted a cluster-randomised controlled trial, in schoolchildren, aged 9-10 years, across 40 schools over one year. Schools were randomly assigned either to the "Magic Glasses Philippines" health education intervention package (consisting of a cartoon video, classroom discussions, drawing and essay competition) complementing the standard health education activities of the Philippines Departments of Health and Education, or to a control group, which involved only the standard health education activities. The primary trial outcomes were the proportion of STH infected schoolchildren and their knowledge, attitude and behaviour of STH assessed in both groups at baseline and through two follow-up surveys undertaken immediately prior to the semi-annual national mass administration of albendazole. The outcomes between the study arms were compared using generalized estimating equation models, accounting for clustering at the school level. The trial is registered with Australian New Zealand Clinical Trials Registry number: ACTRN12616000508471. Findings At follow-up assessments, the mean knowledge and behaviour scores in the intervention group were, respectively, 5·3 (95% confidence interval [CI]:4·2-6·5; p=<0.001) and 1·1 (95% CI: 0·4-1·7; p=0.002) percentage points higher than the control group. There was no overall effect on helminth infections (any STH; adjusted odds ratio [aOR]:1·0; 95% CI: 0·8-1·3; p=0·856), Ascaris lumbricoides; aOR:1·0; 95% CI: 0·7-1·6; p=0·894, or Trichuris trichiura; aOR:1·7; 95% CI: 0·9-1·6; p=0·315) but sub-group analysis showed a 60% reduction in the odds of any STH infection resulting from the "Magic Glasses" intervention in schools with a baseline prevalence ≤15% (aOR: 0·4; 95% CI: 0·2-0·7; p=0·001). Interpretation The health-education package demonstrated a modest but statistically significant impact on the students' overall STH knowledge and changes in their behaviour but was only effective in preventing STH infections in intervention schools where the baseline prevalence was ≤15%. Funding National Health and Medical Research Council, Australia, and the UBS-Optimus Foundation, Switzerland.
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Affiliation(s)
- Mary Lorraine S Mationg
- Research School of Population Heath, The Australian National University, Canberra, Australia.,Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Gail M Williams
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Veronica L Tallo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Remigio M Olveda
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Eindra Aung
- Research School of Population Heath, The Australian National University, Canberra, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Portia Alday
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Mark Donald Reñosa
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Chona Mae Daga
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Jhoys Landicho
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Maria Paz Demonteverde
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Eunice Diane Santos
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Thea Andrea Bravo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Franziska Angly Bieri
- Research School of Population Heath, The Australian National University, Canberra, Australia
| | - Andrew Bedford
- Research School of Population Heath, The Australian National University, Canberra, Australia
| | - Yuesheng Li
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Hunan Institute of Parasitic Diseases, World Health Organization Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Yueyang, China
| | | | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Kate Halton
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Donald E Stewart
- Research School of Population Heath, The Australian National University, Canberra, Australia.,School of Medicine, Griffith University, Brisbane, Australia
| | - Donald P McManus
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Darren J Gray
- Research School of Population Heath, The Australian National University, Canberra, Australia
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Gilmour B, Xu Z, Bai L, Addis Alene K, Clements ACA. Risk factors associated with unsuccessful tuberculosis treatment outcomes in Hunan Province, China. Trop Med Int Health 2022; 27:290-299. [PMID: 35014123 PMCID: PMC9305245 DOI: 10.1111/tmi.13720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Globally, China has the third highest number of tuberculosis (TB) cases despite high rates (85.6%) of effective treatment coverage. Identifying risk factors associated with unsuccessful treatment outcomes is an important component of maximizing the efficacy of TB control programs. METHODS Retrospective cohort study to evaluate the outcomes of 306,860 drug-susceptible TB patients who underwent treatment in Hunan Province, China between 2013 and 2018. Univariable and multivariable logistic regression models were used to identify factors associated with unsuccessful TB treatment outcomes. RESULTS A successful treatment outcome was recorded for 98.6% of patients, defined as the sum of patients who were cured (36.2%) and completed treatment (62.4%). An unsuccessful treatment outcome was recorded for 1.8% of patients, defined as the sum of treatment failure (1.1%), deaths (0.5%) and lost to follow up (0.2%). The odds of an unsuccessful treatment outcome showed an increasing trend in more recent years of registration (2018 Adjusted Odds Ratio (AOR): 1.43; 95% Confidence Interval (CI) 1.31, 1.57 relative to 2013). Other significant risk factors were male sex (AOR: 1.17; 95% CI 1.10, 1.25); increasing age (AOR:1.02 per year increase; 95% CI 1.02,1.02); being severely ill (AOR: 1.50; 95% CI 1.33, 1.70); having a history of TB treatment (AOR: 2.93; 95% CI 2.69, 3.20); not being under systematic management (AOR: 16.10 (14.49, 17.88) and treatment regimens that differed from full course management. CONCLUSIONS The increasing likelihood of an unsuccessful treatment outcome over time necessitates the need for further research.
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Affiliation(s)
- Beth Gilmour
- Faculty of Health Sciences, Curtin University, Bentley, Australia
| | - Zuhui Xu
- Xiangya School of Public Health, Central South University, Changsha, China.,TB Control Institute of Hunan Province, Changsha, China
| | - Liqiong Bai
- TB Control Institute of Hunan Province, Changsha, China
| | - Kefyalew Addis Alene
- Faculty of Health Sciences, Curtin University, Bentley, Australia.,Telethon Kids Institute, Nedlands, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Bentley, Australia.,Telethon Kids Institute, Nedlands, Australia
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Tsheten T, Tenzin P, Clements ACA, Gray DJ, Ugyel L, Wangdi K. The COVID-19 vaccination campaign in Bhutan: strategy and enablers. Infect Dis Poverty 2022; 11:6. [PMID: 34986883 PMCID: PMC8727980 DOI: 10.1186/s40249-021-00929-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
Bhutan has reported a total of 2596 COVID-19 cases and three deaths as of September 15, 2021. With support from India, the United States, Denmark, the People's Republic of China, Croatia and other countries, Bhutan was able to conduct two rounds of nationwide vaccination campaign. While many countries struggle to overcome vaccine refusal or hesitancy due to complacency, a lack of trust, inconvenience and fear, escalated in some countries by anti-vaccine groups, Bhutan managed to inoculate more than 95% of its eligible populations in two rounds of vaccination campaign. Enabling factors of this successful vaccination campaign were strong national leadership, a well-coordinated national preparedness plan, and high acceptability of vaccine due to effective mass communication and social engagement led by religious figures, volunteers and local leaders. In this short report, we described the national strategic plan and enabling factors that led to the success of this historical vaccination campaign.
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Affiliation(s)
- Tsheten Tsheten
- College of Health and Medicine, Research School of Population Health, Australian National University, 62 Mills Road, Acton, Canberra, ACT, 2601, Australia. .,Royal Centre for Disease Control, Ministry of Health, Thimphu, Bhutan.
| | - Phurpa Tenzin
- Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | - Archie C A Clements
- Telethon Kids Institute, Nedlands, Australia.,Curtin University, Perth, Australia
| | - Darren J Gray
- College of Health and Medicine, Research School of Population Health, Australian National University, 62 Mills Road, Acton, Canberra, ACT, 2601, Australia
| | - Lhawang Ugyel
- School of Business, University of New South Wales, Canberra, ACT, Australia
| | - Kinley Wangdi
- College of Health and Medicine, Research School of Population Health, Australian National University, 62 Mills Road, Acton, Canberra, ACT, 2601, Australia
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Clements ACA, Addis Alene K. Global distribution of human hookworm species and differences in their morbidity effects: a systematic review. The Lancet Microbe 2022; 3:e72-e79. [DOI: 10.1016/s2666-5247(21)00181-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 11/24/2022] Open
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Mationg MLS, Williams GM, Tallo VL, Olveda RM, Aung E, Alday P, Reñosa MD, Daga CM, Landicho J, Demonteverde MP, Santos ED, Bravo TA, Bieri FA, Li Y, Clements ACA, Steinmann P, Halton K, Stewart DE, McManus DP, Gray DJ. Soil-transmitted helminth infections and nutritional indices among Filipino schoolchildren. PLoS Negl Trop Dis 2021; 15:e0010008. [PMID: 34936644 PMCID: PMC8694453 DOI: 10.1371/journal.pntd.0010008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/19/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Soil-transmitted helminth (STH) infections are still prevalent among schoolchildren in the Philippines. We evaluated the risk factors associated with STH and the relationship between STH and nutritional indices among schoolchildren aged 9-10 years in Laguna province, the Philippines. METHODS We used the baseline data from 40 schools enrolled in a randomised controlled trial of the Magic Glasses Philippines health education package. Data on demographic and socio-economic variables, and STH related knowledge, attitudes and practices, were obtained through a questionnaire. Stool samples were collected and assessed for STH egg presence using the Kato-Katz technique. Haemoglobin levels and height and weight of study participants were also determined. The generalized estimating equations approach was used to construct logistic regression models to assess STH-associated risk factors, and the association between any STH infection and anaemia, child stunting, wasting and being underweight. The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616000508471). FINDINGS Among 1,689 schoolchildren, the prevalence of any STH was 23%. The prevalence of anaemia, stunting, being underweight and wasting was 13%, 20.2%, 19% and 9.5%, respectively. Age, socio-economic status, rural/urban classification of schools and knowledge of STH were significant risk factors for acquiring a STH infection. Moreover, infections with any STH were significantly associated with stunting (P = <0.001) and being underweight (P = <0.003), but not wasting (P = 0.375) or anaemia (P = 0.462) after controlling for confounding covariates. CONCLUSION The study findings emphasise the need for sustainable deworming in tandem with other measures such as the provision of health education, improvements in sanitation and hygiene, and nutritional programs in order to control STH infections and improve morbidity outcomes in schoolchildren. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12616000508471).
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Affiliation(s)
- Mary Lorraine S. Mationg
- Research School of Population Heath, The Australian National University, Canberra, Australia
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Gail M. Williams
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Veronica L. Tallo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Remigio M. Olveda
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Eindra Aung
- Research School of Population Heath, The Australian National University, Canberra, Australia
- St Vincent’s Clinical School, University of New South Wales, Sydney, Australia
| | - Portia Alday
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Mark Donald Reñosa
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Chona Mae Daga
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Jhoys Landicho
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Maria Paz Demonteverde
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Eunice Diane Santos
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Thea Andrea Bravo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Franziska Angly Bieri
- Research School of Population Heath, The Australian National University, Canberra, Australia
| | - Yuesheng Li
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Australia
- Hunan Institute of Parasitic Diseases, World Health Organization Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Yueyang, China
| | | | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kate Halton
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Donald E. Stewart
- Research School of Population Heath, The Australian National University, Canberra, Australia
- School of Medicine, Griffith University, Brisbane, Australia
| | - Donald P. McManus
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Darren J. Gray
- Research School of Population Heath, The Australian National University, Canberra, Australia
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Wangdi K, Penjor K, Tsheten T, Tshering C, Gething P, Gray DJ, Clements ACA. Author Correction: Spatio-temporal patterns of childhood pneumonia in Bhutan: a Bayesian analysis. Sci Rep 2021; 11:22549. [PMID: 34782639 PMCID: PMC8593158 DOI: 10.1038/s41598-021-01075-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Kinley Wangdi
- Department of Global Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia.
| | - Kinley Penjor
- Vector-Borne Diseases Control Programme, Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | - Tsheten Tsheten
- Department of Global Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia.,Royal Centre for Disease Control, Ministry of Health, Thimphu, Bhutan
| | - Chachu Tshering
- Child Health Program, Communicable Diseases Division, Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | - Peter Gething
- Telethon Kids Institute, Nedlands, Australia.,Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Darren J Gray
- Department of Global Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Archie C A Clements
- Telethon Kids Institute, Nedlands, Australia.,Faculty of Health Sciences, Curtin University, Perth, Australia
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Suwannatrai AT, Thinkhamrop K, Suwannatrai K, Pratumchart K, Wangdi K, Kelly M, Restrepo AMC, Gray DJ, Clements ACA, Tangkawattana S, Sripa B. Opisthorchis viverrini and Strongyloides stercoralis mono- and co-infections: Bayesian geostatistical analysis in an endemic area, Thailand. Acta Trop 2021; 223:106079. [PMID: 34363777 DOI: 10.1016/j.actatropica.2021.106079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 12/19/2022]
Abstract
Parasitic infections caused by Opisthorchis viverrini and Strongyloides stercoralis remain a major public health threat in the Greater Mekong Sub-region. An understanding of climate and other environmental influences on the geographical distribution and emergence of parasitic diseases is a crucial step to guide targeted control and prevention programs. A parasitological survey was conducted from 2008 to 2013 and included 12,554 individuals (age between 20 and 60 years) from 142 villages in five districts in Khon Kaen Province, Thailand. Geographical information systems, remote sensing technologies and a Bayesian geostatistical framework were used to develop models for O. viverrini and S. stercoralis mono- and co-infections in areas where both parasites are known to co-occur. The results indicate that male sex, increased age, altitude, precipitation, and land surface temperature have influenced the infection rate and geographical distribution of mono- and co-infections of O. viverrini and S. stercoralis in this area. Males were 6.69 times (95% CrI: 5.26-8.58) more likely to have O. viverrini - S. stercoralis co-infection. We observed that O. viverrini and S. stercoralis mono-infections display distinct spatial pattern, while co-infection is predicted in the center and southeast of the study area. The observed spatial clustering of O. viverrini and S. stercoralis provides valuable information for the spatial targeting of prevention interventions in this area.
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Affiliation(s)
- Apiporn T Suwannatrai
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Health and Epidemiology Geoinformatics Research (HEGER), Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.
| | - Kavin Thinkhamrop
- Health and Epidemiology Geoinformatics Research (HEGER), Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand; Cholangiocarcinoma Screening and Care Program (CASCAP), Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Data Management and Statistical Analysis Center (DAMASAC), Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Kulwadee Suwannatrai
- Department of Biology, Faculty of Science and Technology, Sakon Nakhon Rajabhat University, Sakon Nakhon, Thailand
| | - Khanittha Pratumchart
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Health and Epidemiology Geoinformatics Research (HEGER), Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Kinley Wangdi
- Department of Global Health, Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Matthew Kelly
- Department of Global Health, Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Angela M Cadavid Restrepo
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Darren J Gray
- Department of Global Health, Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia; Telethon Kids Institute, Nedlands, WA, Australia
| | | | - Banchob Sripa
- WHO Collaborating Centre for Research and Control of opisthorchiasis, Tropical Disease Research Center, Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Gilmour B, Alene KA, Clements ACA. The prevalence of soil transmitted helminth infections in minority indigenous populations of South-East Asia and the Western Pacific Region: A systematic review and meta-analysis. PLoS Negl Trop Dis 2021; 15:e0009890. [PMID: 34758024 PMCID: PMC8580241 DOI: 10.1371/journal.pntd.0009890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/09/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Soil transmitted helminth (STH) infections cause one of the most prevalent diseases in man. STHs disproportionately impact socio-economically disadvantaged communities including minority indigenous populations. This systematic review aimed to quantify the prevalence of STH infection within minority indigenous populations of the South-East Asia and Western Pacific Regions. METHODS The systematic review was conducted in accordance with The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines following a published protocol. A random effects meta-analysis was used to estimate the pooled prevalence of STH infection, and meta-regression analysis was used to quantify associations with study characteristics. Where comparative data were available, sub-group analysis was conducted to evaluate the risk of STH infection in minority indigenous people relative to other population groups. The heterogeneity between studies was evaluated visually using Forest plots and was assessed quantitatively by the index of heterogeneity (I2) and Cochran Q-statistics. RESULTS From 1,366 unique studies that were identified, 81 were included in the final analysis. The pooled prevalence of infection within minority indigenous populations was 61.4% (95% CI 50.8, 71.4) for overall STH infection; 32.3% (95% CI 25.7, 39.3) for Ascaris.lumbricoides; 43.6% (95% CI 32.6, 54.8) for Trichuris.trichiura; 19.9% (95% CI 15.7, 24.5) for hookworm and 6.3% (95% CI 3.2, 10.2) for Strongyloides.stercoralis. A significant increase in T. trichiura prevalence was observed over time. The stratified analysis showed that the prevalence of infection for STH overall and for each STH species were not significantly different in minority indigenous participants compared to other populations groups. CONCLUSION The prevalence of STH infection is high within minority indigenous populations across countries at very different levels of socio-economic development. The increasing prevalence of T. trichiura calls for the implementation of more effective therapies and control strategies.
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Affiliation(s)
- Beth Gilmour
- Faculty of Health Sciences, Curtin University, Western Australia, Australia
| | - Kefyalew Addis Alene
- Faculty of Health Sciences, Curtin University, Western Australia, Australia
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Archie C. A. Clements
- Faculty of Health Sciences, Curtin University, Western Australia, Australia
- Telethon Kids Institute, Nedlands, WA, Australia
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Wangdi K, Penjor K, Tsheten T, Tshering C, Gething P, Gray DJ, Clements ACA. Spatio-temporal patterns of childhood pneumonia in Bhutan: a Bayesian analysis. Sci Rep 2021; 11:20422. [PMID: 34650108 PMCID: PMC8516968 DOI: 10.1038/s41598-021-99137-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 09/06/2021] [Indexed: 01/03/2023] Open
Abstract
Pneumonia is one of the top 10 diseases by morbidity in Bhutan. This study aimed to investigate the spatial and temporal trends and risk factors of childhood pneumonia in Bhutan. A multivariable Zero-inflated Poisson regression model using a Bayesian Markov chain Monte Carlo simulation was undertaken to quantify associations of age, sex, altitude, rainfall, maximum temperature and relative humidity with monthly pneumonia incidence and to identify the underlying spatial structure of the data. Overall childhood pneumonia incidence was 143.57 and 10.01 per 1000 persons over 108 months of observation in children aged < 5 years and 5–14 years, respectively. Children < 5 years or male sex were more likely to develop pneumonia than those 5–14 years and females. Each 1 °C increase in maximum temperature was associated with a 1.3% (95% (credible interval [CrI] 1.27%, 1.4%) increase in pneumonia cases. Each 10% increase in relative humidity was associated with a 1.2% (95% CrI 1.1%, 1.4%) reduction in the incidence of pneumonia. Pneumonia decreased by 0.3% (CrI 0.26%, 0.34%) every month. There was no statistical spatial clustering after accounting for the covariates. Seasonality and spatial heterogeneity can partly be explained by the association of pneumonia risk to climatic factors including maximum temperature and relative humidity.
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Affiliation(s)
- Kinley Wangdi
- Department of Global Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia.
| | - Kinley Penjor
- Vector-Borne Diseases Control Programme, Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | - Tsheten Tsheten
- Department of Global Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia.,Royal Centre for Disease Control, Ministry of Health, Thimphu, Bhutan
| | - Chachu Tshering
- Child Health Program, Communicable Diseases Division, Department of Public Health, Ministry of Health, Thimphu, Bhutan
| | - Peter Gething
- Telethon Kids Institute, Nedlands, Australia.,Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Darren J Gray
- Department of Global Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Archie C A Clements
- Telethon Kids Institute, Nedlands, Australia.,Faculty of Health Sciences, Curtin University, Perth, Australia
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Tsheten T, Clements ACA, Gray DJ, Adhikary RK, Furuya-Kanamori L, Wangdi K. Clinical predictors of severe dengue: a systematic review and meta-analysis. Infect Dis Poverty 2021; 10:123. [PMID: 34627388 PMCID: PMC8501593 DOI: 10.1186/s40249-021-00908-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/21/2021] [Indexed: 11/11/2022] Open
Abstract
Background Severe dengue is a life-threatening complication; rapid identification of these cases, followed by adequate management is crucial to improve the clinical prognosis. Therefore, this study aimed to identify risk factors and predictors of severe dengue.
Methods A literature search for studies reporting risk factors of severe dengue among individuals with dengue virus infection was conducted in PubMed, Scopus and Web of Science database from inception to December 31, 2020. Pooled odds ratios (ORs) for patients’ demographic characteristics, co-morbidities, and warning signs were estimated using an inverse variance heterogeneity model.
Results We included 143 articles in the meta-analysis from a total of 13 090 articles retrieved from the literature search. The risk factors of severe dengue were: being a child [OR = 1.96; 95% confidence interval (CI): 1.22–3.13], secondary infection (OR = 3.23; 95% CI: 2.28–4.57), and patients with pre-existing diabetes (OR = 2.88; 95% CI: 1.72–4.81) and renal disease (OR = 4.54; 95% CI: 1.55–13.31). Warning signs strongly associated with severe disease were increased haematocrit with a concurrent decrease in platelet count (OR = 5.13; 95% CI: 1.61–16.34), abdominal pain (OR = 2.00; 95% CI: 1.49–2.68), lethargy (OR = 2.73; 95% CI: 1.05–7.10), vomiting (OR = 1.80; 95% CI: 1.43–2.26), hepatomegaly (OR = 5.92; 95% CI: 3.29–10.66), ascites (OR = 6.30; 95% CI: 3.75–10.60), pleural effusion (OR = 5.72; 95% CI: 3.24–10.10) and melena (OR = 4.05; 95% CI: 1.64–10.00). Conclusions Our meta-analysis identified children, secondary infection, diabetes and renal disease(s) as important predictors of severe dengue. Our finding also supports the predictive ability of the WHO warning signs to identify severe dengue. These findings are useful for clinicians to identify severe dengue for management and timely interventions. ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40249-021-00908-2.
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Affiliation(s)
- Tsheten Tsheten
- Department of Global Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia. .,Royal Centre for Disease Control, Ministry of Health, Thimphu, Bhutan.
| | - Archie C A Clements
- Telethon Kids Institute, Nedlands, Australia.,Curtin University, Perth, Australia
| | - Darren J Gray
- Department of Global Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Ripon K Adhikary
- Department of Global Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Luis Furuya-Kanamori
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
| | - Kinley Wangdi
- Department of Global Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
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Awasthi KR, Jancey J, Clements ACA, Leavy JE. Community engagement approaches for malaria prevention, control and elimination: a scoping review protocol. BMJ Open 2021; 11:e049812. [PMID: 34610938 PMCID: PMC8493896 DOI: 10.1136/bmjopen-2021-049812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Community engagement (CE) is important for malaria prevention, control and ultimately elimination. As the decline of malaria has plateaued over the last 5 years, strengthening CE approaches will be necessary to enhance health promotion practice and policy to drive malaria transmission down further. Countries have adopted a wide range of public health intervention approaches for malaria prevention and control that best suit their context. This review will examine the existing evidence on the various CE approaches adopted by malaria programmes across the world and their outcomes. METHODOLOGY AND ANALYSIS: The review methodology will follow the updated Joanna Briggs Institute guide for scoping review, 2017, which is based on the framework developed by Arksey and O'Malley and further developed by Levac Colquhoun and O'Brien. Proquest, Web of Knowledge and Medline will be searched for publications from January 2000 to 31 March 2021 while Google search engine will be used to find any grey literature. The eligibility criteria will be as follows: review will include primary studies written in the English language using appropriate study designs and methods, including quantitative, qualitative and mixed methods designs; and case, programme or project reports. Information on CE approaches designed specifically for malaria prevention, control, elimination and their outcomes will be explored. Subheadings and free text terms for 'community engagement' and 'malaria' will be used for the search. The article screening and data extraction will be examined by two reviewers after the initial search, and any disputes will be resolved by a third reviewer through discussion. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guide will be used to present the review methods and the results from the search. The scoping review results will identify and map the available evidences, sources of information and research gaps in the area of CE as one approach for malaria prevention, control and/or elimination. ETHICS AND DISSEMINATION: This study only aims to review secondary sources and does not require human research ethics committee approval. The findings of the scoping review will be submitted to a peer-reviewed journal for wider dissemination.
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Affiliation(s)
- Kiran Raj Awasthi
- Curtin School of Population Health, Curtin University-Perth Bentley Campus, Perth, Western Australia, Australia
| | - Jonine Jancey
- Curtin School of Population Health, Curtin University-Perth Bentley Campus, Perth, Western Australia, Australia
| | - Archie C A Clements
- Curtin School of Population Health, Curtin University-Perth Bentley Campus, Perth, Western Australia, Australia
| | - Justine E Leavy
- Curtin School of Population Health, Curtin University-Perth Bentley Campus, Perth, Western Australia, Australia
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Tsheten T, Clements ACA, Gray DJ, Gyeltshen K, Wangdi K. Medical practitioner's knowledge on dengue management and clinical practices in Bhutan. PLoS One 2021; 16:e0254369. [PMID: 34270594 PMCID: PMC8284660 DOI: 10.1371/journal.pone.0254369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 06/24/2021] [Indexed: 12/02/2022] Open
Abstract
Background Dengue has emerged as a major public health problem in Bhutan, with increasing incidence and widening geographic spread over recent years. This study aimed to investigate the knowledge and clinical management of dengue among medical practitioners in Bhutan. Methods We administered a survey questionnaire to all practitioners currently registered under the Bhutan Medical and Health Council. The questionnaire contained items on four domains including transmission, clinical course and presentation, diagnosis and management, and surveillance and prevention of dengue. Participants were able to respond using an online Qualtrics survey, with the invitation and link distributed via email. Results A total of 97 respondents were included in the study (response rate: 12.7%), of which 61.86% were Health Assistants/Clinical Officers (HAs/COs) and 38.14% were medical doctors. The afternoon feeding behaviour of Aedes mosquito was correctly identified by only 24.7% of the respondents, and ~66.0% of them failed to identify lethargy as a warning sign for severe dengue. Knowledge on diagnosis using NS1 antigen and the clinical significance of elevated haematocrit for initial fluid replacement was strikingly low at 47.4% and 27.8% respectively. Despite dengue being a nationally notifiable disease, ~60% of respondents were not knowledgeable on the timing and type of cases to be reported. Respondent’s median score was higher for the surveillance and reporting domain, followed by their knowledge on transmission of dengue. Statistically significant factors associated with higher knowledge included respondents being a medical doctor, working in a hospital and experience of having diagnosed dengue. Conclusion The study revealed major gaps on knowledge and clinical management practices related to dengue in Bhutan. Physicians and health workers working in Basic Health Units need training and regular supervision to improve their knowledge on the care of dengue patients.
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Affiliation(s)
- Tsheten Tsheten
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, Australia
- Royal Centre for Disease Control, Ministry of Health, Thimphu, Bhutan
- * E-mail:
| | - Archie C. A. Clements
- Faculty of Health Sciences, Curtin University, Perth, Australia
- Telethon Kids Institute, Nedlands, Australia
| | - Darren J. Gray
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, Australia
| | | | - Kinley Wangdi
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, Australia
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Cleary E, Hetzel MW, Siba PM, Lau CL, Clements ACA. Correction to: Spatial prediction of malaria prevalence in Papua New Guinea: a comparison of Bayesian decision network and multivariate regression modelling approaches for improved accuracy in prevalence prediction. Malar J 2021; 20:318. [PMID: 34271929 PMCID: PMC8283970 DOI: 10.1186/s12936-021-03838-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Eimear Cleary
- Research School of Population Health, Australian National University, Canberra, Australia.
| | - Manuel W Hetzel
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.,Centre for Health Research and Diagnostics, Divine Word University, Madang, Papua New Guinea
| | - Colleen L Lau
- Research School of Population Health, Australian National University, Canberra, Australia.,School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Bentley, Australia.,Telethon Kids Institute, Nedlands, Australia
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Gilmour B, Alene KA, Clarke NE, Clements ACA. The prevalence of tuberculosis, malaria and soil-transmitted helminth infection in minority indigenous people of Southeast Asia and the Western Pacific: protocol for a systematic review and meta-analysis. Syst Rev 2021; 10:203. [PMID: 34246316 PMCID: PMC8271287 DOI: 10.1186/s13643-021-01753-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 06/25/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Infectious diseases such as tuberculosis (TB), malaria and soil-transmitted helminthiasis continue to impose a significant global health burden and socio-economic impact. Globally, minority indigenous people are disproportionately affected by poverty and are shown to experience a disparate burden of disease and poorer health outcomes than the comparative majority population. Despite these inequalities, countries rarely systematically compile epidemiological data disaggregated by ethnicity to enable the extent of the differential to be quantified. METHODS The systematic review will be reported in accordance with The Preferred Reporting Items for Systematic Review and Meta- Analyses (PRISMA) guidelines. Systematic searches will be conducted in EMBASE, Medline, Scopus and Web of Science for studies reporting data which enable the prevalence of TB, malaria, and/or soil-transmitted helminth (STH) infections amongst minority indigenous populations within the Southeast Asia Region (SEAR) and Western Pacific Region (WPR) to be calculated. Where studies provide data on disease prevalence for both minority indigenous and other populations within the same study, a comparative analysis will be undertaken. In addition to a narrative synthesis, where sufficient data are available, a random-effects meta-analysis will be conducted to obtain a pooled estimate value for each disease/infection by country and mortality stratum. Heterogeneity between studies will be examined using the Cochran's Q test and quantitatively measured by the index of heterogeneity squared (I2) statistics. The methodological quality of the included studies will be assessed using a modified Newcastle-Ottawa Scale. DISCUSSION This systematic review aims to analyse the available data on the prevalence of TB, malaria and STH infections within minority indigenous populations of the SEAR and WPR. REGISTRATION Open Science Framework registration: osf.io/m6sqc.
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Affiliation(s)
- Beth Gilmour
- Faculty of Health Sciences, Curtin University, Western Australia, Australia
| | - Kefyalew Addis Alene
- Faculty of Health Sciences, Curtin University, Western Australia, Australia
- Telethon Kids Institute, West Perth, WA Australia
| | - Naomi E. Clarke
- Research School of Population Health, Australian National University, Canberra, ACT Australia
| | - Archie C. A. Clements
- Faculty of Health Sciences, Curtin University, Western Australia, Australia
- Telethon Kids Institute, West Perth, WA Australia
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44
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Islam N, Wright S, Lau CL, Doi SAR, Mills DJ, Clark J, Clements ACA, Furuya-Kanamori L. Efficacy of a 3-day pretravel schedule of tafenoquine for malaria chemoprophylaxis: a network meta-analysis. J Travel Med 2021; 28:6217513. [PMID: 33834208 DOI: 10.1093/jtm/taab057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Chemoprophylaxis with weekly doses of tafenoquine (200 mg/day for 3 days before departure [loading dose], 200 mg/week during travel and 1-week post-travel [maintenance doses]) is effective in preventing malaria. Effectiveness of malaria chemoprophylaxis drugs in travellers is often compromised by poor compliance. Shorter schedules that can be completed before travel, allowing 'drug-free holidays', could increase compliance and thus reduce travel-related malaria. In this meta-analysis, we examined if a loading dose of tafenoquine alone is effective in preventing malaria in short-term travellers. METHODS Four databases were searched in November 2020 for randomized controlled trials (RCTs) that assessed efficacy and/or safety of tafenoquine for chemoprophylaxis. Network meta-analysis using the generalized pair-wise modelling framework was utilized to estimate the odds ratio (OR) of malaria infection in long-term (>28 days) and short-term (≤28 days) travellers, as well as adverse events (AEs) associated with receiving loading dose of tafenoquine alone, loading dose of tafenoquine followed by maintenance doses, loading dose of mefloquine followed by maintenance doses, or placebo. RESULTS Nine RCTs (1714 participants) were included. In long-term travellers, compared to mefloquine, tafenoquine with maintenance doses (OR = 1.05; 95% confidence interval [CI]: 0.44-2.46) was equally effective in preventing malaria, while there was an increased risk of infection with the loading dose of tafenoquine alone (OR = 2.89; 95% CI: 0.78-10.68) and placebo (OR = 62.91; 95% CI: 8.53-463.88). In short-term travellers, loading dose of tafenoquine alone (OR = 0.98; 95% CI: 0.04-22.42) and tafenoquine with maintenance doses (OR = 1.00; 95% CI: 0.06-16.10) were as effective as mefloquine. The risk of AEs with tafenoquine with maintenance doses (OR = 1.03; 95% CI: 0.67-1.60) was similar to mefloquine, while loading dose of tafenoquine alone (OR = 0.58; 95% CI: 0.20-1.66) was associated with lower risk of AEs, although the difference was not statistically significant. CONCLUSIONS For short-term travellers, loading dose of tafenoquine alone was equally effective, had possibly lower rate of AEs, and likely better compliance than standard tafenoquine or mefloquine chemoprophylaxis schedules with maintenance doses. Studies are needed to confirm if short-term travellers remain free of infection after long-term follow-up. REGISTRATION The meta-analysis was registered in PROSPERO (CRD42021223756). HIGHLIGHT Tafenoquine is the latest approved drug for malaria chemoprophylaxis. A loading dose of tafenoquine (200 mg/day for 3 days before departure) is as effective in preventing malaria in short-term (≤28 days) travellers as chemoprophylaxis schedules of tafenoquine or mefloquine with maintenance doses, allowing travellers to have a 'drug-free holiday'.
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Affiliation(s)
- Nazmul Islam
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, PO BOX 2713, Qatar
| | - Sophie Wright
- ANU Medical School, Australian National University, Canberra, ACT 2601, Australia
| | - Colleen L Lau
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia
- Dr Deb The Travel Doctor, Travel Medicine Alliance, Brisbane, QLD 4000, Australia
| | - Suhail A R Doi
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, PO BOX 2713, Qatar
| | - Deborah J Mills
- Dr Deb The Travel Doctor, Travel Medicine Alliance, Brisbane, QLD 4000, Australia
- Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Robina, QLD 4226, Australia
| | | | - Luis Furuya-Kanamori
- Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029, Australia
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45
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Alene KA, Xu Z, Bai L, Yi H, Tan Y, Gray DJ, Viney K, Clements ACA. Spatiotemporal Patterns of Tuberculosis in Hunan Province, China. Int J Environ Res Public Health 2021; 18:ijerph18136778. [PMID: 34202504 PMCID: PMC8297355 DOI: 10.3390/ijerph18136778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/04/2021] [Accepted: 06/16/2021] [Indexed: 11/25/2022]
Abstract
Tuberculosis (TB) is the leading cause of death from a bacterial pathogen worldwide. China has the third highest TB burden in the world, with a high reported burden in Hunan Province (amongst others). This study aimed to investigate the spatial distribution of TB and identify socioeconomic, demographic, and environmental drivers in Hunan Province, China. Numbers of reported cases of TB were obtained from the Tuberculosis Control Institute of Hunan Province, China. A wide range of covariates were collected from different sources, including from the Worldclim database, and the Hunan Bureau of Statistics. These variables were summarized at the county level and linked with TB notification data. Spatial clustering of TB was explored using Moran’s I statistic and the Getis–Ord statistic. Poisson regression models were developed with a conditional autoregressive (CAR) prior structure, and with posterior parameters estimated using a Bayesian approach with Markov chain Monte Carlo (MCMC) simulation. A total of 323,340 TB cases were reported to the Hunan TB Control Institute from 2013 to 2018. The mean age of patients was 51.7 years (SD + 17.6 years). The majority of the patients were male (72.6%, n = 234,682) and had pulmonary TB (97.5%, n = 315,350). Of 319,825 TB patients with registered treatment outcomes, 306,107 (95.7%) patients had a successful treatment outcome. The annual incidence of TB decreased over time from 85.5 per 100,000 population in 2013 to 76.9 per 100,000 population in 2018. TB case numbers have shown seasonal variation, with the highest number of cases reported during the end of spring and the beginning of summer. Spatial clustering of TB incidence was observed at the county level, with hotspot areas detected in the west part of Hunan Province. The spatial clustering of TB incidence was significantly associated with low sunshine exposure (RR: 0.86; 95% CrI: 0.74, 0.96) and a low prevalence of contraceptive use (RR: 0.88; 95% CrI: 0.79, 0.98). Substantial spatial clustering and seasonality of TB incidence were observed in Hunan Province, with spatial patterns associated with environmental and health care factors. This research suggests that interventions could be more efficiently targeted at locations and times of the year with the highest transmission risk.
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Affiliation(s)
- Kefyalew Addis Alene
- Faculty of Health Sciences, Curtin University, Perth 6102, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth 6009, Australia
| | - Zuhui Xu
- Department of Tuberculosis Control, Tuberculosis Control Institute of Hunan Province, Changsha 410000, China
| | - Liqiong Bai
- Department of Director's Office, Hunan Chest Hospital, Changsha 410013, China
| | - Hengzhong Yi
- Department of MDR-TB, Internal Medicine, Hunan Chest Hospital, Changsha 410013, China
| | - Yunhong Tan
- Department of MDR-TB, Internal Medicine, Hunan Chest Hospital, Changsha 410013, China
| | - Darren J Gray
- Research School of Population Health, the Australian National University, Canberra 2601, Australia
| | - Kerri Viney
- Research School of Population Health, the Australian National University, Canberra 2601, Australia
- Department of Global Public Health, Karolinska Institutet, 141 83 Stockholm, Sweden
- School of Public Health, The University of Sydney, Sydney 2006, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Perth 6102, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth 6009, Australia
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46
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Tsheten T, Gray DJ, Clements ACA, Wangdi K. Epidemiology and challenges of dengue surveillance in the WHO South-East Asia Region. Trans R Soc Trop Med Hyg 2021; 115:583-599. [PMID: 33410916 DOI: 10.1093/trstmh/traa158] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/02/2020] [Accepted: 11/18/2020] [Indexed: 11/13/2022] Open
Abstract
Dengue poses a significant health and economic burden in the WHO South-East Asia Region. Approaches for control need to be aligned with current knowledge on the epidemiology of dengue in the region. Such knowledge will ensure improved targeting of interventions to reduce dengue incidence and its socioeconomic impact. This review was undertaken to describe the contemporary epidemiology of dengue and critically analyse the existing surveillance strategies in the region. Over recent decades, dengue incidence has continued to increase with geographical expansion. The region has now become hyper-endemic for multiple dengue virus serotypes/genotypes. Every epidemic cycle was associated with a change of predominant serotype/genotype and this was often associated with severe disease with intense transmission. Classical larval indices are widely used in vector surveillance and adult mosquito samplings are not implemented as a part of routine surveillance. Further, there is a lack of integration of entomological and disease surveillance systems, often leading to inaction or delays in dengue prevention and control. Disease surveillance does not capture all cases, resulting in under-reporting, and has thus failed to adequately represent the true burden of disease in the region. Possible solutions include incorporating adult mosquito sampling into routine vector surveillance, the establishment of laboratory-based sentinel surveillance, integrated vector and dengue disease surveillance and climate-based early warning systems using available technologies like mobile apps.
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Affiliation(s)
- Tsheten Tsheten
- Department of Globa l Health, Research School of Population Health, Australian National University, Canberra, Australia.,Royal Centre for Disease Control, Ministry of Health, Bhutan
| | - Darren J Gray
- Department of Globa l Health, Research School of Population Health, Australian National University, Canberra, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Perth, Australia.,Telethon Kids Institute, Nedlands, Australia
| | - Kinley Wangdi
- Department of Globa l Health, Research School of Population Health, Australian National University, Canberra, Australia
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47
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Cleary E, Hetzel MW, Siba PM, Lau CL, Clements ACA. Spatial prediction of malaria prevalence in Papua New Guinea: a comparison of Bayesian decision network and multivariate regression modelling approaches for improved accuracy in prevalence prediction. Malar J 2021; 20:269. [PMID: 34120604 PMCID: PMC8201920 DOI: 10.1186/s12936-021-03804-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Considerable progress towards controlling malaria has been made in Papua New Guinea through the national malaria control programme’s free distribution of long-lasting insecticidal nets, improved diagnosis with rapid diagnostic tests and improved access to artemisinin combination therapy. Predictive prevalence maps can help to inform targeted interventions and monitor changes in malaria epidemiology over time as control efforts continue. This study aims to compare the predictive performance of prevalence maps generated using Bayesian decision network (BDN) models and multilevel logistic regression models (a type of generalized linear model, GLM) in terms of malaria spatial risk prediction accuracy. Methods Multilevel logistic regression models and BDN models were developed using 2010/2011 malaria prevalence survey data collected from 77 randomly selected villages to determine associations of Plasmodium falciparum and Plasmodium vivax prevalence with precipitation, temperature, elevation, slope (terrain aspect), enhanced vegetation index and distance to the coast. Predictive performance of multilevel logistic regression and BDN models were compared by cross-validation methods. Results Prevalence of P. falciparum, based on results obtained from GLMs was significantly associated with precipitation during the 3 driest months of the year, June to August (β = 0.015; 95% CI = 0.01–0.03), whereas P. vivax infection was associated with elevation (β = − 0.26; 95% CI = − 0.38 to − 3.04), precipitation during the 3 driest months of the year (β = 0.01; 95% CI = − 0.01–0.02) and slope (β = 0.12; 95% CI = 0.05–0.19). Compared with GLM model performance, BDNs showed improved accuracy in prediction of the prevalence of P. falciparum (AUC = 0.49 versus 0.75, respectively) and P. vivax (AUC = 0.56 versus 0.74, respectively) on cross-validation. Conclusions BDNs provide a more flexible modelling framework than GLMs and may have a better predictive performance when developing malaria prevalence maps due to the multiple interacting factors that drive malaria prevalence in different geographical areas. When developing malaria prevalence maps, BDNs may be particularly useful in predicting prevalence where spatial variation in climate and environmental drivers of malaria transmission exists, as is the case in Papua New Guinea.
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Affiliation(s)
- Eimear Cleary
- Research School of Population Health, Australian National University, Canberra, Australia.
| | - Manuel W Hetzel
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.,Centre for Health Research and Diagnostics, Divine Word University, Madang, Papua New Guinea
| | - Colleen L Lau
- Research School of Population Health, Australian National University, Canberra, Australia.,School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Bentley, Australia.,Telethon Kids Institute, Nedlands, Australia
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48
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Mationg MLS, Tallo VL, Williams GM, Gordon CA, Clements ACA, McManus DP, Gray DJ. The control of soil-transmitted helminthiases in the Philippines: the story continues. Infect Dis Poverty 2021; 10:85. [PMID: 34118990 PMCID: PMC8196932 DOI: 10.1186/s40249-021-00870-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/27/2021] [Indexed: 03/30/2023] Open
Abstract
Background Soil-transmitted helminth (STH) infections have long been an important public health concern in the Philippines. In this review, we describe the current status of STH infections there and highlight the control efforts undertaken to reduce STH burden. Main text A nationwide STH mass drug administration (MDA) programme was started in 2006 but the overall STH prevalence remains stubbornly high across the Philippines, ranging from 24.9% to 97.4%. The continued increase in the prevalence may have been due to the challenges related to MDA implementation which include the lack of people’s awareness about the importance of regular treatment, misconceptions about the MDA strategy, lack of confidence on the drugs used, fear of adverse events and general distrust of government programs. There are existing water, sanitation and hygiene (WASH) programmes implemented in communities [e.g., Community-Led Total Sanitation (CLTS) program and providing toilet bowls and provision of subsidy for latrine construction] and schools [e.g., WASH in School (WINS) program], but sustained implementation is required to achieve expected outcomes. Although WASH in general is being taught in schools, integration of STH as a disease and community problem in the current public elementary school curriculum is still inadequate. The Integrated Helminth Control Program (IHCP) currently implemented in the country, which is focused on improved sanitation and personal hygiene, health education and preventive chemotherapy, will require continuous appraisal. The sustainability of this programme still continues to be a challenge. Conclusions Despite the major efforts to control STH infections for almost two decades in the Philippines, persistently high STH prevalence has been reported across the country, which is likely due to suboptimal MDA coverage and limitations in WASH and health education programs. Sustainable delivery of integrated control approaches will continue to play a pivotal role in the control and elimination of STH in the Philippines. Graphic abstract ![]()
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Affiliation(s)
- Mary Lorraine S Mationg
- Department of Global Health, Research School of Population Health, The Australian National University, Building 62 Mills Rd, Acton ACT, Canberra, 2601, Australia. .,Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines.
| | - Veronica L Tallo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Gail M Williams
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Catherine A Gordon
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Donald P McManus
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Darren J Gray
- Department of Global Health, Research School of Population Health, The Australian National University, Building 62 Mills Rd, Acton ACT, Canberra, 2601, Australia
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49
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Tsheten T, Wangchuk S, Wangmo D, Clements ACA, Gray DJ, Wangdi K. COVID-19 Response and Lessons Learned on Dengue Control in Bhutan. J Med Entomol 2021; 58:502-504. [PMID: 33095868 PMCID: PMC7665684 DOI: 10.1093/jme/tjaa225] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Tsheten Tsheten
- Research School of Population Health, Australian National University, Canberra, Australia
- Royal Centre for Disease Control, Ministry of Health, Thimphu, Bhutan
| | - Sonam Wangchuk
- Royal Centre for Disease Control, Ministry of Health, Thimphu, Bhutan
| | | | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Perth, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
| | - Darren J Gray
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Kinley Wangdi
- Research School of Population Health, Australian National University, Canberra, Australia
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Pasaribu AP, Tsheten T, Yamin M, Maryani Y, Fahmi F, Clements ACA, Gray DJ, Wangdi K. Spatio-Temporal Patterns of Dengue Incidence in Medan City, North Sumatera, Indonesia. Trop Med Infect Dis 2021; 6:tropicalmed6010030. [PMID: 33807820 PMCID: PMC8006016 DOI: 10.3390/tropicalmed6010030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/17/2021] [Accepted: 02/25/2021] [Indexed: 01/04/2023] Open
Abstract
Dengue has been a perennial public health problem in Medan city, North Sumatera, despite the widespread implementation of dengue control. Understanding the spatial and temporal pattern of dengue is critical for effective implementation of dengue control strategies. This study aimed to characterize the epidemiology and spatio-temporal patterns of dengue in Medan City, Indonesia. Data on dengue incidence were obtained from January 2016 to December 2019. Kulldorff’s space-time scan statistic was used to identify dengue clusters. The Getis-Ord Gi* and Anselin Local Moran’s I statistics were used for further characterisation of dengue hotspots and cold spots. Results: A total of 5556 cases were reported from 151 villages across 21 districts in Medan City. Annual incidence in villages varied from zero to 439.32 per 100,000 inhabitants. According to Kulldorf’s space-time scan statistic, the most likely cluster was located in 27 villages in the south-west of Medan between January 2016 and February 2017, with a relative risk (RR) of 2.47. Getis-Ord Gi* and LISA statistics also identified these villages as hotpot areas. Significant space-time dengue clusters were identified during the study period. These clusters could be prioritized for resource allocation for more efficient prevention and control of dengue.
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Affiliation(s)
- Ayodhia Pitaloka Pasaribu
- Department of Pediatrics, Medical School, Universitas Sumatera Utara, Medan 20155, North Sumatera, Indonesia
- Correspondence: ; Tel.: +62-8126024392
| | - Tsheten Tsheten
- Department of Global Health, Research School of Population Health, The Australian National University, Acton, Canberra, ACT 2601, Australia; (T.T.); (D.J.G.); (K.W.)
| | - Muhammad Yamin
- Medical School, Universitas Sumatera Utara, Medan 20155, North Sumatera, Indonesia;
| | - Yulia Maryani
- North Sumatera Provincial Health Office, Medan 20232, North Sumatera, Indonesia;
| | - Fahmi Fahmi
- Faculty of Engineering, Universitas Sumatera Utara, Medan 20155, North Sumatera, Indonesia;
| | - Archie C. A. Clements
- Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia;
- Telethon Kids Institute, Nedlands, WA 6009, Australia
| | - Darren J. Gray
- Department of Global Health, Research School of Population Health, The Australian National University, Acton, Canberra, ACT 2601, Australia; (T.T.); (D.J.G.); (K.W.)
| | - Kinley Wangdi
- Department of Global Health, Research School of Population Health, The Australian National University, Acton, Canberra, ACT 2601, Australia; (T.T.); (D.J.G.); (K.W.)
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