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Clarke NE, O'Keeffe J, Yerramilli A, Bartolo C, Mothobi N, Muleme M, McNamara BJ, O'Brien DP, Athan E, Hussain A. Use of targeted SMS messaging to encourage COVID-19 oral antiviral uptake in South West Victoria. Public Health Res Pract 2024; 34:33342309. [PMID: 37758450 DOI: 10.17061/phrp33342309] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
OBJECTIVES During winter 2022, as part of a multifaceted approach to optimise oral antiviral uptake in the Barwon South West region in Victoria, Australia, the Barwon South West Public Health Unit (BSWPHU) implemented an innovative, targeted SMS messaging program that encouraged people with coronavirus disease 2019 (COVID-19) to be assessed for antiviral treatment. In this study, we investigated patterns of antiviral uptake, identified barriers and facilitators to accessing antivirals, and examined the potential impact of targeted SMS messaging on oral antiviral uptake. METHODS We conducted a cross-sectional study of notified COVID-19 cases aged 50 years and older, and Aboriginal and Torres Strait Islander people aged 30-49 years, in the BSWPHU catchment area over a 6-week period commencing 21 July 2022. We analysed survey data using descriptive statistics and generalised linear models. RESULTS Of the 3829 survey respondents, 36.7% (95% confidence interval (CI) 35.2, 38.2) reported being prescribed oral antivirals, with 75.4% (95% CI 72.8, 77.9) of these aged ≥70. Antiviral prescriptions increased significantly over the 6-week survey period. Most prescriptions (87.5%; 95% CI 85.7, 89.2) were provided by the respondents' usual general practitioners (GPs). Barriers to receiving antivirals included respondents being unable to get a medical appointment in time (3.7%; 95% CI 3.1, 4.2), testing too late in their illness (2.3%; 95% CI 1.8, 2.8) and being unable to access medications in time after receiving a prescription (0.2%; 95% CI 0.1, 0.6). Facilitators to receiving antivirals included respondents first hearing about antivirals from a trusted source such as a family member, friend or usual doctor. Nearly one in eight people who were prescribed antivirals reported first hearing about them from the SMS message sent by BSWPHU. CONCLUSIONS Oral antiviral treatment uptake in south-west Victoria in July-August 2022 was high among survey respondents and increased over time. GPs were the key prescribers in the community. Targeted SMS messaging to COVID-19 cases is a simple, low-cost intervention that potentially increases antiviral uptake.
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Affiliation(s)
- Naomi E Clarke
- Barwon South West Public Health Unit, Geelong, Victoria, Australia;
| | - Jessica O'Keeffe
- Barwon South West Public Health Unit, Geelong, Victoria, Australia; Department of Infectious Diseases, Barwon Health, Geelong, Victoria, Australia
| | - Arvind Yerramilli
- Barwon South West Public Health Unit, Geelong, Victoria, Australia; Department of Infectious Diseases, Barwon Health, Geelong, Victoria, Australia
| | - Caroline Bartolo
- Barwon South West Public Health Unit, Geelong, Victoria, Australia; Department of Infectious Diseases, Barwon Health, Geelong, Victoria, Australia
| | - Nomvuyo Mothobi
- Barwon South West Public Health Unit, Geelong, Victoria, Australia; Department of Infectious Diseases, Barwon Health, Geelong, Victoria, Australia
| | - Michael Muleme
- Barwon South West Public Health Unit, Geelong, Victoria, Australia
| | | | - Daniel P O'Brien
- Barwon South West Public Health Unit, Geelong, Victoria, Australia; Department of Infectious Diseases, Barwon Health, Geelong, Victoria, Australia
| | - Eugene Athan
- Barwon South West Public Health Unit, Geelong, Victoria, Australia; Department of Infectious Diseases, Barwon Health, Geelong, Victoria, Australia; School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Akhtar Hussain
- Barwon South West Public Health Unit, Geelong, Victoria, Australia
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Clarke NE, Shekhawat J, Popat H, Lord DJE, Abdel-Latif ME. Vein of Galen Aneurysmal Malformation: A Case Report. Healthcare (Basel) 2024; 12:716. [PMID: 38610139 PMCID: PMC11011842 DOI: 10.3390/healthcare12070716] [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: 11/21/2023] [Revised: 03/03/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024] Open
Abstract
Vein of Galen aneurysmal malformation is a relatively rare disease in which failure of the median prosencephalic vein of Markowski to involute early in gestation leads to a grossly dilated deep cerebral vein with multiple arterial feeders, causing a large arteriovenous shunt which leads to high-output cardiac failure. We describe a case of a term neonate who presented to a tertiary neonatal centre on day one of life with history, symptoms, and signs consistent with perinatal asphyxia; however, in the context of worsening multi-organ dysfunction and cardiomegaly, the infant was found to have a severe vein of Galen aneurysmal dilatation leading to high-output cardiac failure. The patient was transferred to a tertiary paediatric hospital and underwent a total of four coiling procedures to embolise the multiple feeder arteries supplying the aneurysmal malformation. This case highlights the difficulties in diagnosing this relatively uncommon condition, particularly in the context of a possible perinatal insult.
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Affiliation(s)
- Naomi E. Clarke
- National Centre for Epidemiology and Population Health, Australian National University, Acton, ACT 2601, Australia
- Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
| | - Jatinder Shekhawat
- Department of Radiology, Canberra Hospital, Garran, ACT 2605, Australia
- Garran Medical Imaging, Garran, ACT 2605, Australia
| | - Himanshu Popat
- The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- Sydney Medical School, University of Sydney, Westmead, NSW 2050, Australia
| | - David J. E. Lord
- The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- Sydney Medical School, University of Sydney, Westmead, NSW 2050, Australia
| | - Mohamed E. Abdel-Latif
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Garran, ACT 2605, Australia
- Discipline of Neonatology, School of Medicine and Psychology, College of Health and Medicine, Australian National University, Acton, ACT 2601, Australia
- Department of Public Health, La Trobe University, Bundoora, VIC 3083, Australia
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Le B, Clarke NE, Legrand N, Nery SV. Effectiveness of ivermectin mass drug administration in the control of soil-transmitted helminth infections in endemic populations: a systematic review and meta-analysis. Infect Dis Poverty 2024; 13:16. [PMID: 38369483 PMCID: PMC10874526 DOI: 10.1186/s40249-024-01185-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/01/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Current soil-transmitted helminth (STH) control guidelines endorse the use of albendazole or mebendazole for school-based targeted preventive chemotherapy (PC), yet their reduced efficacy against Strongyloides stercoralis and Trichuris trichiura presents significant limitations. Emerging evidence indicates that community-wide PC [or mass drug administration (MDA)] using ivermectin, commonly used in other neglected tropical disease (NTD) control programs, may play an important role in controlling these parasites. We conducted a systematic review and meta-analysis to evaluate the effectiveness of ivermectin PC in reducing STH prevalence in endemic populations. METHODS We searched Pubmed, EMBASE, and Web of Science on February 14, 2023, for studies that investigated the effectiveness of ivermectin PC, either alone or in combination with other anthelmintic drugs, on STH infections, and provided a measure of STH prevalence before and after PC. We calculated pooled prevalence reductions for each STH using random-effects meta-analyses. Our protocol is available on PROSPERO (registration number CRD42023401219). RESULTS A total of 21 were eligible for the systematic review, of which 15 were eligible for meta-analysis. All studies delivered ivermectin through MDA. The pooled prevalence reduction of S. stercoralis following MDA with ivermectin alone was 84.49% (95% CI 54.96-94.66) across five studies and 81.37% (95% CI 61.62-90.96) across seven studies with or without albendazole. The prevalence reduction of T. trichiura was 49.93% (95% CI 18.23-69.34) across five studies with ivermectin alone, and 89.40% (95% CI 73.66-95.73) across three studies with the addition of albendazole. There was high heterogeneity for all syntheses (I2 > 65%). CONCLUSIONS This study underscores the key role of ivermectin-based MDA in addressing limitations in current global STH guidelines in terms of limited efficacy against S. stercoralis and T. trichiura. Based on these findings, revising international STH guidelines to include ivermectin is a promising option to progress the control and eventual elimination of STHs and other NTDs.
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Affiliation(s)
- Brandon Le
- The Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia.
| | - Naomi E Clarke
- The Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Nicolas Legrand
- The Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Susana Vaz Nery
- The Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
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Le B, Clarke NE, Hii SF, Byrne A, Khattak A, Lake S, Lazu E, Wickham S, Wand H, Olsen N, Zendejas-Heredia PA, Sokana O, Romani L, Engelman D, Nasi T, Boara D, Kaldor J, Steer A, Traub R, Nery SV. Effectiveness of one and two doses of ivermectin mass drug administration in reducing the prevalence and intensity of soil-transmitted helminth (STH) infections in Western Province, Solomon Islands: a cluster-randomised, before-after analysis. Lancet Reg Health West Pac 2024; 42:100942. [PMID: 38357395 PMCID: PMC10865046 DOI: 10.1016/j.lanwpc.2023.100942] [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: 05/23/2023] [Revised: 07/23/2023] [Accepted: 10/09/2023] [Indexed: 02/16/2024]
Abstract
Background Ivermectin mass drug administration (MDA) is effective for controlling onchocerciasis and scabies, with evidence supporting its role in some species of soil-transmitted helminth (STH) infections. In the context of RISE, a cluster-randomised trial for scabies, this study evaluated the effectiveness of ivermectin MDA in reducing STH burden in the Western Province of Solomon Islands. Methods Twenty villages were randomised 1:1 to receive ivermectin MDA as one dose (IVM-1) or two doses (IVM-2) for scabies. The effectiveness of one and two doses in reducing STH prevalence and intensity was evaluated before (May 2019) and 21 months after (February 2021) MDA in May 2019. All residents aged 12 months or older in the study villages were eligible to participate and provide stool specimens. Species-specific STH infection and intensity were assessed using quantitative PCR. We compared prevalence and intensity of infection between baseline and 21 months in each intervention arm individually using cluster-level analysis (adjusted for clustering) and individual-level analysis (adjusted for sex, age, and clustering). The primary outcomes were the prevalence risk difference (RD) from the cluster-level analysis, and the change in adjusted odds of infection from the individual-level analysis. Secondary outcomes included change in incident rates of mean eggs per gram (epg) of stool from baseline to 21 months, relative risk difference in prevalence and relative change in odds of infection between arms at 21 months. Sex data (male/female) were self-reported. Findings Overall, STH infection was assessed in 830 participants from 18 villages at baseline and 1172 from 20 villages at follow-up. Females represented 58% (n = 478) of the sample at baseline and 59% (n = 690) at follow-up. We observed a reduction in Strongyloides spp. prevalence following two doses of ivermectin MDA in the cluster-level analysis from 7.0% (32/458 participants) to 1.2% (8/674 participants), corresponding to a RD of -0.07 (95% CI -0.14 to -0.01, p = 0.036), and in the individual-level analysis (OR 0.11, 95% CI 0.04-0.33, p < 0.001). T. trichiura prevalence decreased following one dose from 19.4% (74/372 participants) to 11.7% (56/505 participants) (OR 0.44, 95% CI 0.26-0.73, p = 0.0040), while egg count reduced in both arms (IVM-1: IRR 0.28, 95% CI 0.11-0.70, p = 0.0070; IVM-2: IRR 0.18, 95% CI 0.08-0.40, p < 0.001), in the individual-level analysis. We did not detect a significant difference in effect measures between the one- and two-dose arms for any species after 21 months. Interpretation Our study highlights the long-term benefits of ivermectin MDA in reducing the burden of Strongyloides spp. and T. trichiura. STH control programs should leverage the geographical overlap of NTDs, existing drug distribution channels, and broad-spectrum agents. Funding The National Health and Medical Research Council of Australia.
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Affiliation(s)
- Brandon Le
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Naomi E. Clarke
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Sze Fui Hii
- The University of Melbourne, Melbourne, Australia
| | - Aisling Byrne
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Alam Khattak
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Susanna Lake
- Murdoch Children's Research Institute, Melbourne, Australia
| | | | | | - Handan Wand
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Nick Olsen
- Stats Central, University of New South Wales, Sydney, Australia
| | | | - Oliver Sokana
- Ministry of Health & Medical Services, Honiara, Solomon Islands
| | - Lucia Romani
- The Kirby Institute, University of New South Wales, Sydney, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Titus Nasi
- Ministry of Health & Medical Services, Honiara, Solomon Islands
| | | | - John Kaldor
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Andrew Steer
- Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Susana Vaz Nery
- The Kirby Institute, University of New South Wales, Sydney, Australia
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Dyer CE, Ng-Nguyen D, Clarke NE, Hii SF, Nguyen HQ, Nguyen VAT, Nguyen TV, Nguyen TV, Ngo TT, Herath HD, Wand H, Coffeng LE, Marshall JC, Gray DJ, Anderson RM, Clements AC, Kaldor JM, Traub RJ, Vaz Nery S. Community-wide versus school-based targeted deworming for soil-transmitted helminth control in school-aged children in Vietnam: the CoDe-STH cluster-randomised controlled trial. Lancet Reg Health West Pac 2023; 41:100920. [PMID: 37860203 PMCID: PMC10583164 DOI: 10.1016/j.lanwpc.2023.100920] [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: 08/20/2023] [Accepted: 09/15/2023] [Indexed: 10/21/2023]
Abstract
Background Soil-transmitted helminth (STH) infection control programs typically consist of school-based preventive chemotherapy (PC) targeted to school-aged children. STH reservoirs in untreated community members contribute to ongoing transmission in children. The CoDe-STH (Community Deworming against STH) trial, conducted in Dak Lak province, Vietnam, between October 2019 and November 2020, aimed to determine whether community-wide mass drug administration (MDA) is more effective than school-based targeted PC in reducing STH prevalence and intensity in children. Methods In this two-arm cluster randomised controlled trial, 64 primary schools were randomly assigned 1:1 to receive either school-based targeted PC ("school arm") or community-wide MDA ("community arm"). A single dose of albendazole 400 mg was used for deworming. The primary outcome was hookworm prevalence in schoolchildren, measured using quantitative real-time PCR. We also measured infection intensity for Necator americanus only, using qPCR cycle threshold (Ct) values converted into eggs per gram of faeces (EPG). Analysis was by intention to treat. The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619000309189). Findings The analysis included 4955 children in the school arm and 5093 children in the community arm. N. americanus was the dominant STH species. The relative reduction in hookworm prevalence was not significantly different between the school arm (30.1%, 95% confidence interval [CI] 20.5-36.9) and the community arm (34.6%, 95% CI 19.9-49.4). Due to lower baseline prevalence than expected, the study was underpowered to detect a difference in prevalence reduction between the study arms. The community arm showed significantly greater relative reduction in N. americanus infection intensity (56.0%, 95% CI 39.9-72.1) compared to the school arm (3.4%, 95% CI -24.7 to 31.4). The community arm also showed greater relative reduction in prevalence of moderate-to-heavy intensity (≥2000 EPG) N. americanus infections (81.1%; 95% CI 69.7-92.6) compared to the school arm (39.0%, 95% CI 13.7-64.2). Interpretation Although no impact was seen on overall prevalence, community-wide MDA was more effective in lowering N. americanus infection intensity in schoolchildren compared to school-based targeted PC, measured 12 months after one round of albendazole deworming with high coverage. Funding National Health and Medical Research Council, Australia (APP1139561).
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Affiliation(s)
- Clare E.F. Dyer
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Dinh Ng-Nguyen
- Faculty of Animal Sciences and Veterinary Medicine, Tay Nguyen University, Dak Lak, Vietnam
| | - Naomi E. Clarke
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Sze Fui Hii
- Faculty of Science, Melbourne Veterinary School, The University of Melbourne, Melbourne, Vic, Australia
| | - Hieu Quoc Nguyen
- Faculty of Animal Sciences and Veterinary Medicine, Tay Nguyen University, Dak Lak, Vietnam
| | - Van-Anh Thi Nguyen
- Faculty of Animal Sciences and Veterinary Medicine, Tay Nguyen University, Dak Lak, Vietnam
| | - Thai Van Nguyen
- Faculty of Animal Sciences and Veterinary Medicine, Tay Nguyen University, Dak Lak, Vietnam
| | - Trong Van Nguyen
- Faculty of Animal Sciences and Veterinary Medicine, Tay Nguyen University, Dak Lak, Vietnam
| | - Tam Thi Ngo
- Centers for Disease Control and Prevention, Dak Lak, Vietnam
| | - H.M.P. Dilrukshi Herath
- Faculty of Science, Melbourne Veterinary School, The University of Melbourne, Melbourne, Vic, Australia
| | - Handan Wand
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Luc E. Coffeng
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Darren J. Gray
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Roy M. Anderson
- Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom
| | - Archie C.A. Clements
- Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Telethon Kids Institute, Perth, WA, Australia
- Peninsula Medical School, University of Plymouth, Plymouth, United Kingdom
| | - John M. Kaldor
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Rebecca J. Traub
- Faculty of Science, Melbourne Veterinary School, The University of Melbourne, Melbourne, Vic, Australia
| | - Susana Vaz Nery
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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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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7
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Le B, Monteiro MAA, Amaral S, Wand H, Matthews A, Hii SF, Clarke NE, Arkell P, Yan J, Engelman D, Fancourt N, Fernandes JL, Steer A, Kaldor J, Traub R, Francis JR, Nery SV. The impact of ivermectin, diethylcarbamazine citrate, and albendazole mass drug administration on the prevalence of scabies and soil-transmitted helminths in school-aged children in three municipalities in Timor-Leste: a before-after assessment. Lancet Glob Health 2023; 11:e924-e932. [PMID: 37202027 DOI: 10.1016/s2214-109x(23)00134-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/07/2023] [Accepted: 02/27/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Integrated programmes that use combination mass drug administration (MDA) might improve control of multiple neglected tropical diseases simultaneously. We investigated the impact of Timor-Leste's national ivermectin, diethylcarbamazine citrate, and albendazole MDA, for lymphatic filariasis elimination and soil-transmitted helminth (STH) control, on scabies, impetigo, and STH infections. METHODS We did a before-after study in six primary schools across three municipalities in Timor-Leste (urban [Dili], semi-urban [Ermera], and rural [Manufahi]) before (April 23 to May 11, 2019) and 18 months after (Nov 9 to Nov 27, 2020) MDA delivery between May 17 and June 1, 2019. Study participants included schoolchildren, as well as infants, children, and adolescents who were incidentally present at school on study days. All schoolchildren whose parents provided consent were eligible to participate in the study. Infants, children, and adolescents younger than 19 years who were not enrolled in the school but were incidentally present at schools on study days were also eligible to participate if their parents consented. Ivermectin, diethylcarbamazine citrate, and albendazole MDA was implemented nationally, with single doses of oral ivermectin (200 μg/kg), diethylcarbamazine citrate (6 mg/kg), and albendazole (400 mg) administered by the Ministry of Health. Scabies and impetigo were assessed by clinical skin examinations, and STHs using quantitative PCR. The primary (cluster-level) analysis adjusted for clustering while the secondary (individual-level) analysis adjusted for sex, age, and clustering. The primary outcomes of the study were prevalence ratios for scabies, impetigo, and STHs (Trichuris trichiura, Ascaris lumbricoides, Necator americanus, and moderate-to-heavy A lumbricoides infections) between baseline and 18 months from the cluster-level analysis. FINDINGS At baseline, 1043 (87·7%) of 1190 children registered for the study underwent clinical assessment for scabies and impetigo. The mean age of those who completed skin examinations was 9·4 years (SD 2·4) and 514 (53·8%) of 956 were female (87 participants with missing sex data were excluded from this percentage calculation). Stool samples were received for 541 (45·5%) of 1190 children. The mean age of those for whom stool samples were received was 9·8 years (SD 2·2) and 300 (55·5%) were female. At baseline, 348 (33·4%) of 1043 participants had scabies, and 18 months after MDA, 133 (11·1%) of 1196 participants had scabies (prevalence ratio 0·38, 95% CI 0·18-0·88; p=0·020) in the cluster-level analysis. At baseline, 130 (12·5%) of 1043 participants had impetigo, compared with 27 (2·3%) of 1196 participants at follow-up (prevalence ratio 0·14, 95% CI 0·07-0·27; p<0·0001). There was a significant reduction in T trichiura prevalence from baseline (26 [4·8%] of 541 participants) to 18-month follow-up (four [0·6%] of 623 participants; prevalence ratio 0·16, 95% CI 0·04-0·66; p<0·0001). In the individual-level analysis, moderate-to-heavy A lumbricoides infections reduced from 54 (10·0%; 95% CI 0·7-19·6) of 541 participants to 28 (4·5%, 1·2-8·4) of 623 participants (relative reduction 53·6%; 95% CI 9·1-98·1; p=0·018). INTERPRETATION Ivermectin, diethylcarbamazine citrate, and albendazole MDA was associated with substantial reductions in prevalence of scabies, impetigo, and T trichiura, and of moderate-to-heavy intensity A lumbricoides infections. Combination MDA could be used to support integrated control programmes to target multiple NTDs. FUNDING National Health and Medical Research Council of Australia and the Department of Foreign Affairs and Trade Indo-Pacific Centre for Health Security. TRANSLATION For the Tetum translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Brandon Le
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | | | - Salvador Amaral
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Handan Wand
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Sze Fui Hii
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Naomi E Clarke
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Paul Arkell
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Jennifer Yan
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Daniel Engelman
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Nicholas Fancourt
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | | | - Andrew Steer
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Rebecca Traub
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Joshua R Francis
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Susana Vaz Nery
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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8
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Dyer CEF, Clarke NE, Nguyen DN, Herath HMPD, Hii SF, Pickford R, Traub RJ, Vaz Nery S. Assessing the efficacy of albendazole against hookworm in Vietnam using quantitative PCR and sodium nitrate flotation. PLoS Negl Trop Dis 2022; 16:e0010767. [PMID: 36315591 PMCID: PMC9668116 DOI: 10.1371/journal.pntd.0010767] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 11/16/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
Preventive chemotherapy (PC), consisting of the regular distribution of anthelmintics to populations or groups of populations at risk, is the primary tool used to control soil-transmitted helminth (STH) infections. This strategy, whilst cost-effective, raises the concern of potential emergence of drug resistance. The efficacy of anthelmintics against STH infections is measured using cure rate (CR) and egg reduction rate (ERR), using microscopy-based techniques such as the Kato-Katz thick smear. However, Kato-Katz has low sensitivity, especially for low-intensity infections, and requires fresh samples that need to be processed quickly. Realtime quantitative PCR (qPCR), which is more sensitive, is emerging as a "gold standard" for STH diagnostics given its higher sensitivity (important in low prevalence settings) and ability to differentiate hookworm species, while sodium nitrate flotation (SNF) may provide a low-cost more sensitive and practical alternative to Kato-Katz in the field. In this study, we examined the efficacy of a locally manufactured brand of albendazole 400 mg ("Alzental") against hookworm in Đắk Lắk province, Vietnam, using both qPCR and SNF. For qPCR, formulae to convert qPCR cycle threshold (Ct) values into eggs per gram of faeces (EPG) were utilised to determine efficacy calculations, and these values directly compared with efficacy values generated using SNF. Factors associated with CR and ERR were examined, and Alzental tablet quality was assessed by comparing with an Australian TGA-approved equivalent "Eskazole" tablet. We observed a CR and ERR of 64.9% and 87.5% respectively using qPCR, and 68.4% and 67.6% respectively using SNF. The tablet composition of Alzental was comparable to Eskazole in terms of active albendazole drug concentration with no evidence of impurities. This study demonstrates that the efficacy of Alzental against hookworm is within the range of previously reported studies for albendazole 400 mg. The study also demonstrates the value of qPCR and SNF as alternatives to standard Kato-Katz methodology for assessment of anthelmintic efficacy.
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Affiliation(s)
- Clare E. F. Dyer
- Kirby Institute, University of New South Wales, Sydney, Australia
- * E-mail:
| | - Naomi E. Clarke
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Dinh Ng Nguyen
- Faculty of Animal Sciences and Veterinary Medicine, Tay Nguyen University, Đắk Lắk, Vietnam
| | | | - Sze Fui Hii
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Victoria, Australia
| | - Russell Pickford
- Bioanalytical Mass Spectrometry Facility, University of New South Wales Analytical Centre, Sydney, Australia
| | - Rebecca J. Traub
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Victoria, Australia
| | - Susana Vaz Nery
- Kirby Institute, University of New South Wales, Sydney, Australia
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9
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Kurcheid J, Gordon CA, Clarke NE, Wangdi K, Kelly M, Lal A, Mutombo PN, Wang D, Mationg ML, Clements ACA, Muhi S, Bradbury RS, Biggs B, Page W, Williams G, McManus DP, Gray D. Neglected tropical diseases in Australia: a narrative review. Med J Aust 2022; 216:532-538. [DOI: 10.5694/mja2.51533] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/25/2021] [Accepted: 11/02/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Johanna Kurcheid
- Australian National University Canberra ACT
- Swiss Tropical and Public Health Institute Basel Switzerland
| | | | - Naomi E Clarke
- Australian National University Canberra ACT
- Kirby Institute University of New South Wales Sydney NSW
| | | | | | - Aparna Lal
- Australian National University Canberra ACT
| | - Polydor N Mutombo
- National Centre for Naturopathic Medicine Southern Cross University Lismore NSW
| | | | | | | | - Stephen Muhi
- Victorian Infectious Diseases Service Royal Melbourne Hospital Melbourne VIC
| | | | - Beverley‐Ann Biggs
- Victorian Infectious Diseases Service Royal Melbourne Hospital Melbourne VIC
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10
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Bartlett AW, Traub R, Amaral S, Hii SF, Clarke NE, Matthews A, Zendejas-Heredia PA, Arkell P, Monteiro MAA, da Conceicao V, da Costa Maia C, Soares MI, Prisca Guterres JD, Francis JR, Vaz Nery S. Comparison between Quantitative Polymerase Chain Reaction and Sodium Nitrate Flotation Microscopy in Diagnosing Soil-Transmitted Helminth Infections. Am J Trop Med Hyg 2021; 105:1210-1213. [PMCID: PMC8592210 DOI: 10.4269/ajtmh.21-0227] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2023] Open
Abstract
There is evolving interest in alternate microscopy techniques and quantitative polymerase chain reaction (qPCR) to evaluate soil-transmitted helminth (STH) burden. Using data from a cross-sectional survey of 540 schoolchildren across six primary schools in three municipalities of Timor-Leste, we compared the performance of microscopy using sodium nitrate flotation (SNF) and qPCR in determining STH prevalence and infection intensity. Prevalence by qPCR was higher than SNF for Ascaris lumbricoides (17.5% versus 11.2%), hookworm (8.3% versus 1.2%), and Trichuris trichiura (4.7% versus 1.6%). Agreement between SNF and qPCR was fair for hookworm (κ = 0.21) and moderate for A. lumbricoides (κ = 0.59) and T. trichiura (κ = 0.44). Moderate or heavy intensity infections were identified in 15.9% of infections detected by SNF, whereas qPCR identified 36.1% as moderate or heavy infections using cycle threshold to eggs per gram conversion formulas. Quantitative PCR is a promising diagnostic technique, though further studies validating infection intensity correlates are required.
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Affiliation(s)
- Adam W. Bartlett
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Rebecca Traub
- University of Melbourne, Parkville, Victoria, Australia
| | - Salvador Amaral
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Sze Fui Hii
- University of Melbourne, Parkville, Victoria, Australia
| | - Naomi E. Clarke
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | | | - Paul Arkell
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | | | | | | | | | | | - Joshua R. Francis
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Royal Darwin Hospital, Darwin, Australia
| | - Susana Vaz Nery
- Kirby Institute, University of New South Wales, Sydney, Australia
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11
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Byrne A, Manalo G, Clarke NE, Vaz Nery S. Impact of hookworm infection and preventive chemotherapy on haemoglobin in non-pregnant populations. Trop Med Int Health 2021; 26:1568-1592. [PMID: 34587315 DOI: 10.1111/tmi.13681] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the impact of hookworm infection and preventive chemotherapy on haemoglobin levels in non-pregnant populations in endemic areas. METHOD Systematic review and meta-analysis searching PubMed and Web of Science for articles published since 2010 reporting either hookworm prevalence and Hb concentration (cross-sectional studies) or Hb concentration before and after the implementation of preventive chemotherapy (before-after studies and randomised controlled trials [RCTs]). For papers published before 2010, data were extracted from a previously published systematic review. Random effects meta-analyses were conducted to examine the relationship between Hb concentration and hookworm infection intensity (from cross-sectional studies) and the effect of preventive chemotherapy on Hb concentration (from before-after studies and RCTs). Sensitivity analyses investigated the impact of malaria endemicity and combined interventions for schistosomiasis and nutrition status on Hb concentration. RESULTS Among cross-sectional studies, both light- and heavy-intensity hookworm infections were associated with lower Hb in school-aged children. School-aged children with heavy hookworm infection in settings of high malaria endemicity had lower mean Hb than those in settings of low malaria endemicity. In non-pregnant populations, deworming with albendazole was associated with an increase in Hb of 3.02 g/L (95% CI 0.1, 6.0 g/L). No additional benefit was seen with deworming using albendazole co-administered with praziquantel for schistosomiasis infection or iron supplementation for nutrition status. CONCLUSION Our findings confirm the benefits of preventive chemotherapy as a public health intervention.
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Affiliation(s)
- Aisling Byrne
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Giselle Manalo
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Naomi E Clarke
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Susana Vaz Nery
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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12
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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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13
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Aw JYH, Clarke NE, Mayfield HJ, Lau CL, Richardson A, Vaz Nery S. Novel statistical approaches to identify risk factors for soil-transmitted helminth infection in Timor-Leste. Int J Parasitol 2021; 51:729-739. [PMID: 33798561 PMCID: PMC8378505 DOI: 10.1016/j.ijpara.2021.01.005] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/31/2020] [Accepted: 01/03/2021] [Indexed: 12/02/2022]
Abstract
We compared logistic regression, recursive partitioning and Bayesian networks to identify risk factors for STH infection. Logistic regression identified fewest variables associated with STH infections compared with the two alternative methods. Recursive partitioning identified more demographic and WASH variables, and Bayesian networks more environmental variables. Model performance was similar across all three statistical techniques. Recursive partitioning can identify at-risk population subgroups, while Bayesian networks can run real-time scenarios.
Soil-transmitted helminths (STHs) are parasitic intestinal worms that infect almost a fifth of the global population. Sustainable control of STHs requires understanding the complex interaction of factors contributing to transmission. Identifying risk factors has mainly relied on logistic regression models where the underlying assumption of independence between variables is not always satisfied. Previously demonstrated risk factors including water, sanitation and hygiene (WASH) access and behaviours, and socioeconomic status are intrinsically linked. Similarly, environmental factors including climate, soil and land attributes are often strongly correlated. Alternative methods such as recursive partitioning and Bayesian networks can handle correlated variables, but there are no published studies comparing these methods with logistic regression in the context of STH risk factor analysis. Baseline cross-sectional data from school-aged children in the (S)WASH-D for Worms study were used to compare risk factors identified from modelling the same data using three different statistical techniques. Outcomes of interest were infection with Ascaris spp. and any hookworm species (Necator americanus, Ancylostoma duodenale, and Ancylostoma ceylanicum). Mixed-effects logistic regression identified the fewest risk factors. Recursive partitioning identified the most WASH and demographic risk factors, while Bayesian networks identified the most environmental risk factors. Recursive partitioning produced classification trees that visualised potentially at-risk population sub-groups. Bayesian networks helped visualise relationships between variables and enabled interactive modelling of outcomes based on different scenarios for the predictor variables of interest. Model performance was similar across all techniques. Risk factors identified across all techniques were vegetation for Ascaris spp., and cleaning oneself with water after defecating for hookworm. This study adds to the limited body of evidence exploring alternative data modelling approaches in identifying risk factors for STH infections. Our findings suggest these approaches can provide novel insights for more robust interpretation.
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Affiliation(s)
- Jessica Yi Han Aw
- Research School of Population Health, Australian National University, Canberra, Australia.
| | - Naomi E Clarke
- Research School of Population Health, Australian National University, Canberra, Australia; Kirby Institute, University of New South Wales, Sydney, Australia
| | - Helen J Mayfield
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Colleen L Lau
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Alice Richardson
- Statistical Consulting Unit, Australian National University, Canberra, Australia
| | - Susana Vaz Nery
- Kirby Institute, University of New South Wales, Sydney, Australia
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14
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Clarke NE, Dyer CEF, Amaral S, Tan G, Vaz Nery S. Improving Uptake and Sustainability of Sanitation Interventions in Timor-Leste: A Case Study. Int J Environ Res Public Health 2021; 18:ijerph18031013. [PMID: 33498840 PMCID: PMC7908170 DOI: 10.3390/ijerph18031013] [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] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/17/2022]
Abstract
Open defecation (OD) is still a significant public health challenge worldwide. In Timor-Leste, where an estimated 20% of the population practiced OD in 2017, increasing access and use of improved sanitation facilities is a government priority. Community-led total sanitation (CLTS) has become a popular strategy to end OD since its inception in 2000, but evidence on the uptake of CLTS and related interventions and the long-term sustainability of OD-free (ODF) communities is limited. This study utilized a mixed-methods approach, encompassing quantitative monitoring and evaluation data from water, sanitation, and hygiene (WASH) agencies, and semi-structured interviews with staff working for these organizations and the government Department of Environmental Health, to examine sanitation interventions in Timor-Leste. Recommendations from WASH practitioners on how sanitation strategies can be optimized to ensure ODF sustainability are presented. Whilst uptake of interventions is generally good in Timor-Leste, lack of consistent monitoring and evaluation following intervention delivery may contribute to the observed slippage back to OD practices. Stakeholder views suggest that long-term support and monitoring after ODF certification are needed to sustain ODF communities.
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Affiliation(s)
- Naomi E Clarke
- Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia; (N.E.C.); (C.E.F.D.)
- Research School of Population Health, College of Health & Medicine, The Australian National University, Canberra, ACT 2601, Australia; (S.A.); (G.T.)
| | - Clare E F Dyer
- Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia; (N.E.C.); (C.E.F.D.)
| | - Salvador Amaral
- Research School of Population Health, College of Health & Medicine, The Australian National University, Canberra, ACT 2601, Australia; (S.A.); (G.T.)
- Menzies School of Health Research, Charles Darwin University, John Mathews Building, Royal Darwin Hospital Campus, Tiwi, NT 0810, Australia
| | - Garyn Tan
- Research School of Population Health, College of Health & Medicine, The Australian National University, Canberra, ACT 2601, Australia; (S.A.); (G.T.)
| | - Susana Vaz Nery
- Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia; (N.E.C.); (C.E.F.D.)
- Research School of Population Health, College of Health & Medicine, The Australian National University, Canberra, ACT 2601, Australia; (S.A.); (G.T.)
- Correspondence: ; Tel.: +61-(2)-9385-0867
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15
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Clarke NE, Doi SAR, Wangdi K, Chen Y, Clements ACA, Nery SV. Efficacy of Anthelminthic Drugs and Drug Combinations Against Soil-transmitted Helminths: A Systematic Review and Network Meta-analysis. Clin Infect Dis 2020; 68:96-105. [PMID: 29788074 DOI: 10.1093/cid/ciy423] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/11/2018] [Indexed: 12/30/2022] Open
Abstract
Background Periodic mass distribution of benzimidazole anthelminthic drugs is the key strategy to control soil-transmitted helminths (STHs) globally. However, benzimidazoles have low efficacy against Trichuris trichiura, and there are concerns about benzimidazole resistance potentially emerging in humans. Therefore, identifying alternative drug regimens is a pressing priority. We present a systematic review and network meta-analysis comparing the efficacy of 21 different anthelminthic drug regimens, including standard, novel, and combination treatments. Methods We searched PubMed, Medline, Embase, Web of Science, and Cochrane databases and identified studies comparing anthelminthic treatments to each other or placebo. The outcomes calculated were relative risk (RR) of cure and difference in egg reduction rates (dERR). We used an automated generalized pairwise modeling framework to generate mixed treatment effects against a common comparator, the current standard treatment (single-dose albendazole). Results Our search identified 4876 studies, of which 114 were included in the meta-analysis. Results identified several drug combinations with higher efficacy than single-dose albendazole for T. trichiura, including albendazole-ivermectin (RR of cure, 3.22 [95% confidence interval {CI}, 1.84-5.63]; dERR, 0.97 [95% CI, .21-1.74]), albendazole-oxantel pamoate (RR, 5.07 [95% CI, 1.65-15.59]; dERR, 0.51 [95% CI, .50-.52]), mebendazole-ivermectin (RR, 3.37 [95% CI, 2.20-5.16]), and tribendimidine-oxantel pamoate (RR, 4.06 [95% CI, 1.30-12.64]). Conclusions There are several promising drug combinations that may enhance the impact of STH control programs on T. trichiura, without compromising efficacy against Ascaris lumbricoides and hookworm. We suggest further, large-scale trials of these drug combinations and consideration of their use in STH control programs where T. trichiura is present. International Prospective Register of Systematic Reviews Registration CRD42016050739.
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Affiliation(s)
- Naomi E Clarke
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory
| | - Suhail A R Doi
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory.,Department of Population Medicine, College of Medicine, Qatar University, Doha
| | - Kinley Wangdi
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory
| | - Yingxi Chen
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory
| | - Archie C A Clements
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory.,Faculty of Health Sciences, Curtin University, Perth, Western Australia
| | - Susana V Nery
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory.,Kirby Institute, University of New South Wales, Sydney, Australia
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16
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Vaz Nery S, Traub RJ, McCarthy JS, Clarke NE, Amaral S, Llewellyn S, Weking E, Richardson A, Campbell SJ, Gray DJ, Vallely AJ, Williams GM, Andrews RM, Clements ACA. WASH for WORMS: A Cluster-Randomized Controlled Trial of the Impact of a Community Integrated Water, Sanitation, and Hygiene and Deworming Intervention on Soil-Transmitted Helminth Infections. Am J Trop Med Hyg 2020; 100:750-761. [PMID: 30628573 DOI: 10.4269/ajtmh.18-0705] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Water, sanitation, and hygiene (WASH) interventions have been proposed as an important complement to deworming programs for sustainable control of soil-transmitted helminth (STH) infections. We aimed to determine whether a community-based WASH program had additional benefits in reducing STH infections compared with community deworming alone. We conducted the WASH for WORMS cluster-randomized controlled trial in 18 rural communities in Timor-Leste. Intervention communities received a WASH intervention that provided access to an improved water source, promoted improved household sanitation, and encouraged handwashing with soap. All eligible community members in intervention and control arms received albendazole every 6 months for 2 years. The primary outcomes were infection with each STH, measured using multiplex real-time quantitative polymerase chain reaction. We compared outcomes between study arms using generalized linear mixed models, accounting for clustering at community, household, and individual levels. At study completion, the integrated WASH and deworming intervention did not have an effect on infection with Ascaris spp. (relative risk [RR] 2.87, 95% confidence interval [CI]: 0.66-12.48, P = 0.159) or Necator americanus (RR 0.99, 95% CI: 0.52-1.89, P = 0.987), compared with deworming alone. At the last follow-up, open defecation was practiced by 66.1% (95% CI: 54.2-80.2) of respondents in the control arm versus 40.2% (95% CI: 25.3-52.6) of respondents in the intervention arm (P = 0.005). We found no evidence that the WASH intervention resulted in additional reductions in STH infections beyond that achieved with deworming alone over the 2-year trial period. The role of WASH on STH infections over a longer period of time and in the absence of deworming remains to be determined.
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Affiliation(s)
- Susana Vaz Nery
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia.,Research School of Population Health, Australian National University, Canberra, Australia
| | - Rebecca J Traub
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, Australia
| | - James S McCarthy
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Naomi E Clarke
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Salvador Amaral
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Stacey Llewellyn
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Alice Richardson
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Suzy J Campbell
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Darren J Gray
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Andrew J Vallely
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | - Gail M Williams
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.,Research School of Population Health, Australian National University, Canberra, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Perth, Australia.,Research School of Population Health, Australian National University, Canberra, Australia
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17
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Aw JYH, Clarke NE, McCarthy JS, Traub RJ, Amaral S, Huque MH, Andrews RM, Gray DJ, Clements ACA, Vaz Nery S. Giardia duodenalis infection in the context of a community-based deworming and water, sanitation and hygiene trial in Timor-Leste. Parasit Vectors 2019; 12:491. [PMID: 31627736 PMCID: PMC6798381 DOI: 10.1186/s13071-019-3752-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 08/07/2019] [Accepted: 10/14/2019] [Indexed: 12/26/2022] Open
Abstract
Background Giardiasis is a common diarrhoeal disease caused by the protozoan Giardia duodenalis. It is prevalent in low-income countries in the context of inadequate access to water, sanitation and hygiene (WASH), and is frequently co-endemic with neglected tropical diseases such as soil-transmitted helminth (STH) infections. Large-scale periodic deworming programmes are often implemented in these settings; however, there is limited evidence for the impact of regular anthelminthic treatment on G. duodenalis infection. Additionally, few studies have examined the impact of WASH interventions on G. duodenalis. Methods The WASH for WORMS cluster randomised controlled trial was conducted in remote communities in Manufahi municipality, Timor-Leste, between 2012 and 2016. All study communities received four rounds of deworming with albendazole at six-monthly intervals. Half were randomised to additionally receive a community-level WASH intervention following study baseline. We measured G. duodenalis infection in study participants every six months for two years, immediately prior to deworming, as a pre-specified secondary outcome of the trial. WASH access and behaviours were measured using questionnaires. Results There was no significant change in G. duodenalis prevalence in either study arm between baseline and the final study follow-up. We found no additional benefit of the community-level WASH intervention on G. duodenalis infection (relative risk: 1.05, 95% CI: 0.72–1.54). Risk factors for G. duodenalis infection included living in a household with a child under five years of age (adjusted odds ratio, aOR: 1.35, 95% CI: 1.04–1.75), living in a household with more than six people (aOR: 1.32, 95% CI: 1.02–1.72), and sampling during the rainy season (aOR: 1.23, 95% CI: 1.04–1.45). Individuals infected with the hookworm Necator americanus were less likely to have G. duodenalis infection (aOR: 0.71, 95% CI: 0.57–0.88). Conclusions Prevalence of G. duodenalis was not affected by a community WASH intervention or by two years of regular deworming with albendazole. Direct household contacts appear to play a dominant role in driving transmission. We found evidence of antagonistic effects between G. duodenalis and hookworm infection, which warrants further investigation in the context of global deworming efforts. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12614000680662. Registered 27 June 2014, retrospectively registered. https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366540.![]()
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Affiliation(s)
- Jessica Y H Aw
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Naomi E Clarke
- Research School of Population Health, Australian National University, Canberra, ACT, Australia. .,The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW, Australia.
| | - James S McCarthy
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Rebecca J Traub
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Salvador Amaral
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Md Hamidul Huque
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW, Australia
| | - Ross M Andrews
- Research School of Population Health, Australian National University, Canberra, ACT, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Darren J Gray
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Archie C A Clements
- Research School of Population Health, Australian National University, Canberra, ACT, Australia.,Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Susana Vaz Nery
- Research School of Population Health, Australian National University, Canberra, ACT, Australia.,The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW, Australia
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Clarke NE, Ng-Nguyen D, Traub RJ, Clements ACA, Halton K, Anderson RM, Gray DJ, Coffeng LE, Kaldor JM, Vaz Nery S. A cluster-randomised controlled trial comparing school and community-based deworming for soil transmitted helminth control in school-age children: the CoDe-STH trial protocol. BMC Infect Dis 2019; 19:822. [PMID: 31533666 PMCID: PMC6751595 DOI: 10.1186/s12879-019-4449-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 08/20/2019] [Accepted: 09/10/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Current guidelines and targets for soil-transmitted helminth (STH) control focus on school-based deworming for school-age children, given the high risk of associated morbidity in this age group. However, expanding deworming to all age groups may achieve improved STH control among both the community in general and school-age children, by reducing their risk of reinfection. This trial aims to compare school-based targeted deworming with community-wide mass deworming in terms of impact on STH infections among school-age children. METHODS The CoDe-STH (Community Deworming against STH) trial is a cluster-randomised controlled trial (RCT) in 64 primary schools in Dak Lak province, Vietnam. The control arm will receive one round of school-based targeted deworming with albendazole, while in the intervention arm, community-wide mass deworming with albendazole will be implemented alongside school-based deworming. Prevalence of STH infections will be measured in school-age children at baseline and 12 months following deworming. The primary outcome is hookworm prevalence in school-age children at 12 months, by quantitative PCR. Analysis will be intention-to-treat, with outcomes compared between study arms using generalised linear and non-linear mixed models. Additionally, cost-effectiveness of mass and targeted deworming will be calculated and compared, and focus group discussions and interviews will be used to assess acceptability and feasibility of deworming approaches. Individual based stochastic models will be used to predict the impact of mass and targeted deworming strategies beyond the RCT timeframe to assess the likelihood of parasite population 'bounce-back' if deworming is ceased due to low STH prevalence. DISCUSSION The first large-scale trial comparing mass and targeted deworming for STH control in South East Asia will provide key information for policy makers regarding the optimal design of STH control programs. TRIAL REGISTRATION ACTRN12619000309189 .
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Affiliation(s)
- Naomi E Clarke
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia.
| | - Dinh Ng-Nguyen
- Faculty of Animal Sciences and Veterinary Medicine, Tay Nguyen University, Dak Lak, Vietnam
| | - Rebecca J Traub
- 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
| | - Kate Halton
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, 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 Center Rotterdam, Rotterdam, The Netherlands
| | - John M Kaldor
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | - Susana Vaz Nery
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
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19
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Banks E, Joshy G, Korda RJ, Stavreski B, Soga K, Egger S, Day C, Clarke NE, Lewington S, Lopez AD. Tobacco smoking and risk of 36 cardiovascular disease subtypes: fatal and non-fatal outcomes in a large prospective Australian study. BMC Med 2019; 17:128. [PMID: 31266500 PMCID: PMC6607519 DOI: 10.1186/s12916-019-1351-4] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/24/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Tobacco smoking is a leading cause of cardiovascular disease (CVD) morbidity and mortality. Evidence on the relation of smoking to different subtypes of CVD, across fatal and non-fatal outcomes, is limited. METHODS A prospective study of 188,167 CVD- and cancer-free individuals aged ≥ 45 years from the Australian general population joining the 45 and Up Study from 2006 to 2009, with linked questionnaire, hospitalisation and death data up to the end of 2015. Hazard ratios (HRs) for hospitalisation with or mortality from CVD among current and past versus never smokers were estimated, including according to intensity and recency of smoking, using Cox regression, adjusting for age, sex, urban/rural residence, alcohol consumption, income and education. Population-attributable fractions were estimated. RESULTS During a mean 7.2 years follow-up (1.35 million person-years), 27,511 (crude rate 20.4/1000 person-years) incident fatal and non-fatal major CVD events occurred, including 4548 (3.2) acute myocardial infarction (AMI), 3991 (2.8) cerebrovascular disease, 3874 (2.7) heart failure and 2311 (1.6) peripheral arterial disease (PAD) events. At baseline, 8% of participants were current and 34% were past smokers. Of the 36 most common specific CVD subtypes, event rates for 29 were increased significantly in current smokers. Adjusted HRs in current versus never smokers were as follows: 1.63 (95%CI 1.56-1.71) for any major CVD, 2.45 (2.22-2.70) for AMI, 2.16 (1.93-2.42) for cerebrovascular disease, 2.23 (1.96-2.53) for heart failure, 5.06 (4.47-5.74) for PAD, 1.50 (1.24-1.80) for paroxysmal tachycardia, 1.31 (1.20-1.44) for atrial fibrillation/flutter, 1.41 (1.17-1.70) for pulmonary embolism, 2.79 (2.04-3.80) for AMI mortality, 2.26 (1.65-3.10) for cerebrovascular disease mortality and 2.75 (2.37-3.19) for total CVD mortality. CVD risks were elevated at almost all levels of current smoking intensity examined and increased with smoking intensity, with HRs for total CVD mortality in current versus never smokers of 1.92 (1.11-3.32) and 4.90 (3.79-6.34) for 4-6 and ≥ 25 cigarettes/day, respectively. Risks diminished with quitting, with excess risks largely avoided by quitting before age 45. Over one third of CVD deaths and one quarter of acute coronary syndrome hospitalisations in Australia aged < 65 can be attributed to smoking. CONCLUSIONS Current smoking increases the risk of virtually all CVD subtypes, at least doubling the risk of many, including AMI, cerebrovascular disease and heart failure. Paroxysmal tachycardia is a newly identified smoking-related risk. Where comparisons are possible, smoking-associated relative risks for fatal and non-fatal outcomes are similar. Quitting reduces the risk substantially. In an established smoking epidemic, with declining and low current smoking prevalence, smoking accounts for a substantial proportion of premature CVD events.
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Affiliation(s)
- Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Mills Road, Acton, ACT, 2601, Australia. .,The Sax Institute, Sydney, Australia.
| | - Grace Joshy
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Mills Road, Acton, ACT, 2601, Australia
| | - Rosemary J Korda
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Mills Road, Acton, ACT, 2601, Australia
| | - Bill Stavreski
- National Heart Foundation of Australia, Melbourne, Australia
| | - Kay Soga
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Mills Road, Acton, ACT, 2601, Australia
| | - Sam Egger
- Cancer Council NSW, Sydney, Australia
| | - Cathy Day
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Mills Road, Acton, ACT, 2601, Australia
| | - Naomi E Clarke
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Mills Road, Acton, ACT, 2601, Australia
| | - Sarah Lewington
- Clinical Trials Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alan D Lopez
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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20
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Vaz Nery S, Clarke NE, Richardson A, Traub R, McCarthy JS, Gray DJ, Vallely AJ, Williams GM, Andrews RM, Campbell SJ, Clements ACA. Risk factors for infection with soil-transmitted helminths during an integrated community level water, sanitation, and hygiene and deworming intervention in Timor-Leste. Int J Parasitol 2019; 49:389-396. [PMID: 30802450 DOI: 10.1016/j.ijpara.2018.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 08/08/2018] [Revised: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 01/21/2023]
Abstract
Water, sanitation and hygiene interventions have been advocated as important complements to deworming programs to improve soil-transmitted helminth control. Evidence for the impact of water, sanitation and hygiene on soil-transmitted helminth infections is mixed, and based mainly on cross-sectional studies. In this study, we assessed associations between individual- and household-level water, sanitation and hygiene variables and soil-transmitted helminth infections, using data collected during the 2 year follow-up study period of the WASH for WORMS randomised controlled trial in Timor-Leste. Data were collected across four surveys, conducted at 6 monthly intervals in 23 communities. We analysed water, sanitation and hygiene and sociodemographic variables as risk factors for infection with Necator americanus, Ascaris spp., and undifferentiated soil-transmitted helminth infection, using generalised linear mixed models to account for clustering at community, household and participant levels. Water, sanitation and hygiene risk factors were examined both concurrently and with a 6 month lag period that coincided with the most recent deworming. The analysis included 2333 participants. Factors associated with N. americanus infection included age group, male sex (adjusted odds ratio (aOR) 3.1, 95% confidence interval (CI) 2.4-4.2), working as a farmer (aOR 1.7, 95% CI 1.2-2.4), and completing secondary school or higher (aOR 0.29, 95% CI 0.16-0.53). Risk factors for Ascaris spp. infection included age group, living in a dwelling with more than six people (aOR 1.6, 95% CI 1.1-2.3), having a tube well or borehole as the household water source (aOR 3.7, 95% CI 1.3-10.8), and using a latrine shared between households 6 months previously (aOR 2.3, 95% CI 1.2-4.3). Handwashing before eating was protective against infection with any soil-transmitted helminth (aOR 0.79, 95% CI 0.65-0.95). In the context of regular deworming, few water, sanitation and hygiene-related factors were associated with soil-transmitted helminth infections. Future research examining the role of water, sanitation and hygiene in soil-transmitted helminth transmission is required, particularly in low transmission settings after cessation of deworming. Identifying improved indicators for measuring water, sanitation and hygiene behaviours is also a key priority.
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Affiliation(s)
- Susana Vaz Nery
- Research School of Population Health, Australian National University, Canberra ACT 0200, Australia.
| | - Naomi E Clarke
- Research School of Population Health, Australian National University, Canberra ACT 0200, Australia
| | - Alice Richardson
- Research School of Population Health, Australian National University, Canberra ACT 0200, Australia
| | - Rebecca Traub
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, VIC 3052, Australia
| | - James S McCarthy
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia; School of Medicine, University of Queensland, Brisbane, QLD 4006, Australia
| | - Darren J Gray
- Research School of Population Health, Australian National University, Canberra ACT 0200, Australia
| | - Andrew J Vallely
- Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
| | - Gail M Williams
- School of Public Health, University of Queensland, Brisbane, QLD 4006, Australia
| | - Ross M Andrews
- Research School of Population Health, Australian National University, Canberra ACT 0200, Australia; Menzies School of Health Research, Charles Darwin University, Darwin, NT 0811, Australia
| | - Suzy J Campbell
- Research School of Population Health, Australian National University, Canberra ACT 0200, Australia
| | - Archie C A Clements
- Research School of Population Health, Australian National University, Canberra ACT 0200, Australia
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21
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Clarke NE, Llewellyn S, Traub RJ, McCarthy J, Richardson A, Nery SV. Quantitative Polymerase Chain Reaction for Diagnosis of Soil-Transmitted Helminth Infections: A Comparison with a Flotation-Based Technique and an Investigation of Variability in DNA Detection. Am J Trop Med Hyg 2018; 99:1033-1040. [PMID: 30062984 PMCID: PMC6159597 DOI: 10.4269/ajtmh.18-0356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/24/2018] [Indexed: 11/07/2022] Open
Abstract
Appropriate diagnostic techniques are crucial to global soil-transmitted helminth (STH) control efforts. The recommended Kato-Katz method has low sensitivity in low-transmission settings. Quantitative polymerase chain reaction (qPCR) is a highly sensitive alternative diagnostic option. However, little is known about the variability in qPCR results, and there are few published comparisons between qPCR and other microscopy-based techniques such as sodium nitrate flotation (SNF). Using 865 stool samples collected from 571 individuals, we compared SNF and qPCR in terms of diagnostic sensitivity and infection intensity measurements. In addition, we conducted repeated examinations on a single Necator americanus-positive stool sample over a 6-month period. Results showed good diagnostic agreement between SNF and qPCR for Ascaris spp. (κ = 0.69, P < 0.001), and moderate agreement for hookworm (κ = 0.55, P < 0.001) and Trichuris spp. (κ = 0.50, P < 0.001). Quantitative polymerase chain reaction demonstrated higher sensitivity than SNF for Ascaris spp. (94.1% versus 68.1%) and hookworm (75.7% versus 66.9%) but not for Trichuris spp. (53.1% versus 81.3%), which had very low prevalence. Sodium nitrate flotation and qPCR infection intensity measurements were strongly correlated for Ascaris spp. (ρ = 0.82, P < 0.001) and moderately correlated for hookworm (ρ = 0.58, P < 0.001). Repeated examinations using qPCR showed that N. americanus cycle threshold values decreased significantly at 1 month and remained stable thereafter. Results confirm the high diagnostic sensitivity of qPCR for Ascaris spp. and hookworm, particularly for light-intensity infections, which is ideal for settings approaching transmission elimination. Results support the potential for qPCR to be used as a quantitative assay for STH. Further research is needed in settings where Trichuris trichiura is endemic.
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Affiliation(s)
- Naomi E. Clarke
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Stacey Llewellyn
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Rebecca J. Traub
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Australia
| | - James McCarthy
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Alice Richardson
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Susana V. Nery
- Research School of Population Health, Australian National University, Canberra, Australia
- Kirby Institute, University of New South Wales, Sydney, Australia
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22
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Vaz Nery S, Qi J, Llewellyn S, Clarke NE, Traub R, Gray DJ, Vallely AJ, Williams GM, Andrews RM, McCarthy JS, Clements ACA. Use of quantitative PCR to assess the efficacy of albendazole against Necator americanus and Ascaris spp. in Manufahi District, Timor-Leste. Parasit Vectors 2018; 11:373. [PMID: 29954461 PMCID: PMC6025744 DOI: 10.1186/s13071-018-2838-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 10/02/2017] [Accepted: 04/09/2018] [Indexed: 11/21/2022] Open
Abstract
Background Soil-transmitted helminths (STHs) including Ascaris lumbricoides, Necator americanus, Ancylostoma spp. and Trichuris trichiura are cause of significant global morbidity. To mitigate their disease burden, at-risk groups in endemic regions receive periodic mass drug administration using anthelmintics, most commonly albendazole and mebendazole. Assessing the efficacy of anthelmintic drugs is important for confirming that these regimens are working effectively and that drug resistance has not emerged. In this study we aimed to characterise the therapeutic efficacy of albendazole against Ascaris spp. and N. americanus in Timor-Leste, using a quantitative polymerase chain reaction (qPCR) method for parasite detection and quantification. Results A total of 314 participants from 8 communities in Timor-Leste provided stool samples before and 10–14 days after the administration of a single 400 mg dose of albendazole. Helminth infection status and infection intensity (measured in Ct-values and relative fluorescence units) were determined using qPCR. Efficacy was determined by examining the cure rates and infection intensity reduction rates. Albendazole was found to be highly efficacious against Ascaris spp., with a cure rate of 91.4% (95% CI: 85.9–95.2%) and infection intensity reduction rate of 95.6% (95% CI: 88.3–100%). The drug was less efficacious against N. americanus with a cure rate of 58.3% (95% CI: 51.4–64.9%) and infection intensity reduction rate of 88.9% (95% CI: 84.0–97.0%). Conclusions The observed cure rates and infection intensity reduction rates obtained for Ascaris spp. and to a lower extent N. americanus, demonstrate the continued efficacy of albendazole against these species and its utility as a mass chemotherapy agent in Timor-Leste. Furthermore, this study demonstrates the usefulness of qPCR as a method to measure the efficacy of anthelminthic drugs. Additional research is necessary to translate Ct-values into eggs per gram in a systematic way. Trial registration Australian and New Zealand Clinical Trials Registry 12614000680662 (registered 27 June 2014).
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Affiliation(s)
- Susana Vaz Nery
- Research School of Population Health, Australian National University, 62 Mills Rd, Canberra, 2601, ACT, Australia. .,Present Address: Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, 2052, NSW, Australia.
| | - Jessica Qi
- Medical School, Australian National University, Building 42, Canberra, ACT, 2601, Australia
| | - Stacey Llewellyn
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Brisbane, QLD 4006, Australia
| | - Naomi E Clarke
- Research School of Population Health, Australian National University, 62 Mills Rd, Canberra, 2601, ACT, Australia
| | - Rebecca Traub
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Darren J Gray
- Research School of Population Health, Australian National University, 62 Mills Rd, Canberra, 2601, ACT, Australia
| | - Andrew J Vallely
- Kirby Institute, University of New South Wales, Wallace Wurth Building, Sydney, 2052, NSW, Australia
| | - Gail M Williams
- School of Public Health, The University of Queensland, Corner of Herston Road and Wyndham Street, Brisbane, QLD 4006, Australia
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT 0811, Australia
| | - James S McCarthy
- Clinical Tropical Medicine Laboratory, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Brisbane, QLD 4006, Australia
| | - Archie C A Clements
- Research School of Population Health, Australian National University, 62 Mills Rd, Canberra, 2601, ACT, Australia
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Vaz Nery S, Bennett I, Clarke NE, Lin A, Rahman Z, Rahman M, Clements ACA. Characterisation of environmental enteropathy biomarkers and associated risk factors in children in the context of a WASH trial in Timor-Leste. Int J Hyg Environ Health 2018; 221:901-906. [PMID: 29891218 DOI: 10.1016/j.ijheh.2018.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 03/23/2018] [Revised: 05/23/2018] [Accepted: 05/28/2018] [Indexed: 01/24/2023]
Abstract
Environmental enteropathy (EE) is characterised by subclinical inflammation and hyperpermeability of the small intestine, hypothesised to be caused by recurrent ingestion of faecal bacteria. It has been suggested that EE may be a contributor to malnutrition and growth delays seen in children living in unsanitary conditions. We measured putative faecal EE markers myeloperoxidase (MPO) (ng/mL) and alpha-1-antitrypsin (AAT) (mg/g) in stool samples collected from 133 children aged 1-5 years in 16 communities enrolled in the WASH for WORMS randomised controlled trial in Timor-Leste. Samples were collected two years after a community-wide water, sanitation and hygiene (WASH) intervention that was integrated with regular deworming. Mixed effects multivariable linear regression models were used to examine the impact of the study intervention and of various WASH and infection-related factors on EE biomarkers. Children who lived in communities that received both the WASH intervention and deworming had similar AAT values as those who lived in communities that received only deworming (regression coefficient -0.14, p = 0.583), but they had a trend towards lower MPO values (coeff -0.51, p = 0.055). Younger children showed significantly higher MPO levels (coeff: -0.29, p = 0.002). No WASH variables or parasitic infections were associated with AAT levels. Household water being stored in covered containers was associated with lower MPO levels (coeff -1.75, p = 0.046). We found little evidence that a community-based WASH intervention had an impact on EE over a two-year period.
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Affiliation(s)
- Susana Vaz Nery
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.
| | - Isaac Bennett
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Naomi E Clarke
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Audrie Lin
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California, USA
| | - Ziaur Rahman
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Mahbubur Rahman
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Archie C A Clements
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
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Clarke NE, Clements ACA, Amaral S, Richardson A, McCarthy JS, McGown J, Bryan S, Gray DJ, Nery SV. (S)WASH-D for Worms: A pilot study investigating the differential impact of school- versus community-based integrated control programs for soil-transmitted helminths. PLoS Negl Trop Dis 2018; 12:e0006389. [PMID: 29723193 PMCID: PMC5933686 DOI: 10.1371/journal.pntd.0006389] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 08/14/2017] [Accepted: 03/16/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Soil-transmitted helminths (STH) infect nearly 1.5 billion individuals globally, and contribute to poor physical and cognitive development in children. STH control programs typically consist of regular delivery of anthelminthic drugs, targeting school-aged children. Expanding STH control programs community-wide may improve STH control among school-aged children, and combining deworming with improvements to water, sanitation and hygiene (WASH) may further reduce transmission. The (S)WASH-D for Worms pilot study aims to compare the differential impact of integrated WASH and deworming programs when implemented at primary schools only versus when additionally implemented community-wide. METHODOLOGY/PRINCIPAL FINDINGS A two-arm, non-randomized cluster intervention study was conducted. Six communities were identified by partner WASH agencies and enrolled in the study. All communities received a school-based WASH and deworming program, while three additionally received a community-based WASH and deworming program. STH infections were measured in school-aged children at baseline and six months after deworming. Over 90% of eligible children were recruited for the study, of whom 92.3% provided stool samples at baseline and 88.9% at follow-up. The school WASH intervention improved school sanitation, while the community WASH intervention reduced open defecation from 50.4% (95% CI 41.8-59.0) to 23.5% (95% CI 16.7-32.0). There was a trend towards reduced odds of N. americanus infection among children who received the community-wide intervention (OR 0.42, 95% CI 0.07-2.36, p = 0.32). CONCLUSIONS This pilot study provides proof of principle for testing the hypothesis that community-wide STH control programs have a greater impact on STH infections among children than school-based programs, and supports the rationale for conducting a full-scale cluster randomized controlled trial. High recruitment and participation rates and successful implementation of school WASH programs demonstrate study feasibility and acceptability. However, eliminating open defecation remains a challenge; ongoing work is required to develop community sanitation programs that achieve high and sustainable latrine coverage. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12615001012561.
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Affiliation(s)
- Naomi E. Clarke
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Archie C. A. Clements
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Salvador Amaral
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Alice Richardson
- Research School of Population Health, Australian National University, Canberra, Australia
| | | | - John McGown
- Plan International Timor-Leste, Dili, Timor-Leste
| | | | - Darren J. Gray
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Susana V. Nery
- Research School of Population Health, Australian National University, Canberra, Australia
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Clarke NE, Doi SA, Clements AC, Gray D, Campbell S, Wang D, Nery SV. The expansion of soil-transmitted helminth control strategies - Authors' reply. Lancet 2017; 389:2191. [PMID: 28589892 DOI: 10.1016/s0140-6736(17)31343-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/27/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Naomi E Clarke
- Research School of Population Health, Australian National University, Acton, ACT 2601, Australia.
| | - Suhail A Doi
- Research School of Population Health, Australian National University, Acton, ACT 2601, Australia
| | - Archie C Clements
- Research School of Population Health, Australian National University, Acton, ACT 2601, Australia
| | - Darren Gray
- Research School of Population Health, Australian National University, Acton, ACT 2601, Australia
| | - Suzy Campbell
- Research School of Population Health, Australian National University, Acton, ACT 2601, Australia
| | - Dongxu Wang
- Research School of Population Health, Australian National University, Acton, ACT 2601, Australia
| | - Susana V Nery
- Research School of Population Health, Australian National University, Acton, ACT 2601, Australia
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Clarke NE, Clements ACA, Doi SA, Wang D, Campbell SJ, Gray D, Nery SV. Differential effect of mass deworming and targeted deworming for soil-transmitted helminth control in children: a systematic review and meta-analysis. Lancet 2017; 389:287-297. [PMID: 27979381 DOI: 10.1016/s0140-6736(16)32123-7] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Soil-transmitted helminth infections are a major global health issue, causing substantial morbidity in the world's poorest populations. Regular delivery of anthelmintic drugs is the mainstay for global soil-transmitted helminth control. Deworming campaigns are often targeted to school-aged children, who are at high risk of soil-transmitted-helminth-associated morbidity. However, findings from modelling studies suggest that deworming campaigns should be expanded community-wide for effective control of soil-transmitted helminth transmission. We aimed to do a systematic review and meta-analysis to compare the effect of mass (community-wide) and targeted (children only) anthelmintic delivery strategies on soil-transmitted helminth prevalence in school-aged children. METHODS In this systematic review and meta-analysis, we searched MEDLINE, Embase, and Web of Science for articles published on or before Nov 5, 2015, reporting soil-transmitted helminth prevalence before and after distribution of albendazole or mebendazole, either targeted to children or delivered to the whole community. We excluded studies in which drug delivery was restricted to infected individuals or to a subset of the community or school, or if follow-up time was less than 3 months or greater than 18 months after drug delivery. We extracted data on study year, country, drug administration strategy, drug dose, number of deworming rounds, treatment coverage, diagnostic method, follow-up interval, and soil-transmitted helminth prevalence before and after treatment. We used inverse variance weighted generalised linear models, with prevalence reduction as the outcome variable, to examine the effect of mass versus targeted drug administration, as well as baseline prevalence, number of drug doses, and follow-up time. This study is registered with PROSPERO, number CRD42016026929. FINDINGS Of 10 538 studies identified, 56 studies were eligible for the systematic review and 38 of these were included in meta-analysis. Results of the regression models showed that mass deworming led to a significantly greater reduction in prevalence in children than targeted deworming, for both hookworm (odds ratio 4·6, 95% CI 1·8-11·6; p=0·0020) and Ascaris lumbricoides (16·4, 2·1-125·8; p=0·0092), with no effect seen for Trichuris trichiura. There was significant heterogeneity across studies; for targeted studies I2 was 97% for A lumbricoides and hookworm, and 96% for T trichiura, and for mass studies, I2 was 89% for A lumbricoides, 49% for hookworm, and 66% for T trichiura. INTERPRETATION The results of this meta-analysis suggest that expanding deworming programmes community-wide is likely to reduce the prevalence of soil-transmitted helminths in the high-risk group of school-aged children, which could lead to improved morbidity outcomes. These findings are in support of recent calls for re-evaluation of global soil-transmitted helminth control guidelines. FUNDING None.
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Affiliation(s)
- Naomi E Clarke
- Research School of Population Health, Australian National University, Canberra, ACT, Australia.
| | - Archie C A Clements
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Suhail A Doi
- Research School of Population Health, Australian National University, Canberra, ACT, Australia; College of Medicine, Qatar University, Doha, Qatar; School of Agricultural, Computational and Environmental Sciences, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Dongxu Wang
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Suzy J Campbell
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Darren Gray
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Susana V Nery
- Research School of Population Health, Australian National University, Canberra, ACT, Australia
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Clarke NE, Clements ACA, Bryan S, McGown J, Gray D, Nery SV. Investigating the differential impact of school and community-based integrated control programmes for soil-transmitted helminths in Timor-Leste: the (S)WASH-D for Worms pilot study protocol. Pilot Feasibility Stud 2016; 2:69. [PMID: 27965884 PMCID: PMC5154107 DOI: 10.1186/s40814-016-0109-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 05/20/2016] [Accepted: 11/08/2016] [Indexed: 12/18/2022] Open
Abstract
Background Water, sanitation and hygiene (WASH) interventions represent an important component of soil-transmitted helminth (STH) infection control, alongside the administration of anthelmintic drugs, which are generally targeted to school-aged children. Recent modelling studies have suggested that STH control programmes should be broadened to include all age groups across the community. We describe the protocol for a pilot study investigating the impact of school-versus-community-based delivery of integrated WASH and deworming programmes on STH infections in school-aged children in Timor-Leste. Methods The (S)WASH-D for Worms pilot is a two-arm, non-randomised cluster intervention study. The aims are to determine feasibility and acceptability of the intervention and study procedures and to establish proof of principle for the hypothesis that STH control programmes directed to the entire community will lead to greater reductions in STH infections in children than programmes directed only to school-aged children. Of the six participating communities, three receive a school-based integrated WASH and deworming programme and three additionally receive a community-based integrated WASH and deworming programme. The primary outcomes are the proportions of eligible children who enrol in the study and participate in the data collection, and outcomes relating to WASH and deworming programme completion, coverage, and use. Secondary outcomes are the cumulative incidence and mean intensity of STH infection in school-aged children at 6-month follow-up, mean haemoglobin concentration and several anthropometric indices. Results will inform the design of a cluster-randomised controlled trial (RCT). Discussion This pilot study is being conducted in preparation for a cluster-RCT investigating the differential impact of school- and community-based integrated STH control programmes on STH infections in school-aged children. It aims to establish feasibility and proof of principle, while results of the subsequent RCT could have significant implications for global STH control policy. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12615001012561 Electronic supplementary material The online version of this article (doi:10.1186/s40814-016-0109-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Naomi E Clarke
- Research School of Population Health, Australian National University, Canberra, ACT 0200 Australia
| | - Archie C A Clements
- Research School of Population Health, Australian National University, Canberra, ACT 0200 Australia
| | | | - John McGown
- Plan International Timor-Leste, Dili, Timor-Leste
| | - Darren Gray
- Research School of Population Health, Australian National University, Canberra, ACT 0200 Australia
| | - Susana V Nery
- Research School of Population Health, Australian National University, Canberra, ACT 0200 Australia
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Clarke NE, Gilby D, Savoia H, Oliver MR, Rogerson S. Fulminant liver failure in a neonate. J Paediatr Child Health 2016; 52:338-341. [PMID: 27124844 DOI: 10.1111/jpc.13090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/13/2015] [Accepted: 10/19/2015] [Indexed: 11/27/2022]
Abstract
Neonatal acute liver disease is relatively rare, with multiple different aetiologies including congenital infections, metabolic disorders, gestational alloimmune liver disease, haemophagocytic lymphohistiocytosis, and ischaemic injury. We report a case of neonatal liver failure in a preterm, growth-restricted infant, who underwent extensive investigation and was clinically diagnosed with gestational alloimmune liver disease, which was confirmed on post-mortem examination. We then discuss management of neonatal liver failure and gestational alloimmune liver disease, including maternal management in future pregnancies.
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Affiliation(s)
- Naomi E Clarke
- Department of Neonatal Services, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Damien Gilby
- Department of Neonatal Services, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Helen Savoia
- Department of Clinical Haematology, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Mark R Oliver
- Department of Gastroenterology, Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Women's Research Institute, Melbourne, Victoria, Australia
| | - Sheryle Rogerson
- Department of Neonatal Services, Royal Women's Hospital, Melbourne, Victoria, Australia
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Patel VB, Clarke NE, Wang Z, Putko B, Parajuli N, Lo J, Turner AJ, Oudit GY. Angiotensin II Induced Proteolytic Cleavage of Angiotensin Converting Enzyme 2 Is Mediated Via the Tnf-Alpha Converting Enzyme (TACE/ADAM-17): A Positive Feedback Mechanism in the Renin Angiotensin System. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.154] [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] [Indexed: 10/26/2022] Open
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Abstract
BACKGROUND The use of complementary and alternative medicines (CAM) in patients with cancer is well recognized. Little is known, however, about the use of CAM in children with cancer during the end-of-life period. METHODS We interviewed 96 parents of children who had died of cancer in Melbourne, Australia between 1996 and 2004 to establish the prevalence of CAM use during the end-of-life period. Factors affecting the use of CAM were explored. We also determined the perceived efficacy of CAM use and its effect on the overall experience of end-of-life care. RESULTS Thirty percent of parents caring for a child with cancer reported using some form of CAM during the end-of-life period, with 44% of these families using more than one type. The most common therapies used were organic foods, faith healing, and homeopathy. There was a strong correlation between open discussion about treatment alternatives with the treating physician and parental use of CAM. The majority (78%) of respondents felt CAM use had benefited their child significantly and most felt it had not caused additional suffering. CONCLUSIONS A significant number of children with cancer are administered CAM during the end-of-life period and most families in our study had found it beneficial. The main focus should continue to be on open and honest communication between caregivers and families in order to provide the best possible holistic care.
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Affiliation(s)
- John A Heath
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia.
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Hii MW, Clarke NE, Hopkins GH. Gastrogastric herniation: an unusual complication following greater curve plication for the treatment of morbid obesity. Ann R Coll Surg Engl 2012; 94:e76-8. [PMID: 22391359 PMCID: PMC5827249 DOI: 10.1308/003588412x13171221588695] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [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] [Accepted: 08/27/2011] [Indexed: 01/14/2023] Open
Abstract
Greater curve plication is an emerging procedure for the treatment of morbid obesity. A median weight loss of up to 61% at one year has been reported in initial reports. Thus far, operative morbidity is low and there is no reported mortality. We present a case of gastric herniation after greater curve plication. Severe nausea and vomiting occurred in our patient with an excessively tight greater curve plication. Two gastric hernias developed through the plication suture. Surgical reduction of these hernias and revision of the original procedure was required. We recommend that greater curve plication is performed over a bougie and that two rows of closely spaced interrupted sutures are used to secure the plication.
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Affiliation(s)
- M W Hii
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
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Gyorki DE, Clarke NE, Hii MW, Banting SW, Cade RJ. Management of synchronous tumours of the oesophagus and pancreatic head: a novel approach. Ann R Coll Surg Engl 2011; 93:e111-3. [PMID: 21929904 DOI: 10.1308/147870811x591675] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Synchronous tumours of the oesophagus and pancreatic head are very rare. This report describes a unique case of an adenocarcinoma of the distal oesophagus and a neuroendocrine tumour of the pancreatic head diagnosed synchronously but successfully managed metachronously. Initially, the patient underwent an oesophagectomy, with a colonic reconstruction following some months later by pylorus-preserving pancreaticoduodenectomy. A staged resection was performed after a review of the literature suggested increased morbidity with synchronous major abdominal operations.
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Affiliation(s)
- D E Gyorki
- Upper Gastrointestinal and Hepatobiliary Unit, St Vincent's Hospital, Melbourne, Australia.
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McCarthy MC, Clarke NE, Ting CL, Conroy R, Anderson VA, Heath JA. Prevalence and predictors of parental grief and depression after the death of a child from cancer. J Palliat Med 2010; 13:1321-6. [PMID: 20954828 DOI: 10.1089/jpm.2010.0037] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To investigate patterns of grief and depression in a sample of parents whose child had died of cancer, and to examine factors related to burden of illness and end-of-life care as potential predictors of parental grief and depression outcomes. METHODS Fifty-eight parents completed standardized self-report questionnaires measuring prolonged grief disorder (Inventory of Complicated Grief-Revised [ICG-R]) and depression (Beck Depression Inventory-Second Edition [BDI-II]) and participated in structured interviews designed to elicit their perceptions of their child's end-of-life care and burden of illness. The majority of participants were mothers (84%) and the mean length of time since child death was 4.5 (standard deviation [SD] = 2.4) years (range, 1.0-9.8 years). RESULTS Rates of prolonged grief disorder (PGD) were similar to those reported in other bereaved populations (10.3%); however, 41% of parents met diagnostic criteria for grief-related separation distress. Twenty-two percent of parents reported clinically significant depressive symptoms. Time since death and parental perception of the oncologist's care predicted parental grief symptoms but not depressive symptoms. Perceptions of the child's quality of life during the last month, preparedness for the child's death, and economic hardship also predicted grief and depression outcomes. CONCLUSIONS A minority of parents met criteria for PGD and depression, however, almost half the sample was experiencing significant separation distress associated with persistent longing and yearning for their child. Time since death is a significant predictor of parental psychological distress. This study also highlights the importance of end-of-life factors in parents' long-term adjustment and the need for optimal palliative care to ensure the best possible outcomes for parents.
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Affiliation(s)
- Maria C McCarthy
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia.
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Heath JA, Clarke NE, Donath SM, McCarthy M, Anderson VA, Wolfe J. Symptoms and suffering at the end of life in children with cancer: an Australian perspective. Med J Aust 2010; 192:71-5. [PMID: 20078405 DOI: 10.5694/j.1326-5377.2010.tb03420.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Accepted: 05/07/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the symptoms, level of suffering, and care of Australian children with cancer at the end of life. DESIGN, SETTING AND PARTICIPANTS In a study conducted at the Royal Children's Hospital, Melbourne, parents of children who had died of cancer over the period 1996-2004 were interviewed between February 2004 and August 2006. Parents also completed and returned self-report questionnaires. MAIN OUTCOME MEASURES Proportions of children suffering from and treated for various symptoms; proportion of children receiving cancer-directed therapy at the end of life; proportion of children whose treatment of symptoms was successful; location of death. RESULTS Of 193 eligible families, 96 (50%) were interviewed. All interviews were conducted in person, and occurred a mean of 4.5 years (SD, 2.1 years) after the child's death. Eighty-four per cent of parents reported that their child had suffered "a lot" or "a great deal" from at least one symptom in their last month of life--most commonly pain (46%), fatigue (43%) and poor appetite (30%). Children who received cancer-directed therapy during the end-of-life period (47%) suffered from a greater number of symptoms than those who did not receive treatment (P = 0.03), but the severity of symptoms did not differ between these groups. Of the children treated for specific symptoms, treatment was successful in 47% of those with pain, 18% of those with fatigue and 17% of those with poor appetite. Of the 61 families who felt they had time to plan where their child would die, 89% preferred to have their child die at home. The majority of children (61%) died at home. Of those who died in hospital, less than a quarter died in the intensive care unit. CONCLUSIONS Relatively high rates of death at home and low rates of unsuccessful medical interventions suggest a realistic approach at the end of life for Australian children dying of cancer. However, many suffer from unresolved symptoms, and greater attention should be paid to palliative care for these children.
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Affiliation(s)
- John A Heath
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, VIC, Australia.
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Clarke NE, McCarthy MC, Downie P, Ashley DM, Anderson VA. Gender differences in the psychosocial experience of parents of children with cancer: a review of the literature. Psychooncology 2009; 18:907-15. [PMID: 19319828 DOI: 10.1002/pon.1515] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To build a descriptive literature base of investigated and identified gender differences in the psychosocial experience of parents of children with cancer, in order to guide future research in this area. METHODS An extensive literature search was conducted using Medline, PsycINFO, CINAHL and EMBASE databases. Thirty papers were included in the review. Themes from these papers were identified, and on this basis, the review findings were grouped according to five main outcome categories: role perceptions, illness beliefs, psychological distress, coping strategies and perceptions of marital, family and child functioning. RESULTS Few gender differences were found in perceptions of marital, family and child functioning. There was a tendency toward traditional gender roles in the division of parental tasks. Findings in relation to parent psychological distress and preferred coping strategies were mixed, with trends toward increased distress, more emotion-focused coping and greater social support-seeking in mothers. CONCLUSIONS Further studies using longitudinal designs with solid theoretical groundings will provide valuable information on the unique psychosocial experiences of mothers and fathers throughout the child's illness, which may in turn guide the development of evidence-based interventions.
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Affiliation(s)
- Naomi E Clarke
- Children's Cancer Centre, Royal Children's Hospital, Vic., Australia.
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Abstract
AIM Current Australian guidelines for the provision of paediatric palliative care highlight the importance of services being focused on the needs of the child and family. We aimed to establish parents' level of satisfaction with the quality of care currently being provided to children dying of cancer. METHODS We interviewed 96 parents of children who died of cancer in Melbourne, Australia between 1996 and 2004 to ascertain how they rated the care provided to their child during the end-of-life period. RESULTS A majority of parents were satisfied with the care provided by their primary oncologist, local doctors, palliative care services and home-care nurses. Most parents felt that discussions about key medical and treatment decisions were appropriate and clearly understood. Parents were generally satisfied with the leadership roles undertaken in decision-making in the end-of-life period; however, parents who were not satisfied indicated that they would like additional involvement of their primary oncologist. CONCLUSIONS Current approaches to end-of-life care in children with cancer appear to be satisfactory. The main focus should continue to be on open and honest communication.
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Affiliation(s)
- John A Heath
- Children's Cancer Centre, Royal Children's Hospital, University of Melbourne, Melbourne, Victoria 3052, Australia.
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McCarthy MC, Clarke NE, Vance A, Ashley DM, Heath JA, Anderson VA. Measuring psychosocial risk in families caring for a child with cancer: the Psychosocial Assessment Tool (PAT2.0). Pediatr Blood Cancer 2009; 53:78-83. [PMID: 19343796 DOI: 10.1002/pbc.22007] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Psychosocial Assessment Tool 2.0 (PAT2.0) is a recently developed screening measure for assessing psychosocial risk in families caring for a child with cancer. This study aimed to assess the external validity of the PAT2.0 in an Australian pediatric oncology sample. Further aims included examining mothers' and fathers' PAT2.0 scores, change in psychosocial risk over time, and the relationship between treatment intensity and psychosocial risk. PROCEDURE Parents of 143 children newly diagnosed with cancer completed the PAT2.0 at diagnosis (T1) and 6-8 months later (T2). A treatment intensity measure (ITR-2) was completed by two clinical oncologists. RESULTS The PAT2.0 stratified families into a 3-tiered risk framework and was consistent with existing data from the authors of the scale. The majority of families were stratified into the Universal (lowest risk) category; more than one-third of families had some elevated psychosocial risk. PAT2.0 scores of mothers and fathers were correlated and psychosocial risk remained relatively stable between T1 and T2. Treatment intensity scores were not related to PAT2.0 scores at T2. CONCLUSIONS Findings support the external validity of the PAT2.0 as a psychosocial screener. Mothers' and fathers' ratings of risk are similar; however, multi-informant use of the PAT2.0 may be clinically useful. Psychosocial risk, as measured by the PAT2.0, is a relatively stable construct over the first months of treatment and is independent of treatment intensity.
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Affiliation(s)
- Maria C McCarthy
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia.
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Clarke NE. Silicosis and diseases of retired iron foundry workers. IMS Ind Med Surg 1972; 41:22-5. [PMID: 4503575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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