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Cribb DM, Sarmento N, Moniz A, Fancourt NSS, Glass K, Draper ADK, Francis JR, Lay dos Santos MM, Soares da Silva E, Polkinghorne BG, de Lourdes da Conceiҫão V, da Conceiҫão F, da Silva P, Jong J, Kirk MD, Colquhoun S. A pilot study using hospital surveillance and a birth cohort to investigate enteric pathogens and malnutrition in children, Dili, Timor-Leste. PLoS One 2024; 19:e0296774. [PMID: 38300944 PMCID: PMC10833528 DOI: 10.1371/journal.pone.0296774] [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: 11/01/2023] [Accepted: 12/18/2023] [Indexed: 02/03/2024] Open
Abstract
In low-to-middle-income countries (LMICs), enteric pathogens contribute to child malnutrition, affecting nutrient absorption, inducing inflammation, and causing diarrhoea. This is a substantial problem in LMICs due to high disease burden, poor sanitation and nutritional status, and the cyclical nature of pathogen infection and malnutrition. This relationship remains understudied in Timor-Leste. In our pilot study of enteric pathogens and malnutrition in Dili, Timor-Leste (July 2019-October 2020), we recruited 60 infants in a birth cohort from Hospital Nacional Guido Valadares (HNGV) with up to four home visits. We collected faecal samples and details of demographics, anthropometrics, diet and food practices, and animal husbandry. Additionally, we collected faecal samples, diagnostics, and anthropometrics from 160 children admitted to HNGV with a clinical diagnosis of severe diarrhoea or severe acute malnutrition (SAM). We tested faeces using the BioFire® FilmArray® Gastrointestinal Panel. We detected high prevalence of enteric pathogens in 68.8% (95%CI 60.4-76.2%) of infants at home, 88.6% of SAM cases (95%CI 81.7-93.3%) and 93.8% of severe diarrhoea cases (95%CI 67.7-99.7%). Diarrhoeagenic Escherichia coli and Campylobacter spp. were most frequently detected. Pathogen presence did not significantly differ in birth cohort diarrhoeal stool, but hospital data indicated associations between Salmonella and Shigella and diarrhoea. We observed wasting in 18.4% (95%CI 9.2-32.5%) to 30.8% (95%CI 17.5-47.7%) of infants across home visits, 57.9% (95%CI 34.0-78.9%) of severe diarrhoea cases, and 92.5% (95%CI 86.4-96.2%) of SAM cases. We associated bottle feeding with increased odds of pathogen detection when compared with exclusive breastfeeding at home (OR 8.3, 95%CI 1.1-62.7). We detected high prevalence of enteric pathogens and signs of malnutrition in children in Dili. Our pilot is proof of concept for a study to fully explore the risk factors and associations between enteric pathogens and malnutrition in Timor-Leste.
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Affiliation(s)
- Danielle M. Cribb
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Nevio Sarmento
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Timor-Leste Ministry of Health, Dili, Timor-Leste
| | - Almerio Moniz
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Nicholas S. S. Fancourt
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Kathryn Glass
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Anthony D. K. Draper
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Northern Territory Centre for Disease Control, Northern Territory Government Department of Health, Darwin, Northern Territory, Australia
| | - Joshua R. Francis
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | | | | | - Benjamin G. Polkinghorne
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Virginia de Lourdes da Conceiҫão
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Timor-Leste Ministry of Health, Dili, Timor-Leste
| | | | - Paulino da Silva
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Joanita Jong
- Ministry of Agriculture and Fisheries, Dili, Timor-Leste
| | - Martyn D. Kirk
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Samantha Colquhoun
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
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Arkell P, Sheridan SL, Martins N, Tanesi MY, Gomes N, Amaral S, Oakley T, Solano V, David M, Draper ADK, Sarmento N, da Silva E, Alves L, Freitas C, Machado FDN, Gusmão C, da Costa Barreto I, Fancourt NSS, Macartney K, Yan J, Francis JR. Vaccine Preventable Disease Seroprevalence in a Nationwide Assessment of Timor-Leste (VASINA-TL): study protocol for a population-representative cross-sectional serosurvey. BMJ Open 2023; 13:e071381. [PMID: 37202138 PMCID: PMC10201250 DOI: 10.1136/bmjopen-2022-071381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/25/2023] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Historic disruption in health infrastructure combined with data from a recent vaccine coverage survey suggests there are likely significant immunity gaps to vaccine preventable diseases and high risk of outbreaks in Timor-Leste. Community-based serological surveillance is an important tool to augment understanding of population-level immunity achieved through vaccine coverage and/or derived from prior infection. METHODS AND ANALYSIS This national population-representative serosurvey will take a three-stage cluster sample and aims to include 5600 individuals above 1 year of age. Serum samples will be collected by phlebotomy and analysed for measles IgG, rubella IgG, SARS-CoV-2 antispike protein IgG, hepatitis B surface antibody and hepatitis B core antigen using commercially available chemiluminescent immunoassays or ELISA. In addition to crude prevalence estimates and to account for differences in Timor-Leste's age structure, stratified age-standardised prevalence estimates will be calculated, using Asia in 2013 as the standard population. Additionally, this survey will derive a national asset of serum and dried blood spot samples which can be used for further investigation of infectious disease seroepidemiology and/or validation of existing and novel serological assays for infectious diseases. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Research Ethics and Technical Committee of the Instituto Nacional da Saúde, Timor-Leste and the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research, Australia. Co-designing this study with Timor-Leste's Ministry-of-Health and other relevant partner organisations will allow immediate translation of findings into public health policy, which may include changes to routine immunisation service delivery and/or plans for supplementary immunisation activities.
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Affiliation(s)
- Paul Arkell
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Dili, Timor-Leste
| | - Sarah L Sheridan
- National Centre for Immunisation Research and Surveillance (NCIRS), Westmead, New South Wales, Australia
| | - Nelson Martins
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Dili, Timor-Leste
| | - Maria Y Tanesi
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Dili, Timor-Leste
| | - Nelia Gomes
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Dili, Timor-Leste
| | - Salvador Amaral
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Dili, Timor-Leste
| | - Tessa Oakley
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Dili, Timor-Leste
| | - Vanessa Solano
- Faculty of Science and Technology, Research Institute for the Environment and Livelihoods, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Michael David
- The Daffodil Centre, The University of Sydney, Sydney, New South Wales, Australia
- School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
| | - Anthony D K Draper
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Dili, Timor-Leste
- Centre for Disease Control, Northern Territory Department of Health, Casuarina, Northern Territory, Australia
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Northern Territory, Australia
| | - Nevio Sarmento
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Dili, Timor-Leste
| | - Endang da Silva
- Laboratório Nacional da Saúde, Timor-Leste Ministry of Health, Dili, Timor-Leste
| | - Lucsendar Alves
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Carlito Freitas
- Departemento Vigilancia e Epidemiologia, Timor-Leste Ministry of Health, Dili, Timor-Leste
| | - Filipe de Neri Machado
- Departemento Vigilancia e Epidemiologia, Timor-Leste Ministry of Health, Dili, Timor-Leste
| | - Celia Gusmão
- Department of Internal Medicine, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Ismael da Costa Barreto
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Dili, Timor-Leste
- Health System Strengthening Department, World Health Organisation, Timor-Leste Office, Dili, Timor-Leste
| | - Nicholas S S Fancourt
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance (NCIRS), Westmead, New South Wales, Australia
| | - Jennifer Yan
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Joshua R Francis
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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3
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Sarmento N, Ico LC, Sheridan SL, Tanesi MY, Santos CG, Barreto I, Gomes N, Oakley T, Draper ADK, Fancourt NSS, Yan J, Macartney K, Francis JR, Arkell P. The use of residual serum samples to perform serological surveillance of severe acute respiratory syndrome coronavirus 2 in Dili and regional areas of Timor-Leste. Trans R Soc Trop Med Hyg 2022; 117:313-315. [PMID: 36482768 PMCID: PMC10069296 DOI: 10.1093/trstmh/trac117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 10/17/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
ABSTRACT
Background
Lack of access to diagnostic testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can limit disease surveillance in remote areas. Serological surveillance can indicate the true extent and distribution of infections in such settings.
Methods
This study monitored SARS-CoV-2 seroprevalence in residual serum samples salvaged from laboratories at five healthcare facilities across Timor-Leste from March to October 2021.
Results
Seroprevalence increased from 8.3% to 87.0% during the study period. Potential immunity gaps were identified among children aged 0–15 y (who had not been eligible for vaccination) and individuals aged >60 y.
Conclusions
Efforts to vaccinate vulnerable individuals including older people should be maintained. Residual serum samples can be analysed to give local, contemporary information about the extent and distribution of antibodies to infections, especially SARS-CoV-2, in areas where epidemiological information is limited.
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Affiliation(s)
- Nevio Sarmento
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Lourenço C Ico
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Sarah L Sheridan
- National Centre for Immunisation Research and Surveillance , Westmead, NSW 2145 , Australia
| | - Maria Y Tanesi
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Celia G Santos
- Department of Internal Medicine, Hospital Nacional Guido Valadares , Dili , Timor-Leste
| | - Ismael Barreto
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Nelia Gomes
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Tessa Oakley
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Anthony D K Draper
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Nicholas S S Fancourt
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Jennifer Yan
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance , Westmead, NSW 2145 , Australia
| | - Joshua R Francis
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Paul Arkell
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
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Baillie VL, Moore DP, Mathunjwa A, Baggett HC, Brooks A, Feikin DR, Hammitt LL, Howie SRC, Knoll MD, Kotloff KL, Levine OS, O’Brien KL, Scott AG, Thea DM, Antonio M, Awori JO, Driscoll AJ, Fancourt NSS, Higdon MM, Karron RA, Morpeth SC, Mulindwa JM, Murdoch DR, Park DE, Prosperi C, Rahman MZ, Rahman M, Salaudeen RA, Sawatwong P, Somwe SW, Sow SO, Tapia MD, Simões EAF, Madhi SA. Epidemiology of the Rhinovirus (RV) in African and Southeast Asian Children: A Case-Control Pneumonia Etiology Study. Viruses 2021; 13:v13071249. [PMID: 34198998 PMCID: PMC8310211 DOI: 10.3390/v13071249] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/16/2022] Open
Abstract
Rhinovirus (RV) is commonly detected in asymptomatic children; hence, its pathogenicity during childhood pneumonia remains controversial. We evaluated RV epidemiology in HIV-uninfected children hospitalized with clinical pneumonia and among community controls. PERCH was a case-control study that enrolled children (1–59 months) hospitalized with severe and very severe pneumonia per World Health Organization clinical criteria and age-frequency-matched community controls in seven countries. Nasopharyngeal/oropharyngeal swabs were collected for all participants, combined, and tested for RV and 18 other respiratory viruses using the Fast Track multiplex real-time PCR assay. RV detection was more common among cases (24%) than controls (21%) (aOR = 1.5, 95%CI:1.3–1.6). This association was driven by the children aged 12–59 months, where 28% of cases vs. 18% of controls were RV-positive (aOR = 2.1, 95%CI:1.8–2.5). Wheezing was 1.8-fold (aOR 95%CI:1.4–2.2) more prevalent among pneumonia cases who were RV-positive vs. RV-negative. Of the RV-positive cases, 13% had a higher probability (>75%) that RV was the cause of their pneumonia based on the PERCH integrated etiology analysis; 99% of these cases occurred in children over 12 months in Bangladesh. RV was commonly identified in both cases and controls and was significantly associated with severe pneumonia status among children over 12 months of age, particularly those in Bangladesh. RV-positive pneumonia was associated with wheezing.
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Affiliation(s)
- Vicky L. Baillie
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2050, South Africa; (D.P.M.); (A.M.); (E.A.F.S.); (S.A.M.)
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg 1864, South Africa
- Correspondence: ; Tel.: +27-(11)-9834283
| | - David P. Moore
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2050, South Africa; (D.P.M.); (A.M.); (E.A.F.S.); (S.A.M.)
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg 1864, South Africa
- Department of Paediatrics & Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg 1864, South Africa
| | - Azwifarwi Mathunjwa
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2050, South Africa; (D.P.M.); (A.M.); (E.A.F.S.); (S.A.M.)
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg 1864, South Africa
| | - Henry C. Baggett
- Division of Global Health Protection, Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi 11000, Thailand; (H.C.B.); (P.S.)
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Abdullah Brooks
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab, Bangladesh; (M.Z.R.); (M.R.)
| | - Daniel R. Feikin
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (D.R.F.); (L.L.H.); (M.D.K.); (O.S.L.); (K.L.O.); (A.J.D.); (N.S.S.F.); (M.M.H.); (D.E.P.); (C.P.)
- Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Laura L. Hammitt
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (D.R.F.); (L.L.H.); (M.D.K.); (O.S.L.); (K.L.O.); (A.J.D.); (N.S.S.F.); (M.M.H.); (D.E.P.); (C.P.)
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi 80108, Kenya; (A.G.S.); (J.O.A.); (S.C.M.)
| | - Stephen R. C. Howie
- Medical Research Council Unit at the London School of Hygiene and Tropical Medicine, Basse 273, The Gambia; (S.R.C.H.); (M.A.); (R.A.S.)
- Department of Paediatrics: Child & Youth Health, University of Auckland, Park Rd, Auckland 1023, New Zealand
| | - Maria Deloria Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (D.R.F.); (L.L.H.); (M.D.K.); (O.S.L.); (K.L.O.); (A.J.D.); (N.S.S.F.); (M.M.H.); (D.E.P.); (C.P.)
| | - Karen L. Kotloff
- Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21205, USA; (K.L.K.); (M.D.T.)
| | - Orin S. Levine
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (D.R.F.); (L.L.H.); (M.D.K.); (O.S.L.); (K.L.O.); (A.J.D.); (N.S.S.F.); (M.M.H.); (D.E.P.); (C.P.)
| | - Katherine L. O’Brien
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (D.R.F.); (L.L.H.); (M.D.K.); (O.S.L.); (K.L.O.); (A.J.D.); (N.S.S.F.); (M.M.H.); (D.E.P.); (C.P.)
| | - Anthony G. Scott
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi 80108, Kenya; (A.G.S.); (J.O.A.); (S.C.M.)
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Donald M. Thea
- Department of Global Health, Boston University School of Public Health, Boston, MA 02118, USA;
| | - Martin Antonio
- Medical Research Council Unit at the London School of Hygiene and Tropical Medicine, Basse 273, The Gambia; (S.R.C.H.); (M.A.); (R.A.S.)
- Department of Pathogen Molecular Biology, London School of Hygiene & Tropical Medicine, Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry CV4 7JJ, UK
| | - Juliet O. Awori
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi 80108, Kenya; (A.G.S.); (J.O.A.); (S.C.M.)
| | - Amanda J. Driscoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (D.R.F.); (L.L.H.); (M.D.K.); (O.S.L.); (K.L.O.); (A.J.D.); (N.S.S.F.); (M.M.H.); (D.E.P.); (C.P.)
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21205, USA
| | - Nicholas S. S. Fancourt
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (D.R.F.); (L.L.H.); (M.D.K.); (O.S.L.); (K.L.O.); (A.J.D.); (N.S.S.F.); (M.M.H.); (D.E.P.); (C.P.)
| | - Melissa M. Higdon
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (D.R.F.); (L.L.H.); (M.D.K.); (O.S.L.); (K.L.O.); (A.J.D.); (N.S.S.F.); (M.M.H.); (D.E.P.); (C.P.)
| | - Ruth A. Karron
- Department of International Health, Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Susan C. Morpeth
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi 80108, Kenya; (A.G.S.); (J.O.A.); (S.C.M.)
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
- Microbiology Laboratory, Middlemore Hospital, Counties Manukau District Health Board, Auckland 1640, New Zealand
| | - Justin M. Mulindwa
- Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka 50110, Zambia; (J.M.M.); (S.W.S.)
| | - David R. Murdoch
- Department of Pathology and Biomedical Sciences, University of Otago, Christchurch 8011, New Zealand;
- Microbiology Unit, Canterbury Health Laboratories, Christchurch 8140, New Zealand
| | - Daniel E. Park
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (D.R.F.); (L.L.H.); (M.D.K.); (O.S.L.); (K.L.O.); (A.J.D.); (N.S.S.F.); (M.M.H.); (D.E.P.); (C.P.)
- Milken Institute School of Public Health, Department of Epidemiology, George Washington University, Washington, DC 20052, USA
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (D.R.F.); (L.L.H.); (M.D.K.); (O.S.L.); (K.L.O.); (A.J.D.); (N.S.S.F.); (M.M.H.); (D.E.P.); (C.P.)
| | - Mohammed Ziaur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab, Bangladesh; (M.Z.R.); (M.R.)
| | - Mustafizur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab, Bangladesh; (M.Z.R.); (M.R.)
| | - Rasheed A. Salaudeen
- Medical Research Council Unit at the London School of Hygiene and Tropical Medicine, Basse 273, The Gambia; (S.R.C.H.); (M.A.); (R.A.S.)
- Medical Microbiology Department, Lagos University Teaching Hospital, Lagos 100254, Nigeria
| | - Pongpun Sawatwong
- Division of Global Health Protection, Thailand Ministry of Public Health–U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi 11000, Thailand; (H.C.B.); (P.S.)
| | - Somwe Wa Somwe
- Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka 50110, Zambia; (J.M.M.); (S.W.S.)
| | - Samba O. Sow
- Centre pour le Développement des Vaccins (CVD-Mali), Bamako 198, Mali;
| | - Milagritos D. Tapia
- Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21205, USA; (K.L.K.); (M.D.T.)
| | - Eric A. F. Simões
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2050, South Africa; (D.P.M.); (A.M.); (E.A.F.S.); (S.A.M.)
- Department of Pediatrics, University of Colorado School of Medicine and Center for Global Health, Colorado School of Public Health, Aurora, CO 80309, USA
| | - Shabir A. Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2050, South Africa; (D.P.M.); (A.M.); (E.A.F.S.); (S.A.M.)
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg 1864, South Africa
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5
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Matthews A, Le B, Amaral S, Arkell P, Monteiro M, Clarke N, Barros T, de Jesus Mendonça J, Gusmão SME, Dos Reis Seixas LM, da Piedade JHA, Engelman D, Steer AC, Fancourt NSS, Yan J, Kaldor J, Francis JR, Nery SV. Prevalence of scabies and impetigo in school-age children in Timor-Leste. Parasit Vectors 2021; 14:156. [PMID: 33722285 PMCID: PMC7962383 DOI: 10.1186/s13071-021-04645-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 02/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background Scabies and impetigo are endemic in many tropical, low- and middle-income countries. Mass drug administration (MDA) with ivermectin has emerged as a control strategy for these conditions. In 2019, Timor-Leste Ministry of Health planned to implement MDA including ivermectin for the control of lymphatic filariasis, so we undertook a baseline assessment of scabies and impetigo to better understand local epidemiology and contribute to future surveys assessing the impact of MDA. Methods A cross-sectional school survey was conducted in April–May 2019 at six primary schools in a semi-urban (Dili) and two rural (Ermera and Manufahi) settings. Children under 19 years of age present at school on survey days were eligible to participate, of whom we enrolled 1183. Trained health workers interviewed and examined 1043 participants to clinically diagnose scabies using the 2020 International Alliance for the Control of Scabies (IACS) diagnostic criteria, as well as impetigo. Prevalence was adjusted for age and sex. Mixed-effects logistic regression models were used to analyse odds of scabies and impetigo infection. All models accounted for clustering at the school level through the use of random effect terms. Population attributable risk of scabies as a cause of impetigo was also estimated. Results The overall weighted prevalence of scabies was 30.6%. Children in rural Manufahi were more likely to have scabies than those in semi-urban Dili (53.6% vs 28.2%, adjusted odds ratio [AOR] 3.5). Most cases of scabies were mild (3 to 10 lesions), and lesions were usually distributed on more than one body region. Scabies prevalence was lower among 10 to 14 year olds compared to 5 to 9 year olds. Overall weighted prevalence of impetigo was 11.3%. Relative to Dili, children in rural Ermera and Manufahi were twice as likely to have impetigo. Impetigo was twice as common in children with scabies than in those without, corresponding to an attributable risk of scabies as a cause of impetigo of 22.7%. Conclusions Scabies and impetigo prevalence in Timor-Leste is among the highest reported globally, particularly in rural areas. Scabies infestation was strongly associated with impetigo. Comprehensive control strategies are urgently needed in Timor-Leste.![]()
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Affiliation(s)
| | - Brandon Le
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Salvador Amaral
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Paul Arkell
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | | | - Naomi Clarke
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | | | | | | | | | | | - Daniel Engelman
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Australia
| | - Andrew C Steer
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Australia
| | - Nicholas S S Fancourt
- Royal Darwin Hospital, Darwin, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Jennifer Yan
- Royal Darwin Hospital, Darwin, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Joshua R Francis
- Royal Darwin Hospital, Darwin, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Susana Vaz Nery
- The Kirby Institute, University of New South Wales, Sydney, Australia
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6
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McCollum ED, Higdon MM, Fancourt NSS, Sternal J, Checkley W, De Campo J, Shet A. Training physicians in India to interpret pediatric chest radiographs according to World Health Organization research methodology. Pediatr Radiol 2021; 51:1322-1331. [PMID: 33704543 PMCID: PMC8266794 DOI: 10.1007/s00247-021-04992-2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/19/2020] [Accepted: 01/26/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Chest radiography is the standard for diagnosing pediatric lower respiratory infections in low-income and middle-income countries. A method for interpreting pediatric chest radiographs for research endpoints was recently updated by the World Health Organization (WHO) Chest Radiography in Epidemiological Studies project. Research in India required training local physicians to interpret chest radiographs following the WHO method. OBJECTIVE To describe the methodology for training Indian physicians and evaluate the training's effectiveness. MATERIALS AND METHODS Twenty-nine physicians (15 radiologists and 14 pediatricians) from India were trained by two WHO Chest Radiography in Epidemiological Studies members over 3 days in May 2019. Training materials were adapted from WHO Chest Radiography in Epidemiological Studies resources. Participants followed WHO methodology to interpret 60 unique chest radiographs before and after the training. Participants needed to correctly classify ≥80% of radiographs for primary endpoint pneumonia on the post-training test to be certified to interpret research images. We analyzed participant performance on both examinations. RESULTS Twenty-six of 29 participants (89.7%) completed both examinations. The average score increased by 9.6% (95% confidence interval [CI] 5.0-14.1%) between examinations (P<0.001). Participants correctly classifying ≥80% of images for primary endpoint pneumonia increased from 69.2% (18/26) on the pretraining to 92.3% (24/26) on the post-training examination (P=0.003). The mean scores of radiologists and pediatricians on the post-training examination were not statistically different (P=0.43). CONCLUSION Our results demonstrate this training approach using revised WHO definitions and tools was successful, and that non-radiologists can learn to apply these methods as effectively as radiologists. Such capacity strengthening is important for enabling research to support national policy decision-making in these settings. We recommend future research incorporating WHO chest radiograph methodology to consider modelling trainings after this approach.
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Affiliation(s)
- Eric D. McCollum
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA ,Department of Pediatrics, Johns Hopkins Global Program in Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins School of Medicine, 200 North Wolfe St., Baltimore, MD 21287 USA
| | - Melissa M. Higdon
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Nicholas S. S. Fancourt
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia ,Murdoch Children’s Research Institute, Melbourne, Australia
| | - Jack Sternal
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD USA ,Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - John De Campo
- Murdoch Children’s Research Institute, Melbourne, Australia ,Department of Radiology, Melbourne University, Melbourne, Australia
| | - Anita Shet
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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7
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McCollum ED, Park DE, Watson NL, Fancourt NSS, Focht C, Baggett HC, Brooks WA, Howie SRC, Kotloff KL, Levine OS, Madhi SA, Murdoch DR, Scott JAG, Thea DM, Awori JO, Chipeta J, Chuananon S, DeLuca AN, Driscoll AJ, Ebruke BE, Elhilali M, Emmanouilidou D, Githua LP, Higdon MM, Hossain L, Jahan Y, Karron RA, Kyalo J, Moore DP, Mulindwa JM, Naorat S, Prosperi C, Verwey C, West JE, Knoll MD, O'Brien KL, Feikin DR, Hammitt LL. Digital auscultation in PERCH: Associations with chest radiography and pneumonia mortality in children. Pediatr Pulmonol 2020; 55:3197-3208. [PMID: 32852888 PMCID: PMC7692889 DOI: 10.1002/ppul.25046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/15/2020] [Accepted: 08/17/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Whether digitally recorded lung sounds are associated with radiographic pneumonia or clinical outcomes among children in low-income and middle-income countries is unknown. We sought to address these knowledge gaps. METHODS We enrolled 1 to 59monthold children hospitalized with pneumonia at eight African and Asian Pneumonia Etiology Research for Child Health sites in six countries, recorded digital stethoscope lung sounds, obtained chest radiographs, and collected clinical outcomes. Recordings were processed and classified into binary categories positive or negative for adventitial lung sounds. Listening and reading panels classified recordings and radiographs. Recording classification associations with chest radiographs with World Health Organization (WHO)-defined primary endpoint pneumonia (radiographic pneumonia) or mortality were evaluated. We also examined case fatality among risk strata. RESULTS Among children without WHO danger signs, wheezing (without crackles) had a lower adjusted odds ratio (aOR) for radiographic pneumonia (0.35, 95% confidence interval (CI): 0.15, 0.82), compared to children with normal recordings. Neither crackle only (no wheeze) (aOR: 2.13, 95% CI: 0.91, 4.96) or any wheeze (with or without crackle) (aOR: 0.63, 95% CI: 0.34, 1.15) were associated with radiographic pneumonia. Among children with WHO danger signs no lung recording classification was independently associated with radiographic pneumonia, although trends toward greater odds of radiographic pneumonia were observed among children classified with crackle only (no wheeze) or any wheeze (with or without crackle). Among children without WHO danger signs, those with recorded wheezing had a lower case fatality than those without wheezing (3.8% vs. 9.1%, p = .03). CONCLUSIONS Among lower risk children without WHO danger signs digitally recorded wheezing is associated with a lower odds for radiographic pneumonia and with lower mortality. Although further research is needed, these data indicate that with further development digital auscultation may eventually contribute to child pneumonia care.
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Affiliation(s)
- Eric D McCollum
- Global Program in Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniel E Park
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | | | - Nicholas S S Fancourt
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Henry C Baggett
- Global Disease Detection Center, US Centers for Disease Control and Prevention Collaboration, Thailand Ministry of Public Health, Mueang Nonthaburi, Nonthaburi, Thailand.,Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - W Abdullah Brooks
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab, Bangladesh
| | - Stephen R C Howie
- Medical Research Council Unit, Basse, The Gambia.,Department of Paediatrics, University of Auckland, Auckland, New Zealand.,Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Karen L Kotloff
- Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Orin S Levine
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unite, University of the Witwatersrand, Johannesburg, South Africa
| | - David R Murdoch
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand.,Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - J Anthony G Scott
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Donald M Thea
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Juliet O Awori
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - James Chipeta
- Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia
| | - Somchai Chuananon
- Global Disease Detection Center, US Centers for Disease Control and Prevention Collaboration, Thailand Ministry of Public Health, Mueang Nonthaburi, Nonthaburi, Thailand
| | - Andrea N DeLuca
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Amanda J Driscoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Bernard E Ebruke
- Medical Research Council Unit, Basse, The Gambia.,International Foundation Against Infectious Disease in Nigeria, Abuja, Nigeria
| | - Mounya Elhilali
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Dimitra Emmanouilidou
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Melissa M Higdon
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lokman Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab, Bangladesh
| | - Yasmin Jahan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab, Bangladesh
| | - Ruth A Karron
- Department of International Health, Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joshua Kyalo
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - David P Moore
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa.,Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Justin M Mulindwa
- Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia
| | - Sathapana Naorat
- Global Disease Detection Center, US Centers for Disease Control and Prevention Collaboration, Thailand Ministry of Public Health, Mueang Nonthaburi, Nonthaburi, Thailand
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Charl Verwey
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa.,Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - James E West
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Maria Deloria Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Katherine L O'Brien
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniel R Feikin
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Laura L Hammitt
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
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