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Trapani D, Garcia PJ, Schroeder L, Abdul-Ghani R, Hansali A, Offutalu PN, Sewell W, Shakoor S, Yunfeng L, Hashimoto N, Moussy FG, Aceves Capri A, Fleming K. WHO model list of essential in vitro diagnostics: strengthening diagnostics capacity to transform health care for all. Lancet Glob Health 2024; 12:e364-e365. [PMID: 38365406 DOI: 10.1016/s2214-109x(23)00568-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/30/2023] [Indexed: 02/18/2024]
Affiliation(s)
- Dario Trapani
- Department of Oncology and Haematology, University of Milan, Milan, Italy; European Institute of Oncology, IRCCS, Milan 20141, Italy.
| | - Patricia J Garcia
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Lee Schroeder
- Department of Pathology, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Rashad Abdul-Ghani
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen; Tropical Disease Research Center, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana'a, Yemen
| | - Amina Hansali
- Institut National d'Hygiène Ministère de la Santé et de la Protection Sociale, Rabat, Morocco
| | - Paulinus Nnamdi Offutalu
- Public Health In-Vitro Diagnostics Control Laboratory, Medical Laboratory Science Council of Nigeria, Lagos, Nigeria
| | - William Sewell
- St Vincent's Healthcare Clinical Campus, University of New South Wales, Sydney, NSW, Australia; St Vincent's Pathology, St Vincent's Hospital, Sydney, NSW, Australia; Precision Immunology Program, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Sadia Shakoor
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Lyu Yunfeng
- Center for Medical Device Evaluation, National Medical Products Administration, Beijing, China
| | - Naofumi Hashimoto
- Health Products Policy and Standards Department, World Health Organization, Geneva, Switzerland
| | - Francis G Moussy
- Health Products Policy and Standards Department, World Health Organization, Geneva, Switzerland
| | - Ana Aceves Capri
- Health Products Policy and Standards Department, World Health Organization, Geneva, Switzerland
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Magboul AM, Nour BYM, Tamomh AG, Abdul-Ghani R, Albushra SM, Eltahir HB. Unraveling Key Chloroquine Resistance-Associated Alleles Among Plasmodium falciparum Isolates in South Darfur State, Sudan Twelve Years After Drug Withdrawal. Infect Drug Resist 2024; 17:221-227. [PMID: 38283109 PMCID: PMC10822104 DOI: 10.2147/idr.s439875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/17/2024] [Indexed: 01/30/2024] Open
Abstract
Background Due to the increasing resistance of Plasmodium falciparum to chloroquine (CQ) in Sudan, a shift from CQ to artesunate combined with sulfadoxine/pyrimethamine as a first-line treatment for uncomplicated falciparum malaria was adopted in 2004. This study aimed to determine the frequency distribution of K76T and N86Y mutations in P. falciparum chloroquine resistance transporter (pfcrt) and P. falciparum multidrug resistance 1 (pfmdr1) genes as key markers of resistance to CQ among P. falciparum isolates from patients in Nyala district of South Darfur state, west of Sudan. Methods A descriptive, cross-sectional study was conducted among 75 P. falciparum isolates from Sudanese patients diagnosed with falciparum malaria mono-infection. Parasite DNA was extracted from dried blood spots and amplified using a nested polymerase chain reaction (PCR). Then, restriction fragment length polymorphism (RFLP) was used to detect the genetic polymorphisms in codons 76 of pfcrt and 86 of pfmdr1. PCR-RFLP products were analyzed using 1.5% gel electrophoresis to identify the genetic polymorphisms in the studied codons. The wild-type (pfcrt K76 and pfmdr1 N86), mutant (pfcrt 76T and pfmdr1 86Y) and mixed-type (pfcrt K76T and pfmdr1 N86Y) alleles were expressed as frequencies and proportions. Results The wild-type pfcrt K76 allele was observed among 34.7% of isolates and the mutant 76T allele among 20% of isolates, while the mixed-type K76T allele was observed among 45.3% of isolates. On the other hand, 54.7% of isolates harbored the wild-type pfmdr1 N86 allele and 5.3% of isolates had the mutant 86Y allele, while the mixed-type N86Y allele was observed among 40% of isolates. Conclusion The key molecular markers associated with CQ resistance (pfcrt 76T and pfmdr1 86Y) are still circulating in high frequency among P. falciparum isolates in South Darfur state, about twelve years after the official withdrawal of the drug as a treatment for uncomplicated falciparum malaria.
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Affiliation(s)
- Abdalmoneim M Magboul
- Department of Parasitology & Medical Entomology, Faculty of Medical Laboratory Sciences, University of El Imam El Mahdi, Kosti, Sudan
| | - Bakri Y M Nour
- Department of Parasitology, Faculty of Medical Laboratory Sciences, University of Gezira, Wad Madani, Sudan
| | - Abdelhakam G Tamomh
- Department of Parasitology & Medical Entomology, Faculty of Medical Laboratory Sciences, University of El Imam El Mahdi, Kosti, Sudan
| | - Rashad Abdul-Ghani
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
- Tropical Disease Research Center, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana’a, Yemen
| | - Sayed Mustafa Albushra
- Department of Internal Medicine, Faculty of Medicine, University of Gezira, Wad Madani, Sudan
| | - Hanan Babiker Eltahir
- Department of Biochemistry, Faculty of Medicine, University of El Imam El Mahdi, Kosti, Sudan
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Al-Mikhlafy AA, Al Karawani M, Abdul-Ghani R, Alsubol I, Al-Awadi AA, Nassar MY, Alshehab MA, Almutawakel A, Salah A, Abdultwab AA. COVID-19 vaccine acceptability among healthcare workers in Yemen. East Mediterr Health J 2023; 26:877-884. [PMID: 38279883 DOI: 10.26719/emhj.23.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 04/28/2023] [Indexed: 01/29/2024]
Abstract
Background Acceptability of COVID-19 vaccine by healthcare workers (HCWs) can affect its acceptability by the general population. Aim To assess COVD-19 vaccine acceptability among HCWs in Sana'a, Yemen. Methods We conducted a multicentre cross-sectional study among 391 HCWs in Sana'a, Yemen, from January to March 2022. We used a self-administered questionnaire to collect data on the demographics, profession, academic qualifications, and experience of HCWs, as well as their COVID-19 vaccine acceptability or hesitancy. We used univariate and multivariable logistic regression to analyse the association between the independent variables and vaccine hesitancy (P < 0.05). Results Of the 391 HCWs, only 194 (49.6%) were willing to accept the COVID-19 vaccine. The most frequent reasons for vaccine hesitancy were fear of adverse reactions (77.7%), concerns about unknown effects of the vaccine in the future (73.1%), and uncertainty about the safety of new vaccines (69.5%). Female gender and working in the public sector were independent predictors of vaccine hesitancy among the HCWs. Conclusion Nearly half of the HCWs in Sana'a, Yemen, were willing to accept the COVID-19 vaccine. Female gender and working in the public health sector were independent predictors of vaccine hesitancy. We recommend further studies to compare COVID-19 acceptability among HCWs in the public and private sectors in Yemen.
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Affiliation(s)
- Abdullah A Al-Mikhlafy
- Department of Community Medicine, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana'a, Yemen
| | - Mahdi Al Karawani
- Department of Community Medicine, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana'a, Yemen
| | - Rashad Abdul-Ghani
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
- Tropical Disease Research Center, Faculty of Medicine and Health Sciences, University, of Science and Technology, Sana'a, Yemen
| | - Ibrahim Alsubol
- Department of Microbiology, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana'a, Yemen
| | - Asmaa Ah Al-Awadi
- Department of Microbiology, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana'a, Yemen
| | - Mogahid Y Nassar
- Department of Clinical Pathology, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana'a, Yemen
| | - Mohammed A Alshehab
- Department of Pediatrics, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana'a, Yemen
| | - Adel Almutawakel
- Department of Community Medicine, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana'a, Yemen
| | - Adeeb Salah
- Department of Clinical Pathology, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana'a, Yemen
| | - Ahlam A Abdultwab
- Department of Pediatrics, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana'a, Yemen
- Department of Pediatrics, Al-Thawra Modern General Hospital, Sana'a, Yemen
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Adam M, Nahzat S, Kakar Q, Assada M, Witkowski B, Tag Eldin Elshafie A, Abuobaida D, Safi N, Khan MA, Nagi M, Mustafa SA, Kohestani K, Muhammad J, Khim N, Al-Hadi M, Elfaki TM, Habib MN, Khairy AKA, Hamid H, Uddin Z, Amer Y, Hassan AH, Elhag MS, Sediqi AW, Kakar I, Abdul-Ghani R, Amran JGH, Abdallrahim TA, Tamim MS, Aljasari A, Rasmussen C, Azkoul L, Warsame M. Antimalarial drug efficacy and resistance in malaria-endemic countries in HANMAT-PIAM_net countries of the Eastern Mediterranean Region 2016-2020: Clinical and genetic studies. Trop Med Int Health 2023; 28:817-829. [PMID: 37705047 DOI: 10.1111/tmi.13929] [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] [Indexed: 09/15/2023]
Abstract
INTRODUCTION The World Health Organization recommends regular monitoring of the efficacy of nationally recommended antimalarial drugs. We present the results of studies on the efficacy of recommended antimalarials and molecular markers of artemisinin and partner resistance in Afghanistan, Pakistan, Somalia, Sudan and Yemen. METHODS Single-arm prospective studies were conducted to evaluate the efficacy of artesunate-sulfadoxine-pyrimethamine (ASSP) in Afghanistan and Pakistan, artemether-lumefantrine (AL) in all countries, or dihydroartemisinin-piperaquine (DP) in Sudan for the treatment of Plasmodium falciparum. The efficacy of chloroquine (CQ) and AL for the treatment of Plasmodium vivax was evaluated in Afghanistan and Somalia, respectively. Patients were treated and monitored for 28 (CQ, ASSP and AL) or 42 (DP) days. Polymerase chain reaction (PCR)-corrected cure rate and parasite positivity rate at Day 3 were estimated. Mutations in the P. falciparum kelch 13 (Pfk13) gene and amplifications of plasmepsin (Pfpm2) and multidrug resistance-1 (Pfmdr-1) genes were also studied. RESULTS A total of 1680 (249 for ASSP, 1079 for AL and 352 for DP) falciparum cases were successfully assessed. A PCR-adjusted ASSP cure rate of 100% was observed in Afghanistan and Pakistan. For AL, the cure rate was 100% in all but four sites in Sudan, where cure rates ranged from 92.1% to 98.8%. All but one patient were parasite-free at Day 3. For P. vivax, cure rates were 98.2% for CQ and 100% for AL. None of the samples from Afghanistan, Pakistan and Yemen had a Pfk13 mutation known to be associated with artemisinin resistance. In Sudan, the validated Pfk13 R622I mutation accounted for 53.8% (14/26) of the detected non-synonymous Pfk13 mutations, most of which were repeatedly detected in Gadaref. A prevalence of 2.7% and 9.3% of Pfmdr1 amplification was observed in Pakistan and Yemen, respectively. CONCLUSION High efficacy of ASSP, AL and DP in the treatment of uncomplicated falciparum infection and of CQ and AL in the treatment of P. vivax was observed in the respective countries. The repeated detection of a relatively high rate of Pfk13 R622I mutation in Sudan underscores the need for close monitoring of the efficacy of recommended ACTs, parasite clearance rates and Pfk13 mutations in Sudan and beyond. Registration numbers of the trials: ACTRN12622000944730 and ACTRN12622000873729 for Afghanistan, ACTRN12620000426987 and ACTRN12617001025325 for Pakistan, ACTRN12618001224213 for Somalia, ACTRN12617000276358, ACTRN12622000930785 and ACTRN12618001800213 for Sudan and ACTRN12617000283370 for Yemen.
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Affiliation(s)
| | - Sami Nahzat
- National Malaria and Leishmania Control Programme, Ministry of Public Health, Kabul, Afghanistan
| | | | - Methaq Assada
- National Malaria Control Programme, Ministry of Health, Sana'a, Yemen
| | - Benoit Witkowski
- Malaria Research Unit, Pasteur Institute of Cambodia, Phnom Penh, Cambodia
| | | | - Duha Abuobaida
- Communicable Diseases Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | | | - Munir Ahmed Khan
- Provincial Malaria and VBDs Control Programme, Quetta, Balochistan, Pakistan
| | - Mustafa Nagi
- National Malaria Control Programme, Ministry of Health, Sana'a, Yemen
| | - Sayed Ali Mustafa
- Communicable Diseases Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | - Khalilahmad Kohestani
- National Malaria and Leishmania Control Programme, Ministry of Public Health, Kabul, Afghanistan
| | - Jamil Muhammad
- Provincial Malaria and VBDs Control Programme, Khyber Pakhtunkhwa, Pakistan
| | - Nimol Khim
- Malaria Research Unit, Pasteur Institute of Cambodia, Phnom Penh, Cambodia
| | - Mohammed Al-Hadi
- National Malaria Control Programme, Ministry of Health, Sana'a, Yemen
| | - Tarig Mohamed Elfaki
- Communicable Diseases Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | - Muhammad Naeem Habib
- Malaria & Other Vector Borne Disease Program, Ministry of Public Health, Kabul, Afghanistan
| | | | - Hamida Hamid
- Malaria & Other Vector Borne Disease Program, Ministry of Public Health, Kabul, Afghanistan
| | - Zain Uddin
- District Headquarter Hospital, Zhob, Pakistan
| | - Yahya Amer
- Almarawiah Hospital Ministry of Health, Al Mahrah, Yemen
| | | | - Mousab Siddig Elhag
- Communicable Diseases Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | - Ahmad Walid Sediqi
- Global Fund Programme, United Nations Development Programme, Kabul, Afghanistan
| | - Inamullah Kakar
- Directorate of Malaria Control, Common Management Unit Global Fund grant for Malaria Control, Ministry of National Health Services Regulations and Coordination, Islamabad, Pakistan
| | - Rashad Abdul-Ghani
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | | | | | - Mohammad Shoaib Tamim
- Malaria & Other Vector Borne Disease Program, Ministry of Public Health, Kabul, Afghanistan
| | | | | | | | - Marian Warsame
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
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Albagawi B, Alkubati SA, Abdul-Ghani R. Levels and predictors of nurses' knowledge about diabetes care and management: disparity between perceived and actual knowledge. BMC Nurs 2023; 22:342. [PMID: 37770877 PMCID: PMC10537144 DOI: 10.1186/s12912-023-01504-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/12/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Nurses have a crucial role in managing, educating, and caring for diabetic patients. However, their knowledge should be regularly assessed to avoid preventable complications and reduce costs. Therefore, the present study assessed the perceived and actual knowledge about diabetes among nurses in Hail province of Saudi Arabia and investigated predictors of such knowledge. METHODS A cross-sectional study was conducted among 325 conveniently sampled nurses from all public hospitals and primary healthcare centres in Hail province from September to December 2022. A pre-designed questionnaire was used to collect demographic and practice-related characteristics of the nurses. In addition, data on nurses' perceived and actual knowledge about diabetes were collected using the Diabetes Self-Report Tool (DSRT) and Diabetes Basic Knowledge Tool (DBKT) self-report questionnaires, respectively. The mean knowledge scores for demographic and practice-related variables were compared using the independent-samples t-test and one-way analysis of variance. Multiple linear regression was used to identify significant predictors of perceived and actual knowledge. The correlation between perceived and actual knowledge was investigated using Pearson's correlation coefficient. A P-value ˂0.05 was considered statistically significant. RESULTS Based on a highest maximum score of 60 using the DSRT, the mean score of perceived knowledge was 38.4 ± 12.0, corresponding to a percentage mean score of 64%. On the other hand, based on a highest maximum score of 49 using the DBKT, the mean score of actual knowledge was 23.2 ± 9.6, corresponding to a percentage mean score of 47.3% of correct responses. Being Indian, having a diploma or a bachelor's degree, and having a poor or fair self-perception of competence in diabetes care were predictors of lower perceived knowledge scores, whereas having no access to diabetes guidelines was a predictor of higher scores. However, being non-Saudi and having experience of at least 16 years were predictors of higher actual knowledge scores. The correlation between actual and perceived knowledge about diabetes was negligible and statistically non-significant (r = 0.011, P = 0.055). CONCLUSION Nurses affiliated with public health facilities in Hail province lack adequate knowledge about diabetes, with no correlation between what is perceived to be known and what is actually known. Indian citizenship, having a diploma or bachelor's degree, not having access to diabetes guidelines, not attending courses/workshops, and having a poor or fair self-perception of competence in diabetes care can significantly predict nurses' perceived knowledge. However, being non-Saudi (Filipino or Indian) and having at least 16 years of experience can significantly predict their actual knowledge of diabetes.
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Affiliation(s)
- Bander Albagawi
- Department of Medical Surgical Nursing, College of Nursing, University of Hail, Hail City, Saudi Arabia
| | - Sameer A Alkubati
- Department of Medical Surgical Nursing, College of Nursing, University of Hail, Hail City, Saudi Arabia.
- Department of Nursing, Faculty of Medicine and Health Sciences, Hodeida University, Hodeida, Yemen.
| | - Rashad Abdul-Ghani
- Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
- Tropical Disease Research Center, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana'a, Yemen
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da Silva CFA, Virgüez E, Eker S, Zdenek CN, Bergh C, Gerarduzzi C, Ge Y, Klinger M, Allareddy V, Hoots E, Henriquez T, Waiho K, D'Ippoliti C, Al Harraq A, Xu H, Zou J, Xia Y, Abdul-Ghani R, Chugh M. The future of scientific societies. Science 2023; 380:30-32. [PMID: 37023192 DOI: 10.1126/science.adh8182] [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] [Indexed: 04/08/2023]
Affiliation(s)
| | - Edgar Virgüez
- Biosphere Sciences & Engineering Division, Carnegie Institution for Science, Stanford, CA, USA
| | - Sibel Eker
- Radboud University, Nijmegen, Netherlands and International Institute for Applied Systems Analysis, Laxenburg, Austria
| | - Christina N Zdenek
- School of Biological Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Cathrine Bergh
- KTH Royal Institute of Technology, 11423 Stockholm, Sweden
| | | | - Yan Ge
- College of Resources and Environment, Northeast Agricultural University, Harbin 150030, Heilongjiang, China
| | - Madeline Klinger
- Helen Wills Neuroscience Institute, University of California, Berkeley, Emeryville, CA, USA
| | | | - Elizabeth Hoots
- Department of Science, Engineering, and Built Environment, Deakin University, Queenscliff, VIC, Australia
| | - Tania Henriquez
- Department of Medical Biotechnologies, University of Siena, Siena, Tuscany, Italy
| | - Khor Waiho
- Higher Institution Centre of Excellence, Institute of Tropical Aquaculture and Fisheries, Universiti Malaysia Terengganu, Kuala Nerus, Terengganu, Malaysia
| | - Carlo D'Ippoliti
- Department of Statistical Sciences, Sapienza University of Rome, Rome, Italy
| | - Ahmed Al Harraq
- Cain Department of Chemical Engineering, Louisiana State University, Baton Rouge, LA, USA
| | - Hui Xu
- School of Agronomy, Anhui Agricultural University, Hefei, Anhui 230036, China
| | - Junyu Zou
- School of Environmental Science and Engineering, Southern University of Science and Technology, Shenzhen, China
| | - Yuanxing Xia
- Department of Electrical Engineering, Southeast University, Nanjing, Jiangsu Province, China
| | - Rashad Abdul-Ghani
- Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen and Faculty of Medicine and Health Sciences, Tropical Disease Research Center, University of Science and Technology, Sana'a, Yemen
| | - Mayank Chugh
- Department of Systems Biology, Harvard Medical School, Boston, MA, USA
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Saleh AG, Shehab AY, Abdul-Ghani R, Allam AF, Osman MM, Ibrahim HS, El-Taweel HA, Moneer EA, Hagras NAE, Farag HF. Key cytokines and hematological parameters in patients with uncomplicated falciparum malaria in Hodeidah, Yemen. Cytokine 2023; 164:156156. [PMID: 36857851 DOI: 10.1016/j.cyto.2023.156156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/14/2023] [Accepted: 02/11/2023] [Indexed: 02/28/2023]
Abstract
Immunity to malaria has a major role in controlling disease and pathogenesis with cytokine production being involved in almost every phase of the immune response. The present study aimed to assess hematological variables and to measure plasma levels of TNFα, IFNγ and IL10, their ratios, and their relation to parasitemia among patients with uncomplicated falciparum malaria in Hodeidah, Yemen. Forty patients with uncomplicated P. falciparum monoinfection and 40 healthy age and sex-matched controls were enrolled in the study. Parasitological diagnosis was confirmed, and parasite density was estimated. Plasma cytokine levels, hematologic parameters, and the presence of gametocytes were determined. Results revealed higher TNFα, IFNγ and IL10 in patients than in controls. A relatively higher IL10 production was demonstrated by the significantly lower TNFα/IL10 and IFNγ/IL10 ratios in patients than in controls. TNFα and IL10 correlated positively with parasite density. Lower Hb levels, RBC, lymphocyte and platelet counts, and higher neutrophil and reticulocyte counts were observed in patients compared to controls. Reticulocyte count was higher and IFNγ level was lower in the presence of gametocytes. Conclusively, uncomplicated falciparum malaria is associated with the ability to regulate the production of pro-inflammatory and anti-inflammatory cytokines. This mediates parasite clearance while simultaneously avoiding severe pathology.
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Affiliation(s)
- Ali Gamali Saleh
- Faculty of Medicine and Health Sciences, Hodeidah University, Yemen
| | - Amel Youssef Shehab
- Department of Parasitology, Medical Research Institute, University of Alexandria, Egypt
| | - Rashad Abdul-Ghani
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen and Tropical Disease Research Center, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana'a, Yemen
| | - Amal Farahat Allam
- Department of Parasitology, Medical Research Institute, University of Alexandria, Egypt
| | - Mervat Mostafa Osman
- Department of Parasitology, Medical Research Institute, University of Alexandria, Egypt
| | - Heba Said Ibrahim
- Department of Parasitology, Medical Research Institute, University of Alexandria, Egypt
| | - Hend Ali El-Taweel
- Department of Parasitology, Medical Research Institute, University of Alexandria, Egypt.
| | - Esraa Abdelhamid Moneer
- Department of Medical Laboratory, Faculty of Applied Health Sciences Technology, Pharos University, Alexandria, Egypt
| | - Nancy Abd-Elkader Hagras
- Department of Medical Laboratory, Faculty of Applied Health Sciences Technology, Pharos University, Alexandria, Egypt
| | - Hoda Fahmy Farag
- Department of Parasitology, Medical Research Institute, University of Alexandria, Egypt
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Al-Quhaiti MAA, Abdul-Ghani R, Mahdy MAK, Assada MA. Malaria among under-five children in rural communities of Al-Mahweet governorate, Yemen. Malar J 2022; 21:344. [PMID: 36401272 PMCID: PMC9675118 DOI: 10.1186/s12936-022-04371-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/07/2022] [Indexed: 11/19/2022] Open
Abstract
Background Malaria burden among under-five children living in endemic areas of Yemen is largely unknown due to the lack of community-based studies. Therefore, this study determined the prevalence and risk factors associated with falciparum malaria among under-five children in rural communities of Al-Mahweet governorate, Yemen. Methods This community-based, cross-sectional study recruited 400 under-five children from two rural districts of Al-Mahweet governorate in December 2019. Demographic characteristics (gender, age, education and occupation of the child’s parents, and household size) and risk factors associated with malaria were collected through interviews with children’s caregivers using a structured questionnaire. Finger-prick blood was screened for Plasmodium falciparum and non-falciparum species using rapid diagnostic tests (RDTs), and duplicate Giemsa-stained thick and thin blood films were examined for malaria parasites. The density of asexual P. falciparum stages was also estimated. Data were then analysed, and the agreement between the results of thick-film microscopy and RDTs for diagnosing falciparum malaria was assessed using the kappa index. Statistical significance was set at a P-value of < 0.05. Results Plasmodium falciparum was prevalent among 9.8% (95% CI 7.0–13.1) of under-five children in the rural communities of Al-Mahweet, with a median asexual parasite density of 763 ± 2606 parasites/μl of blood (range: 132–4280) and low-to-moderate parasitaemia levels. Approximately one-third of microscopy-confirmed cases were gametocyte carriers. Multivariable logistic regression analysis confirmed that age of three years or older (AOR = 5.6, 95% CI 1.6–19.8; P = 0.007), not sleeping under a mosquito net the previous night of the survey (AOR = 8.0, 95% CI 2.4–27.4; P = 0.001), sleeping outdoors at night (AOR = 4.4, 95% CI 2.0–10.0; P < 0.001), and absence of indoor residual spraying (IRS) during the last year (AOR = 4.2, 95% CI 1.9–9.4; P < 0.001) were the independent predictors of falciparum malaria among under-five children in the rural communities of Al-Mahweet. The observed percentage agreement between thick-film microscopy and RDTs was 98.5%, with a very good agreement (k-index = 0.9) between the two methods for falciparum malaria diagnosis that was statistically significant. Conclusion Approximately one in ten under-five children in rural communities of Al-Mahweet is infected with P. falciparum based on microscopy and RDTs. Age of three years or older, not sleeping under mosquito nets, sleeping outdoors at night and absence of IRS can independently predict falciparum malaria among them. The very good agreement between thick-film microscopy and RDTs for diagnosing falciparum malaria in children supports the usefulness of using RDTs in such resource-limited rural communities.
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Al-Azazi AA, Abdul-Ghani R, El-Sayad MH, Sadek NA, El-Taweel HA. Levels of Serum Ferritin and Hepcidin in Patients with Uncomplicated Falciparum Malaria in Hodeidah, Yemen: Considerations for Assessing Iron Status. Hemoglobin 2022; 46:100-105. [PMID: 35924733 DOI: 10.1080/03630269.2022.2083970] [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] [Indexed: 11/04/2022]
Abstract
Understanding the key regulator of iron homeostasis is critical to the improvement of iron supplementation practices in malaria-endemic areas. This study aimed to determine iron indices and hepcidin (HEPC) level in patients infected with Plasmodium falciparum compared to apparently healthy, malaria-negative subjects in Hodeidah, Yemen. The study included 70 Plasmodium falciparum-infected and 20 malaria-negative adults. Blood films were examined for detection and estimation of parasitemia. Hemoglobin (Hb) level was measured using an automated hematology analyzer. Serum iron and total iron binding capacity (TIBC) were determined by spectrophotometric methods. Levels of serum ferritin (FER) and HEPC were measured by enzyme-linked immunosorbent assays. Data were stratified by sex and age. Comparable Hb levels were found in P. falciparum-infected patients and malaria-negative subjects in each sex and age group (p > 0.05). Compared to their malaria-negative counterparts, disturbed iron homeostasis in patients was evidenced by the significantly lower serum iron levels in females (p = 0.007) and those aged <25 years (p = 0.02) and the significantly higher TIBC in males (p = 0.008). Levels of serum FER and HEPC were significantly elevated in P. falciparum-infected patients compared to the corresponding malaria-negative participants (p < 0.001). Serum FER correlated positively with parasite density (p = 0.004). In conclusion, patients with uncomplicated P. falciparum in Hodeidah display elevated levels of serum HEPC and FER. Hemoglobin level may not reflect the disturbed iron homeostasis in these patients. The combined measurement of iron indices and HEPC provides comprehensive information on the iron status so that the right intervention can be chosen.
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Affiliation(s)
| | - Rashad Abdul-Ghani
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Mona H El-Sayad
- Department of Parasitology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Nadia A Sadek
- Department of Hematology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Hend A El-Taweel
- Department of Parasitology, Medical Research Institute, Alexandria University, Alexandria, Egypt
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Al-Awadi AAH, Abdul-Ghani R, Al-Mekhlafi AM. Toxoplasma gondii Infection Among Institutionalized Children with Down syndrome in Sana'a city, Yemen: Implications of Low IgG Seroprevalence. Acta Parasitol 2022; 67:530-534. [PMID: 34623612 PMCID: PMC8499612 DOI: 10.1007/s11686-021-00473-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/15/2021] [Indexed: 11/28/2022]
Abstract
Purpose To assess the IgG seroprevalence of Toxoplasma gondii as an indicator of past exposure and immunity against infection among children with Down syndrome (DS) in Sana’a city, Yemen. This preliminary study is justified by the primary immunodeficiency of children with DS and the opportunistic nature of the parasite, considering the vague situation of anti-Toxoplasma IgG seroprevalence among children with DS because of neglecting its study on local and global scales. Methods This descriptive, facility-based, cross-sectional study was conducted among 107 children with DS hosted in six randomly selected rehabilitation centers for children with special needs in Sana’a city. Demographics of children and their mothers’ knowledge of toxoplasmosis were collected using a pre-designed, structured questionnaire. Anti-Toxoplasma IgG antibodies were measured in the sera of children using electrochemiluminescence assay. Results Of 107 children with DS, 3 (2.8%) were seropositive for anti-Toxoplasma IgG. Approximately two-thirds (71/106) of the mothers of children with DS were aware of toxoplasmosis. Of whom, 83.1% (59/71) were aware of its congenital complications. Conclusion The majority of children with DS in Sana’a city are seronegative for anti-Toxoplasma IgG, where the seropositivity rate is lower than 3.0%. Therefore, children with DS are non-immune and susceptible to the acquisition of primary infections during their life. Further analytical studies are recommended to determine whether the defective immune response of children with DS is associated with false seronegativity, to assess the role of their mothers’ knowledge in reducing their exposure to infection if they were confirmed truly seronegative and to identify the predictors of infection among them.
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Affiliation(s)
- Asmaa A H Al-Awadi
- Department of Medical Laboratories, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana'a, Yemen
| | - Rashad Abdul-Ghani
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.
- Tropical Disease Research Center, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana'a, Yemen.
| | - Abdulsalam M Al-Mekhlafi
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
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11
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Al-Brhami KAR, Abdul-Ghani R, Al-Qobati SA. Intestinal microsporidiosis among HIV/AIDS patients receiving antiretroviral therapy in Sana'a city, Yemen: first report on prevalence and predictors. BMC Infect Dis 2022; 22:11. [PMID: 34983416 PMCID: PMC8724650 DOI: 10.1186/s12879-021-07009-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 12/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background Intestinal microsporidiosis is an opportunistic infection associated with persistent diarrhea among HIV/AIDS patients. In Yemen, however, its epidemiology is unknown. Therefore, this study determined its prevalence and predictors among HIV/AIDS patients receiving antiretroviral therapy (ART) in Sana’a city, the capital of Yemen. Methods This cross-sectional study included 402 patients receiving ART at Al-Jomhori Educational Hospital in Sana’a from November 2019 to December 2020. Data about demographics, clinical characteristics and risk factors were collected using a pre-designed questionnaire. Stool samples were collected and examined for microsporidian spores using the Gram-chromotrope Kinyoun staining. Blood samples were also collected and used for CD4 cell counting by flow cytometry. Univariate analysis was used to test the association of patients’ characteristics and risk factors with intestinal microsporidiosis. Multivariable logistic regression was then used to identify the independent predictors of infection. Statistical significance was considered at P-values < 0.05. Results Intestinal microsporidiosis was prevalent among 14.2% (57/402) of HIV/AIDS patients and was significantly associated with diarrhea (OR 3.4, 95% CI 1.7–6.6; P = 0.001). The significant independent predictors of infection were < 200 CD4 cells/µl (AOR 3.2, 95% CI 1.5–6.9; P = 0.003), not washing hands after contacting soil (AOR 2.5, 95% CI 1.1–5.4; P = 0.026) and before eating (AOR 3.1, 95% CI 1.5–6.4; P = 0.003), eating unwashed raw produce (AOR 2.5, 95% CI 1.2–5.3; P = 0.017) and absence of indoor latrines (AOR 6.2, 95% CI 1.5–25.9; P = 0.012). Conclusions The prevalence of intestinal microsporidiosis among HIV/AIDS patients in Sana'a is high and comparable to that reported from several other countries, being prevalent among approximately 14.0% of patients and significantly associated with diarrhea. It could be predicted among patients who have < 200 CD4 cells/µl, have poor hand hygiene after contacting soil and before eating, usually eat unwashed raw produce, or do not possess indoor latrines. Large-scale studies on its epidemiology and predictors among HIV/AIDS patients across the country are warranted.
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Affiliation(s)
- Kwkab A R Al-Brhami
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Rashad Abdul-Ghani
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen. .,Tropical Disease Research Center, Faculty of Medicine and Health Sciences, University, of Science and Technology, Sana'a, Yemen.
| | - Salah A Al-Qobati
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
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12
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Abdul-Ghani R, Al-Brhami KAR, Baalawi AKM, Khodeif AAM, Al-Wshali AAY, Abo-Hadi AHY, Al-Saigel EHS, Al-Gomaei HAA, Al-Gatta HMA, Abdo MHM, Al-Musheriae MSA, Al-Mohiya RSS, Al-Dobhany SSA. Intestinal parasitic infections among type-2 diabetics seeking healthcare in Sana'a city, Yemen. Ann Parasitol 2022; 68:673-683. [PMID: 37573498 DOI: 10.17420/ap6804.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 08/14/2023]
Abstract
Intestinal parasitic infections (IPIs) are common in developing countries, particularly in countries witnessing conflicts and humanitarian crises like Yemen. Type-2 diabetics are among the population categories most vulnerable to a variety of infections, including IPIs. Therefore, this study determined the prevalence and risk factors associated with IPIs among Yemeni type-2 diabetics in Sana'a city. This hospital-based, cross-sectional study recruited 389 type-2 diabetics seeking healthcare in Sana'a from December 2019 to February 2020. Sociodemographic data and risk factors were collected from interviewed participants using a structured questionnaire. Stool samples were collected and examined for parasites using standard techniques. The association of sociodemographic characteristics and risk factors with IPIs was tested using univariate analysis, and a multivariable logistic regression model was developed to identify the independent predictors of IPIs at a significance level of <0.05. The overall prevalence of IPIs among diabetics was 38.6%. Entamoeba histolytica/dispar (30.3%) was the most frequent parasite, followed by Cryptosporidium species (8.2%). The significant independent predictors of IPIs were duration of diabetes mellitus > 10 years (AOR = 1.6; 95% CI: 1.10-2.47, P = 0.029), eating unwashed vegetables/fruits (AOR = 3.2; 95% CI: 1.44-6.92, P = 0.004) and not practicing handwashing before meals (AOR = 2.4; 95% CI: 1.10-5.48, P = 0.035). Over one-third of type-2 diabetics seeking healthcare in Sana'a city are infected with one or more IPIs, predominantly with E. histolytica/dispar, followed by Cryptosporidium species. Such infections cannot be predicted from the sociodemographic characteristics of diabetics. Nevertheless, prolonged duration of diabetes mellitus, eating unwashed vegetables/fruits and not practicing handwashing before meals are independent predictors of IPIs among type-2 diabetics. Large-scale studies are recommended for IPIs among type-2 diabetics with and without gastrointestinal complaints, preferably in comparison to non-diabetics.
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Affiliation(s)
- Rashad Abdul-Ghani
- 1Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
- Tropical Disease Research Center, Faculty of Medicine and Health Sciences, University, of Science and Technology, Sana'a, Yemen
| | - Kwkab A R Al-Brhami
- 1Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Abdulslam K M Baalawi
- Division of Medical Laboratories, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Amani A M Khodeif
- Division of Medical Laboratories, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Asma'a A Y Al-Wshali
- Division of Medical Laboratories, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Azhar H Y Abo-Hadi
- Division of Medical Laboratories, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Eshtiaq H S Al-Saigel
- Division of Medical Laboratories, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Hanan A A Al-Gomaei
- Division of Medical Laboratories, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Hani M A Al-Gatta
- Division of Medical Laboratories, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Maroof H M Abdo
- Division of Medical Laboratories, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Muhammad S A Al-Musheriae
- Division of Medical Laboratories, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Roqia S S Al-Mohiya
- Division of Medical Laboratories, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Shaima S A Al-Dobhany
- Division of Medical Laboratories, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
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13
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Elkhalifa AME, Abdul-Ghani R, Tamomh AG, Eltaher NE, Ali NY, Ali MM, Bazie EA, KhirAlla A, DfaAlla FA, Alhasan OAM. Hematological indices and abnormalities among patients with uncomplicated falciparum malaria in Kosti city of the White Nile state, Sudan: a comparative study. BMC Infect Dis 2021; 21:507. [PMID: 34059017 PMCID: PMC8166086 DOI: 10.1186/s12879-021-06228-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hematological abnormalities are common features in falciparum malaria but vary among different populations across countries. Therefore, we compared hematological indices and abnormalities between Plasmodium falciparum-infected patients and malaria-negative subjects in Kosti city of the White Nile State, Sudan. METHODS A comparative, cross-sectional study was conducted at the Clinical Laboratory Unit of Kosti Teaching Hospital from June to December 2018. A total of 392 participants (192 P. falciparum-infected patients and 200 malaria-negative subjects) were recruited in the study. Hematological indices of hemoglobin (Hb), red blood cells (RBCs), white blood cells (WBCs) and platelets were measured, and their median values were statistically compared. RESULTS The majority of P. falciparum-infected patients (67.6%) showed a low-level parasitemia. The median values of Hb concentration, RBC count, mean corpuscular volume (MCV), mean corpuscular Hb (MCH) and mean corpuscular Hb concentration (MCHC) were significantly lower in P. falciparum-infected patients, while the median red cell distribution width (RDW) was significantly higher in the patients compared to malaria-negative subjects. Anemia, low MCV, low MCH, low MCHC and high RDW were significantly associated with falciparum malaria, but parasitemia level was not significantly associated with anemia severity. The median total WBC count was non-significantly higher in P. falciparum-infected patients, with neutropenia being significantly associated with falciparum malaria. The median platelet count was significantly lower in P. falciparum-infected patients, with thrombocytopenia being significantly associated with falciparum malaria. CONCLUSIONS Falciparum malaria among patients in Kosti city of the White Nile State, Sudan is predominantly of low-level parasitemia. It is significantly associated with anemia, low MCV, low MCH, low MCHC, high RDW, thrombocytopenia and neutropenia. However, parasitemia level is not a significant predictor of anemia severity. On the other hand, leucopenia is not useful to predict falciparum malaria. Further large-scale studies in community and healthcare settings and inclusion of patients with complicated or severe malaria and those with high parasite densities are recommended.
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Affiliation(s)
- Ahmed M E Elkhalifa
- Department of Public Health, College of Health Sciences Saudi Electronic University, Riyadh, Kingdom of Saudi Arabia.,Department of Hematology, Faculty of Medical Laboratory Sciences, University of El Imam El Mahdi, Kosti, Sudan
| | - Rashad Abdul-Ghani
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen. .,Tropical Disease Research Center, Faculty of Medicine and Health Sciences, University, of Science and Technology, Sana'a, Yemen.
| | - Abdelhakam G Tamomh
- Department of Parasitology and Medical Entomology, Faculty of Medical Laboratory Sciences, University of El Imam El Mahdi, Kosti, Sudan
| | - Nur Eldin Eltaher
- Department of Public Health, Faculty of Public and Environmental Health, University of El Imam El Mahdi, Kosti, Sudan
| | - Nada Y Ali
- Department of Hematology, Faculty of Medical Laboratory Sciences, University of El Imam El Mahdi, Kosti, Sudan
| | - Moataz M Ali
- Department of Pathology, Faculty of Medicine, University of El Imam El Mahdi, Kosti, Sudan.,Department of Pathology, Faculty of Medicine, Albaha University, Albaha, Kingdom of Saudi Arabia
| | - Elsharif A Bazie
- Department of Pediatrics, Faculty of Medicine, University of El Imam El Mahdi, Kosti, Sudan
| | - Aboagla KhirAlla
- Department of Hematology, Faculty of Medical Laboratory Sciences, University of El Imam El Mahdi, Kosti, Sudan
| | - Fatin A DfaAlla
- Department of Hematology, Faculty of Medical Laboratory Sciences, University of El Imam El Mahdi, Kosti, Sudan
| | - Omnia A M Alhasan
- Department of Hematology, Faculty of Medical Laboratory Sciences, University of El Imam El Mahdi, Kosti, Sudan
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Abdul-Ghani R, Fouque F, Mahdy MAK, Zhong Q, Al-Eryani SMA, Alkwri A, Beier JC. Multisectoral Approach to Address Chikungunya Outbreaks Driven by Human Mobility: A Systematic Review and Meta-Analysis. J Infect Dis 2021; 222:S709-S716. [PMID: 33119099 PMCID: PMC7594244 DOI: 10.1093/infdis/jiaa500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The role of human mobility in the epidemiology of emerging Aedes-transmitted viral diseases is recognized but not fully understood. The objective of this systematic review and meta-analysis was to examine how human mobility patterns are driving chikungunya outbreaks. METHODS Literature was systematically reviewed for studies on chikungunya prevalence in countries/territories with high-level evidence of human mobility-driven outbreaks, based on: (1) emergence of chikungunya outbreaks with epidemic chikungunya virus genotypes among displaced/migrant populations and their hosting communities; and (2) identification of imported index case(s) with epidemic genotypes phylogenetically related to the genotypes circulating during emerging or subsequent outbreaks. RESULTS The meta-analysis of extracted prevalence data revealed that a large proportion of the population in countries/territories afflicted by outbreaks is still at risk of infection during future outbreaks. On the other hand, approximately one-half of suspected chikungunya cases could be infected with other co-circulating acute febrile illnesses. CONCLUSIONS We discussed in this paper how human mobility-driven chikungunya outbreaks can be addressed, and how the involvement of several sectors in addition to the health sector in multisectoral approaches (MSAs) is important for prevention and control of chikungunya and other Aedes-transmitted arboviral outbreaks.
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Affiliation(s)
- Rashad Abdul-Ghani
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.,Tropical Disease Research Center, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana'a, Yemen
| | - Florence Fouque
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Mohammed A K Mahdy
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.,Tropical Disease Research Center, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana'a, Yemen
| | - Qingxia Zhong
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Samira M A Al-Eryani
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Abdulsamad Alkwri
- Integrated Vector Management Unit, National Malaria Control Programme, Ministry of Public Health and Population, Sana'a, Yemen
| | - John C Beier
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
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15
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Alwajeeh TS, Abdul-Ghani R, Allam AF, Farag HF, Khalil SSM, Shehab AY, El-Sayad MH, Alharbi RA, Almalki SSR, Azazy AA. Uncomplicated falciparum malaria among schoolchildren in Bajil district of Hodeidah governorate, west of Yemen: association with anaemia and underweight. Malar J 2020; 19:358. [PMID: 33028361 PMCID: PMC7542704 DOI: 10.1186/s12936-020-03431-1] [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] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria, malnutrition and anaemia are major public health problems in Yemen, with Hodeidah being the most malaria-afflicted governorate. To address the lack of relevant studies, this study was conducted to determine the prevalence of Plasmodium falciparum and its relation to nutritional status and haematological indices among schoolchildren in Bajil district of Hodeidah governorate, west of Yemen. METHODS A cross-sectional study was conducted among 400 schoolchildren selected randomly from four schools in Bajil district. Data about demographic characteristics, risk factors and anthropometric measurements of age, height and weight were collected. Duplicate thick and thin blood films were prepared, stained with Giemsa and examined microscopically for malaria parasites. The density of P. falciparum asexual stages was estimated on thick films. EDTA-blood samples were examined for the haematological indices of haemoglobin (Hb) and blood cell counts. RESULTS Plasmodium falciparum was prevalent among 8.0% (32/400) of schoolchildren with a mean parasite density of 244.3 ± 299.3/µL of blood and most infections showing low-level parasitaemia, whereas Plasmodium vivax was detected in one child (0.25%). Residing near water collections was a significant independent predictor of falciparum malaria [adjusted odds ratio (AOR) = 2.6, 95.0% CI 1.20-5.72; p = 0.016] in schoolchildren. Mild anaemia was prevalent among more than half of P. falciparum-infected schoolchildren and significantly associated with falciparum malaria (AOR = 5.8, 95.0% CI 2.39-14.17; p < 0.001), with a mean Hb concentration of 10.7 ± 1.0 g/dL. Although the mean values of the total white blood cells, monocytes and platelets were significantly lower in infected than non-infected schoolchildren, they were within normal ranges. More than half of the children were malnourished, with stunting (39.3%) and underweight (36.0%) being the most prevalent forms of malnutrition; 6.3% of children were wasted. Underweight (AOR = 5.3, 95.0% CI 2.09-13.62; p < 0.001) but not stunting or wasting, was a significant predictor of falciparum malaria among schoolchildren. CONCLUSION Asymptomatic falciparum malaria is prevalent among schoolchildren in Bajil district of Hodeidah Governorate, with predominance of low parasitaemic infections and significant association with mild anaemia and underweight. Residence near water collection is a significant predictor of infection with falciparum malaria among schoolchildren. Further studies among children with severe malaria and those with high parasite densities are recommended.
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Affiliation(s)
- Talal S Alwajeeh
- Laboratory Department, Kuwait University Hospital, Sana'a University, Sana'a, Yemen
| | - Rashad Abdul-Ghani
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen. .,Tropical Disease Research Center, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana'a, Yemen.
| | - Amal F Allam
- Department of Parasitology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Hoda F Farag
- Department of Parasitology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Safia S M Khalil
- Department of Parasitology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Amel Y Shehab
- Department of Parasitology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Mona H El-Sayad
- Department of Parasitology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Raed A Alharbi
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Al Baha University, Al Baha, Saudi Arabia
| | - Shaia S R Almalki
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Al Baha University, Al Baha, Saudi Arabia
| | - Ahmed A Azazy
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Al Baha University, Al Baha, Saudi Arabia
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16
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Abdul-Aziz M, Mahdy MAK, Abdul-Ghani R, Alhilali NA, Al-Mujahed LKA, Alabsi SA, Al-Shawish FAM, Alsarari NJM, Bamashmos W, Abdulwali SJH, Al Karawani M, Almikhlafy AA. Bacterial vaginosis, vulvovaginal candidiasis and trichomonal vaginitis among reproductive-aged women seeking primary healthcare in Sana'a city, Yemen. BMC Infect Dis 2019; 19:879. [PMID: 31640583 PMCID: PMC6805389 DOI: 10.1186/s12879-019-4549-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/09/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In Yemen, the underlying causes of infectious vaginitis have been neglected. Therefore, this study aimed to determine the prevalence and risk factors associated with bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and trichomonal vaginitis (TV) among non-pregnant reproductive-aged women. METHODS A cross-sectional study was conducted among 347 non-pregnant reproductive-aged women seeking primary healthcare in Sana'a city, Yemen. Data about sociodemographic characteristics, lifestyle-related behaviors, routine hygienic practices, menstrual care and history and type of contraceptive intake were collected using a structured questionnaire. Vaginal discharge samples were collected and examined for discharge characteristics and pH by a gynecologist. Then, samples were examined for BV, VVC and TV. Data were analyzed using suitable statistical tests. RESULTS Vaginal infections were prevalent among 37.6% of reproductive-aged women, where BV was the most prevalent (27.2%). VVC was significantly higher among symptomatic women and significantly associated with itching (P = 0.005). Using bivariate analysis, the age of < 25 years (odds ratio [OR] = 1.9, 95% confidence interval [CI]: 1.16-3.10; P = 0.010) and using intrauterine contraceptive devices (IUCDs) (OR = 1.8, 95% CI: 1.09-2.89; P = 0.020) were significantly associated with BV, while history of miscarriage was significantly associated with a lower risk of BV (OR = 0.5, 95% CI: 0.31-0.85, P = 0.009). However, polygyny was significantly associated with VVC (OR = 3.4, 95% CI: 1.33-8.66; P = 0.007). Multivariable analysis confirmed that age of < 25 years and using IUCD were the independent predictors of BV, while history of miscarriage was an independent protective factor against BV. On the other hand, marriage to a polygamous husband was the independent predictor of VVC. CONCLUSIONS More than a third of non-pregnant reproductive-aged women seeking PHC in Sana'a have single or mixed infections with BV, VVC or TV. BV is the most frequent cause of vaginitis and is significantly associated with the age of < 25 years and using IUCDs, while VVC is significantly higher among women with polygamous husbands. Health education of polygamous husbands and their wives, regular monitoring of BV among IUCD users and screening women for vaginitis before treatment are recommended.
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Affiliation(s)
- Maha Abdul-Aziz
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Science and Technology, Sana'a, Yemen
| | - Mohammed A K Mahdy
- Tropical Disease Research Center, Faculty of Medicine, University of Science and Technology, Sana'a, Yemen. .,Department of Parasitology, Faculty of Medicine, Sana'a University, Sana'a, Yemen.
| | - Rashad Abdul-Ghani
- Tropical Disease Research Center, Faculty of Medicine, University of Science and Technology, Sana'a, Yemen.,Department of Parasitology, Faculty of Medicine, Sana'a University, Sana'a, Yemen
| | - Nuha A Alhilali
- Medical Laboratory Sciences Program, Faculty of Medicine, University of Science and Technology, Sana'a, Yemen
| | - Leena K A Al-Mujahed
- Medical Laboratory Sciences Program, Faculty of Medicine, University of Science and Technology, Sana'a, Yemen
| | - Salma A Alabsi
- Medical Laboratory Sciences Program, Faculty of Medicine, University of Science and Technology, Sana'a, Yemen
| | - Fatima A M Al-Shawish
- Medical Laboratory Sciences Program, Faculty of Medicine, University of Science and Technology, Sana'a, Yemen
| | - Noura J M Alsarari
- Medical Laboratory Sciences Program, Faculty of Medicine, University of Science and Technology, Sana'a, Yemen
| | - Wala Bamashmos
- Medical Laboratory Sciences Program, Faculty of Medicine, University of Science and Technology, Sana'a, Yemen
| | - Shahad J H Abdulwali
- Medical Laboratory Sciences Program, Faculty of Medicine, University of Science and Technology, Sana'a, Yemen
| | - Mahdi Al Karawani
- Department of Community Medicine, Faculty of Medicine, University of Science and Technology, Sana'a, Yemen
| | - Abdullah A Almikhlafy
- Department of Community Medicine, Faculty of Medicine, University of Science and Technology, Sana'a, Yemen
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Abdul-Ghani R, Mahdy MAK, Al-Eryani SMA, Fouque F, Lenhart AE, Alkwri A, Al-Mikhlafi AM, Wilke ABB, Thabet AAQ, Beier JC. Impact of population displacement and forced movements on the transmission and outbreaks of Aedes-borne viral diseases: Dengue as a model. Acta Trop 2019; 197:105066. [PMID: 31226251 DOI: 10.1016/j.actatropica.2019.105066] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 11/12/2018] [Revised: 05/31/2019] [Accepted: 06/17/2019] [Indexed: 01/06/2023]
Abstract
Population displacement and other forced movement patterns following natural disasters, armed conflicts or due to socioeconomic reasons contribute to the global emergence of Aedes-borne viral disease epidemics. In particular, dengue epidemiology is critically affected by situations of displacement and forced movement patterns, particularly within and across borders. In this respect, waves of human movements have been a major driver for the changing epidemiology and outbreaks of the disease on local, regional and global scales. Both emerging dengue autochthonous transmission and outbreaks in countries known to be non-endemic and co-circulation and hyperendemicity with multiple dengue virus serotypes have led to the emergence of severe disease forms such as dengue hemorrhagic fever and dengue shock syndrome. This paper reviews the emergence of dengue outbreaks driven by population displacement and forced movements following natural disasters and conflicts within the context of regional and sub-regional groupings.
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Affiliation(s)
- Rashad Abdul-Ghani
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen; Tropical Disease Research Center, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana'a, Yemen.
| | - Mohammed A K Mahdy
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen; Tropical Disease Research Center, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana'a, Yemen
| | - Samira M A Al-Eryani
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Florence Fouque
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Audrey E Lenhart
- Center for Global Health/Division of Parasitic Diseases and Malaria/Entomology Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Abdulsamad Alkwri
- Integrated Vector Management Unit, National Malaria Control Programme, Ministry of Public Health and Population, Sana'a, Yemen
| | - Abdulsalam M Al-Mikhlafi
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - André B B Wilke
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ahmed A Q Thabet
- Neglected Tropical Diseases and Pandemic Influenza Preparedness Department, WHO Office, Sana'a, Yemen
| | - John C Beier
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Kumar B, Jensen MM, Strielkowski W, Johnston JT, Sharma V, Dandara C, Shehata MM, Struett MM, Nikolaou A, Szymanski DW, Abdul-Ghani R, Cao B, Varzinczak LH, Kerman BE, Arthur PK, Oda FS, Bohon W, Ellwanger JH, Tyner S, Jordan EJ, Murphy C. NextGen Voices: Science-inspired sustainable behavior. Science 2019; 364:822-824. [PMID: 31147504 DOI: 10.1126/science.aax8945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Brijesh Kumar
- Dr. Sneh Lata Singla-Pareek's Lab, Plant Stress Biology Lab, International Centre for Genetic Engineering and Biotechnology, New Delhi 110067, India.
| | - Mark Martin Jensen
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA
| | - Wadim Strielkowski
- Centre for Energy Studies, Cambridge Institute for Advanced Studies, Cambridge CB11AH, UK.
| | - Juliet Tegan Johnston
- Department of Civil, Environmental, and Geo-Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Vandana Sharma
- Department of Hematology, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Collet Dandara
- Department of Pathology, Division of Human Genetics, University of Cape Town, Cape Town, Western Cape 7925, South Africa
| | - Mahmoud M Shehata
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Cairo 12622, Egypt.
| | | | - Athanasia Nikolaou
- German Aerospace Center (DLR), Institute of Planetary Research, 12489 Berlin, Germany
| | - David W Szymanski
- Department of Natural and Applied Sciences, Bentley University, Waltham, MA 02452, USA.
| | - Rashad Abdul-Ghani
- Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.
| | - Bo Cao
- Core Research Laboratory, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China.
| | - Luiz H Varzinczak
- Department of Zoology, Ecology, and Conservation Graduate Program, Federal University of Paraná, Curitiba, Parana, 81530-000, Brazil.
| | - Bilal Ersen Kerman
- Regenerative and Restorative Medicine Research Center, Istanbul Medipol University, Istanbul 34810, Turkey.
| | - Patrick Kobina Arthur
- Department of Biochemistry, Cell, and Molecular Biology, University of Ghana, Legon-Accra, GAR LG54, Ghana
| | | | | | - Joel Henrique Ellwanger
- Department of Genetics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, 91501-970, Brazil.
| | - Sam Tyner
- CSAFE, Iowa State University, Ames, IA 50011, USA
| | - E Joseph Jordan
- Department of Biochemistry & Biophysics, Stockholm University, Stockholm, Sweden.
| | - Colin Murphy
- Policy Institute for Energy, Environment, and the Economy, University of California, Davis, Davis, CA 95616, USA
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Shehata AI, Hassanein F, Abdul-Ghani R. Opportunistic parasitoses among Egyptian hemodialysis patients in relation to CD4+ T-cell counts: a comparative study. BMC Infect Dis 2019; 19:480. [PMID: 31142275 PMCID: PMC6542030 DOI: 10.1186/s12879-019-4110-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 05/20/2019] [Indexed: 12/30/2022] Open
Abstract
Background Some reports are available on the prevalence of opportunistic parasitoses among hemodialysis (HD) patients, yet there is a paucity of data on the association of CD4+ T-cell counts with such infections. Therefore, this study aimed to determine the prevalence of intestinal parasites and Toxoplasma gondii in relation to CD4+ counts among HD patients in Alexandria, Egypt. Methods A comparative cross-sectional study was conducted on 120 HD patients and 100 apparently healthy individuals between December 2014 and January 2016. Data and samples (stool and blood) were collected from the participants after obtaining their informed consent. Stool samples were examined for parasites after concentration and staining, EDTA-blood samples were used for CD4+ counting by flow cytometry, and sera were analyzed for anti-Toxoplasma IgM and IgG antibodies. Results A significantly higher prevalence rate of intestinal parasitoses was found among HD patients compared to apparently healthy individuals (52.5% vs. 12.0%, respectively), with absence of helminths. Cryptosporidium species (32.5%), B. hominis(24.2%) and microsporidia (11.7%) were the most frequent parasites among HD patients, while B. hominis (13.0%), Cryptosporidium species (11.0%) and G. lamblia (4.0%) were the most frequent parasites among their counterparts. Statistically significant differences in parasite infection rates between patients and their counterparts were found for Cryptosporidium species, B. hominis and microsporidia. However, parasite species were not significantly associated with diarrhea. On the other hand, the overall T. gondii seroprevalence rate among HD patients was significantly higher than that among their counterparts (33.3% vs. 8%, respectively). HD patients with CD4+ counts < 200 cells/μl were twice more exposed to intestinal parasitoses compared to those with counts ≥200 cells/μl, but the difference was not statistically significant. However, low CD4+ counts were significantly associated with higher rates of Cryptosporidium species, microsporidia and T. gondii. Conclusions Intestinal parasitoses and T. gondii infection rates are significantly higher among Egyptian HD patients compared to apparently healthy individuals, with Cryptosporidium species, B. hominis, microsporidia and T. gondii being the most frequent parasites. CD4+ counts < 200 cells/μl are significantly associated with Cryptosporidium species, microsporidia and T. gondii among HD patients. Therefore, regular screening of HD patients for opportunistic parasites is recommended.
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Affiliation(s)
- Amany I Shehata
- Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Faika Hassanein
- Department of Microbiology and Immunology, Faculty of Pharmacy and Drug Manufacturing, Pharos University, Alexandria, Egypt
| | - Rashad Abdul-Ghani
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen. .,Tropical Disease Research Center, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana'a, Yemen.
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Mahdy MAK, Abdul-Ghani R, Abdulrahman TAA, Al-Eryani SMA, Al-Mekhlafi AM, Alhaidari SAA, Azazy AA. Onchocerca volvulus infection in Tihama region - west of Yemen: Continuing transmission in ivermectin-targeted endemic foci and unveiled endemicity in districts with previously unknown status. PLoS Negl Trop Dis 2018; 12:e0006329. [PMID: 29505580 PMCID: PMC5854432 DOI: 10.1371/journal.pntd.0006329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 03/15/2018] [Accepted: 02/20/2018] [Indexed: 11/29/2022] Open
Abstract
Background Onchocerciasis in Yemen is one of the most neglected diseases, where baseline estimates of onchocerciasis and monitoring of the impact of ivermectin regularly administered to the affected individuals on its transmission are lacking. Therefore, this study aimed to determine the anti-Ov16 IgG4 seroprevalence among local communities of Hodeidah and Al-Mahwit governorates of Tihama region. The factors possibly associated with previous exposure to infection were also studied. Methodology/Principal findings This cross-sectional study was conducted in two ivermectin-targeted districts endemic for onchocerciasis in Hodeidah and Al-Mahwit and two untargeted districts with unknown previous endemicity in Hodeidah between February and July 2017. For 508 residents sampled by a multi-stage random approach, data were collected and blood specimens were screened for anti-Ov16 IgG4 using the SD BIOLINE Onchocerciasis IgG4 rapid tests. The study revealed an overall anti-Ov16 IgG4 rate of 18.5% (94/508) in all surveyed districts, with 10.2% (12/118) of children aged ≤10 years being seropositive. Moreover, rates of 8.0% (4/50) and 6.1% (4/66) were found in districts not officially listed as endemic for the disease. Multivariable analysis confirmed the age of more than ten years and residing within a large family as the independent predictors of exposure to infection. Conclusions/Significance Onchocerciasis transmission is still ongoing as supported by the higher anti-Ov16 IgG4 seroprevalence rate among children aged ≤10 years compared to that (<0.1%) previously set by the World Health Organization as a serologic criterion for transmission interruption. Further large-scale studies combining serologic and entomologic criteria are recommended for the mapping of O. volvulus in human and blackfly populations in endemic foci and their neighboring areas of uncertain endemicity. In addition, ivermectin distribution, coverage and impact on disease transmission need to be continually assessed. Onchocerciasis is endemic in certain foci in the western governorates of Yemen. Monitoring the impact of the regular ivermectin administration to affected individuals on the transmission status and providing baseline onchocerciasis estimates in endemic areas are crucial for planning effective elimination strategies. We found that the disease transmission is still ongoing in Hodeidah and Al-Mahwit governorates of Tihama region as indicated by the anti-Ov16 IgG4 seropositivity among children aged ≤10 years. In Bani Sa'ad, where affected individuals had been regularly targeted with ivermectin over the last 15 years, we found that the anti-Ov16 IgG4 seroprevalence rate was significantly lower among children aged ≤10 years (9.1%; 5/55) compared to those >10 years (24.5%; 37/151), reflecting a possible decline in disease transmission. We also revealed onchocerciasis transmission in districts with unknown previous endemicity for the first time, with rates of 8.0% and 6.1% being found in Al Marawi'ah and As Sukhnah districts of Hodeidah. Large-scale surveys are recommended for mapping of O. volvulus in human and blackfly populations in endemic foci and neighboring untargeted areas of uncertain endemicity as a forward step towards the elimination of the disease from the country.
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Affiliation(s)
- Mohammed A. K. Mahdy
- Tropical Disease Research Center, University of Science and Technology, Sana’a, Yemen
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
- * E-mail:
| | - Rashad Abdul-Ghani
- Tropical Disease Research Center, University of Science and Technology, Sana’a, Yemen
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
| | | | - Samira M. A. Al-Eryani
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
| | - Abdulsalam M. Al-Mekhlafi
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
| | - Sami A. A. Alhaidari
- National Schistosomiasis and Parasites Control Program, Ministry of Public Health and Population, Sana’a, Yemen
| | - Ahmed A. Azazy
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, KSA
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Azazy AA, Alhawery AJ, Abdul-Ghani R, Alharbi RA, Almalki SSR. Evaluation of rapid PfHRP-2/pLDH-based tests in diagnosing microscopy-confirmed falciparum malaria in Hodeidah governorate, Yemen. Acta Trop 2018; 178:252-257. [PMID: 29217380 DOI: 10.1016/j.actatropica.2017.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 11/29/2017] [Accepted: 12/02/2017] [Indexed: 11/15/2022]
Abstract
Along with the determination of malaria infection rate among suspected patients attending hospitals in Hodeidah governorate, the present study evaluated the accuracy of Plasmodium falciparum histidine-rich protein-2 (PfHRP-2)/parasite-specific lactate dehydrogenase (pLDH)-based rapid diagnostic test (RDT) for the diagnosis of microscopy-confirmed falciparum malaria. An overall malaria infection rate of 19.3% (57/295) among suspected patients attending hospitals was microscopically confirmed. The sensitivity of thin blood films for the detection of malaria parasites was 79.0% compared to thick films and was greatly affected by the parasite density, being 65.0% or less at parasite densities of ≤1000 parasites/μl of blood. Compared to light microscopy, the present study revealed sensitivity levels of 100.0% (95% CI: 92.0-100.0) vs. 94.7% (95% CI: 84.2-98.6), specificity levels of 97.3% (95% CI: 89.8-99.5) vs. 100.0% (95% CI: 93.9-100.0), positive predictive values of 89.9% (95% CI: 88.3-99.0) vs. 100.0 (95% CI: 91.6-100.0) and negative predictive values of 100.0% (95% CI: 93.9-100.0) vs. 98.7% (95% CI: 89.3-98.7) for the PfHRP-2 and pLDH components of SD BIOLINE® RDT, respectively, for falciparum malaria diagnosis. Therefore, the overall accuracy levels of the PfHRP-2 and pLDH components of the investigated RDT for the diagnosis of microscopy-confirmed falciparum malaria are 98.5% (95% CI: 94.6-99.6) and 97.7% (95% CI: 93.5-99.2), respectively.
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Affiliation(s)
- Ahmed A Azazy
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, KSA, Saudi Arabia
| | - Ali Jamaly Alhawery
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Hodeidah University, Hodeidah, Yemen
| | - Rashad Abdul-Ghani
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen; Tropical Disease Research Center, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana'a, Yemen.
| | - R A Alharbi
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, KSA, Saudi Arabia
| | - Shaia S R Almalki
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, KSA, Saudi Arabia
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Hassanein FI, Shehata AI, Abdul-Ghani R. G. lamblia and H. pylori infections among mentally challenged individuals in rehabilitation centers in Alexandria, Egypt. J Infect Dev Ctries 2017; 11:577-582. [DOI: 10.3855/jidc.8783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 11/09/2016] [Indexed: 10/31/2022] Open
Abstract
Introduction: Concomitant infections with pathogens are common, particularly when there are shared modes of infection or when one pathogen promotes the other. Residence among closed-type care institutions may pose an additional risk of such infections. Mentally challenged patients in rehabilitation centers constitute one of the special needs groups exposed to parasitic infections, including giardiasis. Several studies reported concomitant infection with G. lamblia and H. pylori worldwide and in Egypt; however, the co-existence of these two pathogens among mentally challenged individuals remains unexplored. The present study aimed to study the prevalence and association between G. lamblia and H. pylori among mentally challenged patients in rehabilitation centers in Alexandria, Egypt.
Methodology: 200 individuals admitted to four mental rehabilitation centers in the period from June 2013 to January 2014, who guardians gave informed consent, were recruited. Stool samples were collected and subjected to trichrome stain for G. lamblia and to antigen detection for H. pylori.
Results: The overall prevalence rates of G. lamblia and H. pylori were 8.5% and 24.0%, respectively. Monoinfection rates were 5.5% for G. lamblia and 21.0% for H. pylori, while concomitant infection with both species was detected in only 3.0% of cases. However, individuals who were H. pylori-positive were about two times more likely to be infected with G. lamblia than those who were H. pylori-negative (12.5% vs. 7.2%).
Conclusions: Mentally challenged individuals in Alexandria harbouring H. pylori are about two times more likely to be exposed to G. lamblia. Large-scale studies are recommended to confirm this association.
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Mahdy MAK, Alareqi LMQ, Abdul-Ghani R, Al-Eryani SMA, Al-Mikhlafy AA, Al-Mekhlafi AM, Alkarshy F, Mahmud R. A community-based survey of Toxoplasma gondii infection among pregnant women in rural areas of Taiz governorate, Yemen: the risk of waterborne transmission. Infect Dis Poverty 2017; 6:26. [PMID: 28190399 PMCID: PMC5304399 DOI: 10.1186/s40249-017-0243-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 12/29/2015] [Accepted: 01/13/2017] [Indexed: 11/10/2022] Open
Abstract
Background Toxoplasma gondii is a zoonotic coccidian parasite causing morbidity and mortality. In Yemen, T. gondii infection has been reported among pregnant women seeking healthcare in the main cities. However, no data are available on the prevalence of T. gondii infection and its associated risk factors among pregnant women in the rural communities of the country. Thus, the present study aimed to determine the seroprevalence of T. gondii and identify its risk factors among pregnant women in the rural communities of Taiz governorate, Yemen. Methods A total of 359 pregnant women living in the rural communities of Taiz governorate were enrolled in this study by house-to-house visits. Data were collected using a pre-designed questionnaire, and blood samples were collected and tested for the detection of anti- T. gondii IgM and IgG antibodies by enzyme-linked immunosorbent assay. Results The prevalence of T. gondii infection among pregnant women in this study was 46.2% (166/359). Bivariate analysis identified the age of ≥ 30 years (odds ratio [OR] = 1.7; 95% confidence interval [CI] = 1.09–2.65, P = 0.019) and unimproved water sources (OR = 2.2; 95% CI = 1.10–4.55, P = 0.023) as factors associated with T. gondii infection among pregnant women. The multivariable analysis, however, identified unimproved water sources as an independent risk factor (adjusted OR = 2.4; 95% CI = 1.16–5.0, P = 0.018) associated with T. gondii infection among pregnant women. Conclusions Pregnant women in the rural communities of Taiz, Yemen are at high risk of contracting T. gondii infection. Unimproved water sources (wells, water streams and water tanks) are significantly associated with T. gondii infection and should be considered in prevention and control strategies, especially among pregnant women. Electronic supplementary material The online version of this article (doi:10.1186/s40249-017-0243-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mohammed A K Mahdy
- Tropical Disease Research Center, University of Science and Technology, Sana'a, Yemen. .,Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.
| | - Lina M Q Alareqi
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Rashad Abdul-Ghani
- Tropical Disease Research Center, University of Science and Technology, Sana'a, Yemen.,Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Samira M A Al-Eryani
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Abdullah A Al-Mikhlafy
- Department of Community Medicine, Faculty of Medicine, University of Science and Technology, Sana'a, Yemen
| | - Abdulsalam M Al-Mekhlafi
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Fawzya Alkarshy
- Yemeni-Swedish Hospital, Ministry of Public Health and Population, Taiz, Yemen
| | - Rohela Mahmud
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Abdul-Ghani R, Mahdy MAK, Beier JC, Basco LK. Hidden reservoir of resistant parasites: the missing link in the elimination of falciparum malaria. Infect Dis Poverty 2017; 6:12. [PMID: 28166813 PMCID: PMC5294824 DOI: 10.1186/s40249-016-0227-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 12/20/2016] [Indexed: 11/29/2022] Open
Abstract
Background To successfully eliminate malaria, an integrated system that includes a number of approaches and interventions—aimed at overcoming the threat of antimalarial drug resistance—is required. Significant progress has been made in reducing malaria incidence through large-scale use of artemisinin-based combination therapies and insecticide-treated nets. To consolidate these gains, attention should be paid to the missing links in the elimination of malaria. One of these gaps is the residual reservoir of submicroscopic resistant parasites, which remains after case management or other control measures have been carried out. Therefore, the present opinion piece highlights the importance of exploring the role that submicroscopic resistant parasites could play in hindering malaria elimination by allowing the persistence of transmission, particularly in areas of low transmission or in the pre-elimination and/or elimination phase. Discussion If malaria elimination interventions are to be effective, the relative role of the hidden reservoir of resistant parasites needs to be assessed, particularly in regions that are low-transmission settings and/or in pre-elimination and/or elimination phases. Various ongoing studies are focusing on the role of submicroscopic malaria infections in malaria transmission but overlook the possible build-up of resistance to antimalarial drugs among submicroscopic parasite populations. This is an important factor as it may eventually limit the effectiveness of malaria elimination strategies. Conclusions An evidence-based estimation of the “true” reservoir of resistant parasites can help target the existing and emerging foci of resistant parasites before they spread. Emergence and spread of artemisinin-resistant Plasmodium falciparum malaria in Southeast Asia underline the need to contain drug resistance. Electronic supplementary material The online version of this article (doi:10.1186/s40249-016-0227-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rashad Abdul-Ghani
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen. .,Tropical Disease Research Center, University of Science and Technology, Sana'a, Yemen.
| | - Mohammed A K Mahdy
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.,Tropical Disease Research Center, University of Science and Technology, Sana'a, Yemen
| | - John C Beier
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Leonardo K Basco
- Unité de Recherche 198, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Institut de Recherche pour le Développement, Faculté de Médecine La Timone, Aix-Marseille Université, Marseille, France
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Al-Mekhlafi AM, Abdul-Ghani R, Al-Eryani SM, Saif-Ali R, Mahdy MA. School-based prevalence of intestinal parasitic infections and associated risk factors in rural communities of Sana'a, Yemen. Acta Trop 2016; 163:135-41. [PMID: 27515811 DOI: 10.1016/j.actatropica.2016.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/01/2016] [Accepted: 08/06/2016] [Indexed: 02/06/2023]
Abstract
Yemen is a developing country overwhelmed with a triad of poverty, diseases and social conflicts. Moreover, the majority of its population live in rural communities and suffer from intestinal parasitic infections (IPIs). Therefore, the present school-based, cross-sectional survey aimed to detect the prevalence of such infections and associated risk factors among schoolchildren in the rural communities of Bani Alharith, Hamdan and Bani Hushaysh districts of Sana'a, north of Yemen. Socio-demographic data and certain behavioral risk factors as well as stool samples were collected from 1218 schoolchildren from ten randomly schools in the study area. Fresh stool samples were examined for parasites by direct saline and iodine preparations and after concentration with formol-ether technique. The overall prevalence of IPIs was 54.8%, with a higher frequency of protozoal than helminthic infections (37.6 vs. 17.2%, respectively). Parasite species recovered were Entameba histolytica (21.5%), Giardia lamblia (16.1%), Ascaris lumbricoides (8.3%), Hymenolepis nana (5.3%), Schistosoma mansoni (2.6%), Trichuris trichiura (0.5%) and Enterobius vermicularis (0.4%). Univariate analysis showed that the male gender and illiteracy of fathers and/or mothers were the socio-demographic factors significantly associated with higher infection rates. The illiteracy of mothers was also confirmed as an independent risk factor by multivariable analysis. On the other hand, not washing hands before eating, not washing fruits and vegetables before consumption, eating uncovered food and not clipping fingernails were the risk behaviors significantly associated with higher infection rates, with the last three ones being confirmed as independent risk factors. Therefore, control measures should include regular treatment of protozoal infections and deworming of schoolchildren, promotion of hygiene in rural schools through health education programs, regular inspection of schoolchildren for personal hygiene practices and the provision of a healthy school infrastructure.
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Alyousefi TAA, Abdul-Ghani R, Mahdy MAK, Al-Eryani SMA, Al-Mekhlafi AM, Raja YA, Shah SA, Beier JC. A household-based survey of knowledge, attitudes and practices towards dengue fever among local urban communities in Taiz Governorate, Yemen. BMC Infect Dis 2016; 16:543. [PMID: 27717333 PMCID: PMC5054547 DOI: 10.1186/s12879-016-1895-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 02/12/2016] [Accepted: 10/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Yemen has witnessed several dengue fever outbreaks coincident with the social unrest and war in the country. The aim of the present study was to describe the knowledge, attitudes and practices (KAPs) of at-risk urban populations residing in Taiz, southwest of Yemen. In addition, factors possibly associated with poor preventive practices were investigated. METHODS A household-based, cross-sectional survey was conducted in three urban districts encompassing 383 households. Data on the socio-demographic characteristics and KAPs of the participating household heads were collected using a pre-designed, structured questionnaire. The association of socio-demographic characteristics, knowledge and attitudes of the population with poor preventive practices against dengue fever was then analyzed using logistic regression. RESULTS More than 90.0 % of respondent household heads had correct knowledge about fever, headache and joint pain as common signs and symptoms of dengue fever. Moreover, muscular pain and bleeding were perceived by more than 80.0 % of the respondents as being associated with dengue fever; however, only 65.0 % of the respondents reported skin rash as a sign of dengue fever. More than 95.0 % of respondents agreed about the seriousness and possible transmission of dengue fever; however, negative attitudes regarding the facts of being at risk of the disease and that the infection is preventable were expressed by 15.0 % of respondents. Despite the good level of knowledge and attitudes of the respondent population, poor preventive practices were common. Bivariate analysis identified poor knowledge of dengue signs and symptoms (OR = 2.1, 95 % CI = 1.24-3.68; P = 0.005) and its vector (OR = 2.1, 95 % CI = 1.14-3.84; P = 0.016) as factors significantly associated with poor preventive practices. However, multivariable analysis showed that poor knowledge of the vector is an independent predictor of poor preventive practices of the population (adjusted OR = 2.1, 95 % CI = 1.14-3.84; P = 0.018). CONCLUSION The majority of people in urban communities of Taiz have a clear understanding of most signs/symptoms of dengue fever as well as positive attitudes towards the seriousness and possible transmissibility of dengue fever. However, negative attitudes regarding their perception of the risk and possible prevention of the infection are prevailing among a small proportion of the population and need to be targeted by educational campaigns. It appears that the good level of the population knowledge of the signs/symptoms of dengue fever and the factors contributing to the spread and control of its vectors did not translate into good practices.
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Affiliation(s)
- Thaker A A Alyousefi
- Department of Hematology, Faculty of Medical Sciences, Al-Razi University, Sana'a, Yemen
| | - Rashad Abdul-Ghani
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.,Tropical Disease Research Center, University of Science and Technology, Sana'a, Yemen
| | - Mohammed A K Mahdy
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen. .,Tropical Disease Research Center, University of Science and Technology, Sana'a, Yemen.
| | - Samira M A Al-Eryani
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Abdulsalam M Al-Mekhlafi
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Yahia A Raja
- Faculty of Public Health and Informatics, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Shamusul Azhar Shah
- Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - John C Beier
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Abdul-Ghani R, Mahdy MA, Beier JC. Onchocerciasis in Yemen: Time to take action against a neglected tropical parasitic disease. Acta Trop 2016; 162:133-141. [PMID: 27325293 DOI: 10.1016/j.actatropica.2016.06.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 06/08/2016] [Accepted: 06/16/2016] [Indexed: 11/25/2022]
Abstract
Onchocerciasis is a neglected parasitic disease affecting the poorest underserved people in Yemen. A national control programme with goals to eliminate onchocerciasis has yet to be launched due to the current upheaval and social unrest in the country. The disease, locally termed as sowda, is unique in its clinicopathologic pattern, being of the localized, non-blinding, hyperreactive onchocercal skin disease. Although early reports identified endemic foci along seasonal watercourses, there is a need to redefine its epidemiologic patterns as well as health and socioeconomic impacts. Laboratory diagnosis of sowda among Yemeni patients is difficult due to the low load of microfilariae in skin snips and the presence of asymptomatic itching-free microfilaria carriers. Adoption of ivermectin use at three-month intervals as a control strategy has not been evaluated because the drug is mostly used in clinics and distributed to only a few affected communities. This paper addresses key aspects of onchocerciasis in Yemen and highlights the need for screening at-risk populations using highly sensitive techniques and mapping the distributions of the parasite in human and vector populations of blackflies. The new research should be integrated with the launch of a national onchocerciasis control programme to achieve onchocerciasis elimination.
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Alareqi LM, Mahdy MA, Lau YL, Fong MY, Abdul-Ghani R, Mahmud R. Molecular markers associated with resistance to commonly used antimalarial drugs among Plasmodium falciparum isolates from a malaria-endemic area in Taiz governorate-Yemen during the transmission season. Acta Trop 2016; 162:174-179. [PMID: 27343362 DOI: 10.1016/j.actatropica.2016.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/13/2016] [Accepted: 06/13/2016] [Indexed: 12/28/2022]
Abstract
Since 2005, artesunate (AS) plus sulfadoxine/pyrimethamine (SP) combination has been adopted as the first-line treatment for uncomplicated malaria in Yemen in response to the high level of Plasmodium falciparum resistance to chloroquine (CQ). Therefore, the aim of the present study was to determine the frequency distribution of molecular markers associated with resistance to CQ and AS plus SP combination among P. falciparum isolates from a malaria-endemic area in Taiz governorate, Yemen. Fifty P. falciparum isolates were collected during a cross-sectional study in Mawza district, Taiz, in the period from October 2013 to April 2014. The isolates were investigated for drug resistance-associated molecular markers in five genes, including P. falciparum CQ resistance transporter (pfcrt) 76T and P. falciparum multidrug resistance 1 (pfmdr1) 86Y as markers of resistance to CQ, mutations in the Kelch 13 (K13) propeller domain for resistance to AS, and P. falciparum dihydrofolate reductase (pfdhfr) and P. falciparum dihydropteroate synthase (pfdhps) genes for resistance to SP. Nested polymerase chain reaction was used to amplify target genes in DNA extracts of the isolates followed by restriction fragment length polymorphism for detecting 76T and 86Y mutations in pfcrt and pfmdr1, respectively, and by DNA sequencing for detecting mutations in K13, pfdhfr and pfdhps. All the investigated isolates from Mawza district were harboring the pfcrt 76T mutant and the pfmdr1 N86 wild-type alleles. The pfdhfr 51I/108N double mutant allele was found in 2.2% (1/45) of the isolates; however, no mutations were detected at codons 436, 437, 540, 581 and 613 of pfdhps. All P. falciparum isolates that were successfully sequenced (n=47) showed the K13 Y493, R539, I543 and C580 wild-type alleles. In conclusion, the pfcrt 76T mutant allele is fixed in the study area about six years after the official withdrawal of CQ, possibly indicating its over-the-counter availability and continued use as a self-medication in the study area. However, the almost predominant wild-type alleles of the genes associated with resistance to AS and SP among P. falciparum isolates in the present study indicates the sustained efficacy of the currently adopted first-line treatment of AS plus SP in the study area.
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Abdul-Ghani R, Mahdy MAK, Saif-Ali R, Alkubati SA, Alqubaty AR, Al-Mikhlafy AA, Al-Eryani SM, Al-Mekhlafi AM, Alhaj A. Glucose-6-phosphate dehydrogenase deficiency among Yemeni children residing in malaria-endemic areas of Hodeidah governorate and evaluation of a rapid diagnostic test for its detection. Malar J 2016; 15:327. [PMID: 27329471 PMCID: PMC4915072 DOI: 10.1186/s12936-016-1372-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/01/2016] [Accepted: 06/03/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Glucose-6-phosphate dehydrogenase (G6PD) deficiency, the most common genetic enzymopathy worldwide, is associated with an acute haemolytic anaemia in individuals exposed to primaquine. The present study aimed to determine G6PD deficiency among Yemeni children in malaria-endemic areas as well as to assess the performance of the CareStart™ G6PD rapid diagnostic test (RDT) for its detection. METHODS A cross-sectional study recruiting 400 children from two rural districts in Hodeidah governorate was conducted. Socio-demographic data and blood samples were collected and G6PD deficiency was qualitatively detected in fresh blood in the field using the CareStart™ G6PD RDT, while the enzymatic assay was used to quantitatively measure enzyme activity. Performance of the CareStart™ G6PD RDT was assessed by calculating its sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) against the reference enzymatic assay. RESULTS The ranges of enzyme activity were 0.14-18.45 and 0.21-15.94 units/g haemoglobin (U/gHb) for males and females, respectively. However, adjusted male median G6PD activity was 5.0 U/gHb. Considering the adjusted male median as representing 100 % normal enzyme activity, the prevalence rates of G6PD deficiency were 12.0 and 2.3 % at the cut-off activities of ≤60 and ≤10 %, respectively. Multivariable analysis showed that gender, district of residence and consanguinity between parents were independent risk factors for G6PD deficiency at the cut-off activity of ≤30 % of normal. The CareStart™ G6PD RDT showed 100 % sensitivity and NPV for detecting G6PD deficiency at the cut-off activities of ≤10 and ≤20 % of normal activity compared to the reference enzymatic method. However, it showed specificity levels of 90.0 and 95.4 % as well as positive/deficient predictive values (PPVs) of 18.0 and 66.0 % at the cut-off activities of ≤10 and ≤20 %, respectively, compared to the reference method. CONCLUSIONS G6PD deficiency with enzyme activity of ≤60 % of normal is prevalent among 12.0 % of children residing in malaria-endemic areas of Hodeidah governorate, with 2.3 % having severe G6PD deficiency. Gender, district of residence and consanguinity between parents are significant independent predictors of G6PD deficiency at the cut-off activity of ≤30 % of normal among children in malaria-endemic areas of Hodeidah. The CareStart™ G6PD RDT proved reliable as a point-of-care test to screen for severely G6PD-deficient patients, with 100 % sensitivity and NPV, and it can be used for making clinical decisions prior to the administration of primaquine in malaria elimination strategies.
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Affiliation(s)
- Rashad Abdul-Ghani
- />Tropical Disease Research Center, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana’a, Yemen
- />Department of Parasitology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
| | - Mohammed A. K. Mahdy
- />Tropical Disease Research Center, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana’a, Yemen
- />Department of Parasitology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
| | - Reyadh Saif-Ali
- />Department of Biochemistry, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
| | - Sameer A. Alkubati
- />Department of Critical Care Nursing, Faculty of Medicine and Health Sciences, Hodeidah University, Hodeidah, Yemen
| | - Abdulhabib R. Alqubaty
- />Department of Biochemistry, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana’a, Yemen
| | - Abdullah A. Al-Mikhlafy
- />Department of Community Medicine, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana’a, Yemen
| | - Samira M. Al-Eryani
- />Department of Parasitology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
| | - Abdusalam M. Al-Mekhlafi
- />Department of Parasitology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
| | - Ali Alhaj
- />Department of Biochemistry, Faculty of Medicine and Health Sciences, University of Science and Technology, Sana’a, Yemen
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Mahdy MAK, Al-Mekhlafi AM, Abdul-Ghani R, Saif-Ali R, Al-Mekhlafi HM, Al-Eryani SM, Lim YAL, Mahmud R. First Molecular Characterization of Leishmania Species Causing Visceral Leishmaniasis among Children in Yemen. PLoS One 2016; 11:e0151265. [PMID: 26966902 PMCID: PMC4788415 DOI: 10.1371/journal.pone.0151265] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 02/25/2016] [Indexed: 11/19/2022] Open
Abstract
Visceral leishmaniasis (VL) is a debilitating, often fatal disease caused by Leishmania donovani complex; however, it is a neglected tropical disease. L. donovani complex comprises two closely related species, L. donovani that is mostly anthroponotic and L. infantum that is zoonotic. Differentiation between these two species is critical due to the differences in their epidemiology and pathology. However, they cannot be differentiated morphologically, and their speciation using isoenzyme-based methods poses a difficult task and may be unreliable. Molecular characterization is now the most reliable method to differentiate between them and to determine their phylogenetic relationships. The present study aims to characterize Leishmania species isolated from bone marrows of Yemeni pediatric patients using sequence analysis of the ribosomal internal transcribed spacer-1 (ITS1) gene. Out of 41 isolates from Giemsa-stained bone marrow smears, 25 isolates were successfully amplified by nested polymerase chain reaction and sequenced in both directions. Phylogenetic analysis using neighbor joining method placed all study isolates in one cluster with L. donovani complex (99% bootstrap). The analysis of ITS1 for microsatellite repeat numbers identified L. infantum in 11 isolates and L. donovani in 14 isolates. These data suggest the possibility of both anthroponotic and zoonotic transmission of VL-causing Leishmania species in Yemen. Exploring the possible animal reservoir hosts is therefore needed for effective control to be achieved.
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Affiliation(s)
- Mohammed A. K. Mahdy
- Tropical Disease Research Center, Faculty of Medicine, University of Science and Technology, Sana’a, Yemen
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
- * E-mail:
| | - Abdulsalam M. Al-Mekhlafi
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
| | - Rashad Abdul-Ghani
- Tropical Disease Research Center, Faculty of Medicine, University of Science and Technology, Sana’a, Yemen
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
| | - Reyadh Saif-Ali
- Department of Biochemistry, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
| | - Hesham M. Al-Mekhlafi
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Samira M. Al-Eryani
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
| | - Yvonne A. L. Lim
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Rohela Mahmud
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Alareqi LMQ, Mahdy MAK, Lau YL, Fong MY, Abdul-Ghani R, Ali AA, Cheong FW, Tawfek R, Mahmud R. Field evaluation of a PfHRP-2/pLDH rapid diagnostic test and light microscopy for diagnosis and screening of falciparum malaria during the peak seasonal transmission in an endemic area in Yemen. Malar J 2016; 15:49. [PMID: 26821911 PMCID: PMC4730713 DOI: 10.1186/s12936-016-1103-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 01/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria is a public health threat in Yemen, with 149,451 cases being reported in 2013. Of these, Plasmodium falciparum represents 99%. Prompt diagnosis by light microscopy (LM) and rapid diagnostic tests (RTDs) is a key element in the national strategy of malaria control. The heterogeneous epidemiology of malaria in the country necessitates the field evaluation of the current diagnostic strategies, especially RDTs. Thus, the present study aimed to evaluate LM and an RDT, combining both P. falciparum histidine-rich protein-2 (PfHRP-2) and Plasmodium lactate dehydrogenase (pLDH), for falciparum malaria diagnosis and survey in a malaria-endemic area during the transmission season against nested polymerase chain reaction (PCR) as the reference method. METHODS A household-based, cross-sectional malaria survey was conducted in Mawza District, a malaria-endemic area in Taiz governorate. A total of 488 participants were screened using LM and PfHRP-2/pLDH RDT. Positive samples (160) and randomly selected negative samples (52) by both RDT and LM were further analysed using 18S rRNA-based nested PCR. RESULTS The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the RDT were 96.0% (95% confidence interval (CI): 90.9-98.3), 56.0% (95% CI: 44.7-66.8), 76.3% (95% CI: 69.0-82.3), and 90.4% (95% CI: 78.8-96.8), respectively. On the other hand, LM showed sensitivity of 37.6% (95% CI: 29.6-46.3), specificity of 97.6% (95% CI: 91.7-99.7), PPV of 95.9% (95% CI: 86.3-98.9), and NPV of 51.3% (95% CI: 43.2-59.2). The sensitivity of LM dropped to 8.5% for detecting asymptomatic malaria. Malaria prevalence was 32.8% (32.1 and 37.5% for ≥10 and <10 years, respectively) with the RDT compared with 10.7% (10.8 and 9.4% for age groups of ≥10 and <10 years, respectively) with LM. Among asymptomatic malaria individuals, LM and RDT-based prevalence rates were 1.6 and 25.6%, respectively. However, rates of 88.2 and 94.1% of infection with P. falciparum were found among patients who reported fever in the 48 h prior to the survey by LM and PfHRP-2/pLDH RDT, respectively. CONCLUSIONS The PfHRP-2/pLDH RDT shows high sensitivity for the survey of falciparum malaria even for asymptomatic malaria cases. Although the RDT had high sensitivity, its high false-positivity rate limits its utility as a single diagnostic tool for clinical diagnosis of malaria. On the other hand, low sensitivity of LM indicates that a high proportion of malaria cases is missed, underestimating the true prevalence of malaria in the community. Higher NPV of PfHRP-2/pLDH RDT than LM can give a straightforward exclusion of malaria among febrile patients, helping to avoid unnecessary presumptive treatments.
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Affiliation(s)
- Lina M Q Alareqi
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Mohammed A K Mahdy
- Tropical Disease Research Center, University of Science and Technology, Sana'a, Yemen. .,Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.
| | - Yee-Ling Lau
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Mun-Yik Fong
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Rashad Abdul-Ghani
- Tropical Disease Research Center, University of Science and Technology, Sana'a, Yemen. .,Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.
| | - Arwa A Ali
- Yemeni-Swedish Hospital, Ministry of Public Health and Population, Taiz, Yemen.
| | - Fei-Wen Cheong
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Rehab Tawfek
- Yemeni-Swedish Hospital, Ministry of Public Health and Population, Taiz, Yemen.
| | - Rohela Mahmud
- Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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Abdul-Ghani R, Basco LK, Beier JC, Mahdy MAK. Inclusion of gametocyte parameters in anti-malarial drug efficacy studies: filling a neglected gap needed for malaria elimination. Malar J 2015; 14:413. [PMID: 26481312 PMCID: PMC4617745 DOI: 10.1186/s12936-015-0936-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 10/09/2015] [Indexed: 11/29/2022] Open
Abstract
Standard anti-malarial drug efficacy and drug resistance assessments neglect the gametocyte parameters in their protocols. With the spread of drug resistance and the absence of clinically proven vaccines, the use of gametocytocidal drugs or drug combinations with transmission-blocking activity is a high priority for malaria control and elimination. However, the limited repertoire of gametocytocidal drugs and induction of gametocytogenesis after treatment with certain anti-malarial drugs necessitate both regular monitoring
of gametocytocidal activities of anti-malarial drugs in clinical use and the effectiveness of candidate gametocytocidal agents. Therefore, updating current protocols of anti-malarial drug efficacy is needed to reflect the effects of anti-malarial drugs or drug combinations on gametocyte carriage and gametocyte density along with asexual parasite density. Developing protocols of anti-malarial drug efficacy that include gametocyte parameters related to both microscopic and submicroscopic gametocytaemias is important if drugs or drug combinations are to be strategically used in transmission-blocking interventions in the context of malaria elimination. The present piece of opinion highlights the challenges in gametocyte detection and follow-up and discuss the need for including the gametocyte parameter in anti-malarial efficacy studies.
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Affiliation(s)
- Rashad Abdul-Ghani
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen. .,Tropical Disease Research Center, University of Science and Technology, Sana'a, Yemen.
| | - Leonardo K Basco
- Unité de Recherche 198, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Institut de Recherche pour le Développement, Faculté de Médecine La Timone, Aix-Marseille Université, Marseille, France.
| | - John C Beier
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Mohammed A K Mahdy
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen. .,Tropical Disease Research Center, University of Science and Technology, Sana'a, Yemen.
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Allam AF, Farag HF, Zaki A, Kader OA, Abdul-Ghani R, Shehab AY. Detection of low-intensitySchistosoma mansoniinfection by Percoll sedimentation and real-time PCR techniques in a low-endemicity Egyptian setting. Trop Med Int Health 2015; 20:658-664. [DOI: 10.1111/tmi.12470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Amal F. Allam
- Department of Parasitology; Medical Research Institute; Alexandria University; Alexandria Egypt
| | - Hoda F. Farag
- Department of Parasitology; Medical Research Institute; Alexandria University; Alexandria Egypt
| | - Adel Zaki
- Department of Medical Statistics; Medical Research Institute; Alexandria University; Alexandria Egypt
| | - Ola A. Kader
- Department of Microbiology; Medical Research Institute; Alexandria University; Alexandria Egypt
| | - Rashad Abdul-Ghani
- Department of Parasitology; Faculty of Medicine and Health Sciences; Sana'a University; Sana'a Yemen
| | - Amel Y. Shehab
- Department of Parasitology; Medical Research Institute; Alexandria University; Alexandria Egypt
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Affiliation(s)
- Rashad Abdul-Ghani
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
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Shen Y, Demel B, Unite J, Briscoe J, Hall D, Chudzikowski K, Mayrhofer W, Abdul-Ghani R, Bogicevic Milikic B, Colorado O, Fei Z, Las Heras M, Ogliastri E, Pazy A, Poon J, Shefer D, Taniguchi M, Zikic J. Career success across 11 countries: implications for international human resource management. The International Journal of Human Resource Management 2014. [DOI: 10.1080/09585192.2014.962562] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abdul-Ghani R, Al-Maktari MT, Al-Shibani LA, Allam AF. A better resolution for integrating methods for monitoring Plasmodium falciparum resistance to antimalarial drugs. Acta Trop 2014; 137:44-57. [PMID: 24801884 DOI: 10.1016/j.actatropica.2014.04.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/25/2014] [Accepted: 04/27/2014] [Indexed: 12/16/2022]
Abstract
Effective chemotherapy is the mainstay of malaria control. However, resistance of falciparum malaria to antimalarial drugs compromised the efforts to eliminate the disease and led to the resurgence of malaria epidemics. Three main approaches are used to monitor antimalarial drug efficacy and drug resistance; namely, in vivo trials, in vitro/ex vivo assays and molecular markers of drug resistance. Each approach has its implications of use as well as its advantages and drawbacks. Therefore, there is a need to use an integrated approach that would give the utmost effect to detect resistance as early as its emergence and to track it once spread. Such integration becomes increasingly needed in the era of artemisinin-based combination therapy as a forward action to deter resistance. The existence of regional and global networks for the standardization of methodology, provision of high quality reagents for the assessment of antimalarial drug resistance and dissemination of open-access data would help in approaching an integrated resistance surveillance system on a global scale.
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Abdul-Ghani R. Towards rapid genotyping of resistant malaria parasites: could loop-mediated isothermal amplification be the solution? Malar J 2014; 13:237. [PMID: 24934581 PMCID: PMC4066272 DOI: 10.1186/1475-2875-13-237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 04/28/2014] [Indexed: 11/10/2022] Open
Abstract
Loop-mediated isothermal amplification (LAMP) is an innovative molecular technique that has been validated for point-of-care testing to diagnose malaria. Molecular detection and tracking of anti-malarial drug resistance is mainly based on highly sophisticated, costly and time-consuming techniques. With the validation of resistance-associated gene mutations in malaria parasites, there is a need to develop rapid, easy-to-use molecular tests for anti-malarial drug resistance genotyping. LAMP could be further developed as a point-of-care test to rapidly detect anti-malarial drug resistance-associated molecular markers, thereby help detecting and monitoring drug resistance in surveillance studies.
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Affiliation(s)
- Rashad Abdul-Ghani
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.
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Abdul-Ghani R, Farag HF, Allam AF, Shawky SM. Prevailing Plasmodium falciparum dihydrofolate reductase 108-asparagine in Hodeidah, Yemen: a questionable sulfadoxine-pyrimethamine partner within the artemisinin-based combination therapy. Acta Trop 2014; 132:39-44. [PMID: 24406851 DOI: 10.1016/j.actatropica.2013.12.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 12/22/2013] [Accepted: 12/26/2013] [Indexed: 11/17/2022]
Abstract
Given that the evolution and spread of resistance to sulfadoxine-pyrimethamine (SP) have been documented at a quick pace worldwide, the present study investigated the mutant Plasmodium falciparum dihydrofolate reductase 108-asparagine (dhfr 108 N) as a key marker of resistance to the combination among parasite isolates from Hodeidah. The association of parasitologic indices with the dhfr 108 N mutant allele was also studied. Ninety patients with microscopically confirmed P. falciparum infection from Hodeidah were included in the present study. Polymerase chain reaction-restriction fragment length polymorphism approach was adopted for the molecular detection of this marker. The dhfr 108 N was detected among about 61% of P. falciparum isolates, in its pure and mixed-type forms, from Hodeidah. Age, gender and residence of patients were not significant predictors for the presence of the mutant allele among parasite isolates. In contrast, a history of malaria and antimalarial drug intake in the year preceding the study as well as frequent antimalarial drug intake were significantly associated with this mutant allele. The high frequency of dhfr 108 N among parasites isolates makes the role of SP questionable as a partner with outstanding effectiveness within the ACT, at least, in the near future. SP plus artesunate should be monitored for its antimalarial efficacy at regular intervals, preferably through the molecular detection of resistance-associated mutations.
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Affiliation(s)
- Rashad Abdul-Ghani
- Department of Parasitology, Medical Research Institute, Alexandria University, Alexandria, Egypt; Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.
| | - Hoda F Farag
- Department of Parasitology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Amal F Allam
- Department of Parasitology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Sherine M Shawky
- Department of Microbiology, Medical Research Institute, Alexandria University, Alexandria, Egypt
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Abdul-Ghani R, Farag HF, Allam AF, Azazy AA. Measuring resistant-genotype transmission of malaria parasites: challenges and prospects. Parasitol Res 2014; 113:1481-7. [PMID: 24562760 DOI: 10.1007/s00436-014-3789-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 09/28/2013] [Accepted: 01/28/2014] [Indexed: 01/09/2023]
Abstract
Increased gametocytemia in infections with resistant strains of Plasmodium species and their enhanced transmissibility are a matter of concern in planning and evaluating the impact of malaria control strategies. Various studies have determined weekly gametocyte carriage in response to antimalarial drugs in clinical trials. The advent of molecular biology techniques makes it easy to detect and quantify gametocytes, the stages responsible for transmission, and to detect resistant genotypes of the parasite. With the validation of molecular markers of resistance to certain antimalarial drugs, there is a need to devise a simpler formula that could be used with these epidemiological antimalarial resistance tools. Theoretical models for transmission of resistant malaria parasites are difficult to deploy in epidemiological studies. Therefore, devising a simple formula that determines the potential resistant-genotype transmission of malaria parasites should provide further insights into understanding the spread of drug resistance. The present perspective discusses gametocytogenesis in the context of antimalarial treatment and drug resistance. It also highlights the difficulties in applying the available theoretical models of drug resistance transmission and suggests Rashad's devised formula that could perhaps be used in determining potentially transmissible resistant genotypes as well as in mapping areas with high potential risk for the transmission of drug-resistant malaria. The suggested formula makes use of the data on gametocytes and resistant genotypes of malaria parasites, detected by molecular techniques in a certain geographical area within a particular point in time, to calculate the potential risk of resistant genotype transmission.
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Affiliation(s)
- Rashad Abdul-Ghani
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen,
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Abdul-Ghani R, Farag HF, Allam AF, Shawky SM, Al-Mekhlafi AM. Mutant Plasmodium falciparum chloroquine resistance transporter in Hodeidah, Yemen: association with parasitologic indices and treatment-seeking behaviors. Acta Trop 2013; 128:473-8. [PMID: 23906615 DOI: 10.1016/j.actatropica.2013.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 07/04/2013] [Accepted: 07/17/2013] [Indexed: 11/27/2022]
Abstract
Malaria still represents a major health problem in Yemen, particularly in Hodeidah, despite continuing efforts to eliminate it. With the absence of clinically proven vaccines, chemotherapy with antimalarials is still greatly needed. Chloroquine (CQ) has been popular as the drug of choice for malaria control. However, Plasmodium falciparum resistance to CQ has been one of the main obstacles in malaria control and elimination. Although CQ is no longer the recommended antimalarial chemotherapy, it has remained the number one over-the-counter antimalarial drug in many endemic areas, including Yemen, and is still used for self-medication. In addition, promising reports on CQ efficacy reversal in many African countries brought it again into the scene. This has led to a growing interest in the possibility of its re-introduction, particularly with the concerns raised about the parasite resistance to artemisinin-based combination therapies. Therefore, the present study aimed at analyzing the CQ-associated pfcrt 76T mutation in P. falciparum isolates from patients with uncomplicated falciparum malaria in Hodeidah, west of Yemen. The association of treatment-seeking behaviors and antimalarial drug use with the pfcrt 76T mutant allele was also studied. It was revealed that there is still a sustained high frequency of this molecular marker among parasite isolates associated with younger age, decreased parasite density and the presence of gametocytes in blood. Delay in seeking treatment and frequent use of antimalarials were the behaviors significantly associated with the presence of the pfcrt 76T mutant allele among patients reporting a history of malaria treatment.
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Abdul-Ghani R, Farag HF, Allam AF. Sulfadoxine-pyrimethamine resistance in Plasmodium falciparum: a zoomed image at the molecular level within a geographic context. Acta Trop 2013; 125:163-90. [PMID: 23131424 DOI: 10.1016/j.actatropica.2012.10.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 10/25/2012] [Accepted: 10/26/2012] [Indexed: 10/27/2022]
Abstract
Antimalarial chemotherapy is one of the main pillars in the prevention and control of malaria. Following widespread resistance of Plasmodium falciparum to chloroquine, sulfadoxine-pyrimethamine came to the scene as an alternative to the cheap and well-tolerated chloroquine. However, widespread resistance to sulfadoxine-pyrimethamine has been documented. In vivo efficacy tests are the gold standard for assessing drug resistance and treatment failure. However, they have many disadvantages, such as influence of host immunity and drug pharmacokinetics. In vitro tests of antimalarial drug efficacy also have many technical difficulties. Molecular markers of resistance have emerged as epidemiologic tools to investigate antimalarial drug resistance even before becoming clinically evident. Mutations in P. falciparum dihydrofolate reductase and dihydrofolate synthase have been extensively studied as molecular markers for resistance to pyrimethamine and sulfadoxine, respectively. This review highlights the resistance of P. falciparum at the molecular level presenting both supporting and opposing studies on the utility of molecular markers.
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Hassan A, Farouk H, Hassanein F, Abdul-Ghani R, Abdelhady AH. Acanthamoeba contamination of hemodialysis and dental units in Alexandria, Egypt: a neglected potential source of infection. J Infect Public Health 2012; 5:304-10. [PMID: 23021653 DOI: 10.1016/j.jiph.2012.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 05/26/2012] [Accepted: 06/01/2012] [Indexed: 11/16/2022] Open
Abstract
Ubiquitous free-living amoebae of the genus Acanthamoeba can be pathogenic and can serve as carriers of other pathogenic organisms. These amoebae are potentially dangerous when they contaminate health facilities, and these organisms may act as a source of infection for medical personnel and those seeking medical care. The purpose of the present study was to evaluate the extent to which Acanthamoeba species contaminate hemodialysis and dental units in Alexandria, Egypt. Seventy samples were collected aseptically from these systems and cultivated on non-nutrient agar at room temperature, followed by morphological confirmation of the identity of Acanthamoeba using trichrome-stained smears. This study revealed that 42.9% of water samples from the hydraulic systems of both hemodialysis and dental units were positive for Acanthamoeba, with no statistically significant difference between the two unit types or between pre- and post-disinfection samples for each type of unit. The surgical category of dental clinics had the highest contamination rate (72.7%), whereas no contamination was observed for water samples from pediatric dentistry clinics. In conclusion, the hydraulic systems of hemodialysis and dental units in Alexandria are contaminated with Acanthamoeba species, and to minimize the risk of human infections, there is an urgent need to implement effective preventative measures, such as the installation of water filtration units.
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Affiliation(s)
- Azza Hassan
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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Hassan A, Farouk H, Abdul-Ghani R, Hassanein F. Contamination of irrigation systems of dental units with Cryptosporidium species in Alexandria, Egypt: a neglected disinfection pitfall. Risk Manag Healthc Policy 2012; 5:93-5. [PMID: 22936862 PMCID: PMC3426257 DOI: 10.2147/rmhp.s35257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To investigate the contamination of the dental irrigation systems with Cryptosporidium species in Alexandria, Egypt. METHODS Forty water samples from all 20 working dental irrigation machines in a dental center in Alexandria were included in the study. Water samples were taken from the handpieces of dental irrigation machines in all studied units. After filtration through a membrane filter, water sample residues were stained using modified Ziehl-Neelsen staining and examined microscopically for Cryptosporidium spp. RESULTS Cryptosporidium spp. was found as a contaminant in 27.5% of water samples taken from dental irrigation machines. CONCLUSION This indicates a contamination by the public water supplies to which these dental irrigation machines are connected. This disinfection pitfall may pose an infection risk to those seeking dental care.
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Affiliation(s)
- Azza Hassan
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Hanan Farouk
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Rashad Abdul-Ghani
- Parasitology Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
| | - Faika Hassanein
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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Hassan A, Farouk H, Abdul-Ghani R. Parasitological contamination of freshly eaten vegetables collected from local markets in Alexandria, Egypt: A preliminary study. Food Control 2012. [DOI: 10.1016/j.foodcont.2012.01.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abdul-Ghani R, Al-Mekhlafi AM, Karanis P. Loop-mediated isothermal amplification (LAMP) for malarial parasites of humans: would it come to clinical reality as a point-of-care test? Acta Trop 2012; 122:233-40. [PMID: 22366670 DOI: 10.1016/j.actatropica.2012.02.004] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 02/04/2012] [Accepted: 02/08/2012] [Indexed: 11/26/2022]
Abstract
Loop-mediated isothermal amplification (LAMP) is a novel molecular method that accelerates and facilitates DNA amplification and detection under isothermal conditions. It represents a revolution in molecular biology by reducing the high cost, turnaround time and technicality of polymerase chain reaction and other amplification methods. It has been applied for the diagnosis of a variety of viral, bacterial, parasitic and other diseases in the biomedical field. LAMP has been involved in studies concerning the diagnosis of malaria which is still a major cause of morbidity and mortality in different parts of the world. For the success attained with this technology to diagnose human malaria, is it time to think that LAMP-based point-of-care diagnostics come to application to support the diagnosis of clinical malaria cases? The present review deals with the use of LAMP in the diagnosis of malaria and related investigations to make a view on what has been investigated and highlights the future perspectives regarding the possible applications of LAMP in diagnosis of the disease.
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Abdul-Ghani R, Al-Mekhlafi AM, Alabsi MS. Microbial control of malaria: biological warfare against the parasite and its vector. Acta Trop 2012; 121:71-84. [PMID: 22100545 DOI: 10.1016/j.actatropica.2011.11.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 10/31/2011] [Accepted: 11/04/2011] [Indexed: 01/31/2023]
Abstract
Microbial applications in malaria transmission control have drawn global attention. Mosquito midgut microbiota can modulate vector immunity and block Plasmodium development. Paratransgenic manipulation of bacterial symbionts and Wolbachia can affect reproductive characteristics of mosquitoes. Bacillus-based biolarvicides can control mosquito larvae in different breeding habitats, but their effectiveness differs according to the type of formulation applied, and the physical and ecological conditions of the environment. Entomopathogenic fungi show promise as effective and evolution-proof agents against adult mosquitoes. In addition, transgenic fungi can express anti-plasmodial effector molecules that can target the parasite inside its vector. Despite showing effectiveness in domestic environments as well as against insecticide-resistant mosquitoes, claims towards their deployability in the field and their possible use in integrated vector management programmes have yet to be investigated. Viral pathogens show efficacy in the interruption of sporogonic development of the parasite, and protozoal pathogens exert direct pathogenic potential on larvae and adults with substantial effects on mosquito longevity and fecundity. However, the technology required for their isolation and maintenance impedes their field application. Many agents show promising findings; however, the question remains about the epidemiologic reality of these approaches because even those that have been tried under field conditions still have certain limitations. This review addresses aspects of the microbial control of malaria between proof-of-concept and epidemiologic reality.
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Hassan A, Farouk H, Hassanein F, Abdul-Ghani R. Currency as a potential environmental vehicle for transmitting parasites among food-related workers in Alexandria, Egypt. Trans R Soc Trop Med Hyg 2011; 105:519-24. [PMID: 21820691 DOI: 10.1016/j.trstmh.2011.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 05/03/2011] [Accepted: 05/03/2011] [Indexed: 10/17/2022] Open
Abstract
Transmission of parasites may occur indirectly via inanimate objects in the surrounding environment. One of the objects most handled and exchanged by people are currency coins and banknotes, which could be one of the most potential vehicles to transmit parasites, even between countries. However, study of the potential contamination of currency in circulation with intestinal parasites has not been given the interest it deserves and the present study is the first pilot study in Alexandria, Egypt. It was revealed that 60.2% of 103 banknotes and 56.6% of 99 coins obtained from food-related workers had been contaminated with one or more parasitic species. Protozoa were the predominant parasites, with microsporidia and Cryptosporidium spp. being the most prevalent. There was no statistically significant difference between currency types regarding parasitological contamination, but there was a significant (P<0.001) association between the physical condition of currency and its contamination. Moreover, the source of the currency was not statistically associated with parasitological contamination. The denomination of coins was not statistically associated with parasitological contamination, whilst that of banknotes was with the lower denominations being more contaminated.
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Affiliation(s)
- Azza Hassan
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
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Abdul-Ghani R, Loutfy N, Sheta M, Hassan A. Chemotherapeutic efficacy of a natural combination in the treatment of mansonic schistosomiasis: an experimental study. Res Rep Trop Med 2011; 2:1-7. [PMID: 30881175 DOI: 10.2147/rrtm.s15608] [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] [Indexed: 11/23/2022] Open
Abstract
Purpose Combination chemotherapy of schistosomiasis mansoni has been studied previously, with praziquantel being the basis of combination. Artemether and myrrh are compounds of a natural origin that have been investigated experimentally and clinically against schistosomiasis. Artemether is used as an antimalarial drug, and has been used as a chemoprophylactic drug against Schistosoma japonicum in China whereas myrrh extract is manufactured and prescribed as an antischistosomal drug in Egypt. The present study investigated the experimental efficacy of combining artemether and myrrh using three different protocols in mice infected with the Egyptian strain of S. mansoni. Methods Experiments were performed on 40 eight-week-old female Swiss albino mice divided into three experimental groups and one control group. Assessment of efficacy was based on a suite of parasitologic and histopathologic parameters. Parasitologic parameters included reductions in total and female worm burdens, reductions in hepatic and intestinal wall tissue egg loads, and alterations in oogram patterns in the experimental groups compared to the infected untreated control. Histopathologic parameters comprised microscopic examination of liver sections stained with hematoxylin and eosin to study the reductions in the mean counts and diameters of hepatic granulomas as well as their healing ratios compared to the control. Results Reductions of 43.9%-58.2% in total worm burdens and 42.4%-63.7% in female worm burdens were induced. Meanwhile, significant reductions of 63.1%-77.8% in eggs per gram of small intestinal tissue and of 56.5%-66.3% in eggs per gram of liver tissue were also observed. The combination also caused alterations in the oogram pattern as well as amelioration of hepatic lesions as evidenced by increased ratios of healed granulomas in the treated groups compared to the control. Conclusion The experimental efficacy of the artemether-myrrh combination against the Egyptian strain of S. mansoni was evident, but not to an extent that would warrant clinical trials in humans.
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Affiliation(s)
- Rashad Abdul-Ghani
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen,
| | - Naguiba Loutfy
- Tropical Health Department, High Institute of Public Health
| | - Manal Sheta
- Department of Pathology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Azza Hassan
- Tropical Health Department, High Institute of Public Health
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Abdul-Ghani R, Loutfy N, Sheta M, Hassan A. Artemether shows promising female schistosomicidal and ovicidal effects on the Egyptian strain of Schistosoma mansoni after maturity of infection. Parasitol Res 2010; 108:1199-205. [PMID: 21107863 DOI: 10.1007/s00436-010-2163-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [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: 09/13/2010] [Accepted: 11/10/2010] [Indexed: 11/26/2022]
Abstract
Artemether is an artemisinin derivative that is used as an antimalarial drug, especially in situations where chloroquine resistance is suspected. This compound has proved to be a good prophylactic agent against schistosomiasis japonica in China. In the present study, the therapeutic efficacies of different artemether-dosing protocols were evaluated in experimentally infected mice harbouring adult Schistosoma mansoni (Egyptian strain). Mice were treated on day 46 onwards with three dosing protocols (400 mg/kg/day for 2 days; 200 mg/kg/day for 4 days; 100 mg/kg/day for 6 days) after being infected. A number of parasitological and histopathological criteria were employed in the assessment of drug efficacies compared to infected untreated control 2 weeks post-treatment. The results of the present study suggest that artemether is efficacious against the Egyptian strain of S. mansoni with total worm reductions ranging from 40.7% to 59.7% and female worm reductions ranging from 69.3% to >90%. In addition, artemether induced significant reductions, ranging from 75.2% to 82.6%, in the liver tissue egg loads as well as significant reductions, ranging from 68.8% to 78.9% in the intestinal wall egg loads. It also induced significant alterations in the oogram pattern in the intestinal mucosa of infected mice with cessation of oviposition and increased rates of dead eggs. Antipathologic activities were also evident in the amelioration of granulomas in the liver with increased ratios of healed to active ones. In conclusion, artemether could be a promising agent in the control of schistosomiasis mansoni due to its schistosomicidal effects on female worms and to its ovicidal power as well as its potentiality in the improvement of hepatic lesions.
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Affiliation(s)
- Rashad Abdul-Ghani
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen.
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Abdul-Ghani R, Loutfy, Sheta, Azza. Efficacy of low-dose myrrh protocols in the treatment of experimental schistosomiasis mansoni: hepatic improvement without parasitologic cure. Res Rep Trop Med 2010. [DOI: 10.2147/rrtm.s14231] [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: 11/23/2022] Open
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