A century after its discovery, Chagas' disease still represents a major public health challenge in Latin America. Moreover, because of growing population movements, an increasing number of cases of imported Chagas' disease have now been detected in non-endemic areas, such as North America and some E...uropean countries. This parasitic zoonosis, caused by Trypanosoma cruzi, is transmitted to humans by infected Triatominae insects, or occasionally by non-vectorial mechanisms, such as blood transfusion, mother to fetus, or oral ingestion of materials contaminated with parasites. Following the acute phase of the infection, untreated individuals enter a chronic phase that is initially asymptomatic or clinically unapparent. Usually, a few decades later, 40-50% of patients develop progressive cardiomyopathy and/or motility disturbances of the oesophagus and colon. In the last decades several interventions targeting primary, secondary and tertiary prevention of Chagas' disease have been attempted. While control of both vectorial and blood transfusion transmission of T cruzi (primary prevention) has been successful in many regions of Latin America, early detection and aetiological treatment of asymptomatic subjects with Chagas' disease (secondary prevention) have been largely underutilised. At the same time, in patients with established chronic disease, several pharmacological and non-pharmacological interventions are currently available and have been increasingly used with the intention of preventing or delaying complications of the disease (tertiary prevention). In this review we discuss in detail each of these issues.
more
After 100 years of chemotherapy with impractical and toxic drugs, an oral cure for human African trypanosomiasis (HAT) is available: Fexinidazole. In this case, we review the history of drug discovery for HAT with special emphasis on the discovery, pre-clinical development, and operational challenge...s of the clinical trials of fexinidazole. The screening of the Drugs for Neglected Diseases initiative (DNDi) HAT-library by the Swiss TPH had singled out fexinidazole, originally developed by Hoechst (now Sanofi), as the most promising of a series of over 800 nitroimidazoles and related molecules. In cell culture, fexinidazole has an IC50 of around 1 µM against Trypanosoma brucei and is more than 100-fold less toxic to mammalian cells. In the mouse model, fexinidazole cures both the first, haemolymphatic, and the second, meningoencephalitic stage of the infection, the latter at 100 mg/kg twice daily for 5 days. In patients, the clinical trials managed by DNDi and supported by Swiss TPH mainly conducted in the Democratic Republic of the Congo demonstrated that oral fexinidazole is safe and effective for use against first- and early second-stage sleeping sickness. Based on the positive opinion issued by the European Medicines Agency in 2018, the WHO has released new interim guidelines for the treatment of HAT including fexinidazole as the new therapy for first-stage and non-severe second-stage sleeping sickness caused by Trypanosoma brucei gambiense (gHAT). This greatly facilitates the diagnosis and treatment algorithm for gHAT, increasing the attainable coverage and paving the way towards the envisaged goal of zero transmission by 2030.
more
Mental health problems represent the greatest global burden of disease among children and adolescents. There is, however, lack of policy development and implementation for child and adolescent mental health (CAMH), particularly in low- and middle-income countries (LMICs) where children and adolescen...ts represent up to 50% of populations. South Africa, an upper-middle income country is often regarded as advanced in health and social policy-making and implementation in comparison to other LMICs. It is, however, not clear whether this is the case for CAMH.
more
To guide One Health capacity building efforts in the Republic of Guinea in the wake of the 2014–2016 Ebola virus disease (EVD) outbreak, we sought to identify and assess the existing systems and structures for zoonotic disease detection and control. We partnered with the government ministries resp...onsible for human, animal, and environmental health to identify a list of zoonotic diseases – rabies, anthrax, brucellosis, viral hemorrhagic fevers, trypanosomiasis and highly pathogenic avian influenza – as the country's top priorities. We used each priority disease as a case study to identify existing processes for prevention, surveillance, diagnosis, laboratory confirmation, reporting and response across the three ministries. Results were used to produce disease-specific systems “maps” emphasizing linkages across the systems, as well as opportunities for improvement. We identified brucellosis as a particularly neglected condition. Past efforts to build avian influenza capabilities, which had degraded substantially in less than a decade, highlighted the challenge of sustainability. We observed a keen interest across sectors to reinvigorate national rabies control, and given the regional and global support for One Health approaches to rabies elimination, rabies could serve as an ideal disease to test incipient One Health coordination mechanisms and procedures. Overall, we identified five major categories of gaps and challenges: (1) Coordination; (2) Training; (3) Infrastructure; (4) Public Awareness; and (5) Research. We developed and prioritized recommendations to address the gaps, estimated the level of resource investment needed, and estimated a timeline for implementation. These prioritized recommendations can be used by the Government of Guinea to plan strategically for future One Health efforts, ideally under the auspices of the national One Health Platform. This work demonstrates an effective methodology for mapping systems and structures for zoonotic diseases, and the benefit of conducting a baseline review of systemic capabilities prior to embarking on capacity building efforts.
more
Rabies is a disease of animals but too often the outcome is gauged in terms of human suffering and
death. Despite this, in areas of the world where rabies is endemic there is often a lack of communication between veterinary and medical professionals, to the extent that the disease continues to thri...ve and potential victims are not treated. The problem is partly
exacerbated by a lack of awareness and experience of the disease and of what to do when confronted by suspect cases. In these technologically advanced days, although it is possible to learn “all there is to know” about almost any subject, it is sometimes difficult to distil the essence.
more
Existing data on chronic obstructive pulmonary disease (COPD) prevalence are irregularly distributed around the world, and in many geographic regions data are scarce or even nonexistent. This fact hinders the implementation of adequate preventive and therapeutic interventions to reduce the high burd...en and costs of COPD. In the current study, we have used the Geographic Information System (GIS) inverse distance weighted (IDW) interpolation technique with the objective of visualising spatial data of COPD prevalence in the world and obtaining a visual impression of the magnitude of this global health problem. GIS has been recognised as an effective tool to display the geographical distribution of data, even when they are few and widely separated, as is the case with the prevalence of COPD.
more
PLoS Neglected Tropical diseases August 16, 2021 https://doi.org/10.1371/journal.pntd.0009697
Chagas disease, also known as American trypanosomiasis, is a neglected tropical disease transmitted by triatomine insects, first identified in 1909. Chagas disease affects approximately 6–7 million peop...le globally and is highly prevalent in Latin America where most cases are reported. However, there is increasing evidence that Chagas disease is now an important public health issue outside the “classical” endemic countries due to population migration. Our understanding of Chagas disease, including its pathologies and factors relating to progression, remains to date limited, and is also challenged by lack of diagnosis and highly effective treatment. This systematic review aims to describe studies with Chagas patients receiving antiparasitic treatment. Databases were searched for relevant studies published after 1997, and the results of these searches were screened.
more
With the growing prevalence of type 2 diabetes, particularly in emerging countries, its management in the context of available resources should be considered. International guidelines, while comprehensive and scientifically valid, may not be appropriate for regions such as Asia, Latin America or Afr...ica, where epidemiology, patient phenotypes, cultural conditions and socioeconomic status are different from America and Europe. Although glycaemic control and reduction of micro- and macrovascular outcomes remain essential aspects of treatment, access and cost are major limiting factors; therefore, a pragmatic approach is required in restricted-resource settings. Newer agents, such as sodium–glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists in particular, are relatively expensive, with limited availability despite potentially being valuable for patients with insulin resistance and cardiovascular complications. This review makes a case for the role of more accessible second-line treatments with long-established efficacy and affordability, such as sulfonylureas, in the management of type 2 diabetes, particularly in developing or restricted-resource countries.
more
Disability, CBR & Inclusive Development, [S.l.], v. 24, n. 3, p. 112-122, nov. 2013. ISSN 2211-5242
Children with disabilities encounter more violence in their lives than their peers without disability. Organisations involved in Community Based Rehabilitation (CBR) come across many cases of violen...ce against the children they work with. Many organisations have no policy on child protection since it is not within the scope of their expertise. Others work with child protection policies that are hard to apply in the realities they deal with. Through research done in Ethiopia, with a recent update, the author attempts to show that there is a need for policies in CBR, that follow a community approach rather than an individual approach to child protection.
more
Plos Current Outbreaks
An outbreak of Lassa Fever (LF) reported and confirmed in Ondo state, Southwest Nigeria in January 2016 was investigated. This paper provides the epidemiology of the LF and lessons learnt from the investigation of the outbreak.
Results: We identified 90 suspected LF case...s of which 19 were confirmed by the laboratory. More than half (52.6%) of the confirmed cases were females with majority (73.7%) in the age group ≥ 15 years. The Case Fatality Rate (CFR) of 63.2% among the laboratory-confirmed positive cases where 9 of 19 cases died, was significantly higher compared to the laboratory confirmed negative cases where 6 of the 65 cases died ( CFR; 8.5%) p ≤ 0.05. Two hundred and eighty-seven contacts of the confirmed cases were identified, out of which 267(93.0%) completed the follow-up without developing any symptoms and 2 (0.7%) developed symptoms consistent with LF and were confirmed by the laboratory. More than half of the contacts were females (64.5%) with most of them (89.2%) in the age group ≥ 25 years.
more
The Mekong Malaria Elimination (MME) programme is an initiative aimed at supporting Greater Mekong Subregion (GMS) countries – Cambodia, Lao People's Democratic Republic, Myanmar, Thailand, Viet Nam, and Yunnan (China) – in achieving the goal of malaria elimination by 2030. Data for this epidemi...ological summary were compiled from country reports. Between January and March 2024, 22 632 malaria cases were reported. During that period, GMS countries recorded 28% fewer cases, with P. falciparum + mixed and P. vivax cases declining by 50% and 23%, respectively. Meanwhile, testing declined by 21% when compared to the same period in 2023.
more
Journal of Tuberculosis Research, 2017, 5, 189-200
Background: In Benin, little is known about the influence of both gender and
HIV-status on diagnostic patterns and treatment outcomes of Tuberculosis
(TB) patients. Objective: To assess whether differences in gender and HIV
status affect diagn...ostic patterns and treatment outcomes of TB patients. Methods:
Retrospective cohort study of patients registered in 2013 and 2014 in
the three largest TB Basic Management Units in south Benin. Results: Of 2694
registered TB patients, 1700 (63.1%) were male. Case notification rates were
higher in males compared with females (96 vs 53/100,000 inhabitants). The
male to female ratio was 1:1 in HIV positive patients, but was 2:1 among HIV
negative cases. In HIV-positive patients, there were no differences in TB types
between men and women. In HIV-negative patients, there were significantly
higher proportions of females with clinically diagnosed pulmonary TB (p =
0.04) and extrapulmonary TB (p < 0.001). Retreatment TB was 4.65 times
higher amongst males compared with females. For New bacteriologically confirmed
pulmonary TB, no differences were observed in treatment outcomes
between genders in the HIV positive group; but significantly more unfavorable
outcomes were reported among HIV negative males, with higher rates of
failure (p < 0.001) and loss-to-follow up (p = 0.02). Conclusion: The study
has shown that overall TB notification rates were higher in males than in females
in south Benin, with more females co-infected with HIV. Unfavorable outcomes were more common in HIV-negative males.
more
A 2013 Plan study across 30 countries found that children with disabilities were on average 10 times less likely to go to school than children without disabilities. This report presents the findings of a follow-up second phase to the research with a qualitative study on barriers and enablers to educ...ation for children with disabilities in Nepal.
The Full Report and Executive Summary Reports in English, French and Spanish are now available for download at:
http://disabilitycentre.lshtm.ac.uk/include-us-education-study-available-now/
more
The CSMH compiled a list of assessment measures that are in the public domain (free of charge) and available online for clinicians. Below are the recommended measures can be used in school mental health programs to help assess symptoms of clinical disorders (e.g. depression, anxiety, ADHD) an in som...e cases are useful for tracking student progress and outcomes over time.
more
These forms are intended only for clinicians and nurses taking care of patients with Ebola virus disease. They provide standardized information that needs to be collected by the clinicians at admission time, every day and at time of discharge.
The World Health Organization invites clinicians and patients to collect information on COVID-19 in a systematic way and contribute clinical data to the WHO Clinical Platform to expand our knowledge on Post-COVID-19 condition, and support patient care and public health interventions.
WHO’s Post... COVID case report form (CRF) has been designed to report standardized clinical data from individuals after hospital discharge or after the acute illness to examine the medium- and long-term consequences of COVID-19. The forms will be available in multiple languages.
more
PLoS Negl Trop Dis 16(11): e0010885. https://doi.org/10.1371/journal.pntd.0010885
HAT diagnosis in non-endemic countries is rare and can be challenging, but alertness and
surveillance must be maintained to contribute to WHO’s elimination goals. Early detection is
particularly important as it co...nsiderably improves the prognosis.
more
Persons with acute respiratory illness with sudden onset of at least one of the following: cough, sore throat, shortness of breath or fever [≥ 38°C (measured) or history of fever (subjective)] irrespective of admission status AND In the 14 days prior to onset of symptoms, met at least one of the ...following epidemiological criteria: Were in close contact1 with a confirmed2 or probable3 case of SARS-CoV-2 infection; OR Had a history of travel to areas with presumed ongoing community transmission of SARS-CoV-2; (Visit WWW.NICD.AC.ZA for an updated case definition). OR Worked in, or attended a health care facility where patients with SARS-CoV-2 infections were being treated. OR Admitted with severe pneumonia of unknown aetiology.
more
Kan M et al. Journal of the International AIDS Society 2018, 21(S5):e25139 http://onlinelibrary.wiley.com/doi/10.1002/jia2.25139/full | https://doi.org/10.1002/jia2.25139
Shortages of healthcare workers is detrimental to the health of communities, especially children. This paper describes the process of capacity building Community Health Volunteers (CHVs) to deliver integrated preventive and curative package of care of services to manage common childhood illness in h...ard-to-reach communities in Bondo Subcounty, Kenya
more