Tropical Medicine and Health最新文献

{"title":"Variable effects of non-falciparum species infections on malaria disease severity in high transmission regions in Senegal.","authors":"Aissatou Diagne, Babacar Souleymane Sambe, Folly Mawulolo Gaba, Ibrahima Sarr, Arona Sabène Diatta, Ousmane Sadio, Serigne Ousmane Mbacké Diaw, Hélène Ataume Mawounge Diatta, Babacar Diouf, Inès Vigan-Womas, Babacar Mbengue, Makhtar Niang","doi":"10.1186/s41182-024-00655-8","DOIUrl":"10.1186/s41182-024-00655-8","url":null,"abstract":"<p><p>In malaria endemic countries, non-falciparum species are often mixed with Plasmodium falciparum in patients with uncomplicated malaria, and their contribution to malaria severity and death is poorly studied. This study assesses the contribution of non-falciparum species to malaria severity in three regions of Senegal with the highest malaria incidence.We analysed 617 blood samples obtained between 2015 and 2021 from confirmed malaria patients at health facilities in Kedougou, Kolda and Tambacounda in Senegal. Plasmodium species composition was determined by PCR and their distribution were analysed according to age and disease severity, and the relative risk of developing severe malaria.Overall, 94.8% of samples contained P. falciparum either as single or mixed with other species. Non-falciparum P. ovale, P. vivax and P. malariae species were detected in 60.12, 13.61 and 1.62% of samples, respectively. Severe malaria was primarily due to P. falciparum, but co-infection with P. vivax led to a 1.63-fold significant (p = 0.05) increased risk of developing severe malaria, contrasting with the non-significant reduced risk (OR = 0.78; CI 95: 0.55-1.11; p = 0.16) associated with P. ovale infections. Children aged < 15 years old significantly suffered of SM than adults patients, whereas no significant association was found in relation to patient' sex.This study reports the first association of non-falciparum species infections with clinical malaria phenotypes in patients from the three most malaria-affected regions in Senegal. Non-falciparum P. ovale and P. vivax species in combination with P. falciparum had a protective and worsening effect, respectively. The findings suggest that interventions targeting only P. falciparum might not be sufficient to eliminate the overall malaria burden, and should take into account the neglected non-falciparum species.</p>","PeriodicalId":23311,"journal":{"name":"Tropical Medicine and Health","volume":"52 1","pages":"93"},"PeriodicalIF":3.6,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occupational risk of SARS-CoV-2 infection among healthcare workers in Bangladesh: a multicenter hospital-based study and lessons for future epidemics.","authors":"Ahamed Khairul Basher, Md Abdullah Al Jubayer Biswas, Aninda Rahman, Mahmudur Rahman, Fahmida Chowdhury, Md Zakiul Hassan","doi":"10.1186/s41182-024-00663-8","DOIUrl":"10.1186/s41182-024-00663-8","url":null,"abstract":"<p><strong>Background: </strong>Frontline healthcare workers (HCWs) were particularly vulnerable to contracting SARS-CoV-2 infection as a result of occupational exposure. There is a scarcity of data characterizing the risk of SARS-CoV-2 infection among HCWs, particularly in low-income hospital settings. This study aimed to assess the prevalence of COVID-19 among HCWs and identify associated risk factors.</p><p><strong>Methods: </strong>From July 2021 to July 2023, we enrolled HCWs from 13 primary, 2 secondary, and five tertiary care hospitals in four selected districts of Bangladesh. We collected information on demography and risk exposure in a face-to-face interview. We calculated the odds ratio to measure the risk using multivariable logistic regression.</p><p><strong>Results: </strong>We enrolled 3436 HCWs: 22% (747) physicians, 47% (1632) nurses, and 31% (1057) support staff. Most of the HCWs were female 67% (2292), and the mean age was 38.1, IQR = 29-44 years. Overall, 26% (889) of HCWs had lab-confirmed SARS-CoV-2 infection. Among HCWs, nurses accounted for the highest proportion of COVID-19 infections at 53% (473/1632). Physicians had a significantly higher risk of infection with an aOR of 3.08 (95% CI 2.42-3.93; p < .001) compared to support staff. HCWs who had direct exposure to COVID-19 patients were also at a higher risk, with a 1.93 times higher likelihood of infection ([aOR] = 1.93, 95% CI 1.50-2.47; p < .001), compared to HCWs who were not exposed.</p><p><strong>Conclusions: </strong>This study highlights the heightened vulnerability of HCWs to SARS-CoV-2 infection due to occupational exposure and indicates the risk of nosocomial transmission to patients and emphasizes the importance of implementing targeted infection control measures, such as improved workplace safety protocols and comprehensive training to tackle future pandemics of similar traits.</p>","PeriodicalId":23311,"journal":{"name":"Tropical Medicine and Health","volume":"52 1","pages":"92"},"PeriodicalIF":3.6,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11613764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spatial analysis of malaria cases and Anopheles species in East Java region, Indonesia.","authors":"Ngadino, Winarko, Demes Nurmayanti, Marlik, Slamet Wardoyo, Syarifah Nurhayati, Desya Wuryaningtyas","doi":"10.1186/s41182-024-00662-9","DOIUrl":"https://doi.org/10.1186/s41182-024-00662-9","url":null,"abstract":"<p><p>Malaria remains a significant public health challenge worldwide, including in Indonesia, particularly in the East Java region. This study aimed to analyse the spatial distribution of malaria cases and Anopheles species that act as vectors in the area. Using an observational design with a cross-sectional approach, data on malaria cases were collected from tiers from the Community Health Centre, District Health Office and Province, all of which were documented on the Ministry of Health's malaria information system for the period 2021-2023. Malaria Vector Distribution Data from the East Java Health Office and the research team directly. Sampling of mosquitoes and larvae was carried out by researchers using a purposive sampling method, which prioritised locations with districts that have a high risk factor for the presence of breeding Anopheles sp., namely, Treggalek District, Malang District and Pacitan District with diverse topography, such as coastal (lagoon), rice fields and hills. The results of the analysis show that the distribution of imported malaria cases in East Java is uneven, with hotspots identified in several areas that have working population mobility from outside the East Java region. The presence of Anopheles species, particularly An. sundaicus and An. maculatus, contributes to their potential as vectors of malaria transmission, with An. sundaicus being more common in coastal areas and An. maculatus in valley and paddy fields. Environmental factors, such as topography of the region, temperature, humidity, and rainfall, influence the variation of Anopheles species. This study emphasises the importance of an ecosystem-based approach to malaria control, as well as the need to improve access to health services and community education. The findings provide important insights for the development of more effective and sustainable health policies in an effort to maintain malaria elimination areas in East Java.</p>","PeriodicalId":23311,"journal":{"name":"Tropical Medicine and Health","volume":"52 1","pages":"91"},"PeriodicalIF":3.6,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nine fatal cases of dengue: a case series from an intensive care unit in Sri Lanka.","authors":"Pramith Ruwanpathirana, Harindri Athukorala, Thamalee Palliyaguru, Praveen Weeratunga, Dilshan Priyankara","doi":"10.1186/s41182-024-00661-w","DOIUrl":"10.1186/s41182-024-00661-w","url":null,"abstract":"<p><strong>Background: </strong>The case fatality rate of untreated dengue is 20%; it can be reduced to less than 1% with optimal management. The leading causes of death in dengue patients are shock, bleeding, and acute liver injury. We describe the clinical features of patients who died of dengue and discuss the therapeutic challenges and pitfalls of complicated dengue.</p><p><strong>Methods: </strong>This retrospective study was done in the intensive care unit (MICU) of the National Hospital of Sri Lanka over 30 months between 2021 and 2023. All patients who died of serologically confirmed dengue were incorporated.</p><p><strong>Results: </strong>Of the 1722 ICU admissions, 44 (2.6%) patients were treated for dengue-of them, 11 (25.0%) died. Two patients were excluded as their deaths were not directly linked to dengue. Six were females. The average age was 40.2 years. The leading causes of death included shock (n = 5), acute liver failure (n = 6), intracranial bleeding (n = 2), and pulmonary embolism (n = 1). Patient 1 had concomitant leakage and bleeding, which did not respond to fluids or blood products. He developed fluid overload and acute liver failure (ALF) and died of multiorgan dysfunction. Patients 2-5 were in shock for a prolonged period due to leakage ± bleeding. Patients 2-5 developed ALF and lactic acidosis followed by multiorgan dysfunction. Patient 8 developed acute hepatitis and ALF without preceding shock. The patient was treated with immunosuppressants for myasthenia gravis. Patients 6 and 7 experienced intracranial bleeding. Patient 9 died of pulmonary embolism after prolonged ventilation for dengue encephalitis.</p><p><strong>Conclusions: </strong>Prolonged shock, fluid overload and acute liver failure were common causes of dengue related deaths, in our study. Fluid overload occurred when vigorous crystalloid resuscitation was continued in patients who were poorly responding. A prompt switch to colloids or blood could have prevented overload. Patients who were in shock for a prolonged period become unresponsive to fluid resuscitation. How to manage dengue in patients who take anti-inflammatory drugs, immunomodulators, or antiplatelets is not known. Balancing the bleeding risk of dengue in patients predisposed to bleeding or thrombosis is a challenge.</p>","PeriodicalId":23311,"journal":{"name":"Tropical Medicine and Health","volume":"52 1","pages":"90"},"PeriodicalIF":3.6,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11605893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Knowledge, attitude and practice towards intestinal schistosomiasis among school-aged children and adults in Amhara Regional State, northwest Ethiopia. A cross-sectional study.","authors":"Getaneh Alemu, Endalkachew Nibret, Arancha Amor, Abaineh Munshea, Melaku Anegagrie","doi":"10.1186/s41182-024-00648-7","DOIUrl":"10.1186/s41182-024-00648-7","url":null,"abstract":"","PeriodicalId":23311,"journal":{"name":"Tropical Medicine and Health","volume":"52 1","pages":"89"},"PeriodicalIF":3.6,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11605982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distribution of Candida species isolated from people living with human immunodeficiency virus with oropharyngeal and oral candidiasis in Africa in the era of universal test and treat policy: a systematic review and meta-analysis.","authors":"Benson Musinguzi, Ekwaro A Obuku, Alex Mwesigwa, Richard Migisha, Alison Annet Kinengyere, Regina Ndagire, Andrew Baguma, Erick Jacob Okek, Ronald Olum, Herbert Itabangi, Gerald Mboowa, Obondo James Sande, Beatrice Achan","doi":"10.1186/s41182-024-00649-6","DOIUrl":"10.1186/s41182-024-00649-6","url":null,"abstract":"<p><strong>Background: </strong>The introduction of antiretroviral therapy (ART) and the implementation of the human immunodeficiency virus (HIV) universal test and treat (UTT) policy have led to a decline in the incidence of opportunistic infections. However, oropharyngeal and oral candidiasis remain prevalent and continue to pose challenges among people living with human immunodeficiency virus (PLHIV) in Africa, indicating the need for a better understanding of the distribution of Candida species responsible for these infections. This systematic review and meta-analysis aimed to determine the distribution of Candida species isolated from PLHIV with oropharyngeal and oral candidiasis in Africa in the era of UTT policy.</p><p><strong>Methods: </strong>The review followed the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. A comprehensive search was conducted to identify eligible studies to be included in the meta-analysis and analysed using a random effects model in STATA version 17. The risk of bias was assessed using the Joanna Briggs Institute quality assessment tool.</p><p><strong>Results: </strong>Fourteen studies with 4281 participants were included in the review. Overall, 2095 Candida isolates were reported, 78.7% (1650/2095) of which were C. albicans, 19.6% (410/2095), non-albicans Candida (NAC), and 1.7% (35/2095) could not be identified to the Candida specific species level. The most prevalent NAC species were C. glabrata (26.3%), followed by C. tropicalis (24.9%), C. krusei (15.6%), C. parapsilosis (11%), and C. dubliniensis (6.3%). The pooled prevalence of oropharyngeal and oral candidiasis was 48% (95% CI 34-62%). The prevalence of oropharyngeal candidiasis was higher in the pre-UTT era, at 56% (95% CI 40-72%, p < 0.001), than in the post-UTT era, at 34% (95% CI 10-67%, p < 0.001). The risk of bias assessment revealed that 71.4% (10/14) of the included studies had a low risk of bias and that 28.6% (4/14) had a moderate risk of bias.</p><p><strong>Conclusions: </strong>While C. albicans remain, the predominant species causing oropharyngeal and oral candidiasis among PLHIV in Africa, NAC species also contribute significantly to the infection burden. Despite ART and UTT policies, oropharyngeal candidiasis remains prevalent, emphasizing the need for targeted interventions.</p>","PeriodicalId":23311,"journal":{"name":"Tropical Medicine and Health","volume":"52 1","pages":"88"},"PeriodicalIF":3.6,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11600869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142732830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between maternal and child health care and neonatal death in Angola: a secondary analysis of Angola Demographic Health Survey 2015-16.","authors":"Akiko Saito, Masahide Kondo","doi":"10.1186/s41182-024-00658-5","DOIUrl":"10.1186/s41182-024-00658-5","url":null,"abstract":"<p><strong>Background: </strong>Neonatal mortality has decreased in Angola; however, it remains high. Quality maternal and child health (MCH) care is key to improving neonatal survival. In Angola, however, the association between neonatal mortality and MCH care has not yet been investigated. Therefore, this study aimed to identify the association between neonatal mortality and MCH services in Angola.</p><p><strong>Methods: </strong>We used the Angola Demographic Health Survey 2015-16, which is the latest nationally representative dataset of Angola. The associations between early/late neonatal death and MCH care utilization were identified by a multivariable logistic regression analysis, adjusted by the sex of the child, type of residence, wealth index, caesarian section, size of the child at birth and delivery assisted by skilled birth attendant. The individual sample weight, sample strata for sampling errors/design, and cluster number were incorporated in a descriptive and logistic regression analysis to account for the unequal probability sampling in different strata.</p><p><strong>Results: </strong>The early and late neonatal mortality rates were 22 and 2 per 1000 live births, respectively. We found that having none, one, two or three tetanus injections before the last pregnancy compared to five or more injections, and no postnatal health check for children before discharge were associated with the occurrence of late neonatal death. During the first 2 days after childbirth, no observation of breastfeeding, no counseling on breastfeeding, no counseling on newborn danger signs, no measurement of child body temperature, and no examination of the cord as well as not checking child health before discharge were associated with early neonatal death.</p><p><strong>Conclusions: </strong>Doses of maternal tetanus vaccination and postnatal child health check before discharge were modifiable factors associated to late neonatal death. Further studies to improve MCH care coverage are needed.</p>","PeriodicalId":23311,"journal":{"name":"Tropical Medicine and Health","volume":"52 1","pages":"87"},"PeriodicalIF":3.6,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142732826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasmodium falciparum genetic diversity and multiplicity of infection among asymptomatic and symptomatic malaria-infected individuals in Uganda.","authors":"Alex Mwesigwa, Moses Ocan, Bryan Cummings, Benson Musinguzi, Shahid Kiyaga, Steven M Kiwuwa, Stephen Okoboi, Barbara Castelnuovo, Everd Maniple Bikaitwoha, Joan N Kalyango, Charles Karamagi, Joaniter I Nankabirwa, Samuel L Nsobya, Pauline Byakika-Kibwika","doi":"10.1186/s41182-024-00656-7","DOIUrl":"10.1186/s41182-024-00656-7","url":null,"abstract":"<p><strong>Background: </strong>Plasmodium falciparum (P. falciparum) remains a significant public health challenge globally, especially in sub-Saharan Africa (SSA), where it accounts for 99% of all malaria infections. The outcomes of P. falciparum infection vary, ranging from asymptomatic to severe, and are associated with factors such as host immunity, parasite genetic diversity, and multiplicity of infection (MOI). Using seven neutral microsatellite markers, the current study investigated P. falciparum genetic diversity and MOI in both asymptomatic and symptomatic malaria individuals in Uganda.</p><p><strong>Methods: </strong>This cross-sectional study analyzed 225 P. falciparum isolates from both asymptomatic and symptomatic malaria patients, ranging in age from 6 months to ≥ 18 years. P. falciparum genetic diversity, MOI, and multi-locus linkage disequilibrium (LD) were assessed through genotyping of seven neutral microsatellite markers: Poly-α, TA1, TA109, PfPK2, 2490, C2M34-313, and C3M69-383. Genetic data analysis was performed using appropriate genetic analysis software.</p><p><strong>Results: </strong>P. falciparum infections exhibited high genetic diversity in both asymptomatic and symptomatic individuals. The mean expected heterozygosity (He) ranged from 0.79 in symptomatic uncomplicated malaria cases to 0.81 in asymptomatic individuals. There was no significant difference (p = 0.33) in MOI between individuals with asymptomatic and symptomatic infections, with the mean MOI ranging from 1.92 in symptomatic complicated cases to 2.10 in asymptomatic individuals. Polyclonal infections were prevalent, varying from 58.5% in symptomatic complicated malaria to 63% in symptomatic uncomplicated malaria cases. A significant linkage disequilibrium (LD) was observed between asymptomatic and symptomatic uncomplicated/complicated infections (p < 0.01). Genetic differentiation was low, with F_ST values ranging from 0.0034 to 0.0105 among P. falciparum parasite populations in asymptomatic and symptomatic uncomplicated/complicated infections.</p><p><strong>Conclusion: </strong>There is a high level of P. falciparum genetic diversity and MOI among both symptomatic and asymptomatic individuals in Uganda. Asymptomatic carriers harbor a diverse range of parasites, which poses challenges for malaria control and necessitates targeted interventions to develop effective strategies.</p>","PeriodicalId":23311,"journal":{"name":"Tropical Medicine and Health","volume":"52 1","pages":"86"},"PeriodicalIF":3.6,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping lymphatic filariasis morbidities in 24 endemic districts of Ethiopia through the health extension program.","authors":"Haileleuel Bisrat, Fikre Hailekiros, Mebratu Mitiku, Asrat Mengiste, Merga Mekonnon, Fikre Seife, Birhanu Oljira, Haileyesus Terefe, Tamrat Bekele, Tsegahun Manyazewal","doi":"10.1186/s41182-024-00657-6","DOIUrl":"10.1186/s41182-024-00657-6","url":null,"abstract":"<p><strong>Background: </strong>The primary strategy for achieving the second goal of the Global Program to Eliminate Lymphatic Filariasis (GPELF) is morbidity management and disability prevention (MMDP), aimed at alleviating the suffering of affected populations. A significant challenge in many LF-endemic areas is the effective registration and identification of individuals with LF, which is crucial for planning and ensuring access to MMDP services. This study seeks to map the geographical distribution of LF-related morbidities across 24 endemic districts in Ethiopia.</p><p><strong>Methods: </strong>A community-based cross-sectional study was conducted to identify individuals affected by LF in 24 endemic districts using primary health care units (PHCUs). The study involved 946 trained health extension workers (HEWs) conducting house-to-house visits to identify and register cases of lymphedema and hydrocele, with support from 77 trained supervisors and 87 team leaders coordinating the morbidity mapping. Certified surgeons performed confirmatory evaluations through clinical assessments on a randomly selected sample of cases to validate HEW diagnoses, ensuring accurate identification of lymphedema and hydrocele. Statistical analysis of the data, including the severity of lymphedema and acute attacks, was conducted using STATA 17.</p><p><strong>Results: </strong>This study involved 300,000 households with nearly 1.2 million individuals, leading to the identification of 15,527 LF cases-14,946 (96.3%) with limb lymphedema and 581 (3.7%) with hydrocele. Among those with lymphedema, 8396 (54.1%) were women. Additionally, 13,731 (88.4%) patients resided in rural areas. Of the 14,591 cases whose acute attack information was recorded, 10,710 (73.4%) reported experiencing at least one acute attack related to their lymphedema in the past 6 months, with a notable percentage of males (74.5%; n = 4981/6686). Among the 12,680 recorded cases of leg lymphedema, the percentage of acute attacks increased with severity: 64% (n = 5618) mild cases, 68% (n = 5169) moderate cases and 70% (n = 1893) severe cases.</p><p><strong>Conclusion: </strong>This study successfully mapped the geographical distribution of LF morbidities across 24 LF-endemic districts in Ethiopia, identifying a substantial number of lymphedema and hydrocele cases, particularly in rural areas where healthcare access is limited. The findings underscore the potential of Ethiopia's health extension program to identify affected individuals and ensure they receive necessary care. The findings inform targeted interventions and access to MMDP services, contributing to Ethiopia's goal of eliminating LF by 2027.</p>","PeriodicalId":23311,"journal":{"name":"Tropical Medicine and Health","volume":"52 1","pages":"85"},"PeriodicalIF":3.6,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of integrating traditional care with the modern healthcare system in reducing tuberculosis diagnosis delays in Ethiopia: a clustered randomized controlled study.","authors":"Desalegne Amare, Kefyalew Addis Alene, Fentie Ambaw","doi":"10.1186/s41182-024-00641-0","DOIUrl":"10.1186/s41182-024-00641-0","url":null,"abstract":"<p><strong>Background: </strong>Diagnosis and treatment initiation delays for tuberculosis (TB) are significant challenges in resource-limited settings. These delays can result in poor treatment outcomes, disease transmission, and increased costs. This study aimed to assess the effect of integrating traditional care with modern healthcare systems on reducing TB diagnosis delay.</p><p><strong>Methods: </strong>A cluster randomized controlled trial was conducted among TB patients, with 510 participants, 255 individuals were assigned to the intervention group and 255 to the control group. Training in the intervention group was provided for both traditional and modern healthcare providers in three rounds to enhance their knowledge, attitudes, and skills in TB screening and referral. A non-parametric independent sample test was used to compare the baseline and end-line data. The effect size was determined using Cohen's d. To account for individual and cluster-level variations, a mixed-effect parametric survival model was employed. Furthermore, conditional (fixed only) and marginal (random effects) graphs were used to compare between the intervention and control groups.</p><p><strong>Results: </strong>A total of 510 participants were included in the baseline study, with a similar number of participants included in the endline study. In the intervention group, the delay in diagnosis was 4.185 per 1000 person-days post-intervention, compared to 4.608 per 1000 person-days pre-intervention. In the control group, the delay for diagnosis was 4.759 per 1000 person-days pre-intervention and 5.031 per 1000 person-days post-intervention. The median time to diagnosis was 135 days. The non-parametric comparison showed that the intervention significantly reduced patient delays in the intervention group compared to the control group (p = 0.006), with a Cohen's d effect size of 0.246. The intervention also significantly reduced diagnosis delay in the intervention group compared to the control group (p = 0.036), with a Cohen's d effect size of 0.187. The diagnosis of TB was accelerated by 1.076 times due to the integration of traditional care with the modern healthcare system in the intervention group compared to the control group (δ: 1.076; 95% CI 1.021, 1.134).</p><p><strong>Conclusions: </strong>The involvement of traditional care providers in TB control programs significantly reduced diagnosis delays in Ethiopia. These findings suggest the need for integrating traditional care with modern healthcare systems for the effective prevention of TB in high-burden countries. Clinical trial registration ClinicalTrials.gov ID: NCT05236452.</p>","PeriodicalId":23311,"journal":{"name":"Tropical Medicine and Health","volume":"52 1","pages":"83"},"PeriodicalIF":3.6,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11558963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}