Tropical Medicine & International Health最新文献

{"title":"Risk stratification during antenatal care failed to identify most mothers who experienced adverse pregnancy outcomes: A prospective study from Kakamega County, Kenya.","authors":"Jan E Cooper, Margaret Kruk, David Kapaon, Kennedy Opondo, Jacinta Nzinga, Rose J Kosgei, Kevin Croke","doi":"10.1111/tmi.14110","DOIUrl":"https://doi.org/10.1111/tmi.14110","url":null,"abstract":"<p><strong>Introduction: </strong>Risk stratification of pregnancies informs clinical care globally. Yet recent research has cast doubt on the ability of currently used population-level risk measures to accurately predict poor outcomes at the individual level. We examine the assumption that existing forms of risk stratification can successfully identify women likely to develop complications during delivery in a rural setting in Kenya.</p><p><strong>Methods: </strong>We conducted a prospective observational study of 19,653 pregnant women in Kakamega County in Western Kenya. Women were contacted three times during the perinatal period and surveyed about provider-identified risks and self-assessed concerns about pregnancy complications, delivery process outcomes, and adverse delivery outcomes. Measures of risk were derived from women's self-reporting. We compared delivery process outcomes and adverse delivery outcomes between high- and low-risk pregnancies, and between women with and without expressed concerns about delivery complications. Delivery process outcomes included intrapartum referral, unplanned caesarean section, blood transfusion, hysterectomy, or admission to an intensive care unit. Adverse delivery outcomes included stillbirth, neonatal mortality, and maternal mortality. We reported means and confidence intervals for each category, and tested for differences using bivariate linear regression.</p><p><strong>Results: </strong>Thirty-eight percent of pregnancies had at least one risk factor consistent with a high risk pregnancy; the remaining 62% were low risk by this criteria. Rates of most adverse process outcomes and delivery outcomes were higher among pregnancies with known risks. However, 64.5% of maternal deaths and 54.8% of all deaths in the sample took place among pregnancies characterised as low risk.</p><p><strong>Conclusions: </strong>Risk stratification using existing indicators of risk during pregnancy is inadequate to identify women at risk of adverse health outcomes in this setting.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regulator experiences of trials during Ebola epidemics in Sierra Leone, Guinea, and the Democratic Republic of the Congo.","authors":"Kambale Kasonia, Frank Baiden, Frédéric Le Marcis, Bruno Lapika, Joel Kiyulu, Henri Kimina, Freddy Bikioli, Fanny Attas, Anthony Mansaray, Rose Burns, Elysée Nouvet, Séverine Thys, Antea Paviotti, Daniela Manno, Mukeh Kenneth Fahnbulleh, Bailah Leigh, Mohamed Samai, Brian Greenwood, Shelley Lees, Patrick Mitashi Mulopo, Deborah Watson-Jones","doi":"10.1111/tmi.14111","DOIUrl":"https://doi.org/10.1111/tmi.14111","url":null,"abstract":"<p><strong>Introduction: </strong>During the 2014-2016 Ebola epidemic in West Africa and the Ebola outbreaks between 2018 and 2020 in the Democratic Republic of Congo, vaccines and other tools for prevention and treatment had to be taken through trials in exceptional circumstances using accelerated processes.</p><p><strong>Materials and methods: </strong>We interviewed members of ethics committees, health authorities, health professionals, and political authorities in the Democratic Republic of Congo in 2021 and held a workshop with ethics committee members and regulatory authorities from Sierra Leone and Guinea in 2022 in order to document their experiences of reviewing, approving, and regulating current and new studies during epidemics and outbreaks, and to document lessons learnt and their recommendations for the rapid review of clinical trial protocols during public health emergencies.</p><p><strong>Results: </strong>Similar barriers were identified in the three countries. These were related to weak legal frameworks and partnerships between ethics committees and regulatory bodies. Inadequate human resources, outdated standard operating procedures and guidelines, and lack of finance to support timely reviews were identified. We also noted a lack of awareness from politicians, scientists, and communities about the existence and functions of regulatory bodies/ethics committees, a lack of independence, and low interest in research. Opportunities identified by the institutions in the countries concerned included training ethics committee members and networking with experienced international platforms like the African Vaccine Regulatory Forum. Laws on regulating research have been updated in Sierra Leone and in Guinea, but not yet in the Democratic Republic of Congo.</p><p><strong>Conclusion: </strong>Regulatory bodies have been facing many challenges in terms of a lack of a legal framework, a lack of finance, and a lack of support from politicians, scientists, and communities. Networking has been an opportunity for these regulators to mitigate these impediments.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for cholera mortality: A scoping review.","authors":"Despina Pampaka, Kathryn Alberti, David Olson, Iza Ciglenecki, Philippe Barboza","doi":"10.1111/tmi.14106","DOIUrl":"https://doi.org/10.1111/tmi.14106","url":null,"abstract":"<p><strong>Objectives: </strong>Cholera is an easily treatable disease, but many people are still unnecessarily dying from it. To improve current case management practices and prevent mortality requires a comprehensive understanding of who is at higher risk of dying. To identify the most common risk factors, a scoping review was undertaken, to explore the literature and summarise the evidence on cholera mortality and reported risk factors.</p><p><strong>Methods: </strong>Following the scoping review framework proposed by Arksey and O'Malley (2005), Pubmed, EMBASE, Web of Science, LILACS, Scielo, Cochrane and Open Grey and African Journals Online were searched on 24 November 2021, without restrictions in language or date. After screening and assessing the records across predefined criteria, we performed a thematic analysis on mortality.</p><p><strong>Results: </strong>A total of 77 studies were included in the final review. The potential reasons explaining the observed mortality were classified in the following categories: Patient characteristics; Healthcare; and Health-seeking behaviour. The identified risk factors were multi-dimensional, inter-dependent and context-specific. When exploring the patients' characteristics, the available data suggested that in many contexts, case fatality ratios were higher among males and older people, especially those aged 50 or above. Twelve studies reported the place of death, with the percentage of community deaths ranging from 23% to 96%. Evidence on comorbidities and cholera deaths was too scarce for analysis.</p><p><strong>Conclusions: </strong>Cholera has been a disease of global importance for more than two centuries. Despite this, our review highlighted that there has been limited published evidence about factors that increase the risk of cholera-related death. Collecting, reporting and analysing baseline characteristics such as age, sex and predisposing conditions can improve our understanding of cholera mortality risk factors and guide improvements in future case management recommendations.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicians in low- and middle-income settings need better access to point-of-care haemoglobin tests for identifying and managing children and pregnant women with severe anaemia.","authors":"Annabelle South, Imelda Bates, Sophie Uyoga, Florence Alaroker, Elizabeth C George","doi":"10.1111/tmi.14096","DOIUrl":"10.1111/tmi.14096","url":null,"abstract":"","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"231-234"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11965017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating modifiable hypertension risk in Nigerian adults-The Nigerian diet risk score.","authors":"Nimisoere P Batubo, Carolyn I Auma, J Bernadette Moore, Michael A Zulyniak","doi":"10.1111/tmi.14089","DOIUrl":"10.1111/tmi.14089","url":null,"abstract":"<p><strong>Aims: </strong>Our study aimed to derive and validate a diet risk score for clinical use in Nigeria to screen for hypertension risk and evaluate its association against a panel of cardiovascular biomarkers.</p><p><strong>Methods: </strong>The Nigerian dietary screening tool was used to collect dietary intake data from 151 participants visiting the River State University Teaching Hospital, Port Harcourt, Nigeria, for routine medical care. Blood samples were collected from a subsample (n = 94) for biomarker assessment. Multiple logistic regression was used to derive the Nigerian diet risk score for hypertension. Internal validation of the Nigerian diet risk score for hypertension was performed using measures of discrimination and calibration. Mediation analysis was used to evaluate the biomarker-mediated effects of the diet risk score for hypertension on hypertension. All statistical analyses were performed in R.</p><p><strong>Results: </strong>Each one-point increment in Nigerian diet risk score (on a scale of 0 to 30) was associated with a twofold increase in odds of hypertension (odds ratio: 2.04, 95% confidence interval [CI]: 1.16, 3.58, p = 0.01), with the highest score associated with >18-fold increased odds of hypertension, compared to lowest Nigerian diet risk score for hypertension. The score demonstrated good discrimination (area under the curve: 0.92, 95% CI: 0.80, 1.00) with a high sensitivity (0.85) and specificity (0.94). Additionally, mediation analysis suggested that the association between Nigerian diet risk score for hypertension and blood pressure is partly explained by shared biological pathways that mediate cholesterol, triglycerides, LDL-C, CRP and homocysteine levels.</p><p><strong>Conclusion: </strong>The resulting Nigerian diet risk score for hypertension is a valuable tool for clinicians to identify individuals at risk of hypertension, and will advance community efforts in the prevention and management of hypertension in Nigeria.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"260-272"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11965004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dengue dynamics in Bali: Serotype shifts, genotype replacement and multiple virus lineage circulation in the last 10 years.","authors":"R Tedjo Sasmono, Sri Masyeni, Rahma F Hayati, Bunga Rana, Marsha S Santoso, Dionisius Denis, Diana S Hansen, Kouichi Morita","doi":"10.1111/tmi.14095","DOIUrl":"10.1111/tmi.14095","url":null,"abstract":"<p><strong>Background: </strong>Bali, one of the world's most popular tourist destinations, is hyper-endemic to dengue, an acute febrile illness caused by infection with dengue virus (DENV). Outbreaks of dengue occur annually with worrisome rates of morbidity and mortality. Despite this, comprehensive and continuous virus surveillance is yet to be established. We conducted DENV serotype and genotype surveillance in Bali to monitor viral transmission dynamics.</p><p><strong>Methods: </strong>We enrolled febrile patients with dengue clinical symptoms in hospitals in Denpasar, Bali. Clinical evaluations and laboratory assessments were conducted, and blood samples were collected. DENV serotypes were determined using RT-PCR, and genotyping was performed by sequencing the envelope protein gene and the complete genomes. Subsequently, phylogenetic analyses were conducted to analyse the recent data alongside retrospective sequence data.</p><p><strong>Results: </strong>A total of 62 and 66 dengue patients were recruited during 2018-2020 and 2022, and from these, we obtained DENV serotype data for 49 and 48 individuals, respectively. Among the DENV analysed, the most prevalent serotype in 2018-2020 was DENV-1 (30%) and shifted to DENV-3 (57.6%) in 2022. When compared to data from the last 10 years, serotype shifting was clearly observed. We sequenced the genomes of 60 isolates and observed the presence of multiple virus lineages and the replacement of Genotype IV of DENV-1 with Genotype I. The Cosmopolitan, Genotype I and Genotype II remained the predominant genotypes for DENV-2, DENV-3 and DENV-4, respectively.</p><p><strong>Conclusion: </strong>We reveal that DENV serotype predominance in Bali has been shifting in the past 10 years. While genotype replacement occurred, continuous circulation of local endemic viruses was responsible for the annual outbreak of dengue. These findings indicate the genetic diversity and dynamic nature of DENV circulating in Bali. Routine virus surveillance is important to understand the cyclical patterns of DENV serotypes that is useful to predict the future outbreaks.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"303-313"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of training needs in schistosomiasis research to build capacity for schistosomiasis control in Uganda.","authors":"Damalie Nakanjako, Moses Egesa, Helen Byakwaga, Casim Umba Tolo, Anatol Maranda Byaruhanga, Prudence Beinamaryo, Grace Banturaki, Lydia Nakiyingi, Ponsiano Ocama, Moses R Kamya, Alison M Elliott","doi":"10.1111/tmi.14098","DOIUrl":"10.1111/tmi.14098","url":null,"abstract":"<p><strong>Background: </strong>Schistosomiasis is the leading cause of fatal upper gastrointestinal bleeding among adults in East Africa. The prevalence among school-aged children in villages along the Albert-Nile shoreline in North-Western Uganda is estimated at 85%. Efforts to control schistosomiasis in low- and-middle-income countries remain limited due to an incomplete understanding of the pathogenesis, disease manifestations, transmission mechanisms, preventive measures and interventions. In addition, there is insufficient capacity to analyse, model and predict relevant clinical case management systems, biological interventions and disease control efforts. We conducted a needs assessment for schistosomiasis research training at academic and research institutions in Uganda to inform the development of a structured training programme to build capacity to conduct locally relevant research to control the disease.</p><p><strong>Methods: </strong>Using an online survey, we collected data on training needs, potential trainees, available resources including local and international collaborations, as well as priority areas for schistosomiasis research and training at academic and research institutions in Uganda. Data were analysed and presented in frequency tables and figures.</p><p><strong>Results: </strong>Overall, schistosomiasis had the lowest number of studies conducted, based on the studies approved by research ethics committees at the two leading medical schools in Uganda: Makerere University College of Health Sciences (MakCHS) and Mbarara University of Science and Technology (MUST) between 2016 and 2022. The top ranked schistosomiasis focus areas of interest, by scientists at MakCHS, MUST, the Vector Borne and Neglected Tropical Diseases Division of the Ministry of Health and the Uganda Virus Research Institute (UVRI), were schistosomiasis prevention and transmission, vector biology, diagnostics, treatment and clinical trials, respectively. The top ranked training needs were schistosomiasis prevention and control, research ethics, data analysis, epidemiology and research methods (quantitative and qualitative), malacology, infectious diseases modelling, scientific writing and communication skills.</p><p><strong>Conclusion: </strong>Priority areas for schistosomiasis research and training will be utilised to develop a robust, collaborative, multidisciplinary schistosomiasis research training programme, to increase the critical mass of scientists with the competencies required to design, execute and utilise schistosomiasis biology, clinical, laboratory and epidemiology research to advance disease control interventions and minimise/eliminate schistosomiasis-associated morbidity and mortality in sub-Saharan Africa.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"314-321"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11964987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotic resistance in Indonesia: A systematic review and meta-analysis of extended-spectrum beta-lactamase-producing bacteria (2008-2024).","authors":"Ika N Kadariswantiningsih, Derren David Rampengan, Roy Novri Ramadhan, Alina Idrisova, Bulat Idrisov, Maulana A Empitu","doi":"10.1111/tmi.14090","DOIUrl":"10.1111/tmi.14090","url":null,"abstract":"<p><strong>Objective: </strong>Extended-spectrum beta-lactamase-producing bacteria pose a significant threat to public health due to their resistance to commonly used antibiotics. This meta-analysis aims to determine the prevalence and distribution of extended-spectrum beta-lactamase-producing bacteria in Indonesia.</p><p><strong>Methods: </strong>This systematic review and meta-analysis adhere to PRISMA guidelines to estimate the prevalence of extended-spectrum beta-lactamase-producing bacteria in Indonesia from 2008 to 2024. Systematic searches were conducted by PubMed, ScienceDirect, Google Scholar, and Index Medicus, and data were analyzed using a random-effects model to address heterogeneity.</p><p><strong>Results: </strong>A systematic search yielded 1160 records. After duplicate removal and eligibility screening, 64 studies were included in the qualitative synthesis, and 48 were suitable for quantitative analysis. The pooled prevalence of extended-spectrum beta-lactamase-producing-producing bacteria in Indonesia was 46.38% (95% CI: 39.55%-53.21%) with significant heterogeneity (I² = 99.05%), reflecting substantial variability in methodologies, populations, and regional contexts. While Sumatra shows the highest prevalence at 63.99% (95% CI: 62.09%-65.89%) and Kalimantan the lowest at 15.24% (95% CI: 9.45%-21.02%), these findings must be interpreted with caution due to the significant heterogeneity. In hospitals, the prevalence was 47.13% (95% CI: 39.71%-54.54%), and in community was 47.26% (95% CI: 26.47%-59.95%). Adults had a higher prevalence (44.56%, 95% CI: 35.48%-53.64%) than children (32.38%, 95% CI: 20.85%-43.91%). The prevalence of extended-spectrum beta-lactamase-producing Escherichia coli was 57.84% (95% CI: 45.97%-69.72%), and Klebsiella pneumoniae was 51.03% (95% CI: 41.19%-60.86%).</p><p><strong>Conclusion: </strong>These findings highlight the urgent need for stringent infection control measures, tailored surveillance programmes, and effective antibiotic stewardship in Indonesia to mitigate the impact of extended-spectrum beta-lactamase-producing bacteria on public health. The substantial heterogeneity underscores the complexity of antimicrobial resistance epidemiology in Indonesia, necessitating cautious interpretation of pooled prevalence and standardised methodologies for future research to ensure accurate prevalence estimates.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"246-259"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IgA nephropathy is associated with Opisthorchis felineus liver fluke infection: Retrospective 5-year analysis of human kidney samples.","authors":"Anna Kovner, Yaroslav Kapushchak, Elena Hadieva, Mikhail Persidskij, Maria Pakharukova","doi":"10.1111/tmi.14093","DOIUrl":"10.1111/tmi.14093","url":null,"abstract":"<p><strong>Objectives: </strong>Infection with the fish-borne liver fluke Opisthorchis felineus, which is transmitted through the consumption of raw or undercooked fish, results in serious liver damage in humans. Currently, limited clinical and experimental data reveal kidney damage co-occurring with chronic opisthorchiasis. We conducted a retrospective analysis of kidney autopsy samples over a five-year period (n = 84). The aim of the study was to assess pathomorphological changes in the kidneys and evaluate whether there is an association between IgA nephropathy and liver fluke infection.</p><p><strong>Methods: </strong>Histological analysis, immunohistochemistry, and statistical analysis were performed.</p><p><strong>Results: </strong>In this study, we demonstrated for the first time that chronic O. felineus infection in humans was associated with tubular dystrophy, the accumulation of renal tubular casts, and glomerulosclerosis. The hypertension increases the pathomorphological changes associated with chronic opisthorchiasis. We also detected IgA and the O. felineus total antigen in glomeruli of infected people. Fisher's test showed a significant association between O. felineus infection and IgA nephropathy, as well as between O. felineus infection and glomerulosclerosis.</p><p><strong>Conclusions: </strong>Therefore, the findings of this study highlight the importance of recognising O. felineus infection as a more than hepatobiliary disease and emphasise the need for careful, personalised monitoring of kidney function in infected individuals.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"292-302"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for mortality in patients with chikungunya: A systematic review and meta-analysis.","authors":"Jose Pedro Cassemiro Micheleto, Karin Araujo Melo, Felipe Camilo Santiago Veloso, Samir Buainain Kassar, Michelle Jacintha Cavalcante Oliveira","doi":"10.1111/tmi.14088","DOIUrl":"10.1111/tmi.14088","url":null,"abstract":"<p><strong>Introduction: </strong>Chikungunya fever is a debilitating arthritic disease that can lead to atypical severe complications and sometimes be fatal. The risk factors for fatal outcomes of chikungunya fever have not been thoroughly studied. This systematic review and meta-analysis aimed to identify mortality risk factors in patients with chikungunya. These findings will aid clinicians in targeting high-risk groups with severe chikungunya for timely interventions, ultimately improving patient outcomes.</p><p><strong>Objective: </strong>The objective of this study is to identify mortality risk factors in patients with chikungunya.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis by searching the MEDLINE, Embase, Cochrane, BVS, BDTD and OpenGrey databases to identify eligible observational studies on patients with chikungunya. These studies analysed mortality risk factors, providing adjusted risk measures along with their corresponding confidence intervals (CIs). We estimated the pooled weighted mean difference and 95% CIs using a random-effects model, and the methodological quality was assessed using the Newcastle-Ottawa Scale.</p><p><strong>Results: </strong>Our search yielded a total of 334 records. After removing duplicates, we screened 275 records, reviewed 31 full articles and included seven studies in the systematic review and four in the meta-analysis, with a total of 220,215 patients and 908 fatal cases. Diabetes Mellitus (OR = 2.86, 95% CI 1.75-4.69), hypertension (OR = 3.10, 95% CI 2.02-4.77), age ≥ 60 years (OR = 19.49, 95% CI 1.98-191.88), chronic kidney disease (OR = 5.81, 95% CI 1.30-25.99), male sex (OR = 2.07, 95% CI 1.71-2.51) and vomiting (OR = 2.18, 95% CI 1.75-2.73) are significantly and positively associated with mortality in chikungunya.</p><p><strong>Conclusion: </strong>Elderly men with chronic diseases have a higher risk of death from chikungunya; therefore, they deserve more careful evaluation.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"235-245"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}