Tropical Medicine & International Health最新文献

{"title":"Diagnostic Performance of Chimeric Recombinant Antigens of Trypanosoma cruzi for Identifying Chagas Disease in Samples From Rio Grande do Sul.","authors":"Ângelo Antônio Oliveira Silva, Ítalo Ferreira de Leon, Felipe Silva Santos de Jesus, Daniel Dias Sampaio, André Luis Bartz Voigt, Natália Berne Pinheiro, Nathieli Bianchin Bottari, Leda Margarita Castaño-Barrios, Paola Alejandra Fiorani Celedon, Nilson Ivo Tonin Zanchin, Fabricio Klerynton Marchini, Maria Elisabeth Aires Berne, Fred Luciano Neves Santos","doi":"10.1111/tmi.70019","DOIUrl":"10.1111/tmi.70019","url":null,"abstract":"<p><strong>Background: </strong>Chagas disease, caused by Trypanosoma cruzi, remains a significant public health challenge in Latin America, with diagnostic limitations hindering control efforts.</p><p><strong>Aim: </strong>Our study aimed to assess the diagnostic performance of four chimeric recombinant T. cruzi antigens (IBMP-8.1, IBMP-8.2, IBMP-8.3 and IBMP-8.4) in a highly endemic region in southern Brazil.</p><p><strong>Methods: </strong>Serum samples from 333 individuals residing in Canguçu, Rio Grande do Sul, were tested using an in-house ELISA platform. We assessed the sensitivity, specificity, accuracy, and diagnostic odds ratio (DOR) of individual and combined IBMP antigens through serial and parallel testing strategies.</p><p><strong>Results: </strong>All antigens exhibited 100% specificity and high accuracy (≥ 93.4%), with IBMP-8.1 and IBMP-8.4 showing the best overall performance (sensitivities of 80.0% and 76.7%; DORs of 109,136 and 89,659, respectively). Parallel testing using the combinations IBMP-8.1 + IBMP-8.3 and IBMP-8.1 + IBMP-8.4 achieved ≥ 95% sensitivity and > 99% accuracy.</p><p><strong>Conclusions: </strong>These findings support the use of IBMP chimeric antigens, particularly in combination, as reliable tools for Chagas disease diagnosis and surveillance, and highlight the importance of region-specific validation to ensure diagnostic equity in diverse endemic settings.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"1107-1114"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12501557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800456","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":"The Effectiveness of Dengue Vector Control: A Meta-Review.","authors":"Gary K K Low, Sam Froze Jiee, Siong Hee Lim, Osamudiamen Favour Omosumwen, Selvanaayagam Shanmuganathan","doi":"10.1111/tmi.70018","DOIUrl":"10.1111/tmi.70018","url":null,"abstract":"<p><strong>Background: </strong>Dengue vector control plays an important role in reducing the burden of dengue infection. This study aimed to summarise the evidence of published systematic reviews on the efficacy of dengue vector control interventions.</p><p><strong>Methods: </strong>Systematic reviews of cluster randomised controlled trials and randomised controlled trials in populations/people exposed to the risk of dengue infection in the presence of the vector were included. All dengue vector control, all comparators and any outcomes were considered in this review. Electronic databases and reference lists were searched. Screening, full-text reviews, data extractions and quality assessments were conducted independently by two reviewers with resolution by a third reviewer.</p><p><strong>Results: </strong>A total of 15 systematic reviews were included in this study, but narrative synthesis was performed for only 3 reviews that reviewed cluster randomised controlled trials or randomised controlled trials. Community mobilisation and insecticide-treated materials were weakly effective interventions reported by two systematic reviews that have acceptable methodological quality. However, the non-overlapping of randomised controlled trials and cluster randomised controlled trials included in their respective reviews may affect the findings.</p><p><strong>Conclusion: </strong>There is insufficient evidence to recommend a method of dengue vector control management. Novel dengue vector control methods are highly encouraged for urgent trials. Until then, the current respective local governments' vector control management may still play a vital role in controlling the mosquito's propagation and transmission of dengue infection.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"1069-1086"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12501563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971774","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":"Silent Circulation of Dengue Virus in Aedes aegypti Mosquitoes in Non-Epidemic Regions of Tanzania: Implications for Surveillance and Control.","authors":"Clement N Mweya","doi":"10.1111/tmi.70032","DOIUrl":"10.1111/tmi.70032","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to assess the prevalence of dengue virus (DENV) infection in Aedes aegypti mosquitoes and evaluate associated ecological and environmental factors in three inland districts (Bahi, Kyela, Ngorongoro) with distinct agro-ecological characteristics and no prior dengue outbreak reports.</p><p><strong>Methods: </strong>A cross-sectional entomological study was conducted during the wet (April-June 2022) and dry (October-November 2022) seasons. Adult mosquitoes were collected indoors and outdoors using battery-powered aspirators, and immature stages were sampled from natural and artificial water containers. Mosquito pools were screened for DENV RNA using RT-qPCR.</p><p><strong>Results: </strong>A total of 6459 Ae. aegypti mosquitoes were sampled (54% females). DENV RNA was detected in 0.6% (4/631) of the tested pools: one from Bahi and three from Kyela. No infections were detected in Ngorongoro. High mosquito density was observed in Kyela, particularly in paddy plantations and rice farms. Among DENV-positive pools, 100% (4/4) were collected near vegetation, suggesting that outdoor habitats are high-risk sites. The minimum infection rate was 0.6 (95% CI: 0.2-1.6) per 1000 mosquitoes.</p><p><strong>Conclusion: </strong>This study confirms silent DENV circulation in Ae. aegypti populations in Tanzanian regions without prior epidemic reports. The detection of DENV in mosquitoes from Bahi and Kyela highlights the risk of future outbreaks and underscores the need for enhanced vector surveillance and integrated control strategies. These findings emphasise the urgency of preemptive public health measures to mitigate dengue spread in Tanzania. Limitations of the study include reliance on RT-qPCR without viral isolation or serotyping and the absence of concurrent human clinical data.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":"1134-1141"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971790","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":"Immunohistochemical Characterisation of Innate Immune Cellular Responses in Cutaneous Leishmaniasis Caused by Leishmania donovani.","authors":"Hasna Riyal, Nilakshi Samaranayake, Priyani Amarathunga, Deepani Munidasa, Nadira Karunaweera","doi":"10.1111/tmi.70040","DOIUrl":"https://doi.org/10.1111/tmi.70040","url":null,"abstract":"<p><strong>Introduction: </strong>Cutaneous leishmaniasis is a neglected tropical disease affecting humans worldwide. Leishmania donovani is the causative agent of cutaneous leishmaniasis in Sri Lanka, whereas it typically causes visceral leishmaniasis in other regional countries. Identifying pretreatment innate immune responses may offer insights into diverse disease manifestations.</p><p><strong>Methods: </strong>We studied lesion biopsy specimens from 103 cutaneous leishmaniasis patients. Total leucocytes, keratinocyte activation, and the distribution of Langerhans cells were semi-quantified using CD45, Osteopontin, and CD1a immunohistochemistry markers. M1/M2 macrophage polarisation was assessed using CD68, HLA-DR, and CD163 immunohistochemistry markers and quantified via open-source image analysis.</p><p><strong>Results: </strong>Langerhans cell distribution was significantly higher in early lesions (p = 0.017), whereas activated keratinocytes were more prevalent in late lesions (p = 0.004). Total leucocyte count showed no significant association with clinicopathological parameters. Sixty-six patients (64.1%) had M1-dominant macrophage profiles. Macrophage polarisation type was significantly associated with treatment outcome (p = 0.048). Among 17 patients with exclusively M2-dominant profiles, 15 (88.2%) required prolonged Sodium Stibogluconate treatment for complete healing.</p><p><strong>Conclusions: </strong>Our findings suggest that early innate immune responses, particularly M1 macrophage polarisation, keratinocyte activation, and Langerhans cell involvement, contribute to treatment success in Sri Lankan cutaneous leishmaniasis caused by L. donovani, highlighting localised mechanisms of protective immunity.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186852","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":"Challenges and Strategies for the Development and Implementation of Climate-Informed Early Warning Systems for Vector-Borne Diseases: A Systematic Review.","authors":"Cong Tuan Pham, Ha Thu Nguyen, Hong H T C Le, Nu Quy Linh Tran, Kien Quoc Do, Vinh Bui, Hai Phung, Dung Phung, Cordia Chu","doi":"10.1111/tmi.70045","DOIUrl":"https://doi.org/10.1111/tmi.70045","url":null,"abstract":"<p><strong>Background: </strong>Vector-borne diseases, exacerbated by climate change, present an escalating global health threat, necessitating robust surveillance and climate-informed early warning systems to predict outbreaks and enable timely interventions. This systematic review aims to synthesise the challenges and strategies involved in developing and operationalising early warning systems for vector-borne diseases.</p><p><strong>Methods: </strong>Following PRISMA guidelines, we conducted a systematic search across multiple databases (PubMed, Web of Science, Scopus and Embase) and performed a manual search using predefined keywords up to 05 November 2024. Eleven papers were selected for the reviewing process.</p><p><strong>Results: </strong>While early warning systems show significant promise in enhancing outbreak prediction and guiding timely public health interventions, several key challenges persist. Inadequate data quality and integration-characterised by fragmented epidemiological, entomological and meteorological datasets-compromise predictive accuracy. The review also highlights gaps in stakeholder engagement and capacity building. Without comprehensive training and active collaboration among public health officials, climate scientists and data analysts, the practical application and sustainability of these systems are undermined. Enhancing data harmonisation through standardised collection processes and integration protocols is crucial for improving model reliability. The adoption of scalable, cloud-based platforms can mitigate technical and infrastructural limitations by enabling real-time data processing and robust computational capabilities. Strengthening interdisciplinary collaborations-bringing together experts from diverse fields-can refine predictive models and ensure that system outputs are both accurate and actionable. Furthermore, tailored capacity-building initiatives are vital for empowering local authorities to effectively interpret and implement early warning systems' warning signals. Finally, optimising communication strategies by simplifying technical outputs and developing user-friendly interfaces can bridge the gap between complex predictive analytics and practical decision-making processes.</p><p><strong>Conclusion: </strong>Addressing these challenges through integrated solutions will enhance the effectiveness and sustainability of early warning systems, ultimately improving outbreak preparedness and response for vector-borne diseases in a changing climate.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150976","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":"Home Treatment of Childhood Illnesses Prior to Seeking Formal Care: A Cross-Sectional Study at Different Health Care Levels in Ghana.","authors":"Lydia Helen Rautman, Felix Osei Boateng, Isaac Darko Agyiri, Ebenezer Ahenkan, Jones Ankomah, Asare Baffour, Maike Maria Lamshöft, Nicole S Struck, Jürgen May, Oumou Maiga-Ascofaré, Ralf Krumkamp","doi":"10.1111/tmi.70042","DOIUrl":"https://doi.org/10.1111/tmi.70042","url":null,"abstract":"<p><strong>Background: </strong>Many caregivers in Sub-Saharan Africa attempt to manage childhood illnesses at home, which can delay or complicate later diagnosis and treatment at a health facility. Understanding home treatment practices among children could help characterise treatment history when information is unavailable or unreliable. We investigated these practices among children seeking care at three levels of a healthcare system in Ghana.</p><p><strong>Methods: </strong>Children under 15 years of age and their caregivers were recruited from Community-based Health Planning and Services, outpatient departments and inpatient departments in Agogo and Assin Foso, Ghana. Demographic, clinical, socioeconomic and home treatment data were collected via interviews. Urine samples from children were tested for antibiotic use. Hierarchical log-binomial regression models were calculated to estimate risk ratios and control for confounding.</p><p><strong>Results: </strong>Caregivers of 1503 children were interviewed. Forty-six percent (n = 689) reported any home treatment prior to the visit: 37% (n = 560) reported antipyretic use, 11% (n = 167) antimalarial use and 7% (n = 103) antibiotic use. Home medication was lower at Community-based Health Planning and Services (30%, n/N = 148/500) compared to the outpatient departments (61%, n/N = 308/509) and inpatient departments (47%, n/N = 233/494). Children treated at home had longer delays in seeking treatment (median 3 days, IQR: 1, 3) compared to those not treated at home (median 2 days, IQR: 1, 3). In regression models, illness severity and specific symptoms were more strongly associated with antimalarial use than with antibiotic use. For most samples where antibiotic inhibition was detected, no prior antibiotic use had been reported (n/N = 33/46), indicating undisclosed or unrecognised antibiotic intake.</p><p><strong>Conclusions: </strong>The discrepancy between self-reported antibiotic use and antibiotic inhibition suggests a lack of awareness about medication identification and appropriate use. This presents a challenge for clinicians in obtaining an accurate treatment history, which is highly relevant to the timely diagnosis and treatment of the illness in the facility.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138835","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":"All-Oral Shorter Treatment Regimens for Multidrug- and Rifampicin-Resistant Tuberculosis: Evaluating Their Effectiveness, Safety, and Impact on the Quality of Life of Patients in Lao PDR.","authors":"Vibol Iem, Sakhone Suthepmany, Vongkham Inthavong, Anousone Sisouvanh, Khamloun Choumlivong, Kyung Hyun Oh, Philipp du Cros, Fatimata Bintou Sall, Corinne S Merle, Jacques Sebert, Donekham Inthavong","doi":"10.1111/tmi.70041","DOIUrl":"https://doi.org/10.1111/tmi.70041","url":null,"abstract":"<p><strong>Background: </strong>Drug-resistant tuberculosis remains a major public health challenge in Lao PDR, with low second-line treatment uptake and suboptimal outcomes. To improve effectiveness, safety, and tolerability, a shorter all-oral regimen for multidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB) was introduced under the TDR Short, all-Oral Regimens for Rifampicin-resistant Tuberculosis (ShORRT) initiative.</p><p><strong>Methods: </strong>A retrospective and prospective comparative cohort study was conducted across five drug-resistant tuberculosis treatment centres from January 2020 to December 2023. Two programmatic cohorts were analysed during partially overlapping calendar periods: a standard injectable-containing regimen cohort and an all-oral regimen cohort. Outcomes were assessed at the end of treatment and 12 months post-treatment. Safety was evaluated through adverse events, including serious adverse events and adverse events of special interest. Health-related quality of life was measured using EQ-5D-5L and EQ-VAS tools.</p><p><strong>Results: </strong>Among 126 participants, 65 received the all-oral regimen and 61 the standard regimen. Treatment success was higher in the all-oral group (90.8% vs. 80.3%), with lower mortality (7.5% vs. 16.4%) and fewer serious adverse events (12.3% vs. 19.7%). Anaemia was more common in the all-oral group (46.2%), while hepatotoxicity and QTcF prolongation were more frequent in the standard group. Both groups showed improvements in health-related quality of life, but greater recovery in mobility, daily activities, and anxiety reduction was observed in the all-oral group. Between group differences did not reach statistical significance. No cases of tuberculosis recurrence were reported at 12-month follow-up in either group.</p><p><strong>Conclusion: </strong>In this programmatic setting, the all-oral, bedaquiline and linezolid-based regimen demonstrated high effectiveness and acceptable safety. Non-significant trends favoured the all-oral regimen for treatment success, mortality, and quality of life, consistent with but not definitive for improved outcomes. These findings support the transition to all-oral regimens as the preferred approach for drug-resistant tuberculosis care, while acknowledging the observational design and limited power.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151020","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":"Genetic Insights Into Depression Induced by Tuberculosis via Mediating Roles of Interleukins: Evidence From Mendelian Randomization.","authors":"Xue Qiu, Huanhuan Li, Wei Huang, Xiangmin Liu","doi":"10.1111/tmi.70039","DOIUrl":"https://doi.org/10.1111/tmi.70039","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis and depression frequently coexist, with interleukin-associated inflammation recognised as a potential mechanistic link. Nevertheless, the precise causal relationships and mechanisms underlying the associations between tuberculosis, interleukins and their receptors, and depression remain incompletely elucidated.</p><p><strong>Method: </strong>We analysed summary statistics from European individual genome-wide association studies (GWAS) to analyse the genetic causal relationships between tuberculosis (FinnGen), 216 interleukins and receptors (IEU OpenGWAS) and depression (UK Biobank). The genetic causality between tuberculosis and depression was explored by applying bidirectional Mendelian Randomization analysis, supplemented by two-step and multivariate Mendelian Randomization mediation analysis to identify potential mediating interleukins. Inverse variance weighting regression served as the primary method for estimating causal effects. In addition, heterogeneity tests, horizontal pleiotropy tests and sensitivity analyses were performed to validate the robustness of the results.</p><p><strong>Results: </strong>A significant genetic causal effect (β_total = 0.015 [0.004, 0.026]) was demonstrated between tuberculosis and depression. Only one mediating pathway, involving the interleukin receptor interleukin-1R2, was identified linking tuberculosis to depression. The causal effect size from tuberculosis to interleukin-1R2 in the upstream causal pathway was 0.032 [0.002, 0.062], and the multivariate Mendelian Randomisation effect size from interleukin-1R2 to depression in the downstream causal pathway was 0.023 [0.003, 0.043]. The mediation proportion of interleukin-1R2 was 7.30% [0.27%, 15.44%]. None of the identified causal associations exhibited reverse Mendelian Randomisation relationships.</p><p><strong>Conclusion: </strong>Interleukin-1R2 may mediate depressive symptoms in tuberculosis patients, potentially through specific inhibition of interleukin-1-related inflammatory signalling. These findings elucidate genetic mechanisms underlying tuberculosis-depression comorbidity and suggest novel targets for preventive and therapeutic interventions.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138738","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":"Towards Malaria Elimination: A Nationwide Case-Control Study to Assess Risk Factors for Severe Malaria-Related Deaths in Brazil.","authors":"Klauss K S Garcia, Gabriel Z Laporta, Elisabeth Carmen Duarte, Seyi Soremekun, Amanda Amaral Abrahão, Anderson Coutinho da Silva, Anielle de Pina Costa, Marcus Vinícius Guimarães Lacerda, Chris Drakeley, Walter Massa Ramalho, André M Siqueira","doi":"10.1111/tmi.70028","DOIUrl":"https://doi.org/10.1111/tmi.70028","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study is to describe malaria-related deaths and assess their risk factors.</p><p><strong>Methods: </strong>This is a case-control study using data from Brazil's Ministry of Health (2011-2020) on malaria-related deaths (ICD-10: B50-B54). A probabilistic record linkage was performed to match epidemiological data (Sivep-Malaria and Sinan) with death records from the Mortality Information System (SIM). Cases were defined as individuals who died of malaria, and controls were malaria cases that did not result in death. Logistic regression models were used to identify the factors associated with malaria mortality.</p><p><strong>Results: </strong>A total of 632 malaria-related deaths were recorded, with 454 (71.8%) occurring in the Amazon region and 178 (28.1%) outside it. Risk factors in the Amazon included age (< 6 months or > 60 years; p ≤ 0.01), delayed treatment (> 48 h; p < 0.001), illiteracy (p = 0.01), and living in indigenous population villages (p < 0.001), while active case detection was protective (p = 0.01). In the Extra-Amazon, risk factors included delayed treatment (p = 0.049), P. falciparum or mixed infections (p < 0.049), foreign-acquired infections (p = 0.01), and higher education level (p = 0.03)-which is a proxy for increased income and travel frequency, which may increase the likelihood of exposure in endemic areas and delayed diagnosis upon return.</p><p><strong>Conclusion: </strong>This nationwide record-linkage study shows that malaria deaths remain concentrated in socially vulnerable groups: infants, older adults, and especially indigenous populations living in the Amazon. Delayed treatment is also a determinant for deaths, in both endemic and non-endemic regions, while active case detection markedly reduces the odds of death. To reach Brazil's zero-malaria-death target by 2030, it is needed to improve timely diagnosis and treatment, to enhance epidemiological information systems along with active surveillance amplification in remote communities. Finally, integrating national health-information systems allows real-time monitoring, and with coordinated action, eliminating malaria deaths remains achievable.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132096","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":"A Delphi Consensus Checklist for Evaluating the Quality of Snakebite First Aid Education Materials.","authors":"Adhish Gautam, Alexei A Birkun","doi":"10.1111/tmi.70038","DOIUrl":"https://doi.org/10.1111/tmi.70038","url":null,"abstract":"<p><strong>Objectives: </strong>Distribution of inaccurate or misleading information concerning snakebite first aid can potentiate inappropriate and harmful practices in real-life snakebite incidents. This study aimed to develop a consensus-based checklist for evaluating the quality of educational materials on snakebite first aid.</p><p><strong>Methods: </strong>Experts in snakebite management, emergency medicine and toxicology were recruited through a structured invitation process. In a two-round Delphi exercise, the experts completed questionnaires to rate each item of a pre-developed 24-item checklist. Item inclusion was determined by a consensus threshold of ≥ 7 points from ≥ 75% of the expert panel. Anonymous inputs on modifying or adding items were solicited.</p><p><strong>Results: </strong>Of the 48 initial participants, 38 (79.2%) completed both rounds (representatives of 21 nations with a median of 16 years of experience in acute medicine and toxicology). The Delphi process resulted in a 20-item final checklist encompassing critical aspects of snakebite first aid, including safety (n = 3), call for help (n = 1), assessment (n = 2), transport (n = 1), vital signs (n = 1), recovery position (n = 1), CPR (n = 1), support (n = 1), positioning (n = 1), observation (n = 1), handling the bite site (n = 3), restricting physical activity (n = 1), immobilisation (n = 2) and avoidance of unnecessary actions (n = 1).</p><p><strong>Conclusion: </strong>The formulated consensus-based checklist may serve as a tool for educators, healthcare professionals and organisations to ensure the accuracy and completeness of educational materials, ultimately contributing to improved snakebite first aid management outcomes. Future work should focus on validating the checklist's effectiveness and adapting it to various languages and regional practices, contributing to a standardised framework for snakebite education globally.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125858","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}