Tropical Medicine & International Health最新文献

{"title":"An Equity-Focused Systematic Analysis of Antimicrobial Resistance National Action Plans in 14 West African Countries.","authors":"Yusuff Adebayo Adebisi, Isaac Olushola Ogunkola, Adeola Bamisaiye, Aminat Olaitan Adebayo, Noah Sesay, Kwasi Yelarge, Don Eliseo Lucero-Prisno","doi":"10.1111/tmi.70037","DOIUrl":"https://doi.org/10.1111/tmi.70037","url":null,"abstract":"<p><strong>Objectives: </strong>Antimicrobial resistance is a growing global health threat that disproportionately affects socially and economically disadvantaged populations. National Action Plans are critical for coordinating national responses, but the extent to which they address equity remains unclear. This study assessed how antimicrobial resistance National Action Plans from 14 West African countries incorporate equity considerations.</p><p><strong>Methods: </strong>We reviewed antimicrobial resistance National Action Plans from 14 West African countries using a four-domain equity framework: (1) recognition of equity, (2) identification of vulnerable populations, (3) inclusion of equity-oriented interventions and (4) integration of equity into governance and monitoring. We assessed whether National Action Plans acknowledged 16 high-risk groups, including people living with HIV, displaced or mobile populations, children and adolescents, older adults, people with mental health disorders, rural residents, people with chronic illnesses, people living with disabilities, pregnant women, low-income populations, healthcare workers, people with substance use disorders, incarcerated populations, indigenous or minority groups, homeless populations and migrants or seasonal workers.</p><p><strong>Results: </strong>All National Action Plans adopted a One Health approach, but equity was inconsistently addressed. Most did not explicitly reference equity, and none included equity-related indicators in monitoring frameworks. Healthcare workers and rural populations were the most frequently mentioned groups. Common interventions included hygiene promotion, public awareness campaigns and training of healthcare workers, but these were largely generic and rarely adapted to the specific needs of marginalised populations. Stakeholder engagement was often multisectoral but seldom ensured the participation of disadvantaged groups. Across the region, the lack of disaggregated data and tailored strategies highlights a significant equity gap.</p><p><strong>Conclusion: </strong>Equity remains insufficiently integrated into antimicrobial resistance governance in West Africa. Future National Action Plans must explicitly identify at-risk populations, include equity indicators and involve affected communities in planning and oversight. Embedding equity is essential to building resilient and people-centred antimicrobial resistance strategies.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092491","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 Systematic Review of Research and Governance in Child and Adolescent Mental Health in Africa.","authors":"Margaret Isioma Ojeahere, Emelia Pasternak-Albert, Mercury Shitindo, Lily Kpobi, Christopher Goson Piwuna, Tolulope Olumide Afolaranmi, Mariana Pinto da Costa","doi":"10.1111/tmi.70034","DOIUrl":"https://doi.org/10.1111/tmi.70034","url":null,"abstract":"<p><strong>Background: </strong>Children and adolescents with mental health conditions represent a uniquely vulnerable population, particularly in Africa where mental health systems are under-resourced and understudied. Conducting research with this group raises complex ethical questions that require robust legislative and ethical oversight.</p><p><strong>Methods: </strong>This systematic review included searches from Medline, Embase, PsycInfo, Global Health and grey literature, conducted without any time restrictions up to 10 September 2023. Publications included focused on individuals aged 0-17. All study designs were included if they addressed governance and regulations in child and adolescent mental health research in Africa. Excluded publications did not report findings specific to children, to Africa, to governance or regulations in mental health research, or had no available full text. Articles were critically appraised using JBI checklists and data was extracted into Excel. Articles were narratively synthesised using frequencies for dates of regulations and ages of consent and coded in NVivo for attitudes toward regulation. The study protocol is available at PROSPERO (CRD42023464864).</p><p><strong>Results: </strong>This review identified 14 articles from nine countries across Africa. Most regulations were over a decade old, with the most recent from 2017. The publications covered five themes: concerns toward unfavourable existing legislation, concerns about risks of undertaking research on a clinical frontline, a call to action regarding the dearth of African literature in this field, specific recommendations for future research and suggested new research directions.</p><p><strong>Conclusions: </strong>This study highlights the need for improved research governance and legislation to protect children and adolescents in mental health research in Africa. Overall, most African countries place a low priority on child and adolescent mental health research.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076172","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":"Implementation Fidelity of Diabetes Mellitus Screening Among Tuberculosis Patients in Primary Healthcare in Karanganyar District, Indonesia: A Mixed-Method Study.","authors":"Clarissa Augustania, Antonia Morita Iswari Saktiawati, Ari Probandari","doi":"10.1111/tmi.70030","DOIUrl":"https://doi.org/10.1111/tmi.70030","url":null,"abstract":"<p><strong>Background: </strong>Indonesia faces a dual burden of high tuberculosis (TB) burden and rising diabetes mellitus (DM) prevalence. Given that DM is a significant risk factor for TB, screening people with TB for DM comorbidity is important for early management to mitigate adverse outcomes.</p><p><strong>Objectives: </strong>This study aimed to measure the degree of implementation fidelity, moderating factors, and barriers to implementing DM screening among TB patients in Indonesia's Primary Healthcare setting.</p><p><strong>Methods: </strong>A sequential explanatory mixed method was used. A cross-sectional survey was conducted with 42 Directly Observed Treatment, Short-course providers to assess adherence to DM screening guidelines. Screening coverage was evaluated through the TB information system. In-depth interviews with providers, managers, and patients identified key barriers and enablers.</p><p><strong>Results: </strong>Screening coverage ranges from 36.3% to 97.6% between 2020 and 2024. High fidelity was reported among providers, with 95% screening for DM at the time of TB diagnosis. Facilitators included TB-DM policy availability, screening affordability, provision of equipment, and patients' responsiveness. However, delays in data reporting and insufficient cross-sector collaboration posed challenges to the implementation.</p><p><strong>Conclusion: </strong>Despite positive progress in integrating TB-DM care, addressing barriers is essential to optimize the programme's impact. Strengthening reporting mechanisms and fostering collaboration could enhance programme outcomes.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070647","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":"Machine Learning for Improved Dengue Diagnosis in Puerto Rico.","authors":"Zachary J Madewell, Dania M Rodriguez, Maile B Thayer, Vanessa Rivera-Amill, Jomil Torres Aponte, Melissa Marzan-Rodriguez, Gabriela Paz-Bailey, Laura E Adams, Joshua M Wong","doi":"10.1111/tmi.70036","DOIUrl":"https://doi.org/10.1111/tmi.70036","url":null,"abstract":"<p><strong>Objectives: </strong>Diagnosing dengue accurately, especially in resource-limited settings, remains challenging due to overlapping symptoms with other febrile illnesses and limitations of current diagnostic methods. This study aimed to develop machine learning models that leverage readily available clinical data to improve diagnostic accuracy for dengue, potentially offering a more accessible and rapid diagnostic tool for healthcare providers.</p><p><strong>Methods: </strong>We used data from the Sentinel Enhanced Dengue Surveillance System in Puerto Rico (May 2012-June 2024). The Sentinel Enhanced Dengue Surveillance System primarily targets acute febrile illness but also includes cases with other symptoms during outbreaks (e.g., Zika and COVID-19). Machine learning models (logistic regression, random forest, support vector machine, artificial neural network, adaptive boosting, light gradient boosting machine [LightGBM] and extreme gradient boosting [XGBoost]) were evaluated across different feature sets, including demographic, clinical, laboratory and epidemiological variables. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), where higher AUC values indicate better performance in distinguishing dengue cases from non-dengue cases.</p><p><strong>Results: </strong>Among 49,679 patients in SEDSS, 1640 laboratory-confirmed dengue cases were identified. The XGBoost and LightGBM models achieved the highest diagnostic accuracy, with AUCs exceeding 90%, particularly with comprehensive feature sets. Incorporating predictors such as monthly dengue incidence, leukopenia, thrombocytopenia, rash, age and absence of nasal discharge significantly enhanced model sensitivity and specificity for diagnosing dengue. Adding more relevant clinical and epidemiological features consistently improved the models' ability to correctly identify dengue cases.</p><p><strong>Conclusions: </strong>Machine learning models, especially XGBoost and LightGBM, show promise for improving diagnostic accuracy for dengue using widely accessible clinical data, even in resource-limited settings. Future research should focus on developing user-friendly tools, such as mobile apps, web-based platforms, or clinical decision systems integrated into electronic health records, to implement these models in clinical practice and exploring their application for predicting dengue.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070666","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":"Tracing the Itch: A Spatiotemporal Analysis of Scabies Rates and Its Risk Factors Using the Global Burden of Disease 2021 Data.","authors":"Saptorshi Gupta, Simon Thornley, Arthur Morris, Gerhard Sundborn, Cameron Grant","doi":"10.1111/tmi.70029","DOIUrl":"https://doi.org/10.1111/tmi.70029","url":null,"abstract":"<p><strong>Background and objectives: </strong>Scabies is a neglected disease believed to be more prevalent in resource-poor nations. Published data describing global trends in scabies incidence and prevalence rates and factors associated with global regional differences are limited. Identifying regions with scabies prevalence rates over 10% and implementing mass-drug administration is recommended. We aimed to identify global high-risk areas to facilitate region-specific targeted interventions.</p><p><strong>Methods: </strong>Data on scabies incidence and prevalence in 204 countries and regions from 1990 to 2021 were extracted from the Global Burden of Disease database. Temporal trends in age-standardised rates were estimated using Joinpoint regression. Local indicators of spatial association were used to determine contiguous areas of high prevalence. The association of socio-demographic and economic factors with scabies was determined using locally weighted scatterplot smoothing and log-normal regression models.</p><p><strong>Results: </strong>Global prevalence of scabies in 2021 was 2.71% (95% confidence interval [CI]: 2.41% to 3.04%). Age-standardised rates of scabies have marginally declined globally from 1990 to 2021 with an Average Annual Percentage Change (AAPC) of -0.10 (95% CI: -0.05 to -0.14) for incidence and -0.09 (95% CI: -0.05 to -0.14) for prevalence. Spatial clustering of high scabies prevalence was present in tropical Latin America, Southeast Asia, and the Pacific Islands. Rates have shown an increasing trend over time in high-income regions such as Australasia and parts of Europe. Scabies rates have increased over time in high-middle and high sociodemographic index regions. There is a significant positive association between warmer latitudes with increasing urbanisation and scabies prevalence.</p><p><strong>Conclusion: </strong>Owing to the exploratory nature of the GBD data, our findings are hypothesis generating, rather than confirmatory. Scabies prevalence remains high in several global regions. Progress to reduce scabies prevalence is slow with existing programmes. Scabies control policies should be further prioritised to accelerate progress in reducing the prevalence of this important tropical disease.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056074","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":"Expanding the Lens: Functional and Epidemiological Contexts in Genotypic Surveillance of Drug-Resistant Tuberculosis.","authors":"Raza Ur Rehman Rana","doi":"10.1111/tmi.70022","DOIUrl":"https://doi.org/10.1111/tmi.70022","url":null,"abstract":"","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034252","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":"Advancing Geospatial Health Analytics: Reflections on Methodological Rigour in Pandemic Immunity Modelling.","authors":"Raza Ur Rehman Rana","doi":"10.1111/tmi.70023","DOIUrl":"https://doi.org/10.1111/tmi.70023","url":null,"abstract":"","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034235","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":"Mapping the Burden of Tegumentary Leishmaniasis in South America: A Systematic Review and Meta-Analysis.","authors":"Sérgio Caldas, Job Alves de Souza Filho, Janete Soares Coelho Santos, Felipe Campos de Melo Iani, Cristiane Faria de Oliveira Scarponi","doi":"10.1111/tmi.70035","DOIUrl":"https://doi.org/10.1111/tmi.70035","url":null,"abstract":"<p><strong>Introduction: </strong>In recent years, the global burden of tegumentary leishmaniasis (TL) has significantly increased in the Americas.</p><p><strong>Objective: </strong>To estimate the prevalence of TL in South America based on publications from the past 13 years.</p><p><strong>Methods: </strong>Three databases were searched, and articles were selected based on inclusion criteria and methodological relevance. The random effects model was used to calculate pooled prevalence, and heterogeneity was assessed with the I² statistic.</p><p><strong>Results: </strong>Out of the 225 articles initially identified, six studies remained eligible for review and meta-analysis. No publication bias was found. TL prevalence in South America ranged from 0.2% to 87.7%, showing significant heterogeneity (I² = 99.83%, p < 0.001). Colombia and Ecuador had the highest prevalence rates (> 76.6%). The pooled prevalence in the general population was 0.4% (95% CI: 0.1-1.0), and 81.8% (95% CI: 75.4-87.4) in symptomatic patients attending health units.</p><p><strong>Conclusions: </strong>TL prevalence varied widely across countries, reflecting national epidemiological disparities. High positivity rates in suspicious samples and molecular detection in samples confirmed by microscopy underscore the importance of accurate diagnosis and clinical expertise. This meta-analysis emphasises the need for tailored health policies and accessible laboratory diagnoses to guide disease control strategies.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024238","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":"Trends and Inequities in the Continuum of Care for Maternal Healthcare Services in Bangladesh: A National and Subnational Analysis.","authors":"Md Badsha Alam, Md Arif Billah, Shimlin Jahan Khanam, Md Mostaured Ali Khan, Md Bakhtiar Uddin, Noor Shah Kamawal, Md Nuruzzaman Khan","doi":"10.1111/tmi.70024","DOIUrl":"https://doi.org/10.1111/tmi.70024","url":null,"abstract":"<p><strong>Background: </strong>Ensuring a continuum of care in accessing antenatal to postnatal healthcare services is crucial for improving maternal and child health outcomes. This study aims to explore trends in the continuum of care over the years, both nationally and across regions; to provide district-level estimates; and to examine socio-economic disparities and determinants of continuum of care uptake in Bangladesh.</p><p><strong>Methods: </strong>A total of 28,260 samples were analysed. Continuum of care was considered as the outcome variable. District, wealth index, and several socio-demographic factors were included as explanatory variables. Trends of the continuum of care estimates were illustrated over survey years using descriptive statistics. Additional exploration of inequality was conducted across wealth quintiles, educational attainment and urban-rural residence through Equiplot. Finally, a multilevel multinomial logistic regression model was used to assess the factors associated with continuum of care.</p><p><strong>Results: </strong>The study revealed a significant increase in the highest level of continuum of care, rising from 6.0% in 2004 to 30.5% in 2017/2018, before declining to 24.8% in 2022. However, notable dropouts from the continuum of care were observed, particularly during the transitions from Antenatal Care to Skilled Birth Attendant and from Skilled Birth Attendant to postnatal Care. The analysis also identified district-level variations, urban-rural disparities and differences across wealth quintiles. Maternal socio-demographic characteristics, such as higher education and belonging to a higher wealth quintile, were associated with increased likelihoods of achieving moderate to the highest levels of continuum of care. In contrast, higher parity and rural residence were associated with lower likelihoods of attaining these levels of care.</p><p><strong>Conclusion: </strong>The findings underscore substantial progress in maternal healthcare services uptake in Bangladesh over the years, alongside persistent challenges in ensuring continuous care throughout the maternal healthcare continuum and district-level variations. Addressing district-level disparities and socioeconomic inequalities is crucial, necessitating tailored, area-specific policies and programmes to achieve universal access to quality maternal healthcare services across the country.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993719","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":"Environmental Drivers and Spatial Distribution of Dengue Fever in Gandaki Province: Evidence From 2021 to 2024.","authors":"Roshan Kumar Mahato, Kyaw Min Htike, Sushila Baral, Rajesh Kumar Yadav, Khim Bahadur Khadka, Ramesh Prasad Adhikari, Vijay Sharma","doi":"10.1111/tmi.70026","DOIUrl":"https://doi.org/10.1111/tmi.70026","url":null,"abstract":"<p><strong>Background: </strong>Dengue fever, a rapidly expanding mosquito-borne disease influenced by environmental and climatic factors, has increasingly affected Nepal's Gandaki Province, prompting this study to investigate its spatial distribution and drivers from 2021 to 2024.</p><p><strong>Methods: </strong>This study analysed the spatial distribution of dengue incidence in Gandaki Province, Nepal, from 2021 to 2024 by integrating environmental variables such as temperature, precipitation, vegetation, and water indices using remote sensing datasets. Spatial autocorrelation and cluster patterns were assessed through Global and Local Moran's I and Local Indicators of Spatial Association using QGIS and GeoDa software.</p><p><strong>Results: </strong>From 2021 to 2024, the incidence of dengue in Gandaki Province surged from 4.56 to 431 cases per 100,000 population. Spatial autocorrelation analysis showed weak negative clustering from 2021 to 2023 (Moran's I = -0.016, -0.056, -0.031, respectively), followed by the emergence of weak positive clustering in 2024 (Moran's I = 0.049). Local spatial analysis identified dengue hotspots in Devghat, Bandipur and Pokhara. Over time, environmental variables such as Normalised Difference Vegetation Index, Normalised Difference Water Index, Land Surface Temperature, precipitation and Leaf Area Index showed stronger positive correlations with dengue, highlighting the growing influence of climate on transmission patterns.</p><p><strong>Conclusions: </strong>This study highlights the increasing influence of environmental and climatic factors on dengue transmission in Gandaki Province. Spatial analysis identified key hotspots and revealed shifting correlations between dengue incidence and variables such as temperature, vegetation and precipitation. These findings underscore the need for integrated surveillance and early warning systems that incorporate environmental data to enhance dengue prevention and control strategies in the region.</p>","PeriodicalId":23962,"journal":{"name":"Tropical Medicine & International Health","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971823","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}