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Capone D, Cumming O, Flemister A, Ilevbare V, Irish SR, Keenum I, Knee J, Nala R, Brown J. Sanitation in urban areas may limit the spread of antimicrobial resistance via flies. PLoS One 2024; 19:e0298578. [PMID: 38507457 PMCID: PMC10954131 DOI: 10.1371/journal.pone.0298578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/28/2024] [Indexed: 03/22/2024] Open
Abstract
Synanthropic filth flies are common where sanitation is poor and fecal wastes are accessible to them. These flies have been proposed as mechanical vectors for the localized transport of fecal microbes including antimicrobial resistant (AMR) organisms and associated antimicrobial resistance genes (ARGs), increasing exposure risks. We evaluated whether an onsite sanitation intervention in Maputo, Mozambique reduced the concentration of enteric bacteria and the frequency of detection of ARGs carried by flies collected in household compounds of low-income neighborhoods. Additionally, we assessed the phenotypic resistance profile of Enterobacteriaceae isolates recovered from flies during the pre-intervention phase. After fly enumeration at study compounds, quantitative polymerase chain reaction was used to quantify an enteric 16S rRNA gene (i.e., specific to a cluster of phylotypes corresponding to 5% of the human fecal microflora), 28 ARGs, and Kirby Bauer Disk Diffusion of Enterobacteriaceae isolates was utilized to assess resistance to eleven clinically relevant antibiotics. The intervention was associated with a 1.5 log10 reduction (95% confidence interval: -0.73, -2.3) in the concentration of the enteric 16S gene and a 31% reduction (adjusted prevalence ratio = 0.69, [0.52, 0.92]) in the mean number of ARGs per fly compared to a control group with poor sanitation. This protective effect was consistent across the six ARG classes that we detected. Enterobacteriaceae isolates-only from the pre-intervention phase-were resistant to a mean of 3.4 antibiotics out of the eleven assessed. Improving onsite sanitation infrastructure in low-income informal settlements may help reduce fly-mediated transmission of enteric bacteria and the ARGs carried by them.
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Affiliation(s)
- Drew Capone
- Department of Environmental and Occupational Health, Indiana University, Bloomington, Indiana, United States of America
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Abeoseh Flemister
- Roy Blunt NextGen Precision Health, University of Missouri, Columbia, Missouri, United States of America
- Department of Radiology, University of Missouri, Columbia, MO, United States of America
| | - Victor Ilevbare
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Seth R. Irish
- Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Ishi Keenum
- Department of Civil, Environmental and Geospatial Engineering, Michigan Technological University, Houghton, Michigan, United States of America
| | - Jackie Knee
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rassul Nala
- Ministério da Saúde de Moçambique, Instituto Nacional de Saúde, Maputo, Mozambique
| | - Joe Brown
- Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Ageed A, Khan M. Eliminating Trachoma in Africa: The Importance of Environmental Interventions. Cureus 2024; 16:e52358. [PMID: 38234389 PMCID: PMC10792353 DOI: 10.7759/cureus.52358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 01/19/2024] Open
Abstract
Subsequent to the failure of the World Health Organisation (WHO) of achieving their target to eliminate trachoma by the year 2020, the most effective strategy in eliminating trachoma must be re-examined to accomplish the new target of eradication by the year 2030. Whilst antibiotic therapy is a core foundation of this elimination strategy, another important factor is the state of the environmental conditions in trachoma endemic countries. This manuscript aimed to identify the impact of environmental improvement strategies on the prevalence of trachoma and the significance of environmental improvement alongside the use of antibiotic treatment to achieve trachoma elimination. Two independent literature searches were conducted up until the 5th of July 2021. Two main databases were used to carry out these literature searches, namely, Ovid EMBASE and Ovid MEDLINE. All of the relevant references were found using MeSH and free text terms. Key terms used were 'trachoma', 'water', 'sanitation', 'hygiene' and 'environmental Improvement'. The exclusion criteria included non-African-based studies, review papers, protocols and case reports. A total of 17 studies were included for this review. Living within a close range of a water source was significantly associated with reduced risk of trachoma infection. Water obtained from piped water sources was associated with the lowest rates of active trachoma. Studies on facial cleanliness evidenced a strong association with reduced prevalence of trachoma. Whilst the provision of latrine facilities found was significantly associated with reduced prevalence of trachoma, there was no significant difference between the use of private latrine facilities over communal latrine facilities. The use of repeated scheduled antibiotic treatments over single-use antibiotic distribution had a greater impact both short term and long term on the prevalence rates of trachoma. Nonetheless, prevalence rates increased again following the commencement of treatment. Mass antibiotic treatment has been proven to have a greater impact on lowering the prevalence of trachoma initially, but this impact is not sustainable due to the rise in prevalence rates following the completion of treatment. A holistic approach, therefore, must be implemented with evidence showing that an emphasis on longer-term environmental methods should be implemented to compliment antibiotic distribution. Prioritisation of specific interventional measures should be tailored according to local epidemiology; nonetheless, these measures form the backbone of a trachoma elimination strategy to eliminate trachoma by the year 2030.
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Affiliation(s)
- Ahmed Ageed
- Hospital Medicine, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Maaz Khan
- Medical Education, Royal Surrey County Hospital, Guildford, GBR
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Miecha H, Dejene M, Adugna D, Kebede A, Yadeta D, Alemayehu A, Abateneh A, Wondimu A, Dayessa M, Shafi M, Taye E, Balcha L, Gadisa S, Negussu N, Mengistu B, Willis R, Jimenez C, Bakhtiari A, Boyd S, Kebede B, Tadesse F, Mamo A, Bekele M, Sinke Z, Solomon AW, Harding-Esch EM. Prevalence of Trachoma after Implementation of Trachoma Elimination Interventions in Oromia Regional State, Ethiopia: Results of Impact Surveys in 131 Evaluation Units Covering 139 Districts. Ophthalmic Epidemiol 2023; 30:647-654. [PMID: 36519534 PMCID: PMC10581666 DOI: 10.1080/09286586.2022.2119257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 08/11/2022] [Accepted: 08/25/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To determine the prevalence of trachomatous inflammation-follicular (TF), trachomatous trichiasis (TT), water, sanitation, and hygiene (WASH) access in 131 evaluation units (EUs) after implementation of trachoma elimination interventions in Oromia Region, Ethiopia. METHODOLOGY A population-based cross-sectional survey was conducted in each EU using the World Health Organization-recommended two-stage cluster-sampling methodology. Twenty-six clusters, each with a mean of 30 households were enumerated in each EU. All residents aged ≥1 year in selected households were examined for TF and TT. Information on WASH access in surveyed households was also collected through questioning the household head and direct observation. RESULTS A total of 419,858 individuals were enumerated in 131 EUs, of whom 396,134 (94%) were examined, 54% being female. Age-adjusted EU-level prevalence of TF in children aged 1-9 years ranged from 0.15% (95% confidence interval [CI]: 0.0-0.4) to 37.5% (95% CI: 31.1-43.7). The TF prevalence was <5% in 73/131 (56%) EUs. The EU-level age- and gender-adjusted prevalence of TT unknown to the health system among people aged ≥15 years ranged from 0.001% (95% CI: 0.00-0.02) to 2.2% (95% CI: 1.1-3.1) with 37/131 (28%) EUs having a prevalence <0.2%. Only 48% of all households surveyed had access to improved water sources for drinking. Approximately 96% of households did not have an improved latrine. CONCLUSION Oromia is on the path towards elimination of trachoma as a public health problem.
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Affiliation(s)
- Hirpa Miecha
- Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | | | - Dereje Adugna
- Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Ageru Kebede
- The Fred Hollows Foundation, Addis Ababa, Ethiopia
| | - Damtew Yadeta
- Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | | | | | - Asfaw Wondimu
- Asfaw Wondimu Health Research and Consultancy, Addis Ababa, Ethiopia
| | | | | | | | - Leta Balcha
- The Fred Hollows Foundation, Addis Ababa, Ethiopia
| | | | | | | | - Rebecca Willis
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Cristina Jimenez
- International Trachoma Initiative, Task Force for Global Health, Decatur, Georgia, USA
| | - Ana Bakhtiari
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Sarah Boyd
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Biruk Kebede
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Ayele Mamo
- Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | | | - Zelalem Sinke
- Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Anthony W. Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Emma M. Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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Capone D, Adriano Z, Cumming O, Irish SR, Knee J, Nala R, Brown J. Urban Onsite Sanitation Upgrades and Synanthropic Flies in Maputo, Mozambique: Effects on Enteric Pathogen Infection Risks. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2023; 57:549-560. [PMID: 36516327 PMCID: PMC9835884 DOI: 10.1021/acs.est.2c06864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/30/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
Synanthropic filth flies transport enteric pathogens from feces to food, which upon consumption poses an infection risk. We evaluated the effect of an onsite sanitation intervention─including fly control measures─in Maputo, Mozambique, on the risk of infection from consuming fly-contaminated food. After enumerating flies at intervention and control sites, we cultured fecal indicator bacteria, quantified gene copies for 22 enteric pathogens via reverse transcription quantitative polymerase chain reaction (RT-qPCR), and developed quantitative microbial risk assessment (QMRA) models to estimate annual risks of infection attributable to fly-contaminated foods. We found that the intervention reduced fly counts at latrine entrances by 69% (aRR = 0.31, [0.13, 0.75]) but not at food preparation areas (aRR = 0.92, [0.33, 2.6]). Half of (23/46) of individual flies were positive for culturable Escherichia coli, and we detected ≥1 pathogen gene from 45% (79/176) of flies, including enteropathogenic E. coli (37/176), adenovirus (25/176), Giardia spp. (13/176), and Trichuris trichiura (12/176). We detected ≥1 pathogen gene from half the flies caught in control (54%, 30/56) and intervention compounds (50%, 17/34) at baseline, which decreased 12 months post-intervention to 43% (23/53) at control compounds and 27% (9/33) for intervention compounds. These data indicate flies as a potentially important mechanical vector for enteric pathogen transmission in this setting. The intervention may have reduced the risk of fly-mediated enteric infection for some pathogens, but infrequent detection resulted in wide confidence intervals; we observed no apparent difference in infection risk between groups in a pooled estimate of all pathogens assessed (aRR = 0.84, [0.61, 1.2]). The infection risks posed by flies suggest that the design of sanitation systems and service delivery should include fly control measures to prevent enteric pathogen transmission.
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Affiliation(s)
- Drew Capone
- Department
of Environmental and Occupational Health, School of Public Health, Indiana University, 2719 E 10th St, Bloomington, Indiana47401, United States
| | - Zaida Adriano
- WE
Consult ltd, 177 Rua
Tomas Ribeiro, Maputo1102, Mozambique
| | - Oliver Cumming
- Department
of Disease Control, London School of Hygiene
and Tropical Medicine, LondonWC1E 7HT, United
Kingdom
| | - Seth R. Irish
- Epidemiology
and Public Health Department, Swiss Tropical
and Public Health Institute, Kreuzstrasse 2, Allschwil4123, Switzerland
| | - Jackie Knee
- Department
of Disease Control, London School of Hygiene
and Tropical Medicine, LondonWC1E 7HT, United
Kingdom
| | - Rassul Nala
- Ministério
da Saúde, Instituto Nacional de Saúde
Maputo, Maputo1102, Mozambique
| | - Joe Brown
- Department
of Environmental Sciences and Engineering, Gillings School of Public
Health, University of North Carolina at
Chapel Hill, Chapel
Hill, North Carolina27599, United States
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Robinson A, Gomes LRDO, Abdurahman OS, Alemayehu W, Shuka G, Melese E, Guye M, Legesse D, Elias E, Temam K, Koro KH, Adugna D, Seife F, Aga MA, Sarah V, Lambert SM, Walker SL, Habtamu E, Solomon AW, Last A, Macleod D, Burton MJ, Logan JG. Evaluation of the efficacy of insecticide-treated scarves to protect children from the trachoma vector Musca sorbens (Diptera: Muscidae): A phase II randomised controlled trial in Oromia, Ethiopia. EClinicalMedicine 2022; 49:101487. [PMID: 35747196 PMCID: PMC9189873 DOI: 10.1016/j.eclinm.2022.101487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/05/2022] [Accepted: 05/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background The eye-seeking fly Musca sorbens can act as a vector for ocular Chlamydia trachomatis, causing trachoma, yet there has been very little research on control measures. We investigated whether insect repellent products, specifically insecticide-treated clothing, could provide personal protection to the user from eye-seeking flies. Methods We first conducted a series of phase I laboratory studies to inform our choice of field intervention. We then conducted a phase II randomised controlled trial testing the efficacy of permethrin-treated scarves (PTS) in reducing fly-face contact in Oromia, Ethiopia. Children aged 4-10 years in full health and with no known adverse reactions to permethrin or other insecticides were allocated to either arm using restricted randomisation. Intervention arm children wore Insect Shield® versatile wraps (as PTS) for 28 days. The primary outcomes, fly-eye, -nose and -mouth contact, were assessed on the first day (0/30/60/180 minutes), on day 7 and on day 28. All participants present per timepoint were included in analyses. This trial was registered with ClinicalTrials.gov (NCT03813069). Findings Participants were recruited to the field trial between 29/10/2019 and 01/11/2019, 58 were randomised to test or control arm. More fly (-eye, -nose and -mouth) contacts were observed in the PTS arm at baseline. After adjusting for baseline contact rates, across all timepoints there was a 35% decrease in fly-eye contacts in the PTS relative to control arm (rate ratio [RR] 0.65, 95% CI 0.52-0.83). Similar cross-timepoint reductions were seen for fly-nose and fly-mouth contacts (RR 0.69, 95% CI 0.51-0.92 and RR 0.79, 95% CI 0.62-1.01, respectively). All children were included on day 0. Two in the control arm were absent on day 7, one left the study and four were excluded from analysis at day 28. No adverse events occurred in the trial. Interpretation Musca sorbens flies are sufficiently repelled by PTS to reduce fly-eye contacts for the wearer, thus possibly reducing the risk of trachoma transmission. Permethrin-treated scarves may therefore an alternative to insecticide space spraying for protection from these flies. Funding Wellcome Trust.
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Affiliation(s)
- Ailie Robinson
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Laura Reis de Oliveira Gomes
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Oumer Shafi Abdurahman
- The Fred Hollows Foundation, P.O. Box 6307, Addis Ababa, Ethiopia
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Wondu Alemayehu
- The Fred Hollows Foundation, P.O. Box 6307, Addis Ababa, Ethiopia
| | - Gemeda Shuka
- The Fred Hollows Foundation, P.O. Box 6307, Addis Ababa, Ethiopia
| | - Ewunetu Melese
- The Fred Hollows Foundation, P.O. Box 6307, Addis Ababa, Ethiopia
| | - Meseret Guye
- The Fred Hollows Foundation, P.O. Box 6307, Addis Ababa, Ethiopia
| | - Demitu Legesse
- The Fred Hollows Foundation, P.O. Box 6307, Addis Ababa, Ethiopia
| | - Eden Elias
- The Fred Hollows Foundation, P.O. Box 6307, Addis Ababa, Ethiopia
| | - Kedir Temam
- The Fred Hollows Foundation, P.O. Box 6307, Addis Ababa, Ethiopia
| | - Korso Hirpo Koro
- The Fred Hollows Foundation, P.O. Box 6307, Addis Ababa, Ethiopia
| | - Dereje Adugna
- Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Fikre Seife
- The Ethiopian Federal Ministry of Health, Disease Prevention and Control Directorate, Addis Ababa, Ethiopia
| | | | - Virginia Sarah
- Global Partnerships Executive, The Fred Hollows Foundation, 12-15 Crawford Mews, York Street, London W1H1LX
| | - Saba M. Lambert
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Stephen L. Walker
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Esmael Habtamu
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Anthony W. Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Avenue Appia 20, 1202 Genève, Switzerland
| | - Anna Last
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - David Macleod
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Matthew J. Burton
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - James G. Logan
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Abstract
Trachoma is a neglected tropical disease caused by infection with conjunctival strains of Chlamydia trachomatis. It can result in blindness. Pathophysiologically, trachoma is a disease complex composed of two linked chronic processes: a recurrent, generally subclinical infectious-inflammatory disease that mostly affects children, and a non-communicable, cicatricial and, owing to trichiasis, eventually blinding disease that supervenes in some individuals later in life. At least 150 infection episodes over an individual's lifetime are needed to precipitate trichiasis; thus, opportunity exists for a just global health system to intervene to prevent trachomatous blindness. Trachoma is found at highest prevalence in the poorest communities of low-income countries, particularly in sub-Saharan Africa; in June 2021, 1.8 million people worldwide were going blind from the disease. Blindness attributable to trachoma can appear in communities many years after conjunctival C. trachomatis transmission has waned or ceased; therefore, the two linked disease processes require distinct clinical and public health responses. Surgery is offered to individuals with trichiasis and antibiotic mass drug administration and interventions to stimulate facial cleanliness and environmental improvement are designed to reduce infection prevalence and transmission. Together, these interventions comprise the SAFE strategy, which is achieving considerable success. Although much work remains, a continuing public health problem from trachoma in the year 2030 will be difficult for the world to excuse.
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Chirgwin H, Cairncross S, Zehra D, Sharma Waddington H. Interventions promoting uptake of water, sanitation and hygiene (WASH) technologies in low- and middle-income countries: An evidence and gap map of effectiveness studies. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1194. [PMID: 36951806 PMCID: PMC8988822 DOI: 10.1002/cl2.1194] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Background Lack of access to and use of water, sanitation and hygiene (WASH) cause 1.6 million deaths every year, of which 1.2 million are due to gastrointestinal illnesses like diarrhoea and acute respiratory infections like pneumonia. Poor WASH access and use also diminish nutrition and educational attainment, and cause danger and stress for vulnerable populations, especially for women and girls. The hardest hit regions are sub-Saharan Africa and South Asia. Sustainable Development Goal (SDG) 6 calls for the end of open defecation, and universal access to safely managed water and sanitation facilities, and basic hand hygiene, by 2030. WASH access and use also underpin progress in other areas such as SDG1 poverty targets, SDG3 health and SDG4 education targets. Meeting the SDG equity agenda to "leave none behind" will require WASH providers prioritise the hardest to reach including those living remotely and people who are disadvantaged. Objectives Decision makers need access to high-quality evidence on what works in WASH promotion in different contexts, and for different groups of people, to reach the most disadvantaged populations and thereby achieve universal targets. The WASH evidence map is envisioned as a tool for commissioners and researchers to identify existing studies to fill synthesis gaps, as well as helping to prioritise new studies where there are gaps in knowledge. It also supports policymakers and practitioners to navigate the evidence base, including presenting critically appraised findings from existing systematic reviews. Methods This evidence map presents impact evaluations and systematic reviews from the WASH sector, organised according to the types of intervention mechanisms, WASH technologies promoted, and outcomes measured. It is based on a framework of intervention mechanisms (e.g., behaviour change triggering or microloans) and outcomes along the causal pathway, specifically behavioural outcomes (e.g., handwashing and food hygiene practices), ill-health outcomes (e.g., diarrhoeal morbidity and mortality), nutrition and socioeconomic outcomes (e.g., school absenteeism and household income). The map also provides filters to examine the evidence for a particular WASH technology (e.g., latrines), place of use (e.g., home, school or health facility), location (e.g., global region, country, rural and urban) and group (e.g., people living with disability). Systematic searches for published and unpublished literature and trial registries were conducted of studies in low- and middle-income countries (LMICs). Searches were conducted in March 2018, and searches for completed trials were done in May 2020. Coding of information for the map was done by two authors working independently. Impact evaluations were critically appraised according to methods of conduct and reporting. Systematic reviews were critically appraised using a new approach to assess theory-based, mixed-methods evidence synthesis. Results There has been an enormous growth in impact evaluations and systematic reviews of WASH interventions since the International Year of Sanitation, 2008. There are now at least 367 completed or ongoing rigorous impact evaluations in LMICs, nearly three-quarters of which have been conducted since 2008, plus 43 systematic reviews. Studies have been done in 83 LMICs, with a high concentration in Bangladesh, India, and Kenya. WASH sector programming has increasingly shifted in focus from what technology to supply (e.g., a handwashing station or child's potty), to the best way in which to do so to promote demand. Research also covers a broader set of intervention mechanisms. For example, there has been increased interest in behaviour change communication using psychosocial "triggering", such as social marketing and community-led total sanitation. These studies report primarily on behavioural outcomes. With the advent of large-scale funding, in particular by the Bill & Melinda Gates Foundation, there has been a substantial increase in the number of studies on sanitation technologies, particularly latrines. Sustaining behaviour is fundamental for sustaining health and other quality of life improvements. However, few studies have been done of intervention mechanisms for, or measuring outcomes on sustained adoption of latrines to stop open defaecation. There has also been some increase in the number of studies looking at outcomes and interventions that disproportionately affect women and girls, who quite literally carry most of the burden of poor water and sanitation access. However, most studies do not report sex disaggregated outcomes, let alone integrate gender analysis into their framework. Other vulnerable populations are even less addressed; no studies eligible for inclusion in the map were done of interventions targeting, or reporting on outcomes for, people living with disabilities. We were only able to find a single controlled evaluation of WASH interventions in a health care facility, in spite of the importance of WASH in health facilities in global policy debates. The quality of impact evaluations has improved, such as the use of controlled designs as standard, attention to addressing reporting biases, and adequate cluster sample size. However, there remain important concerns about quality of reporting. The quality and usefulness of systematic reviews for policy is also improving, which draw clearer distinctions between intervention mechanisms and synthesise the evidence on outcomes along the causal pathway. Adopting mixed-methods approaches also provides information for programmes on barriers and enablers affecting implementation. Conclusion Ensuring everyone has access to appropriate water, sanitation, and hygiene facilities is one of the most fundamental of challenges for poverty elimination. Researchers and funders need to consider carefully where there is the need for new primary evidence, and new syntheses of that evidence. This study suggests the following priority areas:Impact evaluations incorporating understudied outcomes, such as sustainability and slippage, of WASH provision in understudied places of use, such as health care facilities, and of interventions targeting, or presenting disaggregated data for, vulnerable populations, particularly over the life-course and for people living with a disability;Improved reporting in impact evaluations, including presentation of participant flow diagrams; andSynthesis studies and updates in areas with sufficient existing and planned impact evaluations, such as for diarrhoea mortality, ARIs, WASH in schools and decentralisation. These studies will preferably be conducted as mixed-methods systematic reviews that are able to answer questions about programme targeting, implementation, effectiveness and cost-effectiveness, and compare alternative intervention mechanisms to achieve and sustain outcomes in particular contexts, preferably using network meta-analysis.
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Affiliation(s)
- Hannah Chirgwin
- International Initiative for Impact Evaluation (3ie)London International Development CentreLondonUK
| | | | | | - Hugh Sharma Waddington
- London School of Hygiene and Tropical Medicine and International Initiative for Impact Evaluation (3ie)London International Development CentreLondonUK
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8
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Brewer N, McKenzie MS, Melkonjan N, Zaky M, Vik R, Stoffolano JG, Webley WC. Persistence and Significance of Chlamydia trachomatis in the Housefly, Musca domestica L. Vector Borne Zoonotic Dis 2021; 21:854-863. [PMID: 34520263 DOI: 10.1089/vbz.2021.0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Trachoma is the leading cause of infectious blindness worldwide. Ocular infection by the obligate intracellular pathogen, Chlamydia trachomatis, causes the eyelashes to turn in and scratch the cornea, leading to blindness if left untreated. The disease is most prevalent in poor, rural communities that lack the infrastructure for basic hygiene, clean water, and proper sanitation. Infection is often spread through infected clothes, contaminated hands, and face seeking flies. The goal of this research was to understand the biological role of Musca domestica flies in the transmission of C. trachomatis. PCR, tissue culture, and immunofluorescence microscopy were used to determine the presence, viability, and the anatomical location of C. trachomatis within the digestive tract of M. domestica. Flies were fed with C. trachomatis and then harvested at various time intervals after feeding. The data confirmed the presence of C. trachomatis DNA and viable elementary bodies (EBs) in fly crops, up to 24 h postfeeding. C. trachomatis DNA was also isolated from the upper portions of the alimentary tract of flies up to 48 h postfeeding. In addition, DNA was isolated from the regurgitation material from fly crops up to 12 h postfeeding. The viability of isolated C. trachomatis EBs was repeatedly confirmed between 12 and 48 h and up to 7 days in ex vivo crops stored at room temperature. Our data suggest that eye-seeking flies such as M. domestica can ingest C. trachomatis during regular feeding. Because M. sorbens does not occur in continental United States, we did not use it in any of our studies. These data also confirm, for the first time, that ingested chlamydia remains viable inside the flies for 24-48 h postfeeding. We further show that these flies can regurgitate and transmit the trachoma agent at their next feeding. We believe that these findings reveal an opportunity for efficient intervention strategies through fly vector control, especially as we near new target date for global elimination of trachoma.
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Affiliation(s)
- Natalie Brewer
- Microbiology Department, University of Massachusetts, Amherst, Massachusetts, USA
| | - Marcus S McKenzie
- Microbiology Department, University of Massachusetts, Amherst, Massachusetts, USA
| | - Nsan Melkonjan
- Microbiology Department, University of Massachusetts, Amherst, Massachusetts, USA
| | - Mina Zaky
- Microbiology Department, University of Massachusetts, Amherst, Massachusetts, USA
| | - RoseAnn Vik
- Microbiology Department, University of Massachusetts, Amherst, Massachusetts, USA
| | - John G Stoffolano
- Stockbridge School of Agriculture, University of Massachusetts, Amherst, Massachusetts, USA
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The impact of access to water supply and sanitation on the prevalence of active trachoma in Ethiopia: A systematic review and meta-analysis. PLoS Negl Trop Dis 2021; 15:e0009644. [PMID: 34499655 PMCID: PMC8428667 DOI: 10.1371/journal.pntd.0009644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Trachoma is a worldwide infectious disease causing blindness. Trachoma continued as a public health problem in Ethiopia due to a lack of sanitation and inadequate prevention strategies. This study aimed to identify the impact of water supply and sanitation intervention on preventing active trachoma among children. Methods Systematic literature searches were performed from 4 international databases. The search involved articles published from January 1995 up to March 2019. The Cochran Q and I2 statistical tests were used to check heterogeneity among the studies. A random-effect meta-analysis was employed to determine the pooled estimates with a 95% confidence interval (CI). Data analysis was performed using the CMA V.3 and RevMan 5 software program, and the result of the systematic review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Findings Out of 211 studies screened for the analysis, only 29 studies were finally included in this systematic review and meta-analysis. The result revealed factors that are significantly associated with increased odds of active trachoma. Accordingly, households with no access to toilet facilities (odds ratio [OR]: 2.04, 95% CI: 1.75–2.38), no access to improved water (OR: 1.58, 95% CI: 1.27–1.96), and do not practice regular face washing for children (OR: 4.19, 95% CI: 3.02–5.81) have shown increased odds of active trachoma. Besides, the results show a higher prevalence of active trachoma among children who did not wash their faces with soap and frequently. Conclusions The study found strong evidence that lack of access to water, sanitation, and hygiene (WASH) was associated with increased prevalence of active trachoma among children. Therefore, a comprehensive and partnership-oriented program is needed to tackle the problem, but further study will be required to strengthen its implementation.
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Yushananta P, Ahyanti M. The Effectiveness of Betle Leaf (Piper betle L.) Extract as a Bio-pesticide for Controlled of Houseflies (Musca domestica L.). Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The housefly, Musca domestica L., spreads disease by contaminating food. However, chemical insecticides used to combat houseflies can pollute the environment and can harm non-target insects and humans; this demands safer alternatives and pest control options.
AIM: This study aims to evaluate the effectiveness of Piper betle L. leaf extract as a bio-pesticide against houseflies.
METHODS: This study using a factorial design with six variations in concentration (0%, 5%, 10%, 15%, 20%, and 25%), four variations in contact time (15, 30, 60, and 120 minutes), and 5-day-old M. domestica adults that were bred from residential areas.
RESULTS: The results show that mortality was affected by concentration (p-value < 0.000), contact time (p-value < 0.000), and the interaction between concentration and contact time (p-value = 0.0007). Of the three, concentration had the greatest effect.
CONCLUSION: As such, the use of Piper betle L. extract is a suitable, cheap, and environmentally safe method for controlling M. domestica.
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Sharma Waddington H, Cairncross S. PROTOCOL: Water, sanitation and hygiene for reducing childhood mortality in low- and middle-income countries. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1135. [PMID: 37050969 PMCID: PMC8356349 DOI: 10.1002/cl2.1135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Respiratory tract infections and diarrhoea are the two biggest killers of children in low income contexts. They are closely related to access to, and use of improved water, sanitation and hygiene (WASH). However, there is no high quality systematic review that quantifies the effect of WASH improvements on childhood mortality. Existing systematic reviews of WASH improvements measure effects on morbidity, under the (often implicit) assumption that morbidity is closely correlated with mortality. This is at least partly because the impact evaluations on which they are based are only designed to detect changes in morbidity with statistical precision, whereas mortality is a relatively rare outcome. The proposed review will address this evidence synthesis gap, using the greater statistical power of meta-analysis to pool findings across studies.
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Affiliation(s)
- Hugh Sharma Waddington
- London School of Hygiene and Tropical MedicineLondon International Development CentreLondonUK
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12
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Lietman TM, Ayele B, Gebre T, Zerihun M, Tadesse Z, Emerson PM, Nash SD, Porco TC, Keenan JD, Oldenburg CE. Frequency of Mass Azithromycin Distribution for Ocular Chlamydia in a Trachoma Endemic Region of Ethiopia: A Cluster Randomized Trial. Am J Ophthalmol 2020; 214:143-150. [PMID: 32171768 PMCID: PMC9982657 DOI: 10.1016/j.ajo.2020.02.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Annual mass azithromycin distribution significantly reduces the prevalence of ocular Chlamydia trachomatis, the causative organism of trachoma. However, in some areas a decade or more of treatment has not controlled infection. Here, we compared multiple treatment arms from a community-randomized trial to evaluate whether increasing frequency of azithromycin distribution decreases prevalence in the short term. METHODS Seventy-two communities in Goncha Siso Enesie woreda in the Amhara region of Northern Ethiopia were randomized to 1 of 6 azithromycin distribution strategies: (1) delayed, (2) annual, (3) biannual, (4) quarterly to children only, (5) biennial, or (6) biennial plus latrine promotion. We analyzed data from the 60 communities in the delayed, annual, biannual, quarterly, and biennial distribution arms at the 12-month study visit. Communities in the annual and biennial distribution arm were combined, as they each had a single distribution before any 12-month retreatment. We assessed the effect of increased frequency of azithromycin distribution on ocular chlamydia prevalence. RESULTS Ocular chlamydia prevalence was significantly different across azithromycin distribution frequency in children (P < .0001) and adults (P < .0001), with lower prevalence associated with higher frequency. Among children, quarterly azithromycin distribution led to a significantly greater reduction in ocular chlamydia prevalence than the World Health Organization-recommended annual treatment prevalence (mean difference -11.4%, 95% confidence interval -19.5 to -3.3%, P = .007). CONCLUSIONS Increased frequency of azithromycin distribution leads to decreased ocular chlamydia prevalence over a short-term period. In some regions with high levels of ocular chlamydia prevalence, additional azithromycin distributions may help achieve local elimination of infection.
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Affiliation(s)
- Thomas M. Lietman
- Francis I Proctor Foundation, University of California, San Francisco,Department of Ophthalmology, University of California, San Francisco,Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Berhan Ayele
- The Carter Center Ethiopia, Addis Ababa, Ethiopia
| | - Teshome Gebre
- International Trachoma Initiative, Addis Ababa, Ethiopia
| | | | | | | | | | - Travis C. Porco
- Francis I Proctor Foundation, University of California, San Francisco,Department of Ophthalmology, University of California, San Francisco,Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Jeremy D. Keenan
- Francis I Proctor Foundation, University of California, San Francisco,Department of Ophthalmology, University of California, San Francisco,Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Catherine E. Oldenburg
- Francis I Proctor Foundation, University of California, San Francisco,Department of Ophthalmology, University of California, San Francisco,Department of Epidemiology and Biostatistics, University of California, San Francisco
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13
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West SK. Milestones in the fight to eliminate trachoma. Ophthalmic Physiol Opt 2020; 40:66-74. [PMID: 32017172 DOI: 10.1111/opo.12666] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 12/20/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Trachoma, a chronic conjunctivitis that can result in vision loss from trichiasis, is targeted for global elimination by 2020. Several milestones in the long process towards elimination are noteworthy for the impact they have had on changing or accelerating progress. The purpose of this review is to describe the milestones and the impact they have had both for trachoma elimination and beyond. FINDINGS Eight milestones are presented. They are discovery of the causative agent; development of a clinical grading scheme; establishment of the World Health Organization Alliance for the Global Elimination of Trachoma by 2020; setting targets that define elimination; building an evidence base for trichiasis surgery; azithromycin donation programme; use of the SAFE strategy (Surgery, Antibiotics, Facial cleanliness, and Environmental improvement); and The Global Trachoma Mapping Project. SUMMARY These milestones have significantly pushed the progress towards elimination. Despite challenges to achieving the goal of elimination by 2020, there is continued commitment into the future to ensure that this preventable cause of blindness is no longer a threat.
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Affiliation(s)
- Sheila K West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, USA
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14
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Najnin N, Leder K, Forbes A, Unicomb L, Qadri F, Ram PK, Winch PJ, Begum F, Biswas S, Parvin T, Yeasmin F, Cravioto A, Luby SP. Inconsistency in Diarrhea Measurements when Assessing Intervention Impact in a Non-Blinded Cluster-Randomized Controlled Trial. Am J Trop Med Hyg 2020; 101:51-58. [PMID: 31162005 PMCID: PMC6609177 DOI: 10.4269/ajtmh.18-0872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
To explore the consistency in impact evaluation based on reported diarrhea, we compared diarrhea data collected through two different surveys and with observed diarrhea-associated hospitalization for children aged ≤ 5 years from a non-blinded cluster-randomized trial conducted over 2 years in urban Dhaka. We have previously reported that the interventions did not reduce diarrhea-associated hospitalization for children aged ≤ 5 years in this trial. We randomly allocated 90 geographic clusters comprising > 60,000 low-income households into three groups: cholera vaccine only, vaccine plus behavior change (cholera vaccine and handwashing plus drinking water chlorination promotion), and control. We calculated reported diarrhea prevalence within the last 2 days using data collected from two different survey methods. The "census" data were collected from each household every 6 months for updating household demographic information. The "monthly survey" data were collected every month from a subset of randomly selected study households for monitoring the uptake of behavior change interventions. We used binomial regression with a logarithmic link accounting for clustering to compare diarrhea prevalence across intervention and control groups separately for both census and monthly survey data. No intervention impact was detected in the census (vaccine only versus control: 2.32% versus 2.53%; P = 0.49; vaccine plus behavior change versus control: 2.44% versus 2.53%; P = 0.78) or in the vaccine only versus control in the monthly survey (3.39% versus 3.80%; P = 0.69). However, diarrhea prevalence was lower in the vaccine-plus-behavior-change group than control in the monthly survey (2.08% versus 3.80%; P = 0.02). Although the reasons for different observed treatment effects in the census and monthly survey data in this study are unclear, these findings emphasize the importance of assessing objective outcomes along with reported outcomes from non-blinded trials.
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Affiliation(s)
- Nusrat Najnin
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Karin Leder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew Forbes
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Leanne Unicomb
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Firdausi Qadri
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Peter J Winch
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Farzana Begum
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shwapon Biswas
- Department of Medicine, Rangpur Medical College Hospital, Rangpur, Bangladesh.,International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmina Parvin
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farzana Yeasmin
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Alejandro Cravioto
- Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México.,International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Stephen P Luby
- Stanford University, Stanford, California.,International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Evidence for contamination with C. trachomatis in the household environment of children with active Trachoma: A cross-sectional study in Kongwa, Tanzania. PLoS Negl Trop Dis 2019; 13:e0007834. [PMID: 31869324 PMCID: PMC6946162 DOI: 10.1371/journal.pntd.0007834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 01/07/2020] [Accepted: 10/08/2019] [Indexed: 11/23/2022] Open
Abstract
Background Trachoma, a conjunctivitis caused by repeated infections with Chlamydia trachomatis, remains a significant cause of blindness worldwide. While mass treatments with azithromycin decreases disease and infection, re-emergence occurs, indicating that elimination may require other sustainable interventions. Environmental changes largely focus on facial hygiene and latrines, but further work to identify other possible transmission targets are needed. We sought to determine, in a cross-sectional survey of households of children with active trachoma, if we could detect the presence of Chlamydia trachomatis on household objects and on family members based on sleeping and caretaking patterns. Methods In five villages in Kongwa, Tanzania, children <five years were randomly chosen for examination for trachoma, and households of all children with active trachoma (n = 90) were eligible for this study. We administered structured questionnaires of sleeping and caretaking habits. Based on the responses, environmental swabs of bedding, furniture, clothing, and hands were taken and processed using Amplicor for detecting C. trachomatis DNA. Results Of 80 visited households, 13 (16%) had at least one swab from environmental sources positive for C. trachomatis DNA. A positive environmental swab was associated with the presence of ocular infection in the index child (Odds Ratio = 22.0, p = .007), the presence of an infant <1 year of age in the household, and whether the children’s clothing had not been recently washed. Conclusions C. trachomatis DNA is present in the environment of children with active trachoma, especially in households with an ocular infection. Specific findings also suggest that washing hands, clothing, and bedding may be important. Trachoma is the leading infectious cause of blindness world-wide. It is a conjunctivitis caused by repeated infections with Chlamydia trachomatis, spread from person to person by contact with infected ocular/nasal secretions. While mass treatment with azithromycin decreases infection, re-emergence occurs, indicating that elimination may require other sustainable interventions. Environmental changes largely focus on facial hygiene and latrines, but further work to identify other possible transmission targets is needed. In this cross-sectional study of households where at least one child has trachoma, we found evidence of C. trachomatis DNA on several environmental sources including clothing, bedsheets, furniture, and hands. Besides the presence of infection with C. trachomatis in the index child, chlamydial DNA in the environment was also associated with the presence of an infant in the household. Washing clothes within the past three days was associated with not having C. trachomatis DNA in the environment. Our study provides suggestive evidence that in high prevalence villages, C. trachomatis may be contaminating environmental objects, including hands and clothing. These findings suggest that behavior change communication around hygiene may need to be enlarged to focus on keeping ocular and nasal secretions off faces and hands, and promoting washing of clothing as well.
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Greenland K, White S, Sommers K, Biran A, Burton MJ, Sarah V, Alemayehu W. Selecting behaviour change priorities for trachoma 'F' and 'E' interventions: A formative research study in Oromia, Ethiopia. PLoS Negl Trop Dis 2019; 13:e0007784. [PMID: 31596851 PMCID: PMC6785218 DOI: 10.1371/journal.pntd.0007784] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/16/2019] [Indexed: 11/24/2022] Open
Abstract
Background Trachoma is the leading infectious cause of blindness. However, little is known about the behavioural and environmental determinants of transmission of the causative organism, Chlamydia trachomatis. We conducted formative research in a trachoma hyper-endemic area of Ethiopia to explore the behaviours which are likely to contribute to trachoma transmission and map their determinants. Methodology/Principal findings Data on water use, hygiene, defecation, and sleeping arrangements were collected from five communities during the dry and rainy seasons in 2016. Data collection involved direct observation in households (n = 20), interviews with caregivers (n = 20) and focus group discussions (n = 11). Although several behaviours that likely contribute to trachoma transmission were identified, no single behaviour stood out as the dominant contributor. Hygiene practices reflected high levels of poverty and water scarcity. Face washing and soap use varied within and between households, and were associated with other factors such as school attendance. Children’s faces were rarely wiped to remove nasal or ocular discharge, which was not perceived to be socially undesirable. Bathing and laundry were performed infrequently due to the amount of time and water required. Open defecation was a normative practice, particularly for young children. Latrines, when present, were poorly constructed, maintained and used. Young children and parents slept closely together and shared bedding that was infrequently washed. Conclusions/Significance Existing norms and enabling factors in this context favour the development of interventions to improve facial cleanliness as more feasible than those that reduce unsafe faeces disposal. Interventions to increase the frequency of bathing and laundry may also be infeasible unless water availability within the home is improved. Trachoma is the leading infectious cause of blindness globally. It is caused by Chlamydia trachomatis, which is believed to spread eye to eye through direct transmission on skin (e.g. after touching ocular and nasal secretions), indirect transmission on fomites (e.g. towels and bedsheets) and via eye-seeking flies (which breed in faeces). Interventions aiming to interrupt transmission of C. trachomatis can therefore be designed to promote behaviours ranging from face washing and handwashing to improving sanitation, waste disposal, laundry practices and sleeping practices. Changing behaviour is challenging and interventions are often ineffective if they fail to change important determinants of behaviour. We conducted formative research to understand trachoma-related behaviour and the determinants of these behaviours in order to inform future intervention design. We found that the hygiene practices we observed reflected high levels of poverty and water scarcity. In this context we found that it would be challenging to shift sub-optimal hygiene practices related to latrine use, bathing and laundry without a substantial and large-scale investment in water and sanitation infrastructure. Given this, it may be more feasible for the Government and supporting organisations to design trachoma prevention interventions which target facial cleanliness and hand hygiene.
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Affiliation(s)
- Katie Greenland
- Department for Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Sian White
- Department for Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Katina Sommers
- Department for Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Adam Biran
- Department for Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matthew J. Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Virginia Sarah
- Partnerships and Advocacy, The Fred Hollows Foundation, London, United Kingdom
| | - Wondu Alemayehu
- Berhan Public Health and Eye Care Consultancy, Addis Ababa, Ethiopia
- Technical Advisor, The Fred Hollows Foundation, Addis Ababa, Ethiopia
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von Seidlein L, Wood H, Brittain OS, Tusting L, Bednarz A, Mshamu S, Kahabuka C, Deen J, Bell D, Lindsay SW, Knudsen J. Knowledge gaps in the construction of rural healthy homes: A research agenda for improved low-cost housing in hot-humid Africa. PLoS Med 2019; 16:e1002909. [PMID: 31600205 PMCID: PMC6786526 DOI: 10.1371/journal.pmed.1002909] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Lorenz von Seidlein and colleagues discuss improving house designs in rural Africa to benefit health.
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Affiliation(s)
- Lorenz von Seidlein
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Hannah Wood
- Ingvartsen Architects, Copenhagen K, Denmark
| | | | - Lucy Tusting
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Alexa Bednarz
- Bill and Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Salum Mshamu
- CSK Research Solutions Ltd., Dar es Salaam, Tanzania
| | | | | | - David Bell
- Independent Consultant, Issaquah, Washington, United States of America
| | - Steve W. Lindsay
- Department of Biosciences, Durham University, Durham, United Kingdom
| | - Jakob Knudsen
- Ingvartsen Architects, Copenhagen K, Denmark
- School of Architecture, The Royal Danish Academy of Fine Arts, Copenhagen, Denmark
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Bell M, Irish S, Schmidt WP, Nayak S, Clasen T, Cameron M. Comparing trap designs and methods for assessing density of synanthropic flies in Odisha, India. Parasit Vectors 2019; 12:75. [PMID: 30732628 PMCID: PMC6367737 DOI: 10.1186/s13071-019-3324-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 01/28/2019] [Indexed: 11/21/2022] Open
Abstract
Background There are many different traps available for studying fly populations. The aim of this study was to find the most suitable trap to collect synanthropic fly populations to assess the impact of increased latrine coverage in the state of Odisha, India. Methods Different baits were assessed for use in sticky pot traps (60% sucrose solution, 60 g dry sucrose, half a tomato and an non-baited control), followed by different colours of trap (blue versus yellow) and finally different types of trap (baited sticky pot trap versus sticky card traps). The experiments were undertaken in a semi-urban slum area of Bhubaneswar, the capital of Odisha. The first experiment was conducted in 16 households over 30 nights while experiments 2 and 3 were conducted in 5 households over 30 nights. Results The traps predominantly caught adult Musca domestica and M. sorbens (78.4, 62.6, 83.8% combined total in experiments 1–3 respectively). Non-baited traps did not catch more flies (median 7.0, interquartile range, IQR: 0.0–24.0) compared with baited traps (sucrose solution: 6.5, 1.0–27.0; dry sucrose: 5.0, 0.5–14.5; tomato: 5.0, 1.5–17.5). However, there were significantly more flies collected on blue sticky pot traps, which caught nearly three times as many flies as yellow sticky pot traps (Incidence Rate Ratio, IRR = 2.91; 95% CI: 1.77–4.79); P < 0.001). Sticky card traps (27, 8–58) collected significantly more flies than the non-baited sticky pot traps (10, 1.5–30.5). Conclusions Blue sticky card traps can be recommended for the capture of synanthropic fly species as they are non-intrusive to residents, easy to use, readily allow for species identification, and collect sufficient quantities of flies over 12 hours for use in monitoring and control programmes.
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Affiliation(s)
- Melissa Bell
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Seth Irish
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Present address: President's Malaria Initiative and Entomology Branch, Division of Parasitic Diseases and Malaria, Center of Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Wolf Peter Schmidt
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Soumya Nayak
- Xavier Institute of Management, Xavier Square, Jayadev Vihar, Bhubaneswar, Odisha, 751013, India
| | - Thomas Clasen
- Faculty of Environmental Health, Rollins School of Public Health, Emory University, Clifton Road, Atlanta, Georgia, USA.
| | - Mary Cameron
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Abstract
BACKGROUND Diarrhoeal disease accounts for millions of child deaths every year. Although the role of flies as vectors of infectious diarrhoea has been established, fly control is not often mentioned as an approach to decrease childhood diarrhoea. Theoretically, fly control for decreasing diarrhoea incidence can be achieved by intervening at four different levels: reduction or elimination of fly breeding sites; reduction of sources that attract houseflies; prevention of contact between flies and disease-causing organisms; and protection of people, food, and food utensils from contact with flies. OBJECTIVES To assess the impact of various housefly control measures on the incidence of diarrhoea and its related morbidity and mortality in children under five years of age. SEARCH METHODS We searched electronic databases including the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE, Embase, CINAHL, and LILACS, from database inception to 24 May 2018. We also searched trial registries for relevant grey literature and ongoing trials. We checked the references of the identified studies and reviews. We did not apply any filters for language, publication status (published, unpublished, in press, and ongoing), or publication date. SELECTION CRITERIA We planned to include randomized controlled trials (RCTs), quasi-RCTs, and controlled before-and-after studies that studied the effect of fly control on diarrhoea in children under five years of age. DATA COLLECTION AND ANALYSIS Two review authors extracted the data and independently assessed the risk of bias in the included study. We planned to contact study authors for additional information, where necessary. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included one cluster-RCT (491 participants) conducted in Pakistan that evaluated insecticide spraying in the first two years and baited fly traps in the third year. Insecticide spraying reduced the fly population (house index) in the intervention group during the four months of the year when both flies and cases of diarrhoea were more common, but not at other times. On average, this was associated with a reduction in the incidence of diarrhoea in the first year (illustrative mean episodes per child-year in the intervention group was 6.3 while in the control group was 7.1) and second year of the intervention (illustrative mean episodes per child‒year in the intervention group was 4.4 while in the control group was 6.5; rate ratio (RaR) 0.77, 95% confidence interval (CI) 0.67 to 0.89, low-certainty evidence). In the third year of the intervention, the baited fly traps did not demonstrate an effect on the fly population or on diarrhoea incidence (RaR 1.15, 95% CI 0.90 to 1.47, low-certainty evidence). AUTHORS' CONCLUSIONS The trial, conducted in a setting where there were clear seasonal peaks in fly numbers and associated diarrhoea, shows insecticide spraying may reduce diarrhoea in children. Further research on whether this finding is applicable to other setting is required, as well as work on other fly control methods, their effects, feasibility, costs, and acceptability.
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Affiliation(s)
- Jai K Das
- Aga Khan University HospitalDivision of Women and Child HealthStadium RoadPO Box 3500KarachiSindPakistan
| | - Yousaf Bashir Hadi
- West Virginia UniversityDepartment of Internal Medicine1 Medical Center DriveMorgantownWest VirginiaUSA26506
| | - Rehana A Salam
- Aga Khan University HospitalDivision of Women and Child HealthStadium RoadPO Box 3500KarachiSindPakistan
| | - Mehar Hoda
- Aga Khan University HospitalDivision of Women and Child HealthStadium RoadPO Box 3500KarachiSindPakistan
| | - Zohra S Lassi
- The University of AdelaideThe Robinson Research InstituteAdelaideSouth AustraliaAustralia5005
| | - Zulfiqar A Bhutta
- The Hospital for Sick ChildrenCentre for Global Child HealthTorontoONCanadaM5G A04
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Bernhardt V, Finkelmeier F, Verhoff MA, Amendt J. Myiasis in humans-a global case report evaluation and literature analysis. Parasitol Res 2018; 118:389-397. [PMID: 30456490 DOI: 10.1007/s00436-018-6145-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 11/12/2018] [Indexed: 12/15/2022]
Abstract
Myiasis refers to the infestation of living humans and vertebrates with fly larvae that feed on necrotic or vital tissue of the host. Since the invasion of new fly species in Europe is currently being observed, which live obligatorily parasitically or are close relatives of such species, the aim of this study is to obtain a global overview of the distribution of myiasis-causing fly species in times of climate change and to assess the possible consequences for Western Europe. A systematic literature search was conducted using Pubmed/Medline for the years 1997 to 2017 and a total of 464 international case reports from 79 countries were evaluated. The described cases were caused by 41 different species. In 99.4% of the cases, it was a colonization by just one species, a maximum of three species were detected in a human. Casuistics from Western Europe mostly describe myiasis as a "holiday souvenir" from tropical regions. Reports of autochthonous cases are rare in comparison to other regions. With regard to rising temperatures and the invasion of new fly species, a noticeable increase in the number of cases in Western Europe is to be assumed, which could be an increasing problem in the clinical area and in care, which is why thorough monitoring for professional identification and treatment seems important in the future.
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Affiliation(s)
- Victoria Bernhardt
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe-University, Frankfurt, Main, Germany.
| | - Fabian Finkelmeier
- Department of Medicine I, Gastroenterology, University Hospital Frankfurt, Goethe-University, Frankfurt, Main, Germany
| | - Marcel A Verhoff
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe-University, Frankfurt, Main, Germany
| | - Jens Amendt
- Institute of Legal Medicine, University Hospital Frankfurt, Goethe-University, Frankfurt, Main, Germany
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Favacho J, Alves da Cunha AJL, Gomes STM, Freitas FB, Queiroz MAF, Vallinoto ACR, Ishak R, Ishak MDOG. Prevalence of trachoma in school children in the Marajó Archipelago, Brazilian Amazon, and the impact of the introduction of educational and preventive measures on the disease over eight years. PLoS Negl Trop Dis 2018; 12:e0006282. [PMID: 29447155 PMCID: PMC5831641 DOI: 10.1371/journal.pntd.0006282] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 02/28/2018] [Accepted: 01/30/2018] [Indexed: 11/25/2022] Open
Abstract
Trachoma is the leading infectious cause of blindness in the world and is associated with precarious living conditions in developing countries. The aim of the present study was to evaluate the prevalence of trachoma in three municipalities of the Marajó Archipelago, located in the state of Pará, Brazil. In 2008, 2,054 schoolchildren from the public primary school system of the urban area of the region and their communicants were clinically examined; in 2016, 1,502 schoolchildren were examined. The positive cases seen during the clinical evaluation were confirmed by direct immunofluorescence (DIF) laboratory tests. The presence of antibodies against the genus Chlamydia was evaluated by indirect immunofluorescence (IIF), and the serotypes were determined by microimmunofluorescence (MIF). In 2008, the prevalence of trachoma among schoolchildren was 3.4% (69 cases) and it was more frequent in children between six and nine years of age and in females; among the communicants, a prevalence of 16.5% was observed. In 2016, three cases of trachoma were diagnosed (prevalence of 0.2%), found only in the municipality of Soure. The results of the present study showed that in 2008, trachoma had a low prevalence (3.4%) among schoolchildren in the urban area of Marajó Archipelago; eight years after the first evaluation and the introduction of control and prevention measures (SAFE strategy), there was a drastic reduction in the number of cases (0.2%), demonstrating the need for constant monitoring and effective measures for the elimination of trachoma. Trachoma is one of the main neglected infectious diseases and carry a considerable burden to human health as a consequence of the clinical severity of the disease which may evolve to blindness. The lack of hygiene, education and other indicators of low social and economic markers occurring in developing and underdeveloped countries favour the spread of Chlamydia trachomatis, the bacterium causing trachoma. Although there is an easy, cheap and available treatment, reinfections are common and transmission is a consequence of bad hygienic habits and the various serotypes of the bacterium. The Marajó territory, in the North of the Amazon region of Brazil, is a large area with an ill educated, poor population, with almost no access to health resources and with almost no chance of transportation to major urban centers. Trachoma was detected a long time ago in the island and now, for the first time, a clear effort was produced during an eight year period in order to improve health hygienic habits among children and their relatives. The number of new cases following an initial diagnosis, was significantly reduced by the application of the WHO SAFE (Surgery, Antibiotics, Facial hygiene and Education for better habits) strategy.
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Affiliation(s)
- Joana Favacho
- Health Surveillance Department, Evandro Chagas Institute, Bélem, Pará, Brasil
| | | | | | | | | | | | - Ricardo Ishak
- Biological Sciences Institute, Federal University of Pará, Belém, Pará, Brasil
- * E-mail:
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Traoré L, Dembele B, Keita M, Reid SD, Dembéle M, Mariko B, Coulibaly F, Goldman W, Traoré D, Coulibaly D, Guindo B, Amon JJ, Knieriemen M, Zhang Y. Prevalence of trachoma in the Kayes region of Mali eight years after stopping mass drug administration. PLoS Negl Trop Dis 2018; 12:e0006289. [PMID: 29432434 PMCID: PMC5825163 DOI: 10.1371/journal.pntd.0006289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/23/2018] [Accepted: 01/31/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In 2009, three years after stopping mass treatment with azithromycin, a trachoma impact survey in four health districts in the Kayes region of Mali found a prevalence of trachomatous inflammation-follicular (TF) among children aged 1 to 9 years of >5% and a trachomatous trichiasis (TT) prevalence within the general population (≥1-year-old) of <1%. As a result, the government's national trachoma program expanded trichiasis surgery and related activities required to achieve trachoma elimination. METHODOLOGY/PRINCIPAL FINDINGS In 2015, to assess progress towards elimination, a follow-up impact survey was conducted in the Kayes, Kéniéba, Nioro and Yélimané health districts. The survey used district level two-stage cluster random sampling methodology with 20 clusters of 30 households in each evaluation unit. Subjects were eligible for examination if they were ≥1 year. TF and TT cases were identified and confirmed by experienced ophthalmologists. In total 14,159 people were enumerated and 11,620 (82%) were examined. TF prevalence (95% confidence interval (CI)) was 0.5% (0.3-1%) in Kayes, 0.8% (0.4-1.7%) in Kéniéba, 0.2% (0-0.9%) in Nioro and 0.3% (0.1-1%) in Yélimané. TT prevalence (95% CI) was 0.04% (0-0.25%) in Kayes, 0.29% (0.11-0.6%) in Kéniéba, 0.04% (0-0.25%) in Nioro and 0.07% (0-0.27%) in Yélimané. CONCLUSIONS/SIGNIFICANCE Eight years after stopping MDA and intensifying trichiasis surgery outreach campaigns, all four districts reached the TF elimination threshold of <5% and three of four districts reached the TT elimination threshold of <0.1%.
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Affiliation(s)
- Lamine Traoré
- Programme National de la Santé Oculaire, Ministère de la Santé, Bamako, Mali
| | | | - Modibo Keita
- Mali Office, Helen Keller International, Bamako, Mali
| | - Steven D Reid
- Headquarters, Helen Keller International, New York, New York, United States of America
| | - Mahamadou Dembéle
- Programme National de la Santé Oculaire, Ministère de la Santé, Bamako, Mali
| | - Bréhima Mariko
- District Sanitaire de Kita, Direction Régionale de la Santé de Kayes, Kita, Mali
| | - Famolo Coulibaly
- Programme National de la Santé Oculaire, Ministère de la Santé, Bamako, Mali
| | - Whitney Goldman
- Headquarters, Helen Keller International, New York, New York, United States of America
| | | | - Daouda Coulibaly
- Programme National de la Santé Oculaire, Ministère de la Santé, Bamako, Mali
| | | | - Joseph J Amon
- Headquarters, Helen Keller International, New York, New York, United States of America
| | | | - Yaobi Zhang
- Regional Office for Africa, Helen Keller International, Dakar, Senegal
- * E-mail:
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Lindeberg YL, Egedal K, Hossain ZZ, Phelps M, Tulsiani S, Farhana I, Begum A, Jensen PKM. CanEscherichia colifly? The role of flies as transmitters ofE. colito food in an urban slum in Bangladesh. Trop Med Int Health 2017; 23:2-9. [DOI: 10.1111/tmi.13003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yrja Lisa Lindeberg
- Department of Public Health; Global Health Section; Copenhagen University; København Denmark
| | - Karen Egedal
- Department of Public Health; Global Health Section; Copenhagen University; København Denmark
| | - Zenat Zebin Hossain
- Department of Public Health; Global Health Section; Copenhagen University; København Denmark
| | - Matthew Phelps
- Department of Public Health; Global Health Section; Copenhagen University; København Denmark
| | - Suhella Tulsiani
- Department of Public Health; Global Health Section; Copenhagen University; København Denmark
| | - Israt Farhana
- Department of Microbiology; University of Dhaka; Dhaka Bangladesh
| | - Anowara Begum
- Department of Microbiology; University of Dhaka; Dhaka Bangladesh
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Wolfe MK, Dentz HN, Achando B, Mureithi M, Wolfe T, Null C, Pickering AJ. Adapting and Evaluating a Rapid, Low-Cost Method to Enumerate Flies in the Household Setting. Am J Trop Med Hyg 2017; 96:449-456. [PMID: 27956654 PMCID: PMC5303052 DOI: 10.4269/ajtmh.16-0162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 08/12/2016] [Indexed: 11/30/2022] Open
Abstract
Diarrhea is a leading cause of death among children under 5 years of age worldwide. Flies are important vectors of diarrheal pathogens in settings lacking networked sanitation services. There is no standardized method for measuring fly density in households; many methods are cumbersome and unvalidated. We adapted a rapid, low-cost fly enumeration technique previously developed for industrial settings, the Scudder fly grill, for field use in household settings. We evaluated its performance in comparison to a sticky tape fly trapping method at latrine and food preparation areas among households in rural Kenya. The grill method was more sensitive; it detected the presence of any flies at 80% (433/543) of sampling locations versus 64% (348/543) of locations by the sticky tape. We found poor concordance between the two methods, suggesting that standardizing protocols is important for comparison of fly densities between studies. Fly species identification was feasible with both methods; however, the sticky tape trap allowed for more nuanced identification. Both methods detected a greater presence of bottle flies near latrines compared with food preparation areas (P < 0.01). The grill method detected more flies at the food preparation area compared with near the latrine (P = 0.014) while the sticky tape method detected no difference. We recommend the Scudder grill as a sensitive fly enumeration tool that is rapid and low cost to implement.
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Affiliation(s)
- Marlene K. Wolfe
- Tufts University, Medford, Massachusetts
- Innovations for Poverty Action, New Haven, Connecticut
| | - Holly N. Dentz
- Innovations for Poverty Action, New Haven, Connecticut
- University of California Davis, Davis, California
| | - Beryl Achando
- Innovations for Poverty Action, New Haven, Connecticut
| | | | - Tim Wolfe
- Innovations for Poverty Action, New Haven, Connecticut
| | - Clair Null
- Innovations for Poverty Action, New Haven, Connecticut
- Emory University, Atlanta, Georgia
- Mathematica Policy Research, Washington, District of Columbia
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Oswald WE, Stewart AE, Kramer MR, Endeshaw T, Zerihun M, Melak B, Sata E, Gessese D, Teferi T, Tadesse Z, Guadie B, King JD, Emerson PM, Callahan EK, Flanders D, Moe CL, Clasen TF. Active trachoma and community use of sanitation, Ethiopia. Bull World Health Organ 2017; 95:250-260. [PMID: 28479620 PMCID: PMC5407250 DOI: 10.2471/blt.16.177758] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 12/15/2016] [Accepted: 12/15/2016] [Indexed: 11/27/2022] Open
Abstract
Objective To investigate, in Amhara, Ethiopia, the association between prevalence of active trachoma among children aged 1–9 years and community sanitation usage. Methods Between 2011 and 2014, prevalence of trachoma and household pit latrine usage were measured in five population-based cross-sectional surveys. Data on observed indicators of latrine use were aggregated into a measure of community sanitation usage calculated as the proportion of households with a latrine in use. All household members were examined for clinical signs, i.e. trachomatous inflammation, follicular and/or intense, indicative of active trachoma. Multilevel logistic regression was used to estimate prevalence odds ratios (OR) and 95% confidence intervals (CI), adjusting for community, household and individual factors, and to evaluate modification by household latrine use and water access. Findings In surveyed areas, prevalence of active trachoma among children was estimated to be 29% (95% CI: 28–30) and mean community sanitation usage was 47% (95% CI: 45–48). Despite significant modification (p < 0.0001), no pattern in stratified ORs was detected. Summarizing across strata, community sanitation usage values of 60 to < 80% and ≥ 80% were associated with lower prevalence odds of active trachoma, compared with community sanitation usage of < 20% (OR: 0.76; 95% CI: 0.57–1.03 and OR: 0.67; 95% CI: 0.48–0.95, respectively). Conclusion In Amhara, Ethiopia, a negative correlation was observed between community sanitation usage and prevalence of active trachoma among children, highlighting the need for continued efforts to encourage higher levels of sanitation usage and to support sustained use throughout the community, not simply at the household level.
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Affiliation(s)
- William E Oswald
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, England
| | | | | | | | | | | | | | | | | | | | | | | | - Paul M Emerson
- The Carter Center, Atlanta, United States of America (USA)
| | | | - Dana Flanders
- Rollins School of Public Health, Emory University, Atlanta, USA
| | - Christine L Moe
- Rollins School of Public Health, Emory University, Atlanta, USA
| | - Thomas F Clasen
- Rollins School of Public Health, Emory University, Atlanta, USA
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Knauf S, Raphael J, Mitjà O, Lejora IAV, Chuma IS, Batamuzi EK, Keyyu JD, Fyumagwa R, Lüert S, Godornes C, Liu H, Schwarz C, Šmajs D, Grange P, Zinner D, Roos C, Lukehart SA. Isolation of Treponema DNA from Necrophagous Flies in a Natural Ecosystem. EBioMedicine 2016; 11:85-90. [PMID: 27488881 PMCID: PMC5049926 DOI: 10.1016/j.ebiom.2016.07.033] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/26/2016] [Accepted: 07/27/2016] [Indexed: 11/19/2022] Open
Abstract
Background Recently, the World Health Organization launched a campaign to eradicate the tropical disease yaws, caused by the bacterium Treponema pallidum subsp. pertenue; however, for decades researchers have questioned whether flies act as a vector for the pathogen that could facilitate transmission. Methods A total of 207 fly specimens were trapped in areas of Africa in which T. pallidum-induced skin ulcerations are common in wild baboons; 88 flies from Tarangire National Park and 119 from Lake Manyara National Park in Tanzania were analyzed by PCR for the presence of T. pallidum DNA. Findings We report that in the two study areas, T. pallidum DNA was found in 17–24% of wild-caught flies of the order Diptera. Treponemal DNA sequences obtained from many of the flies match sequences derived from nearby baboon T. pallidum strains, and one of the fly species with an especially high prevalence of T. pallidum DNA, Musca sorbens, has previously been shown to transmit yaws in an experimental setting. Interpretation Our results raise the possibility that flies play a role in yaws transmission; further research is warranted, given how important understanding transmission is for the eradication of this disfiguring disease. Treponema pallidum DNA was found in 17–24% of wild-caught flies in the Manyara region of Tanzania. Results further support the possibility that flies play a role in yaws transmission. New theoretic route of inter-species transmission for Treponema
The discovery of Treponema pallidum DNA on necrophagous flies in Africa supports historical reports on possible transmission of the bacterium by flies as a mechanical vector. The bacterium (subsp. pertenue) causes human yaws, which is currently subject to eradication efforts. It has been shown that African nonhuman primates are also found to be infected with T. pallidum strains that are closely related to human yaws causing strains. The ecology of T. pallidum infection in primates is not yet fully understood and intra- and interspecies transmission pathways, apart from skin-to-skin contact in humans, are largely unknown.
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Affiliation(s)
- Sascha Knauf
- Work Group Neglected Tropical Diseases, Pathology Unit, German Primate Center, Leibniz Institute for Primate Research, Kellnerweg 4, 37077 Göttingen, Germany.
| | - Jane Raphael
- Ecology Monitoring Department, Tanzania National Parks, P.O. Box 3134, Arusha, Tanzania
| | - Oriol Mitjà
- ISGlobal, Barcelona Centre for International Health Research, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Inyasi A V Lejora
- Ecology Monitoring Department, Tanzania National Parks, P.O. Box 3134, Arusha, Tanzania
| | - Idrissa S Chuma
- Ecology Monitoring Department, Tanzania National Parks, P.O. Box 3134, Arusha, Tanzania
| | - Emmanuel K Batamuzi
- Department of Surgery and Theriogenology, Faculty of Veterinary Medicine, Sokoine University of Agriculture, P.O. Box 3020, Morogoro, Tanzania
| | - Julius D Keyyu
- Tanzania Wildlife Research Institute, P.O. Box. 661, Arusha, Tanzania
| | - Robert Fyumagwa
- Tanzania Wildlife Research Institute, P.O. Box. 661, Arusha, Tanzania
| | - Simone Lüert
- Work Group Neglected Tropical Diseases, Pathology Unit, German Primate Center, Leibniz Institute for Primate Research, Kellnerweg 4, 37077 Göttingen, Germany; Primate Genetics Laboratory, German Primate Center, Leibniz Institute for Primate Research, Kellnerweg 4, 37077 Göttingen, Germany
| | - Charmie Godornes
- Department of Medicine, University of Washington, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104, USA
| | - Hsi Liu
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Diseases Control and Prevention, Atlanta, GA 30333, USA
| | - Christiane Schwarz
- Primate Genetics Laboratory, German Primate Center, Leibniz Institute for Primate Research, Kellnerweg 4, 37077 Göttingen, Germany
| | - David Šmajs
- Department of Biology, Faculty of Medicine, Masaryk University, Kamenice 5, Brno 625 00, Czech Republic
| | - Philippe Grange
- Laboratoire de Dermatologie, Centre National de Reference de la Syphilis, 75014 Paris, France
| | - Dietmar Zinner
- Cognitive Ethology Laboratory, German Primate Center, Kellnerweg 4, 37077 Göttingen, Germany
| | - Christian Roos
- Primate Genetics Laboratory, German Primate Center, Leibniz Institute for Primate Research, Kellnerweg 4, 37077 Göttingen, Germany; Gene Bank of Primates, German Primate Center, Leibniz Institute for Primate Research, Göttingen, Germany
| | - Sheila A Lukehart
- Department of Medicine, University of Washington, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104, USA
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Affiliation(s)
- John Cameron Buchan
- London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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Pava-Ripoll M, Pearson REG, Miller AK, Tall BD, Keys CE, Ziobro GC. Ingested Salmonella enterica, Cronobacter sakazakii, Escherichia coli O157:H7, and Listeria monocytogenes: transmission dynamics from adult house flies to their eggs and first filial (F1) generation adults. BMC Microbiol 2015; 15:150. [PMID: 26228457 PMCID: PMC4520200 DOI: 10.1186/s12866-015-0478-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 07/06/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The mechanical transmission of pathogenic bacteria by synanthropic filth flies is widely recognized. While many studies report the fate and the temporospatial distribution of ingested foodborne bacteria by filth flies, there is little evidence about the transmission dynamics of ingested foodborne bacteria by adult house flies (Musca domestica) to their progeny. In this study, we fed parental house fly adults with food contaminated with low, medium, and high concentrations of Salmonella enterica, Cronobacter sakazakii, Escherichia coli O157:H7, and Listeria monocytogenes and evaluated the probability of transmission of these pathogens to house fly eggs and the surface and the alimentary canal of their first filial (F1) generation adults. RESULTS All foodborne pathogens were present in samples containing pooled house fly eggs. The probability of transmission was higher after parental house flies ingested food containing medium bacterial loads. Cronobacter sakazakii was 16, 6, and 3 times more likely to be transmitted to house fly eggs than S. enterica, E. coli O157:H7, and L. monocytogenes, respectively. Only S. enterica and C. sakazakii were transmitted to F1 generation adults and their presence was 2.4 times more likely on their body surfaces than in their alimentary canals. The highest probabilities of finding S. enterica (60 %) and C. sakazakii (28 %) on newly emerged F1 adults were observed after parental house flies ingested food containing medium and high levels of these pathogens, respectively. CONCLUSION Our study demonstrates that adult house flies that fed from food contaminated with various levels of foodborne bacteria were able to transmit those pathogens to their eggs and some were further transmitted to newly emerged F1 generation adults, enhancing the vector potential of these insects. Understanding the type of associations that synanthropic filth flies establish with foodborne pathogens will help to elucidate transmission mechanisms and possible ways to mitigate the spread of foodborne pathogens.
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Affiliation(s)
- Monica Pava-Ripoll
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, Office of Food Safety, 5100 Paint Branch Pkwy, College Park, MD, 20740, USA.
| | - Rachel E Goeriz Pearson
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, Office of Food Safety, 5100 Paint Branch Pkwy, College Park, MD, 20740, USA.
| | - Amy K Miller
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, Office of Food Safety, 5100 Paint Branch Pkwy, College Park, MD, 20740, USA.
| | - Ben D Tall
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, Office of Applied Research and Safety Assessment, 8301 Muirkirk Rd, Laurel, MD, 20708, USA.
| | - Christine E Keys
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, Office of Regulatory Science, 5100 Paint Branch Pkwy, College Park, MD, 20740, USA.
| | - George C Ziobro
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, Office of Food Safety, 5100 Paint Branch Pkwy, College Park, MD, 20740, USA.
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Warren JM, Birrell AL. Trachoma in remote Indigenous Australia: a review and public health perspective. Aust N Z J Public Health 2015; 40 Suppl 1:S48-52. [PMID: 26123218 DOI: 10.1111/1753-6405.12396] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 01/01/2015] [Accepted: 02/01/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Trachoma remains a major health concern in many remote Indigenous Australian communities, despite behaviour-modifying and biomedical strategies. This review aims to examine the social epidemiology of trachoma in remote Indigenous communities and identify practical, sustainable strategies to alter the social determinants of the disease. METHODS A systematic search and critical review explored the proximal, intermediate and distal determinants of trachoma. The impact of swimming pools in remote Indigenous communities on trachoma and other infectious diseases was further examined. RESULTS Having a clean face was found to be protective for trachoma, but face-washing education programs have produced no significant benefits. Sanitation infrastructure in a community was the key determinant of facial cleanliness. Installation of swimming pools in remote Indigenous communities has been demonstrated to reduce the prevalence of several common childhood infections. However, minimal research has explored the impact of pools on trachoma rates. CONCLUSIONS The locally supported construction of pools in remote Indigenous communities may contribute to a decline in trachoma. A prospective, controlled trial is needed to test this hypothesis in endemic communities. IMPLICATIONS If validated by a well-designed study, pool construction may provide a much sought-after practical government strategy to combat trachoma in remote Indigenous communities.
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Das JK, Salam RA, Hoda M, Lassi ZS, Bhutta ZA. Interventions to control flies for preventing diarrhoea in children under five years of age. Hippokratia 2015. [DOI: 10.1002/14651858.cd011654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jai K Das
- Aga Khan University Hospital; Division of Women and Child Health; Stadium Road, P.O. Box 3500 Karachi Sind Pakistan
| | - Rehana A Salam
- Aga Khan University Hospital; Division of Women and Child Health; Stadium Road, P.O. Box 3500 Karachi Sind Pakistan
| | - Mehar Hoda
- Aga Khan University Hospital; Division of Women and Child Health; Stadium Road, P.O. Box 3500 Karachi Sind Pakistan
| | - Zohra S Lassi
- The University of Adelaide; ARCH: Australian Research Centre for Health of Women and Babies, The Robinson Research Institute, Discipline of Obstetrics and Gynaecology; Adelaide South Australia Australia 5005
| | - Zulfiqar A Bhutta
- Hospital for Sick Children; Center for Global Child Health; Toronto ON Canada M5G A04
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Jimenez V, Gelderblom HC, Mann Flueckiger R, Emerson PM, Haddad D. Mass drug administration for trachoma: how long is not long enough? PLoS Negl Trop Dis 2015; 9:e0003610. [PMID: 25799168 PMCID: PMC4370651 DOI: 10.1371/journal.pntd.0003610] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 02/09/2015] [Indexed: 11/20/2022] Open
Abstract
Background Blinding trachoma is targeted for elimination by 2020 using the SAFE strategy (Surgery, Antibiotics, Facial cleanliness, and Environmental improvements). Annual mass drug administration (MDA) with azithromycin is a cornerstone of this strategy. If baseline prevalence of clinical signs of trachomatous inflammation – follicular among 1-9 year-olds (TF1-9) is ≥10% but <30%, the World Health Organization guidelines are for at least 3 annual MDAs; if ≥30%, 5. We assessed the likelihood of achieving the global elimination target of TF1-9 <5% at 3 and 5 year evaluations using program reports. Methodology/Principal Findings We used the International Trachoma Initiative’s prevalence and treatment database. Of 283 cross-sectional survey pairs with baseline and follow-up data, MDA was conducted in 170 districts. Linear and logistic regression modeling was applied to these to investigate the effect of MDA on baseline prevalence. Reduction to <5% was less likely, though not impossible, at higher baseline TF1-9 prevalences. Increased number of annual MDAs, as well as no skipped MDAs, were significant predictors of reduced TF1-9 at follow-up. The probability of achieving the <5% target was <50% for areas with ≥30% TF1-9 prevalence at baseline, even with 7 or more continuous annual MDAs. Conclusions Number of annual MDAs alone appears insufficient to predict program progress; more information on the effects of baseline prevalence, coverage, and underlying environmental and hygienic conditions is needed. Programs should not skip MDAs, and at prevalences >30%, 7 or more annual MDAs may be required to achieve the target. There are five years left before the 2020 deadline to eliminate blinding trachoma. Low endemic settings are poised to succeed in their elimination goals. However, newly-identified high prevalence districts warrant immediate inclusion in the global program. Intensified application of the SAFE strategy is needed in order to guarantee blinding trachoma elimination by 2020. Trachoma, the world’s leading infectious cause of blindness, is scheduled for elimination by 2020. Reaching this elimination target depends on successful implementation of the SAFE strategy (Surgery, Antibiotics, Facial cleanliness, and Environmental improvements). Annual mass antibiotic distributions are key to breaking the cycle of transmission in a community. However, it is not clear how many annual mass treatments need to be carried out in order to achieve elimination. Our study analyzes the effect of mass antibiotic distribution on different baseline prevalence levels of trachoma, in order to assess factors that affect the success of reaching elimination goals. We find that the prevailing belief, which suggests that 3 annual mass treatments can achieve local elimination of trachoma at prevalences between 10–30%, and 5 annual mass treatments for districts above this benchmark, is probably incorrect. In fact, much longer intervals may be required with “business as usual” programmatic strategies, which often include skipped years of treatment. Districts with high prevalence levels may require more intense treatment strategies to eliminate trachoma. Intensified recommendations must be implemented without delay in order to reach the 2020 elimination deadline.
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Affiliation(s)
- Violeta Jimenez
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- International Trachoma Initiative, Task Force for Global Health, Emory University, Atlanta, Georgia, United States of America
- Global Ophthalmology Emory, Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Huub C. Gelderblom
- International Trachoma Initiative, Task Force for Global Health, Emory University, Atlanta, Georgia, United States of America
| | - Rebecca Mann Flueckiger
- International Trachoma Initiative, Task Force for Global Health, Emory University, Atlanta, Georgia, United States of America
| | - Paul M. Emerson
- International Trachoma Initiative, Task Force for Global Health, Emory University, Atlanta, Georgia, United States of America
| | - Danny Haddad
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Global Ophthalmology Emory, Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia, United States of America
- * E-mail:
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Stoffolano JG, Patel B, Tran L. Effect of Crop Volume on Contraction Rate in Adult House Fly. ANNALS OF THE ENTOMOLOGICAL SOCIETY OF AMERICA 2014; 107:848-852. [PMID: 32287359 PMCID: PMC7109989 DOI: 10.1603/an13127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 04/29/2014] [Indexed: 05/28/2023]
Abstract
The functional aspects of the adult house fly crop have not been studied even though various human and domestic animal pathogens have been discovered within the crop lumen. The average volume consumed (midgut and crop) by flies starved for 24 h was 3.88 μl by feeding both sexes on a sucrose phosphate glutamate buffer. In addition, various volumes of a solution (0.125 M sucrose plus Amaranth dye) were fed to 3-d-old adult female house flies to quantify the crop contraction rate as affected by crop volume. As crop volume increased, the contraction rate increased until it reached a peak at 2 μl, after which it declined. It is hypothesized that the high contraction rate of the crop, which in house fly is almost twice the rate of three other fly species, is one of the factors that makes house fly an excellent vector. The mechanism for such a high contraction rate needs to be investigated.
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Affiliation(s)
- John G. Stoffolano
- Stockbridge School of Agriculture, University of Massachusetts Amherst, 204A Fernald Hall, 270 Stockbridge Road, Amherst, MA 01003
| | - Bhavi Patel
- Stockbridge School of Agriculture, University of Massachusetts Amherst, 204A Fernald Hall, 270 Stockbridge Road, Amherst, MA 01003
| | - Lynn Tran
- Stockbridge School of Agriculture, University of Massachusetts Amherst, 204A Fernald Hall, 270 Stockbridge Road, Amherst, MA 01003
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Mousa A, Courtright P, Kazanjian A, Bassett K. Prevalence of Visual Impairment and Blindness in Upper Egypt: A Gender-based Perspective. Ophthalmic Epidemiol 2014; 21:190-6. [DOI: 10.3109/09286586.2014.906629] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ahmed Mousa
- Department of Ophthalmology, College of Medicine, King Saud University
RiyadhSaudi Arabia
| | - Paul Courtright
- Kilimanjaro Centre for Community Ophthalmology International, Division of Ophthalmology, University of Cape Town
Cape TownSouth Africa
- School of Population and Public Health
- British Columbia Centre for Epidemiologic and International Ophthalmology, University of British Columbia
VancouverCanada
| | | | - Ken Bassett
- British Columbia Centre for Epidemiologic and International Ophthalmology, University of British Columbia
VancouverCanada
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Ramesh A, Kovats S, Haslam D, Schmidt E, Gilbert CE. The impact of climatic risk factors on the prevalence, distribution, and severity of acute and chronic trachoma. PLoS Negl Trop Dis 2013; 7:e2513. [PMID: 24244768 PMCID: PMC3820701 DOI: 10.1371/journal.pntd.0002513] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 09/18/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Trachoma is the most common cause of infectious blindness. Hot, dry climates, dust and water scarcity are thought to be associated with the distribution of trachoma but the evidence is unclear. The aim of this study was to evaluate the epidemiological evidence regarding the extent to which climatic factors explain the current prevalence, distribution, and severity of acute and chronic trachoma. Understanding the present relationship between climate and trachoma could help inform current and future disease elimination. METHODS A systematic review of peer-reviewed literature was conducted to identify observational studies which quantified an association between climate factors and acute or chronic trachoma and which met the inclusion and exclusion criteria. Studies that assessed the association between climate types and trachoma prevalence were also reviewed. RESULTS Only eight of the 1751 papers retrieved met the inclusion criteria, all undertaken in Africa. Several papers reported an association between trachoma prevalence and altitude in highly endemic areas, providing some evidence of a role for temperature in the transmission of acute disease. A robust mapping study found strong evidence of an association between low rainfall and active trachoma. There is also consistent but weak evidence that the prevalence of trachoma is higher in savannah-type ecological zones. There were no studies on the effect of climate in low endemic areas, nor on the effect of dust on trachoma. CONCLUSION Current evidence on the potential role of climate on trachoma distribution is limited, despite a wealth of anecdotal evidence. Temperature and rainfall appear to play a role in the transmission of acute trachoma, possibly mediated through reduced activity of flies at lower temperatures. Further research is needed on climate and other environmental and behavioural factors, particularly in arid and savannah areas. Many studies did not adequately control for socioeconomic or environmental confounders.
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Affiliation(s)
- Anita Ramesh
- International Centre of Eye Health (ICEH), Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Sari Kovats
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
- * E-mail:
| | - Dominic Haslam
- Sightsavers International, Haywards Heath, United Kingdom
| | - Elena Schmidt
- Sightsavers International, Haywards Heath, United Kingdom
| | - Clare E. Gilbert
- International Centre of Eye Health (ICEH), Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
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Ross RK, King JD, Damte M, Ayalew F, Gebre T, Cromwell EA, Teferi T, Emerson PM. Evaluation of household latrine coverage in Kewot woreda, Ethiopia, 3 years after implementing interventions to control blinding trachoma. Int Health 2013; 3:251-8. [PMID: 24038498 DOI: 10.1016/j.inhe.2011.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The SAFE strategy for trachoma control includes Surgery, Antibiotic distribution, Facial cleanliness and Environmental improvements, including promotion of latrine construction. In this study, household latrine coverage was estimated in order to evaluate SAFE implementation in a district of Ethiopia where reported coverage in rural areas was 97%. Characteristics of latrine adopters and non-adopters were explored. Interviews were conducted in 442 households selected at random in a multistage cluster sample. Overall, estimated household latrine coverage was 56.2% (95% CI 37.5-74.8%) and in rural areas coverage was 67.7% (95% CI 59.6-75.7%). Previously owning a latrine was reported by 12.7% (95% CI 8.9-16.5%) of respondents, of which 32.0% (95% CI 15.9-48.2%) had built a replacement. Latrine adopters were more likely to be male (P < 0.0001), to report their primary occupation as agriculture (P < 0.0001), have more than five residents in their household (P = 0.004) and live in a rural area (P < 0.0001). Respondents who were advised by a health extension worker (P < 0.0001) or development agent (P < 0.0001) were more likely to have built a latrine. Household latrine coverage has increased from the 2007 zonal estimate (8.9%), but was lower than that reported. Latrine promotion should include emphasis on rebuilding latrines. More support may be needed by small households as well as those with a female head if universal latrine access is to be achieved in Kewot.
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Affiliation(s)
- Rachael K Ross
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, USA
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Stoller NE, Gebre T, Ayele B, Zerihun M, Assefa Y, Habte D, Zhou Z, Porco TC, Keenan JD, House JI, Gaynor BD, Lietman TM, Emerson PM. Efficacy of latrine promotion on emergence of infection with ocular Chlamydia trachomatis after mass antibiotic treatment: a cluster-randomized trial. Int Health 2013; 3:75-84. [PMID: 21785663 DOI: 10.1016/j.inhe.2011.03.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The World Health Organization (WHO) recommends environmental improvements such as latrine construction in the integrated trachoma control strategy, SAFE. We report a cluster-randomized trial assessing the effect of intensive latrine promotion on emergence of infection with ocular Chlamydia trachomatis after mass treatment with antibiotics.Twenty-four communities in Goncha Seso Enesie woreda, Amhara Regional State, Ethiopia, were enumerated, and a random selection of 60 children aged 0- 9 years in each was monitored for clinical signs of trachoma and ocular chlamydial infection at baseline, 12 and 24 months. All community members were offered treatment with a single dose of oral azithromycin or topical tetracycline. After treatment, 12 subkebeles were randomized to receive intensive latrine promotion. Mean cluster ocular infection in the latrine and the non-latrine arms were reduced from 45.5% (95% CI 34.1-56.8%) and 43.0% (95% CI 31.1-54.8%) respectively at baseline to 14.6% (95% CI 7.4-21.8%) and 14.8% (95% CI 8.9-20.8%) respectively at 24 months (P=0.93). Clinical signs fell from 72.0% (95% CI 58.2-85.5%) and 61.3% (95% CI 44.0-78.5%) at baseline to 45.8% (36.0-55.6%) and 48.5% (34.0-62.9%) respectively at 24 months (P=0.69). At 24 months, estimated household latrine coverage and use were 80.8% and 61.7% respectively where there had been intensive latrine promotion and 30.0% and 25.0% respectively in the single treatment only arm. We were unable to detect a difference in the prevalence of ocular chlamydial infection in children due to latrine construction.
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Affiliation(s)
- Nicole E Stoller
- F.I. Proctor Foundation, University of California San Francisco, USA
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Characteristics of latrines in central Tanzania and their relation to fly catches. PLoS One 2013; 8:e67951. [PMID: 23874475 PMCID: PMC3715525 DOI: 10.1371/journal.pone.0067951] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 05/23/2013] [Indexed: 11/29/2022] Open
Abstract
The disposal of human excreta in latrines is an important step in reducing the transmission of diarrhoeal diseases. However, in latrines, flies can access the latrine contents and serve as a mechanical transmitter of diarrhoeal pathogens. Furthermore, the latrine contents can be used as a breeding site for flies, which may further contribute to disease transmission. Latrines do not all produce flies, and there are some which produce only a few, while others can produce thousands. In order to understand the role of the latrine in determining this productivity, a pilot study was conducted, in which fifty latrines were observed in and around Ifakara, Tanzania. The characteristics of the latrine superstructure, use of the latrine, and chemical characteristics of pit latrine contents were compared to the numbers of flies collected in an exit trap placed over the drop hole in the latrine. Absence of a roof was found to have a significant positive association (t=3.17, p=0.003) with the total number of flies collected, and temporary superstructures, particularly as opposed to brick superstructures (z=4.26, p<0.001), and increased total solids in pit latrines (z=2.57, p=0.01) were significantly associated with increased numbers of blowflies leaving the latrine. The number of larvae per gram was significantly associated with the village from which samples were taken, with the largest difference between two villages outside Ifakara (z=2.12, p=0.03). The effect of latrine superstructure (roof, walls) on fly production may indicate that improvements in latrine construction could result in decreases in fly populations in areas where they transmit diarrhoeal pathogens.
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Noa Noatina B, Kagmeni G, Mengouo MN, Moungui HC, Tarini A, Zhang Y, Bella ALF. Prevalence of trachoma in the Far North region of Cameroon: results of a survey in 27 Health Districts. PLoS Negl Trop Dis 2013; 7:e2240. [PMID: 23717703 PMCID: PMC3662655 DOI: 10.1371/journal.pntd.0002240] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 01/02/2013] [Indexed: 12/05/2022] Open
Abstract
Background Cameroon is known to be endemic with trachoma. To appreciate the burden of the disease and facilitate the national planning of trachoma control in the integrated control program for the neglected tropical diseases, an epidemiological mapping of trachoma was conducted in the Far North region in 2010–11. Methodology A cross-sectional, cluster random sampling survey was carried out. The survey focused on two target populations: children aged 1 to 9 years for the prevalence of active trachoma and those aged 15 and over for the prevalence of trichiasis (TT). The sample frame was an exhaustive list of villages and neighborhoods of Health Districts (HDs). The World Health Organization simplified trachoma grading system was used for the recognition and registration of cases of trachoma. Principal Findings 48,844 children aged 1 to 9 years and 41,533 people aged 15 and over were examined. In children aged 1–9 years, the overall prevalence of trachomatous inflammation–follicular (TF) was 11.2% (95% confidence intervals (CI): 11.0–11.5%). More girls were affected than boys (p = 0.003). Thirteen (13) of 27 HDs in the region showed TF prevalence of ≥10%. The overall TT prevalence was 1.0% (95% CI: 0.9–1.1%). There were estimated 17193 (95% CI: 12576–25860) TT cases in the region. The prevalence of blindness was 0.04% (95% CI: 0.03–0.07%) and visual impairment was 0.09% (95% CI: 0.07–0.13%). Conclusions/Significance The survey confirmed that trachoma is a public health problem in the Far North region with 13 HDs qualified for district-level mass drug administration with azithromycin. It provided a foundation for the national program to plan and implement the SAFE strategy in the region. Effort must be made to find resources to provide the surgical operations to the 17193 TT cases and prevent them from becoming blind. Trachoma is the leading infectious cause of blindness in the world, which is caused by repeated eye infections with the bacterium Chlamydia trachomatis. The global objective of trachoma control is to eliminate trachoma as a blinding disease worldwide by Year 2020, using the World Health Organization-endorsed SAFE strategy (Surgery to correct trichiasis, Antibiotics to treat infection, Facial cleanliness and Environmental improvement to interrupt transmission). In order to implement the control program, the knowledge of the disease distribution and prevalence in each district is essential. Disease mapping surveys were conducted in 27 health districts in the Far North region in Cameroon. Thirteen health districts have a prevalence of trachomatous inflammation–follicular ≥10% in children aged 1–9 years and qualify for district-level mass antibiotic treatment as well as intensive implementation of other components of SAFE. There are estimated to be 17193 trichiasis cases in the region, which need surgical operations to prevent from being blinded. The survey provided a foundation for the national program to plan and implement the SAFE strategy in the region.
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Affiliation(s)
- Blaise Noa Noatina
- Programme National de Lutte Contre la Cécité, Ministère de la Santé, Yaoundé, Cameroun.
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Lindsay TC, Jawara M, D'Alessandro U, Pinder M, Lindsay SW. Development of odour-baited flytraps for sampling the African latrine fly, Chrysomya putoria, a putative vector of enteric diseases. PLoS One 2012; 7:e50505. [PMID: 23226296 PMCID: PMC3511572 DOI: 10.1371/journal.pone.0050505] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 10/22/2012] [Indexed: 11/21/2022] Open
Abstract
African pit latrines produce prodigious numbers of the latrine fly, Chrysomya putoria, a putative vector of diarrhoeal pathogens. We set out to develop a simple, low-cost odour-baited trap for collecting C. putoria in the field. A series of field experiments was carried out in The Gambia to assess the catching-efficiency of different trap designs. The basic trap was a transparent 3L polypropylene box baited with 50 g of fish, with a white opaque lid with circular entrance holes. We tested variations of the number, diameter, position and shape of the entrance holes, the height of the trap above ground, degree of transparency of the box, its shape, volume, colour, and the attractiveness of gridded surfaces on or under the trap. Traps were rotated between positions on different sampling occasions using a Latin Square design. The optimal trapping features were incorporated into a final trap that was tested against commercially available traps. Features of the trap that increased the number of flies caught included: larger entrance holes (compared with smaller ones, p<0.001), using conical collars inside the holes (compared with without collars, p = 0.01), entrance holes on the top of the trap (compared with the side or bottom, p<0.001), traps placed on the ground (compared with above ground, p<0.001), the box having transparent sides (compared with being opaque, p<0.001), and with no wire grids nearby (compared with those with grids, p = 0.03). This trap collected similar numbers of C. putoria to other common traps for blow flies. The optimum trap design was a transparent box, with a white plastic lid on top, perforated with 10 conical entrance holes, placed on the ground. Our simple trap provides a cheap, low-maintenance and effective method of sampling C. putoria in the field.
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Affiliation(s)
- Thomas C Lindsay
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Clasen T, Boisson S, Routray P, Cumming O, Jenkins M, Ensink JHJ, Bell M, Freeman MC, Peppin S, Schmidt WP. The effect of improved rural sanitation on diarrhoea and helminth infection: design of a cluster-randomized trial in Orissa, India. Emerg Themes Epidemiol 2012; 9:7. [PMID: 23148587 PMCID: PMC3558431 DOI: 10.1186/1742-7622-9-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 11/01/2012] [Indexed: 11/23/2022] Open
Abstract
Background Infectious diseases associated with poor sanitation such as diarrhoea, intestinal worms, trachoma and lymphatic filariasis continue to cause a large disease burden in low income settings and contribute substantially to child mortality and morbidity. Obtaining health impact data for rural sanitation campaigns poses a number of methodological challenges. Here we describe the design of a village-level cluster-randomised trial in the state of Orissa, India to evaluate the impact of an ongoing rural sanitation campaign conducted under the umbrella of India’s Total Sanitation Campaign (TSC).We randomised 50 villages to the intervention and 50 villages to control. In the intervention villages the implementing non-governmental organisations conducted community mobilisation and latrine construction with subsidies given to poor families. Control villages receive no intervention. Outcome measures include (1) diarrhoea in children under 5 and in all ages, (2) soil-transmitted helminth infections, (3) anthropometric measures, (4) water quality, (5) number of insect vectors (flies, mosquitoes), (6) exposure to faecal pathogens in the environment. In addition we are conducting process documentation (latrine construction and use, intervention reach), cost and cost-effectiveness analyses, spatial analyses and qualitative research on gender and water use for sanitation. Results Randomisation resulted in an acceptable balance between trial arms. The sample size requirements appear to be met for the main study outcomes. Delays in intervention roll-out caused logistical problems especially for the planning of health outcome follow-up surveys. Latrine coverage at the end of the construction period (55%) remained below the target of 70%, a result that may, however, be in line with many other TSC intervention areas in India. Conclusion We discuss a number of methodological problems encountered thus far in this study that may be typical for sanitation trials. Nevertheless, it is expected that the trial procedures will allow measuring the effectiveness of a typical rural sanitation campaign, with sufficient accuracy and validity.
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Affiliation(s)
- Thomas Clasen
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
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Lindsay SW, Lindsay TC, Duprez J, Hall MJR, Kwambana BA, Jawara M, Nurudeen IU, Sallah N, Wyatt N, D'Alessandro U, Pinder M, Antonio M. Chrysomya putoria, a putative vector of diarrheal diseases. PLoS Negl Trop Dis 2012; 6:e1895. [PMID: 23133694 PMCID: PMC3486903 DOI: 10.1371/journal.pntd.0001895] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 09/20/2012] [Indexed: 11/22/2022] Open
Abstract
Background Chrysomya spp are common blowflies in Africa, Asia and parts of South America and some species can reproduce in prodigious numbers in pit latrines. Because of their strong association with human feces and their synanthropic nature, we examined whether these flies are likely to be vectors of diarrheal pathogens. Methodology/Principal Findings Flies were sampled using exit traps placed over the drop holes of latrines in Gambian villages. Odor-baited fly traps were used to determine the relative attractiveness of different breeding and feeding media. The presence of bacteria on flies was confirmed by culture and bacterial DNA identified using PCR. A median of 7.00 flies/latrine/day (IQR = 0.0–25.25) was collected, of which 95% were Chrysomya spp, and of these nearly all were Chrysomya putoria (99%). More flies were collected from traps with feces from young children (median = 3.0, IQR = 1.75–10.75) and dogs (median = 1.50, IQR = 0.0–13.25) than from herbivores (median = 0.0, IQR = 0.0–0.0; goat, horse, cow and calf; p<0.001). Flies were strongly attracted to raw meat (median = 44.5, IQR = 26.25–143.00) compared with fish (median = 0.0, IQR = 0.0–19.75, ns), cooked and uncooked rice, and mangoes (median = 0.0, IQR = 0.0–0.0; p<0.001). Escherichia coli were cultured from the surface of 21% (15/72 agar plates) of Chrysomya spp and 10% of these were enterotoxigenic. Enteroaggregative E. coli were identified by PCR in 2% of homogenized Chrysomya spp, Shigella spp in 1.4% and Salmonella spp in 0.6% of samples. Conclusions/Significance The large numbers of C. putoria that can emerge from pit latrines, the presence of enteric pathogens on flies, and their strong attraction to raw meat and fish suggests these flies may be common vectors of diarrheal diseases in Africa. While it is well recognized that the house fly can transmit enteric pathogens, here we show the common African latrine fly, Chrysomya putoria, is likely to be an important vector of these pathogens, since an average latrine can produce 100,000 latrine flies each year. Our behavioral studies of flies in The Gambia show that latrine flies are attracted strongly to human feces, raw beef and fish, providing a clear mechanism for faecal pathogens to be transferred from faeces to food. We used PCR techniques to demonstrate that these flies are carrying Shigella, Salmonella and E. coli, all important causes of diarrhea. Moreover our culture work shows that these pathogens are viable. Latrine flies are likely to be important vectors of diarrheal disease, although further research is required to determine what proportion of infections are due to this fly.
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Affiliation(s)
- Steven W Lindsay
- School of Biological and Biomedical Sciences, Durham University, Durham City, United Kingdom.
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Mahande MJ, Mazigo HD, Kweka EJ. Association between water related factors and active trachoma in Hai district, Northern Tanzania. Infect Dis Poverty 2012; 1:10. [PMID: 23849896 PMCID: PMC3710161 DOI: 10.1186/2049-9957-1-10] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 09/25/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Trachoma is widely distributed in sub-Saharan Africa and is mainly associated with poor water accessibility. However, these associations have never been demonstrated in some of the communities, especially in northern Tanzania. To cover that gap, the present case control study was conducted to assess the association of water related factors, general hygiene and active trachoma among preschool and school age children in Hai district, northern Tanzania. RESULTS Families reported to use > 60 litres of water per day were less likely to have active disease (OR= 0.4, 95% CI: 0.1 - 0.3; P<0.001) compared to households collecting ≤ 60 litres. The risk of having trachoma increased with increase in distance to the water point (OR= 6.5, 95% CI; 1.8 - 16.7; P= 0.003). Households members who reported to use < 2 liters of water for face washing were more likely to be trachomatous (OR= 5.12, 95% CI: 1.87-14.6, P = 0.001). Increased number of preschool children in the household was also associated with increased risk of active trachoma by 2.46 folds. CONCLUSIONS Improving water supply near the households and providing public health education focusing on improving households socio-economic status and individual hygiene especially in pre-school children in part will help to reduce the prevalence of the disease. In addition, integrating public health education with other interventions such as medical interventions remains important.
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Affiliation(s)
- Michael J Mahande
- Department of Medical Parasitology and Entomology, Catholic University of Health and Allied Sciences, P,O, Box 1464, Mwanza, Tanzania.
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Mpyet C, Lass BD, Yahaya HB, Solomon AW. Prevalence of and risk factors for trachoma in Kano state, Nigeria. PLoS One 2012; 7:e40421. [PMID: 22792311 PMCID: PMC3391244 DOI: 10.1371/journal.pone.0040421] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 06/06/2012] [Indexed: 12/03/2022] Open
Abstract
Background In northern Nigeria, trachoma is an important public health problem, but there are currently few population-based data on prevalence of disease and no formal trachoma control programs. Methodology / Principal Findings In Kano state, Nigeria, we conducted a population-based cross-sectional survey using multistage cluster random sampling, combining examination for clinical signs of trachoma and application of questionnaires assessing potential household-level risk factors. A total of 4491 people were examined in 40 clusters, of whom 1572 were aged 1–9 years, and 2407 (53.6%) were female. In 1–9 year-olds, the prevalence of trachomatous inflammation–follicular (TF) was 17.5% (95% CI: 15.7–19.5%). In a multivariate model, independent risk factors for active trachoma were the presence of flies on the face (OR 1.98, 95% CI 1.30–3.02); a dirty face (OR 2.45, 95% CI 1.85–3.25) and presence of animal dung within the compound of residence (OR 3.46, 95% CI 1.62–7.41). The prevalence of trachomatous trichiasis in persons aged ≥15years was 10.9% (95% CI: 9.7–12.2%). Trichiasis was significantly more common in adult females than in adult males. Conclusion/Significance There is an urgent need for a trachoma control program in Kano state, with emphasis given to provision of good quality trichiasis surgery. Particular effort will need to be made to identify women with trichiasis and engage them with appropriate services while also taking steps to secure azithromycin for mass treatment and ensuring personal and environmental hygiene.
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Affiliation(s)
- Caleb Mpyet
- Department of Ophthalmology, Jos University Teaching Hospital, Jos, Nigeria.
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Lohmeyer KH, Pound JM. Laboratory evaluation of novaluron as a development site treatment for controlling larval horn flies, house flies, and stable flies (Diptera: Muscidae). JOURNAL OF MEDICAL ENTOMOLOGY 2012; 49:647-651. [PMID: 22679873 DOI: 10.1603/me11220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A granular formulation of novaluron (Novaluron 0.2G, 0.2% [AI]), a newer benzoylphenyl urea insecticide, was evaluated for its efficacy in controlling the larval stage of horn flies, Haematobia irritans (L.); house flies, Musca domestica L.; and stable flies, Stomoxys calcitrans (L.), in cow manure. Various rates and insecticide placement locations (top, middle, and bottom of manure) were evaluated in this study and all combinations of these variables reduced adult emergence of all three species when compared with the untreated controls. The presence of deformed pupae indicated that novaluron had an insect growth regulator effect on the developing fly larvae. Top, middle, or bottom application rates of 0.125, 0.195, 0.25, and 0.375 g novaluron onto manure samples, reduced adult horn fly emergence by > 90%. Middle and bottom application rates of 0.195, 0.25, and 0.375 g novaluron reduced adult house fly emergence >93%. All rates and placement combinations resulted in >98% reduction of adult stable fly emergence. The level of control efficacy observed against these three fly species along with the ease of use of a granular formulation, make this product an ideal candidate for use in an integrated livestock pest management program.
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Affiliation(s)
- K H Lohmeyer
- USDA-ARS, Knipling-Bushland U. S. Livestock Insects Research Laboratory, 2700 Fredericksburg Road, Kerrville, TX 78028, USA.
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Rabiu M, Alhassan MB, Ejere HOD, Evans JR. Environmental sanitary interventions for preventing active trachoma. Cochrane Database Syst Rev 2012; 2012:CD004003. [PMID: 22336798 PMCID: PMC4422499 DOI: 10.1002/14651858.cd004003.pub4] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Trachoma is a major cause of avoidable blindness. It is responsible for about six million blind people worldwide, mostly in the poor communities of developing countries. One of the major strategies advocated for the control of the disease is the application of various environmental sanitary measures to such communities. OBJECTIVES To assess the evidence for the effectiveness of environmental sanitary measures on the prevalence of active trachoma in endemic areas. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 9), MEDLINE (January 1950 to September 2011), EMBASE (January 1980 to September 2011), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to September 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and ClinicalTrials.gov (www.clinicaltrials.gov). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 23 September 2011. We checked the reference list of included trials and the Science Citation Index. We also contacted agencies, experts and researchers in trachoma control. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials comparing any form of environmental hygiene measures with no measure. These hygiene measures included fly control, provision of water and health education. Participants in the trials were people normally resident in the trachoma endemic areas. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and assessed the quality of the included trials. Study authors were contacted for additional information. Six trials met the inclusion criteria but we did not conduct meta-analysis due to heterogeneity of the studies. MAIN RESULTS We included six studies with a total of 12,294 participants from 79 communities. Two studies that assessed insecticide spray as a fly control measure found that trachoma is reduced by at least 55% to 61% with this measure compared to no intervention. However, another study did not find insecticide spray to be effective in reducing trachoma. One study found that another fly control measure, latrine provision, reduced trachoma by 29.5% compared to no intervention; this was, however, not statistically significantly different and findings have not been confirmed by a more recent study. Another study revealed that health education reduced the incidence of trachoma. These findings were not confirmed by a second study, however, which found that a modest health education programme with modest water supply did not reduce trachoma. However, all the studies have some methodological concerns. AUTHORS' CONCLUSIONS There is some evidence from two trials that insecticides are effective in reducing trachoma, however, this effect was not demonstrated in another trial that used insecticides. Two trials on latrine provision as a fly control measure have not demonstrated significant trachoma reduction. Health education had shown significant reduction of trachoma in one study but another study did not demonstrate similar findings. Generally there is a dearth of data to determine the effectiveness of all aspects of environmental sanitation in the control of trachoma.
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Affiliation(s)
- Mansur Rabiu
- Prevention of Blindness Union, Riyadh, Saudi Arabia.
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Koroma JB, Heck E, Vandy M, Sonnie M, Hodges M, MacArthur C, Sankara DP. The epidemiology of trachoma in the five northern districts of Sierra Leone. Ophthalmic Epidemiol 2011; 18:150-7. [PMID: 21780873 DOI: 10.3109/09286586.2011.594204] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE In 2008, a trachoma prevalence survey was conducted in the five northern districts of Sierra Leone to determine if and where specific components of the SAFE strategy (Surgery, Antibiotics, Face washing, Environmental change) should be initiated. METHODS A cross-sectional survey at district level was implemented using two-stage random cluster sampling: probability proportionate sampling was used to select villages in the first stage and compact segment sampling of households in the second stage. Both eyes of 16,780 individuals were examined using the World Health Organization simplified trachoma grading system. Data were also collected on village- and household-level behavior and environmental factors related to trachoma. RESULTS Prevalence of trachomatous inflammation-follicular (TF) in children aged 1-9 years was highest in Kambia at 3.52% (95% Confidence Interval (CI): 2.28-4.75%), while the prevalence of trachomatous trichiasis (TT) in persons over 15 years of age was highest in Port Loko at 0.27% (95% CI: 0.03-0.50%). Across all districts, the percentage of households reporting washing children's faces less than once per day was very low, while latrine coverage and accessible and safe water sources were not highly prevalent. CONCLUSIONS In all districts but Koinadugu, TT prevalence was greater than the WHO elimination threshold, indicating the need for 1,016 TT surgeries to prevent blindness. District TF prevalence rates did not warrant mass antibiotic distribution. Although not required given the low prevalence of TF, we recommend the construction of 35,941 household latrines and provision of water sources within a 30-minute walk roundtrip for 17,551 households to bring Sierra Leone closer to reaching Millennium Development Goal 7.
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Affiliation(s)
- Joseph Brima Koroma
- Neglected Tropical Diseases Control Programme, Ministry of Health and Sanitation, Government of Sierra Leone, New England, Freetown, Sierra Leone
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Curtis V, Schmidt W, Luby S, Florez R, Touré O, Biran A. Hygiene: new hopes, new horizons. THE LANCET. INFECTIOUS DISEASES 2011; 11:312-21. [PMID: 21453872 PMCID: PMC7106354 DOI: 10.1016/s1473-3099(10)70224-3] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although promotion of safe hygiene is the single most cost-effective means of preventing infectious disease, investment in hygiene is low both in the health and in the water and sanitation sectors. Evidence shows the benefit of improved hygiene, especially for improved handwashing and safe stool disposal. A growing understanding of what drives hygiene behaviour and creative partnerships are providing fresh approaches to change behaviour. However, some important gaps in our knowledge exist. For example, almost no trials of the effectiveness of interventions to improve food hygiene in developing countries are available. We also need to figure out how best to make safe hygiene practices matters of daily routine that are sustained by social norms on a mass scale. Full and active involvement of the health sector in getting safe hygiene to all homes, schools, and institutions will bring major gains to public health.
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Affiliation(s)
- Val Curtis
- The Hygiene Centre, London School of Hygiene and Tropical Medicine, London, UK.
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Ahmad A, Ghosh A, Schal C, Zurek L. Insects in confined swine operations carry a large antibiotic resistant and potentially virulent enterococcal community. BMC Microbiol 2011; 11:23. [PMID: 21269466 PMCID: PMC3039560 DOI: 10.1186/1471-2180-11-23] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Accepted: 01/26/2011] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Extensive use of antibiotics as growth promoters in the livestock industry constitutes strong selection pressure for evolution and selection of antibiotic resistant bacterial strains. Unfortunately, the microbial ecology and spread of these bacteria in the agricultural, urban, and suburban environments are poorly understood. Insects such as house flies (Musca domestica) and German cockroaches (Blattella germanica) can move freely between animal waste and food and may play a significant role in the dissemination of antibiotic resistant bacteria within and between animal production farms and from farms to residential settings. RESULTS Enterococci from the digestive tract of house flies (n = 162), and feces of German cockroaches (n = 83) and pigs (n = 119), collected from two commercial swine farms were isolated, quantified, identified, and screened for antibiotic resistance and virulence. The majority of samples (93.7%) were positive for enterococci with concentrations 4.2 ± 0.7 × 10⁴ CFU/house fly, 5.5 ± 1.1 × 10⁶ CFU/g of cockroach feces, and 3.2 ± 0.8 × 10⁵ CFU/g of pig feces. Among all the identified isolates (n = 639) Enterococcus faecalis was the most common (55.5%), followed by E. hirae (24.9%), E. faecium (12.8%), and E. casseliflavus (6.7%). E. faecalis was most prevalent in house flies and cockroaches, and E. hirae was most common in pig feces. Our data showed that multi-drug (mainly tetracycline and erythromycin) resistant enterococci were common from all three sources and frequently carried antibiotic resistance genes including tet(M) and erm(B) and Tn916/1545 transposon family. E. faecalis frequently harbored virulence factors gelE, esp, and asa1. PFGE analysis of selected E. faecalis and E. faecium isolates demonstrated that cockroaches and house flies shared some of the same enterococcal clones that were detected in the swine manure indicating that insects acquired enterococci from swine manure. CONCLUSIONS This study shows that house flies and German cockroaches in the confined swine production environment likely serve as vectors and/or reservoirs of antibiotic resistant and potentially virulent enterococci and consequently may play an important role in animal and public health.
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Affiliation(s)
- Aqeel Ahmad
- Department of Entomology, Kansas State University, Manhattan, KS, USA
- Monsanto Company, St. Louis, MO 63167, USA
| | - Anuradha Ghosh
- Department of Diagnostic Medicine and Pathobiology, Kansas State University, Manhattan, KS, USA
| | - Coby Schal
- Department of Entomology, North Carolina State University, Raleigh, NC, USA
| | - Ludek Zurek
- Department of Entomology, Kansas State University, Manhattan, KS, USA
- Department of Diagnostic Medicine and Pathobiology, Kansas State University, Manhattan, KS, USA
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Ecology and transmission of Buruli ulcer disease: a systematic review. PLoS Negl Trop Dis 2010; 4:e911. [PMID: 21179505 PMCID: PMC3001905 DOI: 10.1371/journal.pntd.0000911] [Citation(s) in RCA: 200] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Accepted: 11/11/2010] [Indexed: 01/27/2023] Open
Abstract
Buruli ulcer is a neglected emerging disease that has recently been reported in some countries as the second most frequent mycobacterial disease in humans after tuberculosis. Cases have been reported from at least 32 countries in Africa (mainly west), Australia, Southeast Asia, China, Central and South America, and the Western Pacific. Large lesions often result in scarring, contractual deformities, amputations, and disabilities, and in Africa, most cases of the disease occur in children between the ages of 4-15 years. This environmental mycobacterium, Mycobacterium ulcerans, is found in communities associated with rivers, swamps, wetlands, and human-linked changes in the aquatic environment, particularly those created as a result of environmental disturbance such as deforestation, dam construction, and agriculture. Buruli ulcer disease is often referred to as the "mysterious disease" because the mode of transmission remains unclear, although several hypotheses have been proposed. The above review reveals that various routes of transmission may occur, varying amongst epidemiological setting and geographic region, and that there may be some role for living agents as reservoirs and as vectors of M. ulcerans, in particular aquatic insects, adult mosquitoes or other biting arthropods. We discuss traditional and non-traditional methods for indicting the roles of living agents as biologically significant reservoirs and/or vectors of pathogens, and suggest an intellectual framework for establishing criteria for transmission. The application of these criteria to the transmission of M. ulcerans presents a significant challenge.
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Burton MJ, Holland MJ, Makalo P, Aryee EAN, Sillah A, Cohuet S, Natividad A, Alexander NDE, Mabey DCW, Bailey RL. Profound and sustained reduction in Chlamydia trachomatis in The Gambia: a five-year longitudinal study of trachoma endemic communities. PLoS Negl Trop Dis 2010; 4. [PMID: 20957147 PMCID: PMC2950148 DOI: 10.1371/journal.pntd.0000835] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 09/01/2010] [Indexed: 11/26/2022] Open
Abstract
Background The elimination of blinding trachoma focuses on controlling Chlamydia trachomatis infection through mass antibiotic treatment and measures to limit transmission. As the prevalence of disease declines, uncertainty increases over the most effective strategy for treatment. There are little long-term data on the effect of treatment on infection, especially in low prevalence settings, on which to base guidelines. Methodology/Principal Findings The population of a cluster of 14 Gambian villages with endemic trachoma was examined on seven occasions over five years (baseline, 2, 6, 12, 17, 30 and 60 months). Mass antibiotic treatment was given at baseline only. All families had accessible clean water all year round. New latrines were installed in each household after 17 months. Conjunctival swab samples were collected and tested for C. trachomatis by PCR. Before treatment the village-level prevalence of follicular trachoma in 1 to 9 year olds (TF%1–9) was 15.4% and C. trachomatis was 9.7%. Antibiotic treatment coverage was 83% of the population. In 12 villages all baseline infection cleared and few sporadic cases were detected during the following five years. In the other two villages treatment was followed by increased infection at two months, which was associated with extensive contact with other untreated communities. The prevalence of infection subsequently dropped to 0% in these 2 villages and 0.6% for the whole population by the end of the study in the absence of any further antibiotic treatment. However, several villages had a TF%1–9 of >10%, the threshold for initiating or continuing mass antibiotic treatment, in the absence of any detectable C. trachomatis. Conclusions/Significance A single round of mass antibiotic treatment may be sufficient in low prevalence settings to control C. trachomatis infection when combined with environmental conditions, which suppress transmission, such as a good water supply and sanitation. Trachoma is the most common infectious cause of blindness worldwide. Mass antibiotic treatment with azithromycin is used to control ocular Chlamydia trachomatis infection. There is uncertainty over how frequently and for how long treatment is needed, particularly in low prevalence settings. This study examines the effect of a single round of treatment on clinical disease and infection in a cluster of trachoma endemic Gambian villages over a five-year period. These villages had good water supplies and sanitation improved part way through the study. We found treatment was followed by a marked decline in infection prevalence (by PCR) to less than 1%. The decline in prevalence of active disease in children was less marked. Several villages had a prevalence of active trachoma in 1 to 9 year old children of greater than 10% during the follow-up period, mostly in the absence of detectable infection. The implication of this study is that a single, high coverage mass treatment may be sufficient to control C. trachomatis infection in a low prevalence setting, particularly when combined with environmental measures to limit transmission. However, relying on clinical signs to guide treatment decisions is likely to lead to significant amounts of over treatment where current guidelines are implemented.
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Affiliation(s)
- Matthew J Burton
- London School of Hygiene and Tropical Medicine, London, United Kingdom.
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