Neglected tropical diseases in sub-saharan Africa: review of their prevalence, distribution, and disease burden

Attitudes and acceptance of vaccination against neglected tropical diseases: A multi-country study in Asia

This study aims to explore the willingness of individuals to be vaccinated against NTDs in Asian countries and China. Between June and December 2023, an anonymous cross-sectional survey was carried out in five Asian countries alongside China. Overall, 48.4% indicated being somewhat willing and 29.2% expressing extreme willingness to receive NTDs vaccination. High attitude scores (adjusted odds ratio [aOR] = 1.54, 95% confidence interval (CI): 11.35-1.75) was associated with higher willingness to be vaccinated against NTDs. The odds of accepting the NTDs vaccine increased among individuals without occupational exposure to NTDs (aOR = 1.46, 95% CI: 1.27-1.68). Those residing in very clean environments exhibited heightened odds of willingness (aOR = 2.94, 95% CI: 2.10-4.11), whereas individuals in somewhat dirty environments demonstrated reduced odds of willingness (aOR = 0.74, 95% CI: 0.56-0.98) compared to the baseline group (very dirty local environment). Moreover, a higher score in sanitation facilities also correlated with increased odds of willingness to receive the NTDs vaccine (aOR = 1.41, 95% CI: 1.21-1.64). The study highlighted key strategies for improving NTDs vaccine uptake in Asian countries, including China, such as fostering positive attitudes toward the vaccine and enhancing perception of infection risks.

Sensitivity of Three Impact Assessment Methodologies in Adjusting Preventive Chemotherapy Treatment Decisions for Schistosomiasis Elimination in Ondo State, Nigeria

Efforts to eliminate schistosomiasis in Africa have advanced, with most countries evaluating the impact of preventive chemotherapy (PC) on disease burden. WHO has recommended eight distinct methodologies for such assessment. We, therefore, investigated the sensitivity of three prominent methodologies-sentinel, cluster, and practical, each varying in site selection, sampling approach, and data interpretation. We conducted a cross-sectional study among 2,093 children across 45 schools in Ese-Odo, Ile-Oluiji, and Irele local government areas (LGAs) of Ondo, Nigeria. Fresh stool and urine samples were processed using Kato-Katz and urine filtration techniques to estimate prevalence, which was compared with 2014 baseline estimates. Findings showed significant prevalence reductions in Ese-Odo from 1.3% (95% CI: 0.5-3.3) at baseline to 0.1% (95% CI: 0.01-0.95) at impact (d = -92.3%, P = 0.03) and in Ile-Oluiji from 58.0% (95% CI: 53.9-62.1) to 1.8% (95% CI: 0.9-3.3; d = -97%, P = 0.00). However, it increased from 3.0% (95% CI: 1.6-5.6) to 5.3% (95% CI: 3.8-7.3) in Irele (d = 66%, P = 0.13). Higher prevalence estimates were observed with the practical method compared with cluster and sentinel across the three LGAs: 0.3% versus 0.1% versus 0.0% in Ese-Odo, 5.8% versus 5.3% versus 5.4% in Irele, and 2.2% versus 1.8% versus 1.5% in Ile-Oluiji (all P >0.05). Sentinel and cluster methodologies suggest stopping PC, whereas the practical method suggests continued PC in Irele. Our findings demonstrate that practical assessment is a sensitive method for refining PC decisions.

Ongoing presence of Leishmania major cutaneous leishmaniasis in Mauritania, 2016-2024

BACKGROUND

Despite the presence of biologically confirmed cases, cutaneous leishmaniasis (CL) is still absent from the annual health statistical reports of the Ministry of Health in Mauritania. This study aimed to confirm the presence of CL in patients with compatible skin lesions in Mauritania.

METHODS

This cross-sectional descriptive study was conducted between September 2022 and August 2023 and between March and August 2024. It involved subjects with compatible skin lesions who attended dermatological consultations at various healthcare facilities in the Nouakchott and Assaba regions. In parallel, a retrospective study (2016-2024) analyzed data from suspect cases who visited the National Institute of Research in Public Health for laboratory diagnosis of CL infection. Biological confirmation was performed through microscopy using May-Grünwald Giemsa staining. During the cross-sectional study, PCR targeting the 3'UTR-Hsp70 region was also performed on filter papers used for dried blood spot.

RESULTS

Among the 37 suspected patients seen in dermatological consultation, 21 (57%) were female and 16 (43%) were male. The mean age of the subjects was 29 ± 18.4 with a median of 28 years. Skin smears from suspect lesions were positive in 21 (56.7%) patients while the PCR showed only 12 (40%) positive patients. Cutaneous Leishmaniasis infection was higher among women (66.6%) than men (33.3%) (combining microscopy and PCR). Leishmania major was the only encountered species. Skin lesions were dry in 38.1% (8/21), crusted in 33.3% (7/21) and superinfected in 28.6% (6/21) of the microscopy-positive CL cases. Of 21 microscopy-positive cases, 38.1% (8/21) had skin lesions in upper limbs, 47.6% (10/21) in lower limbs and 14.3% (3/21) in both upper and lower limbs. The majority of confirmed CL patients (61.9%; 13/21) had more than 2 skin lesions. In the retrospective study, 95 suspect cases of CL were identified between 2016 and 2024, including 48 (47.1%) cases confirmed by microscopy. These cases mainly came from the southern regions of Mauritania, such as Assaba (n = 15) and Grogol (n = 12).

CONCLUSION

The study confirms the ongoing presence of CL in Mauritania, particularly in the southern areas and provides confirmation of the presence of L. major. It underscores the urgent need to locally develop appropriate diagnostic tools and to authorize the commercialization of meglumine antimoniate in the country. Further studies should be conducted to better determine the disease burden, identify vectors and reservoirs and evaluate therapeutic options.

Optimal control strategies supported by system dynamics modelling: a study on hookworm disease in China

BACKGROUND

Hookworm disease remains a global health issue. In China, it persists with a 0.67% infection rate and uneven distribution in 2021. Optimized control strategies are needed. This study aims to optimize intervention strategies for hookworm disease in China.

METHODS

Structural analysis and parameter estimation were conducted using system dynamics theory. Key variables were identified via the Delphi method, leading to the creation of a causal loop diagram (CLD) and stock flow chart (SFC). Based on the SFC, parameter estimation and quantitative relationships were established and the model was validated. A cost-effectiveness model was then integrated into the intervention mechanism model. Various intervention measures were tested in the model to determine their cost-effectiveness ratio (CER) and effectiveness. Generalized linear models were constructed from simulation data, accounting for the impact of survey sites. The results were used to develop an optimized strategy for hookworm disease control.

RESULTS

In comparing drug treatment methods, whole population deworming (WPD) and key population deworming (KPD) showed lower CERs than examination and voluntarily deworming (EVD), saving 384.79-504.64 CNY and 354.35-506.21 CNY per infection reduced, respectively (P < 0.001). For WPD or KPD alone, CER decreased with increased drug coverage. For examination and deworming (ED) and EVD, CER was highest at 30% coverage for a 1-year intervention, but at 90% coverage for 2-5 years (P < 0.05). WPD, ED, and EVD had higher infection reduction rates than KPD, with ratios of 0.14-0.25, 0.10-0.19, and 0.08-0.17, respectively, over 1-5 years (P < 0.001). Continuous health education over 1-5 years showed that increasing coverage from a 10% baseline led to enhancing cost-effectiveness and intervention outcomes.

CONCLUSIONS

In high-endemic areas (infection rate ≥ 20%) in China, prioritize WPD for better cost-effectiveness and outcomes. In medium-endemic areas (5% ≤ infection rate < 20%) where WPD isn't feasible, use ED for cost-effectiveness and KPD for infection reduction, based on local needs. In low-endemic areas (infection rate < 5%), encourage voluntary examination and treatment due to limited cost-effectiveness of mass treatment. Combining drug treatment with extensive health education can enhance long-term control effect. This strategy can guide control efforts for hookworm diseases in China.

CLINICAL TRIAL NUMBER

Not applicable.

Chemistry as a Catalyst for Transforming the Health and Wealth of South Africa

South Africa's rich natural resources remain a key driver of its chemical industrialisation but are tainted and constrained by its complex colonial history. Thirty years since the advent of democracy in South Africa, deep sociopolitical inequalities are amplified by an intolerable infectious disease burden amongst disadvantaged communities. In that respect, South Africa shares challenges with many other nations in the Global South; there are limited opportunities for the economic development and growth needed to uplift all strata of society. This Viewpoint examines the role of the chemical sciences in South Africa's unique history and the current state of its academic and industrial sectors, with a focus on the intersection of chemistry, healthcare and biomedical research. We argue that the opportunities offered through chemistry research and development, including local manufacturing, should be exploited and that scientific advancements should be tailored to and integrated with the socioeconomic realities of South Africa for an effective and multidisciplinary approach to improving healthcare outcomes. This Viewpoint aims to inspire a renewed focus on the pivotal role of chemical scientists and their broader societal contributions to combating the country's infectious disease burden and shaping a healthier future for South Africa.

Biochemical, coagulation, and platelet count profiles among Schistosoma mansoni infected patients attending at selected Dembiya health institutions, Northwest Ethiopia

BACKGROUND

Schistosomiasis is a parasitic disease that causes coagulation disorders and biochemical abnormalities. This is due to liver failure, platelet destruction, disruption of blood flow, and endothelial function by the schistosomes. However, there is no adequate data on biochemical and coagulation profiles and platelet count of patients infected with Schistosoma mansoni in Dembiya Selected Health Institutions. Hence, the aim of this study was to assess the effect of Schistosoma mansoni infection on selected biochemical and coagulation profiles and platelet count.

METHOD

An institutional-based comparative cross-sectional study was conducted from March to August 2022 at Dembiya Primary Hospital, Chuahit Health Center, and Abrija Health Center, Northwest Ethiopia. A total of 70 individuals were enrolled in the study using convenient sampling techniques. A stool sample was collected for Schistosoma mansoni detection. Likewise, a blood sample was collected for biochemical and coagulation profiles and platelet count analysis. The data were analyzed using SPSS version 25. A p-value less than 0.05 was considered statistically significant.

RESULTS

Median values for alanine aminotransferase, aspartate aminotransferase, creatinine, total bilirubin, and direct bilirubin values were significantly higher, while total protein and glucose were significantly lower in Schistosoma mansoni infected than in the healthy control participants (P < 0.05). Prothrombin time, activated partial thromboplastin time, and international normalization ratio were significantly higher, while the platelet count was significantly lower in the Schistosoma mansoni infected than healthy control participants (P < 0.05). The values of alanine aminotransferase, aspartate aminotransferase, creatinine, total bilirubin, direct bilirubin, prothrombin time, activated partial thromboplastin time, and international normalization ratio were significantly higher, while total protein, glucose, and platelet count were significantly lower in those with moderate and heavy Schistosoma mansoni infection intensity compared to healthy control participants (P < 0.05). The number of Schistosoma mansoni eggs per gram of stool had a positive correlation with biochemical and coagulation profiles, except for total protein, glucose, and platelet count, which were correlated negatively in Schistosoma mansoni infected participants (P < 0.05).

CONCLUSION

Biochemical and coagulation profiles, including alanine aminotransferase, aspartate aminotransferase, creatinine, total bilirubin, direct bilirubin, glucose, total protein, prothrombin time, activated partial thromboplastin time, international normalization ratio, and platelet count, were significantly altered in S. mansoni infected participants compared to controls (p < 0.05). These findings underscore the need for routine biochemical and coagulation monitoring in endemic areas.

Primary CALVARIAL tuberculosis: A case report

INTRODUCTION

Calvarial tuberculosis is a rare manifestation of extra pulmonary tuberculosis. Primary calvarial tuberculosis, with no evidence of tuberculosis elsewhere in the body, is an even rarer entity. Most cases are often misdiagnosed as osteomyelitis, syphilis, or bony metastasis among others.

CASE PRESENTATION

We report a case of primary calvarial tuberculosis in a 17 years old female with complaints of progressively increasing swelling over the right frontoparietal region and headache with no history of previous tuberculosis. The patient was operated, and histopathological examination of excised tissue was suggestive of tubercular pathology. The patient is doing well after surgery and anti-tubercular therapy.

DISCUSSION

Skeletal tuberculosis occurs in approximately 1 % of cases of mycobacterial infection, and calvarial tuberculosis accounts for 0.2 % to 1.3 % of all cases of skeletal tuberculosis. Early clinical signs are usually absent. The emergence of a painless, fluctuant swelling stands out as the most common presentation. Radiological findings, which are very valuable tools to reach a diagnosis, are known to be variable and nonspecific. The gold standard for diagnosis is the demonstration of Acid Fast Bacilli (AFB) on microscopy and growth on culture. Treatment includes surgery and antituberculous therapy.

CONCLUSION

Primary calvarial tuberculosis is a rare entity that can present with diverse symptoms and mimic other pathologies. A high index of suspicion should be maintained, especially in endemic areas, to ensure timely and accurate diagnosis. Surgery and antituberculous therapy remain the treatment of choice. Follow up is crucial to monitor for recurrence and other associated complications.

Enhanced Nanogel Formulation Combining the Natural Photosensitizer Curcumin and Pectis brevipedunculata (Asteraceae) Essential Oil for Synergistic Daylight Photodynamic Therapy in Leishmaniasis Treatment

Background/Objectives: Neglected tropical diseases (NTDs), such as leishmaniasis, remain a global health challenge due to limited therapeutic options and rising drug resistance. In this study, we developed an advanced nanogel formulation incorporating curcumin (CUR) and Pectis brevipedunculata essential oil (EOPb) within an F127/Carbopol 974P matrix to enhance bioavailability and therapeutic efficacy against Leishmania (Leishmania) amazonensis (LLa) promastigotes. Methods: The chemical profile of EOPb was determined through GC-MS and NMR analyses, confirming the presence of key bioactive monoterpenes such as neral, geranial, α-pinene, and limonene. The nanogel formulation (nGPC) was optimized to ensure thermosensitivity, and stability, exhibiting a sol-gel transition at physiological temperatures. Rheological analysis revealed that nGPC exhibited Newtonian behavior at 5 °C, transitioning to shear-thinning and thixotropic characteristics at 25 and 32 °C, respectively. This behavior facilitates its application and controlled drug release, making it ideal for topical formulations. Dynamic light scattering (DLS) analysis demonstrated that nGPC maintained a stable nanoscale structure with hydrodynamic radius below 300 nm, while Fourier-transform infrared spectroscopy (FTIR) confirmed strong molecular interactions between EOPb, CUR, and the polymer matrix. Biological assays demonstrated that nGPC significantly enhanced anti-promastigote activity compared to free CUR and OEPb. Results: At the highest tested concentration (50 μg/mL EOPb and 17.5 μg/mL CUR) nGPC induced over 88% mortality in LLa promastigotes across 24, 48, and 72 h, indicating sustained efficacy. Even at lower concentrations, nGPC retained dose-dependent activity, suggesting a synergistic effect between CUR and EOPb. These findings highlight the potential of nGPC as an innovative nanocarrier for daylight photodynamic therapy (dPDT) in the treatment of leishmaniasis. Future studies will investigate the underlying mechanisms of this synergism and explore the potential application of photodynamic therapy (PDT) to further enhance therapeutic outcomes.

The retinoic acid family-like nuclear receptor SmRAR identified by single-cell transcriptomics of ovarian cells controls oocyte differentiation in Schistosoma mansoni

Studies on transcription regulation in platyhelminth development are scarce, especially for parasitic flatworms. Here, we employed single-cell transcriptomics to identify genes involved in reproductive development in the trematode model Schistosoma mansoni. This parasite causes schistosomiasis, a major neglected infectious disease affecting >240 million people worldwide. The pathology of schistosomiasis is closely associated with schistosome eggs deposited in host organs including the liver. Unlike other trematodes, schistosomes exhibit distinct sexes, with egg production reliant on the pairing-dependent maturation of female reproductive organs. Despite this significance, the molecular mechanisms underlying ovary development and oocyte differentiation remain largely unexplored. Utilizing an organ isolation approach for S. mansoni, we extracted ovaries of paired females followed by single-cell RNA sequencing (RNA-seq) with disassociated oocytes. A total of 1967 oocytes expressing 7872 genes passed quality control (QC) filtering. Unsupervised clustering revealed four distinct cell clusters: somatic, germ cells and progeny, intermediate and late germ cells. Among distinct marker genes for each cluster, we identified a hitherto uncharacterized transcription factor of the retinoic acid receptor family, SmRAR. Functional analyses of SmRAR and associated genes like Smmeiob (meiosis-specific, oligonucleotide/oligosaccharide binding motif (OB) domain-containing) demonstrated their pairing-dependent and ovary-preferential expression and their decisive roles in oocyte differentiation of S. mansoni.

Schistosomiasis Burden and Trend Analysis in Africa: Insights from the Global Burden of Disease Study 2021

Schistosomiasis remains a major public health concern in Africa, despite global efforts to eliminate the disease by 2030. This study estimates the burden, trends, and inequalities of schistosomiasis in Africa from 1990 to 2021, and projects future prevalence to inform the WHO's elimination strategies. Data from the Global Burden of Disease Study (GBD 2021) were used to calculate annual average percentage change (AAPC) and annual percentage change (APC), with spatial global autocorrelation analysis performed to examine temporal and spatial trends. Five modeling algorithms were constructed to predict disease burden in Africa from 2022 to 2041. The age-standardized prevalences rate (ASPR) of schistosomiasis in Africa decreased from 18,495.51 per 100,000 in 1990 to 9,461.76 per 100,000 in 2021. The total number of cases, disability-adjusted life-years (DALYs), and mortality accounted for 84.25%, 87.92% and 87.28% of the global totals, respectively. ARIMA modeling predicts that by 2030, the ASPR will reach 3.99%. Despite progress, the burden remains significant, and intensified efforts are needed, particularly in high-burden regions like West Africa, to meet the WHO's 2030 elimination targets.

Changes in schistosomiasis prevalence after 2 years of an integrated intervention in the Itilima district of Tanzania

Schistosomiasis remains one of the most prevalent neglected tropical diseases in Tanzania. World Vision Tanzania, in collaboration with the Ministry of Health through the National Neglected Tropical Diseases Control Programme, implemented school- and community-based mass drug administrations, community-led total sanitation, and community voice and action from 2020 to 2022. This study assessed changes in the prevalence of schistosomiasis in the Itilima district of northwestern Tanzania following the implementation of these integrated interventions. A total of 1,405 students from 22 schools participated in the baseline survey in August to September 2020, and 1,320 in September 2022. Additionally, 368 adults from 8 villages participated in the baseline survey, and 401 in the endline survey. The prevalence difference was calculated to assess changes before and after the integrated interventions. We also investigated risk factors for Schistosoma haematobium infection using endline data. The prevalence difference between 2020 and 2022 was -20.0% (95% confidence interval (CI)=-22.2%--17.7%, p<0.001) for students and -19.6% (95% CI=-22.2%--17.7%, p<0.001) for adults. Individuals without a latrine were more likely to have schistosomiasis (adjusted odds ratio=5.9, 95% CI=1.7-21.5, p=0.01) compared to those who had a latrine. The findings indicate substantial changes in schistosomiasis prevalence in the study area following the implementation of integrated interventions. To sustain these achievements in Itilima, a multi-sectorial approach is highly recommended to integrate additional measures for eliminating schistosomiasis as a public health problem.

Genomic basis of schistosome resistance in a molluscan vector of human schistosomiasis

Freshwater snails are obligate intermediate hosts for the transmission of schistosomiasis, one of the world's most devastating parasitic diseases. To decipher the mechanisms underlying snail resistance to schistosomes, recombinant inbred lines (RILs) were developed from two well-defined homozygous lines (iM line and iBS90) of the snail Biomphalaria glabrata. Whole-genome sequencing (WGS) was used to scan the genomes of 46 individual RIL snails, representing 46 RILs, half of which were resistant or susceptible to Schistosoma mansoni. Genome-wide association study (GWAS) and bin marker-assisted quantitative trait loci (QTLs) analysis, aided by our chromosome-level assembled genome, were conducted. A small genomic region (∼3 Mb) on chromosome 5 was identified as being associated with schistosome resistance, designated the B. glabrata schistosome resistance region 1 (BgSRR1). This study, built on our recently developed genetic and genomic resources, provides valuable insights into anti-schistosome mechanisms and the future development of snail-targeted biocontrol programs for schistosomiasis.

High-Throughput Screening of More Than 30,000 Compounds for Anthelmintics against Gastrointestinal Nematode Parasites

Gastrointestinal nematodes (GINs) are among the most common parasites of humans, livestock, and companion animals. GIN parasites infect 1-2 billion people worldwide, significantly impacting hundreds of millions of children, pregnant women, and adult workers, thereby perpetuating poverty. Two benzimidazoles with suboptimal efficacy are currently used to treat GINs in humans as part of mass drug administrations, with many instances of lower-than-expected or poor efficacy and possible resistance. Thus, new anthelmintics are urgently needed. However, screening methods for new anthelmintics using human GINs typically have low throughput. Here, using our novel screening pipeline that starts with human hookworms, we screened 30,238 unique small molecules from a wide range of compound libraries, including ones with generic diversity, repurposed drugs, natural derivatives, known mechanisms of action, as well as multiple target-focused libraries (e.g., targeting kinases, GPCRs, and neuronal proteins). We identified 55 compounds with broad-spectrum activity against adult stages of two evolutionary divergent GINs, hookworms (Ancylostoma ceylanicum) and whipworms (Trichuris muris). Based on known databases, the targets of these 55 compounds were predicted in nematode parasites. One novel scaffold from the diversity set library, F0317-0202, showed good activity (high motility inhibition) against both GINs. To better understand this novel scaffold's structure-activity relationships (SAR), we screened 28 analogs and created SAR models highlighting chemical and functional groups required for broad-spectrum activity. These studies validate our new and efficient screening pipeline at the level of tens of thousands of compounds and provide an important set of new GIN-active compounds for developing novel and broadly active anthelmintics.

Schistosomiasis status and health impact in preschool-aged children in hard-to-reach areas and populations of Homa Bay County, Kenya

Pediatric schistosomiasis in hard-to-reach communities is poorly understood, hampering tailored interventions. This study investigated the prevalence, intensity, health impact, and risk factors for schistosomiasis in preschool-aged children (PSAC) residing in hard-to-reach areas and populations of Homa Bay County, Kenya. A cross-sectional study was conducted among 476 PSAC aged 2-5 years across 6 islands in Lake Victoria, Homa Bay County, Kenya. Kato-Katz and urine filtration techniques diagnosed Schistosoma mansoni and S. haematobium infections respectively. Fecal occult blood (FOB) was tested to assess morbidity, and questionnaires captured sociodemographic and household water, sanitation, and hygiene data. Logistic regression models explored risk factors. The overall prevalence of S. mansoni was 26.0 %, varying considerably between islands; Ringiti had the highest prevalence (62.1 %), while Sukru had the lowest (7.7 %). No S. haematobium infections were diagnosed. Light infections were most common (15.4 %), followed by moderate (8.5 %) and heavy infections (2.2 %). Significantly increased odds for infection were observed in children aged four (aOR = 4.4, 95 % CI: 1.7-11.2) and five years (aOR = 5.6, 95 % CI: 2.2-14.5), in girls (aOR = 2.5, 95 % CI: 1.3-4.8), and in children living in Ringiti (aOR = 6.1, 95 % CI: 1.8-15.0). We noted a strong association between S. mansoni infection and FOB (aOR= 3.3, 95 % CI: 1.6-7.0). We found a high burden of schistosomiasis among PSAC in hard-to-reach communities of Homa Bay County, emphasizing the urgent need to include them in control programs. FOB could be a promising indicator for assessing schistosomiasis-related morbidity in this age group.

Prevalence, intensity and risk factors of soil-transmitted helminthiasis after five effective rounds of preventive chemotherapy across three implementation units in Ondo State, Nigeria

BACKGROUND

Routine epidemiological data are essential for monitoring the effectiveness of preventive chemotherapy (PC), optimizing resource allocation, and addressing the evolving needs in the elimination of soil-transmitted helminthiasis (STH). This study assesses the prevalence, intensity, and associated risk factors of STH following five rounds of albendazole-based PC in three implementation units (IUs) in Ondo State, Nigeria.

METHODOLOGY

Fresh stool samples were collected from 2,093 children aged 5-14 years across 45 systematically selected schools in three IUs: Ese-Odo, Irele, and Ile-Oluji. The samples were analyzed using the Kato-Katz technique. Additionally, standardized questionnaires were administered to gather data on demographics and access to water, sanitation, and hygiene (WASH) resources. Data analysis was conducted using R software version 4.3.2, with a 95% confidence interval.

PRINCIPAL FINDINGS/CONCLUSIONS

The parasitological data indicated a significant decline in the aggregated prevalence of STH across the three IUs. In Ese-Odo, the prevalence decreased to 25.8% (95% CI: 23.0-29.0) from 39% at baseline (d = -34%, p = 0.00). In Irele, prevalence dropped to 9.7% (95% CI: 7.6-12.0) from 51.3% at baseline (d = -81%, p = 0.00), and in Ile-Oluji, prevalence was reduced to 6.4% (95% CI: 4.6-8.7) from 23% at baseline (d = -72.2%, p = 0.00). The most prevalent STH species was Ascaris lumbricoides, with infection rates of 25.5%, 9.4%, and 6.4% in Ese-Odo, Irele, and Ile-Oluji, respectively, followed by Trichuris trichiura in Ese-Odo (2.7%) and Irele (0.4%), while hookworm infections were detected only in Irele (0.7%). The majority of infections were of low intensity in Ese-Odo (91.0%), Irele (96.8%), and Ile-Oluji (100%). Access to improved sanitation (17.7%, 54.9%, and 58.2%), improved water sources (24.5%, 66.1%, and 69.8%), and handwashing facilities (9.0%, 39.6%, and 25.4%) was suboptimal and significantly varied across Ese-Odo, Irele, and Ile-Oluji, respectively (p < 0.05). Open defecation rates were high in Ese-Odo (54.2%), Irele (36.3%), and Ile-Oluji (34.3%). In Ese-Odo, significant risk factors for STH infection included the use of hand-pump boreholes (AOR: 2.44, 95% CI: 1.23-4.88, p = 0.01), unprotected dug wells (AOR: 3.25, 95% CI: 0.96-11.36, p = 0.06), ventilated improved pit latrines (AOR: 3.95, 95% CI: 1.13-16.1, p = 0.04), pit latrines without a slab (AOR: 2.19, 95% CI: 1.27-3.8, p = 0.01), and failure to use soap after defecation, both when soap was available (AOR: 12.09, 95% CI: 1.86-112.97, p = 0.01) and when soap was unavailable (AOR: 8.19, 95% CI: 1.73-76.65, p = 0.04). In Irele, access to protected dug wells was marginally significant (AOR: 1.79, 95% CI: 0.96-3.21, p = 0.06), while in Ile-Oluji, access to river water emerged as a significant risk factor (AOR: 7.97, 95% CI: 1.81-58.58, p = 0.02). The use of rainwater was found to be protective across all three IUs. These findings demonstrate significant progress in reducing STH prevalence across the three IUs following PC interventions. However, the data underscores the need for enhanced efforts to improve access to and use of WASH facilities to achieve STH elimination.

A Review on the Epidemiology and Clinical Management of Neglected Tropical Diseases

Infectious disorders known as Neglected Tropical Diseases (NTDs) initially affect the world's underprivileged citizens. They have been disregarded for many years, first as a result of a general indifference to such a developing world and, more recently, as an outcome of the intense attention on AIDS, TB, and malaria. Tropical diseases mostly affect the region where health and hygiene are sacrificed, and most of the population lacks access to sufficient food and living resources. WHO has drafted and released the directions for regulation, prevention, and successful eradication of NTDs as per the revised roadmap of 2021-2030. This shifts from vertical disease programs to integrated cross-cutting methods. In the current work, we have provided comprehensive information on various aspects of neglected tropical diseases, including the clinical management of NTDs. This encompasses the causative agent of the diseases, their symptoms, pathogenesis, diagnosis, treatment, prognosis, and epidemiological perspective of major NTDs. This review will shed light on several perspectives of NTDs having influential roles in proposing strategies to control and treat them around the world.

Knowledge, attitudes and preventive practices towards soil-transmitted helminthiases among teachers in schools implementing the home-grown school feeding program in Enugu Metropolis, Enugu State, Nigeria

BACKGROUND

Soil-transmitted helminthiases (STHs) are prevalent in low- and middle-income countries, impacting school-aged children significantly. Teachers, integral to STH control through the Home-Grown School Feeding Program (HGSFP), need adequate knowledge, attitudes, and preventive practices (KAP) for successful STH prevention. However, there is limited research on teacher KAP regarding STH in Enugu State, particularly concerning its endemic nature. This study assessed the KAP of primary school teachers involved in the HGSFP in Enugu Metropolis, Nigeria, aiming to inform targeted interventions for STH control.

METHODS

This analytical cross-sectional study, conducted from September 2023 to January 2024, involved 108 primary school teachers from nine randomly selected schools in Enugu Metropolis, Nigeria. Data were collected using a structured questionnaire, which had undergone rigorous validation and reliability testing. Descriptive statistics, chi-square tests, and logistic regression analyses were performed.

RESULTS

While 69.4% of the teachers demonstrated good knowledge and 77.8% had good attitudes towards STH, only 27.8% reported good preventive practices. Younger teachers (25-34 years) exhibited better knowledge (94.1% vs. 56.4%, p = 0.018) and practices (52.9% vs. 30.8%, p = 0.015) compared to their older colleagues (≥ 45 years). Years of teaching experience significantly influenced attitudes, with teachers having 11-20 years of experience exhibiting the most favorable attitudes (95.8%, p = 0.030). Age was a significant predictor of good practice with teachers aged 35-44 years being 7.72 times more likely to report good practices than those ≥ 45 years (AOR: 7.72, 95% CI: 5.66-35.9).

CONCLUSIONS

The study reveals a critical disconnect between high levels of knowledge and positive attitudes towards STH among teachers and their lower levels of good preventive practices. This highlights that positive attitudes alone may not be sufficient for effective implementation of preventive measures. This underscores the need for targeted interventions, particularly tailored training for older and more experienced teachers. Incorporating evidence-based behavior change strategies, addressing potential barriers to practice implementation, and improving access to resources are crucial for enhancing STH prevention efforts within the HGSFP and safeguarding the health of teachers and students.

Intestinal parasitic infections among children aged 7-14 years in Mizan-Aman city, Southwest Ethiopia: a community-based cross-sectional study

Background

Intestinal parasitic infections continue to pose a major threat to human health globally, with a particularly high prevalence in developing countries. Soil-borne helminthiasis and schistosomiasis are notably widespread.

Objective

The objective of the study was to determine the prevalence and contributing factors of intestinal parasites infection among participants aged 7-14 years.

Methods

Community-wide prevalence study was undertaken from 30 August to 30 September 2021 in Mizan Aman Town. Socio-demographic information was collected using questionnaires. Three of the five kebels were randomly chosen. Households with children aged 7-14 were gathered from the chosen kebels and health post to recruit one eligible subject. Allocation of study subjects to each of the chosen kebels was computed proportionally. Two thick smear of Kato Katz technique was applied to examine stool samples. Data were entered and analyzed using SPSS version 20. To investigate the association between the dependent and independent variables, a logistic regression analysis was conducted. Statistics were considered significant for p-values under 0.05.

Results

The overall prevalence of intestinal parasites was 64.6% (215/333). Of these, 51.05% (170/333) were infected with STHs, while 13.5% (45/333) had S. mansoni. T. trichiura was the most prevalent helminth. Infection intensity ranged from light to moderate was observed. Prior information about STHs (aORr:2.022 = CI:1.222-3.340), poor knowledge about STHs (aOR:1.677 = CI:1.057-2.660), unaware of deworming as prevention method of S. mansoni (aOR:2.620:CI:1267-5.418), swimming (aOR:0.448:CI:0.176-0.992) and contact with water (aOR:0.402:CI:0.169-0.957) were significantly associated with the S. mansoni infection.

Conclusion and recommendation

The prevalence of intestinal parasite was high. Heavy infection was not recorded. Beyond mass deworming, the report emphasizes the necessity of ongoing public health interventions to address the high prevalence of these intestinal helminths.

Population genetics and molecular xenomonitoring of Biomphalaria freshwater snails along the southern shoreline of Lake Malawi, Malawi

BACKGROUND

Intestinal schistosomiasis was confirmed endemic in Mangochi District, Malawi, in May of 2018 following an unexpected encounter with discreet populations of Biomphalaria spp. freshwater snails during routine malacological surveillance activities. Since then, only limited malacological surveillance of Biomphalaria has been carried out, and so the distribution of Biomphalaria populations in this area is currently unclear. Additionally, sites of active Schistosoma mansoni transmission in this area are also unknown. In the present study, through extensive malacological surveillance, we aimed to formally document the distribution of Biomphalaria in Mangochi District. We also aimed to identify active intestinal schistosomiasis transmission sites in this area through subjecting all collected Biomphalaria to a recently developed S. mansoni-specific molecular xenomonitoring PCR.

METHODS

Three malacological surveys were carried out along the southern shoreline of Lake Malawi, Mangochi District, Malawi, in November 2021, July 2022 and October/November 2022. All collected Biomphalaria were subjected to cercarial shedding analysis to identify active Schistosoma infections. Shed cercariae were then genotyped to species level using a standard multi-locus PCR and Sanger sequencing protocol. Following this, a subset of Biomphalaria from each collection site were also genotyped to species level using a standard PCR and Sanger sequencing protocol. All collected Biomphalaria were then subjected to a recently developed S. mansoni-specific molecular xenomonitoring PCR to identify infected, but non-shedding, Biomphalaria.

RESULTS

A total of 589 Biomphalaria were collected across all three surveys. One single Biomphalaria (0.17%) specimen was found to be actively shedding Schistosoma cercariae, which were molecularly confirmed as S. mansoni. All genotyped Biomphalaria (n = 42) were molecularly identified as B. pfeifferi. A further 19 Biomphalaria specimens, collected from four different surveillance sites, were found to be infected with S. mansoni through molecular xenomonitoring. Intestinal schistosomiasis transmission was therefore identified at four different foci in Mangochi District.

CONCLUSIONS

Our study highlights the importance of molecular approaches to investigate Biomphalaria populations and monitor Biomphalaria-associated intestinal schistosomiasis transmission in endemic areas. As such, the continued development and use of such approaches, in particular the development and use of molecular xenomonitoring assays that can be carried out in resource-poor schistosomiasis-endemic settings, is encouraged. The revision of ongoing schistosomiasis control programmes in Mangochi District, in line with WHO recommendations, is also encouraged.

Hookworm infection and its determinants among schoolchildren in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Hookworm infection is a common problem among schoolchildren and mothers in tropical and subtropical countries, causing cognitive impairment, growth retardation in children and anaemia, low birth weight, preterm birth, and intrauterine growth delay in susceptible mothers. Since schoolchildren generally have a higher prevalence due to behavioral and hygiene-related factors, our systematic review and meta-analysis aimed to determine the prevalence and risk factors for Hookworm infection among schoolchildren in Ethiopia.

METHODS

Relevant studies were retrieved from several search databases. The data were extracted via a standard data extraction format, and STATA version 11 was utilized for the analysis. Funnel plots and Egger's regression tests were used to evaluate publication bias, whereas the I2 test was used to determine heterogeneity. A random effects model meta-analysis was conducted to determine the pooled prevalence and associated factors of Hookworm infection among schoolchildren.

RESULTS

In this review, 48 studies with 43,285 participants were included. The pooled prevalence of Hookworm among schoolchildren was 13.01% (95% CI: 10.52, 15.51). Hookworm infection was significantly associated with the inability to use protective footwear (OR = 5.90, 95% CI: 2.86, 12.18) and the inability to use latrines (OR = 3.04, 95% CI: 1.77, 5.23). Subgroup analysis by diagnostic methods revealed that the highest prevalence of Hookworm was found to be 28.50% (95% CI: 24.09, 32.91) using combinations of Kato-Katz, McMaster, and spontaneous tube sedimentation techniques.

CONCLUSION

Our study revealed that a significant prevalence of schoolchildren were affected by Hookworms, with substantial regional variations. This suggests that there is a need for better control measures such as improving hygiene, sanitation, and protective measures such as footwear. In addition, a combination of one or more diagnostic methods should be employed for better detection of parasites. This systematic review and meta-analysis have been registered in PROSPERO with reference number CRD42024558542.

Potential Interactions Between Soil-Transmitted Helminths and Herpes Simplex Virus Type II: Implications for Sexual and Reproductive Health in Sub-Saharan African

Sub-Saharan Africa (SSA) bears a disproportionate and overlapping burden of soil-transmitted helminths (STHs) and sexually transmitted viral infections. An estimated 232 million pre-school and school-aged children in SSA are vulnerable to STH infections. Together with this, SSA has a high prevalence of herpes simplex virus type II (HSV-2), the primary cause of genital herpes. Studies have examined the immunological interactions between STHs and human immunodeficiency virus and human papillomavirus during co-infections. However, epidemiological and immunological studies on STH-HSV-2 co-infections are lacking, therefore their impact on sexual and reproductive health is not fully understood. STH-driven Th2 immune responses are known to downregulate Th1/Th17 immune responses. Therefore, during STH-HSV-2 co-infections, STH-driven immune responses may alter host immunity to HSV-2 and HSV-2 pathology. Herein, we provide an overview of the burden of STH and HSV-2 infections in SSA, and host immune responses to STH and HSV-2 infections. Further, we emphasize the relevance and urgent need for (i) focused research into the interactions between these important pathogens, and (ii) integrated approaches to improve the clinical detection and management of STH-HSV-2 co-infections in SSA.

HDAC8 as a target in drug discovery: Function, structure and design

Histone deacetylases (HDACs) have emerged as prominent therapeutic targets in drug discovery. Among the members of the HDAC family, HDAC8 exhibits distinct structural and physiological features from other members of the class Ⅰ HDACs. In addition to histones, numerous non-histone substrates such as structural maintenance of chromosomes 3 (SMC3), p53, estrogen-related receptor alpha (ERRα), etc., have been identified for HDAC8, suggesting the involvement of HDAC8 in diverse biological processes. Studies have demonstrated that HDAC8 plays essential roles in certain disease development, e.g., acute myeloid leukemia (AML), neuroblastoma, and X-Linked disorders. Despite several HDAC8 inhibitors have been discovered, only one compound has progressed to clinical studies. Recently, novel strategies targeting HDAC8 have emerged, including identifying innovative zinc-chelating groups (ZBG), developing multi-target drugs, and HDAC8 PROTACs. This review aims to summarize recent progress in developing new HDAC8 inhibitors that incorporate novel strategies and provide an overview of the clinical improvements associated with HDAC8 inhibitors.

Human Schistosomiasis due to Schistosoma bovis in Nigeria

Schistosomiasis is a global public health challenge, especially in sub-Saharan Africa, where Nigeria has the highest burden of disease. Schistosoma hybrids have been discovered in various countries, including Nigeria, where livestock and human beings share common water resources. This study, carried out in three communities, two of which are endemic for urinary schistosomiasis, aimed to identify the urinary schistosomiasis causative agent by using a species-specific molecular technique and their evolutionary relationship. Polymerase chain reaction using primers specific for a partial DNA sequence of the mitochondrial cox1 gene of Schistosoma haematobium was carried out on pooled urine sediments preserved in 70% ethanol. DNA from the high-intensity pooled samples from Onye-Uku camp amplified, and a BLAST search identified the pooled samples as Schistosoma bovis, whereas S. haematobium DNA did not amplify. The phylogenetic relationship of the sequence showed that it clustered with an S. bovis hybrid obtained from a human host in Côte d'Ivoire and had close ancestry with isolates from cattle in Cameroon. This finding revealed the prevalence of S. bovis among some inhabitants in a zone in Nigeria where schistosomiasis is endemic.

Herpes simplex virus type 2 in sub-Saharan Africa and the potential impact of helminth immune modulation

Herpes simplex virus type 2 (HSV-2) and helminth infections are among the most widespread infectious diseases in sub-Saharan Africa (SSA). Helminths are known to modulate host immune responses and consequently impact the severity and outcomes of unrelated diseases, including allergies, autoimmune conditions, and infectious diseases. In this way, helminths may modulate essential immune responses against HSV-2 during co-infection and may alter susceptibility to and pathology of HSV-2. However, the epidemiology of STH/HSV-2 co-infections is understudied, and whether helminths influence the host immune response to HSV-2 is not well understood. In this perspective piece, we briefly examine the current knowledge on helminth immune modulation of important pathogens that are endemic to SSA, arguing that it is important to explore HSV-2 and helminth co-infections to elucidate potential interactions between HSV-2 and helminths. This is particularly relevant in SSA, where both pathogens are highly prevalent.

The burden of schistosomiasis among school-aged children in Ogoja, Nigeria: current level of infection years after mass drug administration with Praziquantel

Background

Despite various chemotherapy efforts and national-level regulations implemented by the Nigerian government and health sector stakeholders, Schistosoma infections persist as a public health issue.

Objective

This study assessed schistosomiasis prevalence among school-aged children in Ogoja Local Government Area, Cross River State, and identified risk factors for the disease.

Methods

Urine and faecal samples were examined using microscopy involving centrifugation and Kato-Katz techniques respectively.

Results

The overall prevalence of schistosomiasis was 9.7% (49/504). The prevalence of schistosomiasis was 10.8% and 8.7% among females and males, respectively. Schistosoma haematobium infection was higher in the 14-16 year age group (12.7%). Overall mean parasite load for urogenital schistosomiasis was 6.40 eggs/10 mL of urine and 36.00 eggs per gram (EPG) for intestinal schistosomiasis. Infection with schistosomiasis was higher among those who had not heard about schistosomiasis (17.8%) (p=0.000) and who did not know the cause of the infection (12.4%) (p=0.002). Swimming/bathing in open water (OR = 1.199), fetching water from streams/rivers (OR = 1.202), parents/guardians who had no formal education (OR = 2.722) and unemployment (OR = 2.904) were risk factors significantly associated with schistosomiasis (p P<0.05).

Conclusion

Although intensities of infections were generally low, prompt integrated control efforts are still required to lower helminth infection in the study area.

Incidence and Pathological Analysis of Parasitic Infections in Underserved Communities

Background

Parasitic infections remain a significant public health concern, particularly in underserved communities where access to healthcare and sanitation is limited. This study aims to investigate the incidence and pathological characteristics of parasitic infections in such communities, providing insights into the prevalence and impact of these infections on public health.

Materials and Methods

A cross-sectional study was conducted in underserved communities over a period of one year. A total of 500 participants were randomly selected and screened for parasitic infections through stool and blood samples. The samples were analyzed using microscopy and polymerase chain reaction (PCR) techniques to identify and quantify parasitic species. Pathological examinations were performed to assess the impact of infections on host tissues.

Results

The incidence of parasitic infections was found to be 35% among the study population. The most common parasites identified were Ascaris lumbricoides (40%), Giardia lamblia (25%), and Entamoeba histolytica (20%). Pathological analysis revealed that Ascaris lumbricoides caused significant intestinal inflammation in 30% of infected individuals, while Giardia lamblia was associated with malabsorption syndrome in 15% of cases. Entamoeba histolytica was linked to liver abscesses in 10% of the infected participants.

Conclusion

Parasitic infections are highly prevalent in underserved communities, with significant pathological impacts on affected individuals.

Prevalence of intestinal parasites and associated factors among patients with HIV/AIDS at the anti-retroviral treatment clinic of Mizan-Tepi University Teaching Hospital, Southwest Ethiopia

Background

Intestinal parasitic infections remain very common, particularly in areas with a high prevalence of immune-compromised patients, such as HIV/AIDS patients. The purpose of this study was to determine the prevalence of intestinal parasites and associated factors in people living with HIV/AIDS at an ART clinic in Mizan-Tepi University Teaching Hospital, southwest Ethiopia.

Method

A cross-sectional survey was conducted from July to September 2021. A total of 191 adult people living with HIV/AIDS participated in this study. Data on socio-demographic, clinical, and other risk factors were collected using a structured questionnaire. Stool samples were collected and processed using a direct wet mount, formol-ether concentration, and modified Ziehl-Nelson staining techniques. The data were analyzed using the Statistical Package for Social Sciences Version 25 software.

Results

Among 67 adult individuals living with HIV/AIDS, the prevalence of intestinal parasites was 35.1%. Specifically, 31.5% (45/143) of patients on antiretroviral therapy (ART) and 45.8% (22/48) of ART-naïve patients were infected. The distribution of intestinal parasites was as follows: protozoa were found in 14.7% of ART-treated patients and 22.9% of ART-naïve patients; helminths in 15.4% of ART-treated patients and 16.7% of ART-naïve patients; and opportunistic parasites in 1.4% of ART-treated patients and 6.25% of ART-naïve patients. Significant associations with a higher prevalence of intestinal parasites were observed for a CD4 count <200 cells/mm3 (Adjusted Odds Ratio [AOR] = 3.77; 95% Confidence Interval [CI]: 1.01-13.15; p = 0.04), consumption of unwashed raw vegetables (AOR = 3.29; 95% CI: 1.23-8.86; p = 0.02), and residing in rural areas (AOR = 2.34; 95% CI: 1.27-4.32; p = 0.01).

Conclusion

The findings indicate that a significant proportion of adults living with HIV/AIDS are affected by intestinal parasites, with a notably higher prevalence among ART-naïve patients compared to those on ART. Factors such as a low CD4 count, consumption of unwashed raw vegetables, and rural residence are associated with increased risk of intestinal parasite infections. These results underscore the importance of improving hygiene practices and access to healthcare, particularly in rural areas, to reduce the burden of parasitic infections among individuals living with HIV/AIDS.

Prevalence of human visceral leishmaniasis and its risk factors in Eastern Africa: a systematic review and meta-analysis

Introduction

Visceral Leishmaniasis, also known as kala-azar, is a potentially fatal, neglected tropical disease caused by the protozoan parasite Leishmania and transmitted through infected sandflies. It is one of the major global public health problems and contributors to economic crisis among people. Though different studies investigated human visceral leishmaniasis in Eastern Africa, the findings were inconsistent and inconclusive enough, and there is no representative data on this devastating public health concern. Therefore, this systematic review and meta-analysis aimed to determine the pooled prevalence and risk factors associated with human visceral leishmaniasis in Eastern Africa.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA 2020) guidelines were followed for this study. Databases such as PubMed/MEDLINE, CINAHL, LIVIVO, African Journals Online, African Index Medicus (AIM), HINARI, Science Direct, Web of Science, Cochrane Library, Google Scholar, Semantic Scholar, and Google were used to retrieve all the relevant articles. The search was carried out from 23 May 2024 to 17 July 2024. Data were analyzed using STATA 17 software to determine the pooled prevalence of human visceral leishmaniasis with a 95% confidence interval using a random-effects model.

Result

In this meta-analysis, thirty-nine articles with 40,367 study participants were included. The overall pooled prevalence of human visceral leishmaniasis in Eastern Africa was 26.16% [95%; CI: 19.96, 32.36%; I2 = 99.67%; p = 0.00]. Gender, age, family size, presence of termite hill/mound, presence of cattle/domestic animals, outdoor sleeping, presence of VL infected family member/s, and presence of water source/pathway near home were the risk factors significantly associated with human visceral leishmaniasis.

Conclusion

The recorded pooled prevalence of human visceral leishmaniasis in Eastern Africa underscores the urgent need for comprehensive intervention strategies. This includes rigorous health education for residents, covering the disease's cause, transmission, vector breeding sites, and prevention mechanisms.

Prevalence of human Schistosoma mansoni infection in endemic regions (2010-2024): a systematic review and meta-analysis

Background

Schistosoma mansoni infection poses a substantial public health challenge globally, and the World Health Organization (WHO) aims for the elimination of schistosomiasis by 2030. This study aimed to assess the current prevalence of human S. mansoni infection in endemic regions worldwide between 2010 and 2024.

Methods

We conducted a comprehensive search in PubMed/Medline and Scopus databases as well as other public sources from 1 January 2010 to 15 July 2024. Population-based studies reporting the prevalence of S. mansoni infection were eligible. We undertook a random-effects meta-analysis to estimate pooled prevalences with 95% confidence intervals (CIs) in WHO-defined regions and assessed potential risk factors associated with S. mansoni infection. The protocol for this study was registered on PROSPERO (CRD42023438455).

Findings

We identified a total of 542 eligible studies involving 1,163,866 individuals who had been tested for S. mansoni infection in 38 countries. The overall, pooled global prevalence of S. mansoni infection in endemic region was 14.8% (95% CI, 13.5%-16.1%). The pooled prevalences (95% CI) in specific regions were: 15.3% (13.9-16.8%) in sub-Saharan Africa, 12.4% (8.9-16.4%) in South America and 9.5% (5.4-14.6%) in the Eastern Mediterranean region. There was a 52.6% decrease in prevalence of S. mansoni infection and a 37% decrease in high-intensity infection for studies conducted between 2010 and 2014 compared to those conducted between 2020 and 2023. The present analysis revealed that factors including male gender, bathing or swimming in natural water bodies, crossing rivers or lakes, and engaging in water irrigation activities such as fishing, working in rice paddies or maintaining irrigation canals were significantly associated with S. mansoni infection.

Interpretation

The findings of this investigation revealed that, despite a decline in prevalence and high-intensity infection, 7-12% of people in endemic regions, notably in sub-Saharan Africa, remained affected by schistosomiasis mansoni between 2020 and 2024. This study provides data of relevance to policymakers to support efforts to eliminate this disease.

Funding

This study received no funding.

The costs and the potential allocation of costs of bouillon fortification: The cases of Nigeria, Senegal, and Burkina Faso

Food and condiment fortification programs are needed to address micronutrient deficiencies and their health, developmental, and mortality consequences; but these programs are never free. Knowing program costs and their allocation across stakeholders is essential to design and manage effective, efficient, and sustainable programs. We developed 10-year hypothetical bouillon fortification program cost models for Nigeria, Senegal, and Burkina Faso that included start-up and operational costs for government and industry, as well as premix costs generated by an embedded premix cost calculator to allow for alternative premix formulas in cost calculations. The main drivers of total costs were total bouillon consumption and the types and amounts of fortificants in the micronutrient premix. For a premix that meets 30% of Codex Nutrient Reference Values in 2.5 g of bouillon for vitamin A, folate, vitamin B12, zinc, and iron, the cost per metric ton of fortified bouillon was ∼$325 for all countries (∼$0.01 per 2.5 g serving). Annual start-up costs ranged from ∼$324k (Burkina Faso) to ∼$455k (Nigeria); nonpremix annual operating costs ranged from ∼$108k (Burkina Faso) to ∼$3.9m (Nigeria); and annual premix costs varied from ∼$2.4m (Burkina Faso) to ∼$76m (Nigeria). In policy discussions, program costs should be set alongside nutritional benefits.

Exploring the genome-wide transcriptomic responses of Bulinus truncatus to Schistosoma haematobium infection: An important host-parasite system involved in the transmission of human urogenital schistosomiasis

Freshwater snails of the genus Bulinus are critical hosts for Schistosoma haematobium, the causative agent of urogenital schistosomiasis. Among the 37 recognized Bulinus species, B. truncatus is a key vector. Using RNA sequencing (RNAseq), we investigated the genome-wide transcriptional responses of B. truncatus to S. haematobium infection. Our findings suggest that snails employ a complex defense strategy against the parasites by up-regulating genes involved in immune response, stress reaction, structural integrity, metabolism, and detoxification. In response, schistosome parasites appear to manipulate the snail's defense system, as evidenced by the suppression of immune-related genes such as ficolin, peptidoglycan recognition protein, and C-type lectin domain-containing protein genes. The down-regulation of biomphalysin 9, compared to its function in Biomphalaria glabrata, indicates divergent immune strategies among snail hosts. Additionally, we compared transcriptome profiles between embryos and juveniles, providing insights into developmental processes. This study offers valuable genomic data for Bulinus snails, illuminating the molecular interactions between bulinids and schistosomes, and advancing our understanding of their developmental biology.

High-throughput screening of more than 30,000 compounds for anthelmintics against gastrointestinal nematode parasites

Gastrointestinal nematodes (GINs) are amongst the most common parasites of humans, livestock, and companion animals. GIN parasites infect 1-2 billion people worldwide, significantly impacting hundreds of millions of children, pregnant women, and adult workers, thereby perpetuating poverty. Two benzimidazoles with suboptimal efficacy are currently used to treat GINs in humans as part of mass drug administrations, with many instances of lower-than-expected or poor efficacy and possible resistance. Thus, new anthelmintics are urgently needed. However, screening methods for new anthelmintics using human GINs typically have low throughput. Here, using our novel screening pipeline that starts with human hookworms, we screened 30,238 unique small molecules from a wide range of compound libraries, including ones with generic diversity, repurposed drugs, natural derivatives, known mechanisms of action, as well as multiple target-focused libraries (e.g., targeting kinases, GPCRs, and neuronal proteins). We identified 55 compounds with broad-spectrum activity against adult stages of two evolutionary divergent GINs, hookworms ( Ancylostoma ceylanicum ) and whipworms ( Trichuris muris ). Based on known databases, the targets of these 55 compounds were predicted in nematode parasites. One novel scaffold from the diversity set library, F0317-0202, showed good activity (high motility inhibition) against both GINs. To better understand this novel scaffold's structure-activity relationships (SAR), we screened 28 analogs and created SAR models highlighting chemical and functional groups required for broad-spectrum activity. These studies validate our new and efficient screening pipeline at the level of tens of thousands of compounds and provide an important set of new GIN-active compounds for developing novel and broadly-active anthelmintics.

Community Mobilisation for Human Sample Collection in Sensitive Communities: Experiences from Granular Mapping of Schistosomiasis and Soil-Transmitted Helminths in Ekiti State, South West, Nigeria

Community mobilisation is a vital process for raising awareness and increasing participation in healthcare interventions, research, and programmes that require human sample collection and mass management. In this report, we present the community mobilisation approach undertaken for the implementation of the operational mapping and assessment of granular schistosomiasis and soil-transmitted helminths in Ekiti State, Nigeria. The mobilisation was conducted in 177 communities/wards of the 16 local government areas. A total of 15,340 urine and stool samples were collected in 34 days. The efficacy and success of the strategy were evaluated through the following three performance metrics: community compliance rate, the participant response rate at the community level, and the overall compliance response rate of the four most sensitive LGAs. Community compliance was 93.7% as sample collection was denied in nine communities and two other communities demanded the return of the collected samples despite our mobilisation effort because of cultural bias and myths that connect the collection of stool and urine samples to ritual activities in the local context. The participant response rate at the community level was 86.7%. Three of the four sensitive LGAs (based on previous assessment programmes) demonstrated satisfactory compliance rates of 100%, while a response rate of 64.0% was computed for one of the LGAs. We believe our approach contributed to effective community mobilisation and awareness and that the developed model has the potential to improve participation rates in large healthcare assessments and intervention programmes.

Iron Deficiency: Global Trends and Projections from 1990 to 2050

BACKGROUND

Iron deficiency (ID) remains the leading cause of anemia, affects a vast number of persons globally, and continues to be a significant global health burden. Comprehending the patterns of ID burden is essential for developing targeted public health policies.

METHODS

Using data from the Global Burden of Disease (GBD) 2021 study for the years 1990-2021, the XGBoost model was constructed to predict prevalence and disability-adjusted life years (DALYs) for the period 2022-2050, based on key demographic variables. Shapley Additive exPlanations (SHAP) values were applied to interpret the contributions of each variable to the model's predictions. Additionally, the Age-Period-Cohort (APC) model was used to evaluate the effects of age, period, and birth cohort on both prevalence and DALYs. The relationship between the Socio-Demographic Index (SDI) and ID's age-standardized prevalence rate (ASPR) as well as the age-standardized DALYs rate (ASDR) was also analyzed to assess the influence of socioeconomic development on disease burden.

RESULTS

The global prevalent cases of ID grew from 984.61 million in 1990 to 1270.64 million in 2021 and are projected to reach 1439.99 million by 2050. Similarly, global DALYs from ID increased from 28.41 million in 1990 to 32.32 million in 2021, with a projected rise to 36.13 million by 2050. The ASPR declined from 18,204/100,000 in 1990 to 16,433/100,000 in 2021, with an estimated annual percentage change (EAPC) of -0.36% over this period. It is expected to decrease further to 15,922 by 2050, with an EAPC of -0.09% between 2021 and 2050. The ASDR was 518/100,000 in 1990 and 424/100,000 in 2021, with an EAPC of -0.68% from 1990 to 2021. It is expected to remain relatively stable at 419/100,000 by 2050, with an EAPC of -0.02% between 2021 and 2050. In 2021, the highest ASPRs were recorded in Senegal (34,421/100,000), Mali (34,233/100,000), and Pakistan (33,942/100,000). By 2050, Mali (35,070/100,000), Senegal (34,132/100,000), and Zambia (33,149/100,000) are projected to lead. For ASDR, Yemen (1405/100,000), Mozambique (1149/100,000), and Mali (1093/100,000) had the highest rates in 2021. By 2050, Yemen (1388/100,000), Mali (1181/100,000), and Mozambique (1177/100,000) are expected to remain the highest. SHAP values demonstrated that gender was the leading predictor of ID, with age and year showing negative contributions. Females aged 10 to 60 consistently showed higher prevalence and DALYs rates compared to males, with the under-5 age group having the highest rates for both. Additionally, men aged 80 and above exhibited a rapid increase in prevalence. Furthermore, the ASPR and ASDR were significantly higher in regions with a lower SDI, highlighting the greater burden of ID in less developed regions.

CONCLUSIONS

ID remains a significant global health concern, with its burden projected to persist through 2050, particularly in lower-SDI regions. Despite declines in ASPR and ASDR, total cases and DALYs are expected to rise. SHAP analysis revealed that gender had the greatest influence on the model's predictions, while both age and year showed overall negative contributions to ID risk. Children under 5, women under 60, and elderly men aged 80+ were the most vulnerable groups. These findings underscore the need for targeted interventions, such as improved nutrition, early screening, and addressing socioeconomic drivers through iron supplementation programs in low-SDI regions.

Potential associations between Schistosoma mansoni infection and physico-chemical characteristics and water-related human activities in Côte d'Ivoire: a cross-sectional study

BACKGROUND

Schistosomiasis remains a public health problem, particularly in sub-Saharan Africa. The disease is intimately connected to poverty and environmental factors. Our research was readily embedded into a multi-country schistosomiasis oversampling study. The aim of the study presented here was to determine the prevalence of Schistosoma mansoni and to investigate the role of water body characteristics and water-related human activities in disease transmission.

METHODS

In August and September 2022, a cross-sectional study was conducted in the western part of Côte d'Ivoire. Stool and urine samples were collected from 1602 and 1729 children aged 5-14 years, respectively, in 65 villages in the health districts of Biankouma, Ouaninou and Touba. Additionally, data were collected from direct observation of water-related activities at water bodies and interviews conducted with community leaders and health workers. The prevalence and risk factors for Schistosoma infection were assessed using generalised estimating equation models.

RESULTS

The prevalence ofS. mansoni and S. haematobium were 27.4% (95% confidence interval [CI] 21.5-34.3%) and 0.1% (95% CI 0.03-0.5%), respectively. Low prevalence of soil-transmitted helminths was observed with 2.4%, 0.4% and 0.2% for hookworm, Trichuris trichiura and Ascaris lumbricoides, respectively. At the health district level, we found S. mansoni prevalence of 34.4% (95% CI 25.0-45.3%), 34.3% (95% CI 24.0-46.2%) and 16.3% (95% CI 9.5-26.6%) for Biankouma, Ouaninou and Touba, respectively. Female and male participants were at a similar risk of infection (29.0% vs. 26.0%, odds ratio [OR]: 1.18, 95% CI 0.92-1.50). Children aged 9-14 years showed a higher prevalence than their younger counterparts aged 5-8 years (34.5% vs. 22.7%, OR: 1.80, 95% CI 1.42-2.27). High infection prevalence was observed in villages where children were washing clothes and dishes at open surface water sites and pursued recreational activities (e.g. swimming and playing in the water). The temperature, total dissolved solids and pH of water samples showed no significant association with S. mansoni infection at the village unit.

CONCLUSIONS

Human water-related activities such as washing clothes and playing in the water are risk factors for S. mansoni transmission. Hence, preventive chemotherapy should be combined with information, education and communication to avoid or reduce the frequency of water exposure in children as part of a comprehensive package of interventions towards elimination of schistosomiasis as a public health problem.

Diverse RNA viruses of parasitic nematodes can elicit antibody responses in vertebrate hosts

Parasitic nematodes have an intimate, chronic and lifelong exposure to vertebrate tissues. Here we mined 41 published parasitic nematode transcriptomes from vertebrate hosts and identified 91 RNA viruses across 13 virus orders from 24 families in ~70% (28 out of 41) of parasitic nematode species, which include only 5 previously reported viruses. We observe widespread distribution of virus-nematode associations across multiple continents, suggesting an ancestral acquisition event and host-virus co-evolution. Characterization of viruses of Brugia malayi (BMRV1) and Onchocerca volvulus (OVRV1) shows that these viruses are abundant in reproductive tissues of adult parasites. Importantly, the presence of BMRV1 RNA in B. malayi parasites mounts an RNA interference response against BMRV1 suggesting active viral replication. Finally, BMRV1 and OVRV1 were found to elicit antibody responses in serum samples from infected jirds and infected or exposed humans, indicating direct exposure to the immune system.

Molecular epidemiology and population genetics of Schistosoma mansoni infecting school-aged children situated along the southern shoreline of Lake Malawi, Malawi

BACKGROUND

In areas of low disease endemicity, highly sensitive diagnostic tools to identify, diagnose, and monitor intestinal schistosomiasis transmission are needed to reliably measure the burden and risk of infection. Here, we used highly sensitive molecular diagnostic methods to investigate Schistosoma mansoni prevalence and transmission along the southern shoreline of Lake Malawi, five years post-disease outbreak.

METHODOLOGY AND PRINCIPAL FINDINGS

Faecal and urine samples were provided by school-aged children situated along the southern shoreline of Lake Malawi. Kato-Katz faecal-egg microscopy and point-of-care circulating cathodic antigen (POC-CCA) rapid diagnostic tests were then performed to diagnose infection with S. mansoni. Urine-egg microscopy was also used to diagnose infection with Schistosoma haematobium. In addition, Schistosoma miracidia were isolated from faecal material using a standard miracidium hatching technique. A two-step real-time PCR approach was then used to diagnose infection with S. mansoni using DNA isolated from faecal samples. Furthermore, isolated miracidia were genotyped to species level through PCR and Sanger sequencing. Phylogenetic analyses were then carried out to identify which previously defined S. mansoni cox1 lineage group S. mansoni miracidia were most closely related to. The measured prevalence of S. mansoni infection varied considerably depending on which diagnostic assay was used. When compared to real-time PCR, faecal-egg microscopy had a sensitivity of 9% and a specificity of 100%. When POC-CCA 'trace' results were considered positive, POC-CCA had a sensitivity of 73% and a specificity of 81% when compared to real-time PCR. However, when considered negative, POC-CCA sensitivity was reduced to 56%, whereas specificity was increased to 90%. In addition, a high degree of S. haematobium DNA was detected in DNA isolated from faecal samples and motile S. haematobium miracidia were recovered from faecal samples. Schistosoma mansoni miracidia were closely related to two independent cox1 lineage groups, suggesting multiple recent introduction and colonisation events originating from surrounding east African countries.

CONCLUSIONS AND SIGNIFICANCE

Intestinal schistosomiasis is now highly prevalent along the southern shoreline of Lake Malawi just five years post-disease outbreak. In addition, a high prevalence of urogenital schistosomiasis persists. The revision of ongoing schistosomiasis control programmes in this area is therefore recommended. Our study also highlights the need for reliable diagnostic assays capable of distinguishing between Schistosoma species in multispecies co-endemic areas.

Immune targets for schistosomiasis control identified by a genome-wide association study of East African snail vectors

Schistosomiasis, afflicting >260 million people worldwide, could be controlled by preventing infection of freshwater snail vectors. Intestinal schistosomiasis, caused by Schistosoma mansoni, occurs predominantly in Sub-Saharan Africa and is vectored by Biomphalaria sudanica and related Biomphalaria species. Despite their importance in transmission, very little genomic work has been initiated in African snails, thus hindering development of novel control strategies. To identify genetic factors influencing snail resistance to schistosomes, we performed a pooled genome-wide association study (pooled-GWAS) on the offspring of B. sudanica collected from a persistent hotspot of schistosomiasis in Lake Victoria, Kenya, and exposed to sympatric S. mansoni. Results of the pooled-GWAS were used to develop an amplicon panel to validate candidate loci by genotyping individual snails. This validation revealed two previously uncharacterized, evolutionarily dynamic regions, SudRes1 and SudRes2, that were significantly associated with resistance. SudRes1 includes receptor-like protein tyrosine phosphatases and SudRes2 includes a class of leucine-rich repeat-containing G-protein coupled receptors, both comprising diverse extracellular binding domains, suggesting roles in pathogen recognition. No loci previously tied to schistosome resistance in other snail species showed any association with compatibility suggesting that loci involved in the resistance of African vectors differ from those of neotropical vectors. Beyond these two loci, snail ancestry was strongly correlated with schistosome compatibility, indicating the importance of population structure on transmission dynamics and infection risk. These results provide the first detail of the innate immune system of the major schistosome vector, B. sudanica, informing future studies aimed at predicting and manipulating vector competence.

Leveraging wastewater-based epidemiology to monitor the spread of neglected tropical diseases in African communities

Neglected tropical diseases continue to cause a significant burden worldwide, with Africa accounting for more than one-third of the global burden. Over the past decade, progress has been made in eliminating, controlling, and eradicating these diseases in Africa. By December 2022, 47 out of 54 African countries had eliminated at least one neglected tropical disease, and more countries were close to achieving this milestone. Between 2020 and 2021, there was an 80 million reduction in people requiring intervention. However, continued efforts are needed to manage neglected tropical diseases and address their social and economic burden, as they deepen marginalisation and stigmatisation. Wastewater-based epidemiology involves analyzing wastewater to detect and quantify biomarkers of disease-causing pathogens. This approach can complement current disease surveillance systems in Africa and provide an additional layer of information for monitoring disease spread and detecting outbreaks. This is particularly important in Africa due to limited traditional surveillance methods. Wastewater-based epidemiology also provides a tsunami-like warning system for neglected tropical disease outbreaks and can facilitate timely intervention and optimised resource allocation, providing an unbiased reflection of the community's health compared to traditional surveillance systems. In this review, we highlight the potential of wastewater-based epidemiology as an innovative approach for monitoring neglected tropical disease transmission within African communities and improving existing surveillance systems. Our analysis shows that wastewater-based epidemiology can enhance surveillance of neglected tropical diseases in Africa, improving early detection and management of Buruli ulcers, hookworm infections, ascariasis, schistosomiasis, dengue, chikungunya, echinococcosis, rabies, and cysticercosis for better disease control.

Human-water interactions associated to cercarial emergence pattern and their influences on urinary schistosomiasis transmission in two endemic areas in Mali

BACKGROUND

Mali is known to be a schistosomiasis-endemic country with a limited supply of clean water. This has forced many communities to rely on open freshwater bodies for many human-water contact (HWC) activities. However, the relationship between contact with these water systems and the level of schistosome infection is currently receiving limited attention. This study assessed human-water interactions including cercarial emergence pattern and their influences on urinary schistosomiasis transmission in two communities in the Kayes district of Mali.

METHODS

We carried out a parasitological study first in children in September 2021, then a cross-sectional study of quantitative observations of human-water contact activities in the population, and finally a study of snail infectivity at contact points in September 2022. The study took place in two communities, Fangouné Bamanan and Diakalèl in the Kayes region of western Mali. The chronobiological study focused on cercarial release from naturally infected snails. Released cercariae were molecularly genotyped by targeting the cox1 region, and the ITS and 18S ribosmal DNA gene (18S rDNA) regions of the DNA. Links between sociodemographic parameters, human water-contact points and hematuria were established using multivariate statistical analysis or the logistic regression model.

RESULTS

The main factor predisposing the 97 participants to water contact was domestic activity (62.9%). Of the 378 snails collected at 14 sampling sites, 27 (7.1%) excreted schistosome cercariae, with 15.0% (19/126) at Fangouné Bamanan and 3.3% (8/252) at Diakalel. The release of Schistosoma cercariae shows three different patterns in Fangouné Bamanan: (i) an early release peak (6:00-8:00 AM), (ii) a mid-day release peak (10:00 AM-12:00 PM) and (iii) a double peak: (6:00-8:00 AM) and (6:00-8:00 PM) cercariae release; and two release patterns in Diakalel: early release (6:00-8:00 AM) and (ii) mid-day release (12:00-2:00 PM). All cercariae released during early diurnal (6:00-8:00 AM) or nocturnal emission patterns (6:00-8:00 PM) were hybrids parasite having an cox1 S. bovis or S. curassoni associated with an ITS and 18S rDNA of S. haematobium while the cercariae released during diurnal, or mid-day patterns (8:00 AM-6:00 PM) were pure S. haematobium.

CONCLUSIONS

Our study showed that domestic activity is the main source of exposure in the Kayes region. Two and three cercariae emission patterns were observed at Diakalel and Fangouné Bamanan respectively. These results suggest that the parasite adapts to the human-water contact period in order to increase its infectivity.

Colonic schistosomiasis mimicking cancer, polyp, and inflammatory bowel disease: Five case reports and review of literature

BACKGROUND

Schistosomiasis, officially named as a neglected tropical disease by The World Health Organization, is a serious parasitic disease caused by trematode flukes of the genus Schistosoma. It is a common infectious disease, endemic in more than 78 countries. The disease can involve various organs and poses far-reaching public health challenges.

CASE SUMMARY

Here, we present a series of five patients with variable presentations: an asymptomatic patient who was diagnosed with colonic schistosomiasis upon screening colonoscopy; 2 patients with clinical suspicion of colonic cancer; and 2 patients with a clinical diagnosis of inflammatory bowel disease. All patients were subsequently confirmed to have colonic schistosomiasis after colonoscopy and histopathologic examination. The clinical manifestations, colonoscopy features and histologic findings of the patients are described. Most of the patients showed significant clinical improvement following administration of oral praziquantel.

CONCLUSION

Intestinal schistosomiasis can present with features mimicking other gastrointestinal conditions. This disease should be a diagnostic consideration in patients who live in or have traveled to endemic areas.

In Vitro and In Silico Anthelmintic Activity of Extracts of Lannea kerstingii and Ficus thonningii on Heligmosomoides polygyrus

Background: The aim of this study was to assess the anthelmintic activity of Lannea kerstingii and Ficus thonningii, on a nematode model, to promote their use in the Cameroonian pharmacopoeia for the treatment of helminthiases. Methods: One nematode was used, Heligmosomoides polygyrus. First, the effect of the extracts on the eggs and larval stages (L1, L2, and L3) of H. polygyrus was evaluated, 100 μL of extract and 100 μL of parasite suspension (containing 50 eggs) were mixed in a 96-well microplate. The 96-well microplate was incubated for 20 h at 25°C in the WMicroTracker which measures the motility of the worms at various concentrations. Finally, docking studies were conducted by using the Glide module in Schrodinger Maestro. Results: The ethanolic extract of L. kerstingii with the half maximal inhibitory concentration (IC50) of 0.1371 mg/mL produced a higher ovicidal effect than the effect produced by other extracts of these plants. However, with an IC50 of 0.31 mg/mL, the aqueous extract of F. thonningii showed the greatest effect on the L2 stage. The aqueous and ethanolic extracts of L. kerstingii and F. thonningii inhibited the development of the L3 larvae of H. polygyrus with a better effect for the ethanolic extracts. Conclusion: The use of L. kerstingii and F. thonningii for the treatment of helminthiasis has been proved in vitro and in silico by this research. However, more research is required, especially on the acute toxicity and in vivo anthelmintic efficacy to validate this scientific investigation.

Efficacy of praziquantel drug against Schistosoma haematobium and performance of urine reagent strips among pre-and-school aged children during the high transmission season in North-Western Tanzania

The World Health Organization calls for schistosomiasis endemic countries to regularly monitor the efficacy of Praziquantel (PZQ) drug, the only antischistosomal drug used for four decades in Tanzania. In response to that call, the current study investigated the efficacy of single dose of PZQ against Schistosoma haematobium during the high transmission season and further assessed, the sensitivity and specificity of urine reagent strips before and after treatment. The study recruited a total of 2,498 -children aged (4 -17 years old) who provided a single urine sample that was visually examined for macro-haematuria, then using urine dipstick and urine filtration technique for microhaematuria and the presence of S. haematobium eggs. The baseline prevalence of S. haematobium eggs positive based on urine filtration test was 29.2 % (95 %CI:27.5-31.0) and that of microhaematuria was 43.1 % (95 %CI:41.1-45.0). Of the infected participants, 40.9 % (95 %CI:37.4-44.6) had a heavy intensity of infection and the geometrical mean intensity (GMI) of infection was 33.7 eggs/10mls of urine. A single dose of PZQ reduced the prevalence of infection to 16.2 %, the GMI of infection to 18.8eggs/10mls of urine and that of microhaematuria to 27.9 %. Cure rate and egg reduction rates (ERR) were 83.8 % and 44.3 % respectively. At baseline, the sensitivity and specificity of the urine reagent strips were 59.7 % and 93.8 %, whereas at post-treatment they were 16.7 % and 93.6 %. When PZQ drug is administered during the high transmission season, its efficacy in term of ERR is poor. The urine reagent strips had low sensitivity but high specificity at pre-and-post PZQ treatment.

Availability and readiness of health facilities providing services for other infectious diseases to treat neglected tropical diseases in Ethiopia: implications for service integration in high burden areas

BACKGROUND

The burden of neglected tropical diseases (NTDs), HIV/AIDS, tuberculosis, and malaria pose significant public health challenges in Ethiopia. This study aimed to the explore service availability and readiness for NTD care among Ethiopian health facilities treating tuberculosis (TB), HIV/AIDS, and/or malaria.

METHODS

This study utilized secondary data from the Ethiopian Service Provision Assessment 2021-22 survey. The availability of services was calculated as the percentage of HIV/AIDS, tuberculosis, or malaria facilities providing NTD services. Facilities were considered highly prepared to manage any type of NTD if they scored at least half (> 50%) of the tracer items listed in each of the three domains (staff training and guidelines, equipment, and essential medicines). Descriptive statistics and logistic regression models were employed to present the study findings and analyze factors influencing facility readiness, respectively.

RESULTS

Out of 403 health facilities providing NTD care nationally, 179, 183, and 197 also offer TB, HIV/AIDS, and malaria services, respectively. The majority of TB (90.1%), HIV/AIDS (89.6%), and malaria (90.9%) facilities offer soil-transmitted helminth services, followed by trachoma (range 87-90%). The percentages of the aforementioned facilities with at least one trained staff member for any type of NTD were 87.2%, 88.4%, and 82.1%, respectively. The percentage of facilities with guidelines for any type of NTD was relatively low (range 3.7-4.1%). Mebendazole was the most widely available essential medicine, ranging from 69 to 70%. The overall readiness analysis indicated that none of the included facilities (TB = 11.9%; HIV/AIDS = 11.6%; and malaria = 10.6%) were ready to offer NTD care. Specifically, a higher level of readiness was observed only in the domain of medicines across these facilities. Hospitals had better readiness to offer NTD care than did health centers and clinics. Furthermore, a significant associations were observed between facility readiness and factors such as facility type, region, presence of routine management meetings, types of NTD services provided, and fixed costs for services.

CONCLUSIONS

Ethiopian health facilities treating TB, HIV/AIDS, and malaria had an unsatisfactory overall service availability and a lack of readiness to provide NTD care. Given the existing epidemiological risks and high burden of TB, HIV/AIDS, malaria, and NTDs in Ethiopia, there is an urgent need to consider preparing and implementing a collaborative infectious disease care plan to integrate NTD services in these facilities.

Visceral leishmaniasis follow-up and treatment outcomes in Tiaty East and West sub-counties, Kenya: Cure, relapse, and Post Kala-azar Dermal Leishmaniasis

BACKGROUND

Visceral Leishmaniasis (VL) is a neglected tropical disease (NTD) with the highest regional burden in East Africa. Relapse and Post Kala-azar Dermal Leishmaniasis (PKDL) contribute to the spread of VL in endemic areas, making their surveillance imperative for control and elimination. Little is known about long-term patient outcomes in Kenya through follow-up after VL treatment, despite its requirement for control and elimination by the World Health Organization (WHO) and the Kenya Ministry of Health (KMOH).

METHODOLOGY/PRINCIPAL FINDINGS

36 follow-up patients in Tiaty East and West, sub-counties, Kenya, and records from 248 patients at the regional Chemolingot Sub-county Hospital (CSCH) were analyzed separately using Fisher's Exact Tests, two-sample t-tests, and Welch's t-tests in R (Version 4.3.0). The study found a prevalence rate of 88.89% (n = 32) final cure, 5.56% (n = 2) relapse, and 5.56% (n = 2) PKDL in follow-up patients and 92.74% (n = 230) initial cure, 6.86% (n = 17) relapse, and 0.80% (n = 2) PKDL in overall CSCH patients. The mean lengths of time at which follow-up patients relapsed and developed PKDL were 4.5 and 17 months, respectively. Young age (p = 0.04, 95% CI 0.63-24.31), shorter length of time from initial treatment to follow-up (p = 0.002, 95% CI 1.03-∞), lower Hb level at primary treatment (p = 0.0002, 95% CI 1.23-3.24), and living in Tiaty East sub-county (p = 0.04, 95% CI 0.00-1.43) were significantly associated (p<0.05) with VL relapse in follow-up study patients. Female sex (p = 0.04, 95% CI 0.84-∞) and living in Tiaty East sub-county (p = 0.03, 95% CI 0.00-1.43) were significantly associated with PKDL in follow-up study patients.

CONCLUSIONS/SIGNIFICANCE

More research should be done on PKDL in Kenya with active follow-up to understand its true burden. These results on prevalence and risk factors for PKDL and relapse in Kenya should inform knowledge of patient outcomes and interventions in the region.

Towards the development of cost-effective point-of-care diagnostic tools for poverty-related infectious diseases in sub-Saharan Africa

In this review, we examine the current landscape of point-of-care testing (POCT) diagnostic tools designed for poverty-related infectious diseases (PRIDs) in sub-Saharan Africa (sSA) while delineating key avenues for future advancements. Our analysis encompasses both established and emerging diagnostic methods for PRIDs, addressing the persistent challenges in POCT tool development and deployment, such as cost, accessibility, and reliability. We emphasize recent advancements in POCT diagnostic tools as well as platforms poised to enhance diagnostic testing in sSA. Recognizing the urgency for affordable and widely accessible POCT diagnostic tools to detect PRIDs in sSA, we advocate for a multidisciplinary approach. This approach integrates current and emerging diagnostic methods, explicitly addressing challenges hindering point-of-care (POC) tool development. Furthermore, it recognizes the profound impact of misdiagnosis on public and global health, emphasizing the need for effective tools. To facilitate the successful development and implementation of POCT diagnostic tools in sSA, we propose strategies including the creation of multi-analyte detection POCT tools, the implementation of education and training programs, community engagement initiatives, fostering public-private collaborations, and the establishment of reliable supply chains. Through these concerted efforts, we aim to accelerate the development of POCT in the sSA region, ensuring its effectiveness and accessibility in addressing the diagnostic challenges associated with PRIDs.

Factors associated with hookworm and Schistosoma mansoni infections among school-aged children in Mayuge district, Uganda

BACKGROUND

Hookworm infection and schistosomiasis are two of sub-Saharan Africa's most common neglected tropical diseases. An annual mass drug administration (MDA) program against schistosomiasis and soil-transmitted helminths (STHs), including hookworm, has been implemented in Mayuge district, Uganda, since 2003 to date. However, hookworm and schistosomiasis remain prevalent in Mayuge district. Understanding the factors that predispose children to these infections in the context of MDA could inform interventions to reduce prevalence in Uganda and similar settings.

METHOD

This cross-sectional study took place in 33 randomly selected primary schools in the Mayuge district from January to February 2022. Children in primary classes 4 or 5, in the selected schools provided single stool samples and completed questionnaires. Stool specimens were examined using the Kato-Katz method to determine the prevalence of hookworm and schistosomiasis. We performed univariable and multivariable logistic regression to assess the associations of each infection with potential risk factors.

RESULT

A total of 1,617 students (mean age 12.1 years, 50.1% male) were enrolled. The prevalence of hookworm infection and schistosomiasis was 21.8% (95% confidence interval (CI): 19.8-23.9%) and 18.7% (95% CI: 16.8-20.7%), respectively. In multivariable analysis, longer water fetching time (over 30 min versus less than 30 min) and working daily in the soil were associated with increased odds of hookworm infection (adjusted odds ratio (AOR): 1.49, 95% CI: 1.13-1.96 and 1.37, 95% CI: 1.03-1.82, respectively). Higher odds of schistosomiasis were linked to proximity to water bodies within a one-hour walking distance (AOR: 1.84, 95% CI: 1.35-2.50), and not always washing hands before eating (AOR: 2.00, 95% CI: 1.50-2.67). Swimming, bathing, or washing in water bodies twice a week, compared to never, also increased schistosomiasis odds (AOR: 2.91, 95% CI: 1.66-5.13).

CONCLUSION

Consistent with the mechanisms of acquisition, hookworm infection increased with exposure to soil, and schistosomiasis increased with exposure to unclean water. Our findings highlight the importance of Water, Sanitation, and Hygiene programs and strategies aimed at reducing exposure within the framework of Neglected Tropical Disease elimination programs.

Efficacy of ivermectin and albendazole combination in suppressing transmission of lymphatic filariasis following mass administration in Tanzania: a prospective cohort study

BACKGROUND

Preventive chemotherapy with ivermectin and albendazole (IA) in mass drug administration (MDA) programs for all at-risk populations is the core public health intervention to eliminate lymphatic filariasis (LF). Achieving this goal depends on drug effectiveness in reducing parasite reservoirs in the community to halt transmission. We assessed the efficacy of ivermectin and albendazole in clearing microfilariae and circulating filarial antigens (CFA) following MDA.

METHODS

This community-based prospective study was conducted in Mkinga district, Tanga region, Tanzania, from November 2018 to June 2019. A total of 4115 MDA-eligible individuals were screened for CFA using Filarial test strips. CFA positives were re-examined for microfilariae by microscopy. CFA and microfilariae positive individuals were enrolled and received IA through MDA campaign. The status of microfilariae and CFA was monitored before MDA, and on day 7 and six-month following MDA. The primary efficacy outcomes were the clearance rates of microfilariae on day 7 and six-months, and CFA at 6 months of post-MDA. The McNemar test assessed the proportions of microfilariae positive pre- and post-MDA, while Chi-square tests were utilized to examine factors associated with CFA status six months post-MDA.

RESULTS

Out of 4115 individuals screened, 239 (5.8%) tested positive for CFA, of whom 11 (4.6%) were also positive for microfilariae. Out of the ten microfilariae-positive individuals available for follow-up on day 7, nine tested negative, yielding a microfilariae clearance rate of 90% [95% confidence interval (CI): 59.6-98.2%]. Participants who tested negative for microfilariae on day 7 remained free of microfilariae six months after MDA. However, those who did not clear microfilariae on day-7 remained positive six-months post-MDA. The McNemar test revealed a significant improvement in microfilariae clearance on day 7 following MDA (P = 0.02). Out of 183 CFA-positive individuals who were available at 6-month follow-up, 160 (87.4%) remained CFA positive, while 23 became CFA negative. The CFA clearance rate at 6 months post-MDA was 12.6% (95% CI: 8.5-8.5%). There was no significant association of variability in ivermectin plasma exposure, measured by maximum concentration or area under the curve, and the clearance status of microfilariae or CFA post-MDA.

CONCLUSIONS

Preventive chemotherapy with IA effectively clears microfilariae within a week. However, it is less effective in clearing CFA at six months of post-MDA. The low clearance rate for filarial antigenemia underscores the need for alternative drug combinations and additional preventive measures to achieve LF elimination by 2030.

Urinary schistosomiasis and anemia among school-aged children from southwestern Nigeria

Schistosomiasis and anemia, are one of the leading global public health problem among children between age 5 and 14 years in marginalized settings. In this study, we provide prevalence and intensity data for both conditions in three southwestern states of Nigeria, where such are lacking. Epidemiological assessment involving parasitological analysis of urine and blood samples was conducted among 1783 consenting school-aged children in Ondo, Osun, Ekiti States of Nigeria. Participants' age and sex data were obtained using field forms, and statistical analysis was performed in R software with a significance level of 95%. An overall prevalence of 26.8% and 29.5% was recorded for urinary schistosomiasis and anemia, respectively. Prevalence varied by location with (40.3% and 29.8%) in Ondo (34.4% and 37.5%) in Osun and (13.4% and 20.9%) in Ekiti for urinary schistosomiasis and anemia, respectively (p=0.00). Schistosoma infections were found among males (28.7%, p=0.05) and children between the age 9-11 years (30.0%, p=0.01). About 36% of children with anemia was also infected with schistosomiasis. Children who were positive for schistosomiasis (OR:1.51; 95% CI: 1.19, 1.93; p=0.001) and between the age category 15-16 years, (OR:1.86; 95% CI: 1.12, 3.09; p<0.05) were twice likely to become anemic. Our findings have shown that children infected with schistosomiasis are twice likely to become anemic than those without infection. It is important to complement ongoing MDA programmes targeted at schistosomiasis with nutrition intervention programs for example micronutrient supplementation for better impact and cost-effectiveness.

Pattern and predictor of hookworm re-infection among schoolchildren in three districts of Amhara Region, northwest Ethiopia

BACKGROUND

Despite integrated prevention and control measures, the prevalence of hookworm is still high in Ethiopia. The re-infection rates and predictors are poorly addressed. Therefore, this study aimed to determine the patterns of hookworm re-infection rates and predictors among schoolchildren in northwest Ethiopia.

METHODS

A prospective follow-up study was conducted among 86 schoolchildren from May to December 2022. Data on predictors was collected using a questionnaire. Stool samples were collected and processed via Kato-Katz, McMaster, and spontaneous tube sedimentation techniques. All hookworm-infected children were treated with albendazole and followed for six months. The re-infection rates of hookworm were checked in the 4th and 6th months. Data was entered into Epi-data version 3.1 and analysed using SPSS version 25. Descriptive statistics were used to compute the re-infection rate. The associations of predictors with hookworm re-infection rates were calculated by logistic regression. Variables with a p-value < 0.05 were considered statistically significant.

RESULTS

Of the 86, 81 schoolchildren completed the study. The prevalence of hookworm re-infection in the 4th and 6th months was 23.5% and 33.3%, respectively. Living with family members greater than five (p = .017), poor utilization of latrine (p = .008), infrequent shoe wear (p = .039), and participating in irrigation (p = .020) were the predictors significantly associated with hookworm re-infections.

CONCLUSIONS

The re-infection rate was high during the fourth and sixth months. Participating in irrigation, infrequent shoe wear, and poor latrine utilization were predictors of hookworm re-infection. Therefore, mass drug administration, regular shoe wearing, and health education should be advocated.