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Igihozo G, Dusabe L, Uwizeyimana J, Nyiransabimana E, Huston T, Schurer JM. "We all think boots are meant for men": A community-based participatory assessment of rural women's barriers to preventing podoconiosis in Rwanda. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002773. [PMID: 38701034 PMCID: PMC11068164 DOI: 10.1371/journal.pgph.0002773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/21/2024] [Indexed: 05/05/2024]
Abstract
Podoconiosis is a debilitating neglected tropical disease (NTD) that is possibly caused by prolonged exposure to irritant alkaline clay soil. It is endemic to East Africa and disproportionately affects rural female farmers. The condition can be prevented through foot hygiene and regular wearing of protective shoes. In Rwanda, there is limited information on the factors impacting rural female farmers' access to and utilization of boots while farming. Therefore, this community-based participatory study was conducted to explore the cultural, economic, and ergonomic factors affecting rural farmers' use of protective footwear. Sixteen audio-recorded focus group discussions were conducted with female and male farmers in four villages with the highest podoconiosis prevalence across four provinces of Rwanda. Transcripts were coded inductively using Dedoose (version 9.0.86) and analyzed through thematic content analysis. Participants expressed that wearing shoes protects against diseases and injuries but ability to afford a pair of protective footwear was a major barrier to accessing and wearing them. There were differences in women and men's shoe-wearing behaviors while farming, largely driven by the fact that women who wear boots face rumors and backlash. Findings highlight barriers hindering effective podoconiosis prevention among rural female farmers in Rwanda. Opportunities exist to strengthen podoconiosis and NTD prevention programs, through the integration of gender into existing community-based interventions and the inclusion of local communities into the co-designing of contextualized interventions.
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Affiliation(s)
- Gloria Igihozo
- Bill and Joyce Cummings’ Institute of Global Health, University of Global Health Equity, Butaro, Rwanda
- Center for One Health, University of Global Health Equity, Butaro, Rwanda
| | - Leila Dusabe
- Center for One Health, University of Global Health Equity, Butaro, Rwanda
| | | | | | | | - Janna M. Schurer
- Center for One Health, University of Global Health Equity, Butaro, Rwanda
- Department of Infectious Disease and Global Health, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, United States of America
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Seekles ML, Kadima JK, Ding Y, Bulambo CB, Kim JJ, Kukola JK, Omumbu POL, Mulamba RM, Nganda M, Ngenyibungi SM, Ngondu FL, Sabuni LP, Dean L. Mental health, stigma and the quality of life of people affected by neglected tropical diseases of the skin in Kasai Province, Democratic Republic of the Congo: a sex-disaggregated analysis. Int Health 2023; 15:iii28-iii36. [PMID: 38118158 PMCID: PMC10732685 DOI: 10.1093/inthealth/ihad084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/18/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Worldwide, persons affected by skin Neglected Tropical Diseases (NTDs) may experience stigma and discrimination, which could lead to impaired societal functioning and poor mental wellbeing. Evidence of comorbidity of NTDs and mental health conditions is dominated by Leprosy, largely lacking in post-conflict areas, and rarely disaggregated by sex. METHODS This cross-sectional survey is the first to explore depression, anxiety, stigma, and quality of life amongst people affected by Lymphatic Filariasis, Buruli Ulcer, Onchocerciasis or Leprosy in the Democratic Republic of the Congo. After a census through active case identification, the survey was completed by 118 persons (response rate 94.4%). RESULTS In total, 58.3% of men and 80.0% of women screened positive for major depressive disorder (PHQ-9). Symptoms indicative of generalised anxiety disorder (GAD-7) were displayed by 54.8% of men and 62.2% of women. Being female, having a disability, experiencing stigma and lower physical quality of life were predictors of depression. Anxiety was predicted by age, physical quality of life, disability (for men only) and environmental quality of life (for women only). CONCLUSIONS Integrated, intersectoral and gender-sensitive initiatives are needed to respond to the many biopsychosocial challenges that persons affected face. CONTEXTE Dans le monde entier, les personnes atteintes de maladies tropicales négligées (MTN) peuvent faire l'objet d'une stigmatisation et d'une discrimination, ce qui peut entraîner une altération du fonctionnement de la société et un mauvais bien-être mental. Les preuves de la comorbidité des MTN et des troubles de la santé mentale sont dominées par la lèpre, manquent largement dans les zones post-conflit et sont rarement ventilées par sexe. MÉTHODES UTILISÉES Cette enquête transversale est la première à explorer la dépression, l'anxiété, la stigmatisation et la qualité de vie chez les personnes atteintes de filariose lymphatique, d'ulcère de Buruli, d'onchocercose ou de lèpre en République démocratique du Congo. Après un recensement par identification active des cas, 118 personnes ont répondu à l'enquête (taux de réponse 94,4%). RÉSULTATS Au total, 58,3% des hommes et 80,0% des femmes ont été dépistés positifs pour un trouble dépressif majeur (PHQ-9). Des symptômes indiquant un trouble anxieux généralisé (GAD-7) ont été observés chez 54,8 % des hommes et 62,2 % des femmes. Le fait d'être une femme, d'avoir un handicap, d'être stigmatisé et d'avoir une qualité de vie physique inférieure était un facteur prédictif de la dépression. L'anxiété était prédite par l'âge, la qualité de vie physique, le handicap (pour les hommes uniquement) et la qualité de vie environnementale (pour les femmes uniquement). CONCLUSIONS Des initiatives intégrées, intersectorielles et sensibles au genre sont nécessaires pour répondre aux nombreux défis biopsychosociaux auxquels sont confrontées les personnes touchées. ANTECEDENTES En todo el mundo, las personas afectadas por Enfermedades Tropicales Desatendidas (ETD) cutáneas pueden sufrir estigmatización y discriminación, lo que podría conducir a un deterioro del funcionamiento social y a un bienestar mental deficiente. La evidencia científica sobre la comorbilidad de las ETD y las afecciones mentales está dominada por la lepra, en general insuficiente en zonas post-conflicto y rara vez se desglosan por sexo. MÉTODOS Esta encuesta transversal es la primera que explora la depresión, la ansiedad, el estigma y la calidad de vida entre las personas afectadas por la filariasis linfática, la úlcera de Buruli, la oncocercosis o la lepra en la República Democrática del Congo. Tras un censo mediante identificación activa de casos, la encuesta fue completada por 118 personas (tasa de respuesta del 94,4%). RESULTADOS En total, el 58,3% de los hombres y el 80,0% de las mujeres arrojaron resultados positivos para el trastorno depresivo mayor (PHQ-9). El 54,8% de los hombres y el 62,2% de las mujeres presentaban síntomas indicativos de trastorno de ansiedad generalizada (TAG-7). Ser mujer, tener una discapacidad, sufrir estigmatización y una menor calidad de vida física fueron factores predictivos de la depresión. La edad, la calidad de vida física, la discapacidad (sólo en el caso de los hombres) y la calidad de vida ambiental (sólo en el caso de las mujeres) fueron factores predictivos de la ansiedad. CONCLUSIONES Se necesitan iniciativas integradas, intersectoriales y con perspectiva de género para responder a los numerosos retos biopsicosociales a los que se enfrentan las personas afectadas.
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Affiliation(s)
- Maaike L Seekles
- Liverpool School of Tropical Medicine, Department of International Public Health, Pembroke Place, Liverpool L3 5QA, UK
| | - Jacob K Kadima
- The Leprosy Mission DRC, Kinshasa, Democratic Republic of the Congo
| | - Yan Ding
- Liverpool School of Tropical Medicine, Department of International Public Health, Pembroke Place, Liverpool L3 5QA, UK
| | | | - Joy J Kim
- Effect: Hope, Program Team, Markham, ON L3R 6G1, Canada
| | - Junior K Kukola
- The Leprosy Mission DRC, Kinshasa, Democratic Republic of the Congo
| | | | | | - Motto Nganda
- Liverpool School of Tropical Medicine, Department of International Public Health, Pembroke Place, Liverpool L3 5QA, UK
| | - Stephanie M Ngenyibungi
- University of Kinshasa, Department of Psychology, Kinshasa H8J56PX, Democratic Republic of Congo
| | - Florent L Ngondu
- Ministry of Health, Leprosy Programme, Kinshasa, M8R29W2, Democratic Republic of Congo
| | - Louis P Sabuni
- The Leprosy Mission DRC, Kinshasa, Democratic Republic of the Congo
| | - Laura Dean
- Liverpool School of Tropical Medicine, Department of International Public Health, Pembroke Place, Liverpool L3 5QA, UK
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Umbelino-Walker I, Wong F, Cassolato M, Pantelias A, Jacobson J, Kalume C. Integration of female genital schistosomiasis into HIV/sexual and reproductive health and rights and neglected tropical diseases programmes and services: a scoping review. Sex Reprod Health Matters 2023; 31:2262882. [PMID: 37850814 PMCID: PMC10586082 DOI: 10.1080/26410397.2023.2262882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
Female genital schistosomiasis (FGS) affects approximately 56 million women and girls across sub-Saharan Africa and is associated with up to a threefold increased prevalence of HIV. Integrating FGS with HIV programmes as part of comprehensive sexual and reproductive health (SRH) services may be one of the most significant missed opportunities for preventing HIV incidence among girls and women. A search of studies published until October 2021 via Scopus and ProQuest was conducted using PRISMA guidelines to assess how FGS can be integrated into HIV/SRH and neglected tropical diseases (NTDs) programmes and services. Data extraction included studies that integrated interventions and described the opportunities and challenges. A total of 334 studies were identified, with 22 eligible for analysis and summarised conducting a descriptive numerical analysis and qualitative review. We adapted a framework for integrated implementation of FGS, HIV, and HPV/cervical cancer to thematically organise the results, classifying them into five themes: awareness and community engagement, diagnosis, treatment, burden assessment, and economic evaluation. Most activities pertained to awareness and community engagement (n = 9), diagnosis (n = 9) and were primarily connected to HIV/AIDS (n = 8) and school-based services and programming (n = 8). The studies mainly described the opportunities and challenges for integration, rather than presenting results from implemented integration interventions, highlighting an evidence gap on FGS integration into HIV/SRH and NTD programmes. Investments are needed to realise the potential of FGS integration to address the burden of this neglected disease and improve HIV and SRH outcomes for millions of women and girls at risk.
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Affiliation(s)
| | - Felicia Wong
- Independent Consultant, Frontline AIDS, Worthing, UK
| | | | | | - Julie Jacobson
- Managing Partner, Co-Founder, Bridges to Development, Seattle, WA, USA
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Arjyal A, Parajuli A, Kharel C, Del Barrio MO, Baral SC. Understanding gender and its intersection with social stratifiers on prevention and care seeking behavior of lymphatic filariasis in Nepal. Infect Dis Poverty 2023; 12:77. [PMID: 37608332 PMCID: PMC10463999 DOI: 10.1186/s40249-023-01126-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Lymphatic filariasis (LF) is a debilitating and painful neglected tropical disease and is one of the leading causes of permanent disability. In many countries, the intersection of gender with various social stratifiers has influenced exposure to LF and ultimately impacting the disease burden and its elimination. This study aimed to explore the influence of gender and its intersection with other social stratifiers for the prevention and care seeking behavior of LF in Nepal. METHODS This study employed qualitative research methods: in-depth interviews (IDIs) and focus group discussions (FGDs) for data collection in Bardiya, Nepal. A total of 22 IDIs (11 male, 11 female) and 2 FGDs (1 male and 1 female) were conducted with the community people between January and March 2020. The participants were purposively selected to represent different social stratifiers including age, sex, ethnicity, occupation. The data collected were analyzed using a thematic framework approach with use of intersectional gender analysis matrix. RESULTS The study findings revealed that men spend more time outside their household compared to women while fulfilling their roles and responsibilities, largely determined by societal expectations and gender norms. This resulted in limited access to preventive health services for men, as they often missed annual mass drug administration programme in their community and limited access to preventive methods. Further traditional occupation, specific to particular ethnicity, influenced the vulnerability to LF for certain ethnic groups. The ability to prevent exposure varied among individuals. Although women made decisions regarding the use of protective methods, it was influenced by patriarchal and gender norms. They often felt a responsibility to take care and priorities males and other family members when resources are limited. The intersectionality of gender with other social stratifiers such as marital status, ethnicity, and geographical areas influenced individual's ability to access information related to LF and care seeking. CONCLUSIONS Overall, the findings emphasized how access to resources, division of work, norms and values and decision-making power alone and its interaction with various social stratifiers shaped peoples' vulnerability to disease, ability to prevent exposure and response to illness.
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Affiliation(s)
| | | | - Chandani Kharel
- UNICEF, UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Mariam Otmani Del Barrio
- UNICEF, UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
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Godwin-Akpan TG, Chowdhury S, Rogers EJ, Kollie KK, Zaizay FZ, Wickenden A, Zawolo GVK, Parker CBMC, Dean L. The development, implementation, and evaluation of an optimal model for the case detection, referral, and case management of Neglected Tropical Diseases. PLoS One 2023; 18:e0283856. [PMID: 37163515 PMCID: PMC10171595 DOI: 10.1371/journal.pone.0283856] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 03/19/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND People affected by Neglected Tropical Diseases (NTDs), specifically leprosy, Buruli ulcer (BU), yaws, and lymphatic filariasis, experience significant delays in accessing health services, often leading to catastrophic physical, psychosocial, and economic consequences. Global health actors have recognized that Sustainable Development Goal 3:3 is only achievable through an integrated inter and intra-sectoral response. This study evaluated existing case detection and referral approaches in Liberia, utilizing the findings to develop and test an Optimal Model for integrated community-based case detection, referral, and confirmation. We evaluate the efficacy of implementing the Optimal Model in improving the early diagnosis of NTDs, thus minimizing access delays and reducing disease burden. METHODS We used a participatory action research approach to develop, implement, and evaluate an Optimal Model for the case detection, referral, and management of case management NTDs in Liberia. We utilized qualitative and quantitative methods throughout the cycle and implemented the model for 12 months. RESULTS During the implementation of our optimal model, the annual number of cases detected increased compared to the previous year. Cases were detected at an earlier stage of disease progression, however; gendered dynamics in communities shape the case identification process for some individuals. Qualitative data showed increased knowledge of the transmission, signs, symptoms, and management options among community health workers (CHW). CONCLUSION The results provide evidence of the benefits of an integrated approach and the programmatic challenges to improve access to health services for persons affected by NTDs. The effectiveness of an integrated approach depends on a high level of collaboration, joint planning, and implementation embedded within existing health systems infrastructure.
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Affiliation(s)
| | - Shahreen Chowdhury
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Emerson J Rogers
- Neglected Tropical Disease Program, Ministry of Health, Oldest Congo Town, Monrovia, Liberia
| | - Karsor K Kollie
- Neglected Tropical Disease Program, Ministry of Health, Oldest Congo Town, Monrovia, Liberia
| | - Fasseneh Zeela Zaizay
- Neglected Tropical Disease Program, Ministry of Health, Oldest Congo Town, Monrovia, Liberia
| | - Anna Wickenden
- American Leprosy Mission, Greenville, South Carolina, United States of America
| | - Georgina V K Zawolo
- University of Liberia-Atlantic Centre for Research and Evaluation, Capitol Hill, Monrovia, Liberia
| | - Colleen B M C Parker
- Research Unit, Ministry of Health, Liberia, Oldest Congo Town, Monrovia, Liberia
| | - Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Sule MN, Mosha J, Soboka TE, Kinung'hi SM, Sfynia C, Rafiq K, Dower A, Comparet M, Bewley E, Angelo T, Beshah FZ, Templeton MR. A novel theatre-based behaviour change approach for influencing community uptake of schistosomiasis control measures. Parasit Vectors 2022; 15:301. [PMID: 36008841 PMCID: PMC9406251 DOI: 10.1186/s13071-022-05421-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Appropriate behaviour change with regard to safe water contact practices will facilitate the elimination of schistosomiasis as a public health concern. Various approaches to effecting this change have been trialled in the field but with limited sustainable outcomes. Our case study assessed the effectiveness of a novel theatre-based behaviour change technique (BCT), in combination with cohort awareness raising and capacity training intervention workshops. Methodology Our study was carried out in four rural communities in the Mwanza region of Tanzania and in the semi-urban town of Kemise, Ethiopia. We adapted the Risk, Attitude, Norms, Ability and Self-regulation (RANAS) framework and four phases using a mixed methods approach. Participatory project phase engagement and qualitative formative data were used to guide the design of an acceptable, holistic intervention. Initial baseline (BL) data were collected using quantitative questionnaire surveys with 804 participants in Tanzania and 617 in Ethiopia, followed by the theatre-based BCT and capacity training intervention workshops. A post-intervention (PI) survey was carried out after 6 months, with a participant return rate of 65% in Tanzania and 60% in Ethiopia. Results The intervention achieved a significant improvement in the knowledge of schistosomiasis transmission being associated with poorly managed sanitation and risky water contact. Participants in Tanzania increased their uptake of preventive chemotherapy (males: BL, 56%; PI, 73%, females: BL, 43%; PI, 50%). There was a significant increase in the selection of sanitation (Tanzania: BL, 13%; PI, 21%, Ethiopia: BL, 63%; PI, 90%), safe water and avoiding/minimising contact with infested waters as prevention methods in Tanzania and Ethiopia. Some of the participants in Tanzania followed on from the study by building their own latrines. Conclusions This study showed that substantial positive behaviour changes in schistosomiasis control can be achieved using theatre-based BCT intervention and disease awareness training. With the appropriate sensitisation, education and stakeholder engagement approaches, community members were more open to minimising risk-associated contact with contaminated water sources and were mobilised to implement preventive measures. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-022-05421-5.
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Affiliation(s)
- May N Sule
- Department of Civil and Environmental Engineering, Imperial College London, London, UK. .,Cranfield Water Science Institute, School of Water, Energy and Environment, Cranfield University, Bedford, UK. .,School of Geography and the Environment, University of Oxford, Oxford, UK.
| | - Justina Mosha
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Teshome Emana Soboka
- Africa Centre of Excellence for Water Management, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Safari M Kinung'hi
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Chrysoula Sfynia
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | | | | | | | - Emma Bewley
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - Teckla Angelo
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Feleke Zewge Beshah
- Africa Centre of Excellence for Water Management, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Michael R Templeton
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
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Bustinduy AL, Randriansolo B, Sturt AS, Kayuni SA, Leustcher PDC, Webster BL, Van Lieshout L, Stothard JR, Feldmeier H, Gyapong M. An update on female and male genital schistosomiasis and a call to integrate efforts to escalate diagnosis, treatment and awareness in endemic and non-endemic settings: The time is now. ADVANCES IN PARASITOLOGY 2022; 115:1-44. [PMID: 35249661 DOI: 10.1016/bs.apar.2021.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The last decades have brought important insight and updates in the diagnosis, management and immunopathology of female genital schistosomiasis (FGS) and male genital schistosomiasis (MGS). Despite sharing a common parasitic aetiological agent, FGS and MGS have typically been studied separately. Infection with Schistosoma haematobium manifests with gender-specific clinical manifestations and consequences of infection, albeit having a similar pathogenesis within the human genital tract. Schistosoma haematobium is a known urinary bladder carcinogen, but its potential causative role in other types of neoplasia, such as cervical cancer, is not fully understood. Furthermore, the impact of praziquantel treatment on clinical outcomes remains largely underexplored, as is the interplay of FGS/MGS with relevant reproductive tract infections such as HIV and Human Papillomavirus. In non-endemic settings, travel and immigrant health clinics need better guidance to correctly identify and treat FGS and MGS. Our review outlines the latest advances and remaining knowledge gaps in FGS and MGS research. We aim to pave a way forward to formulate more effective control measures and discuss elimination targets. With a growing community awareness in health practitioners, scientists and epidemiologists, alongside the sufferers from these diseases, we aspire to witness a new generation of young women and men free from the downstream disabling manifestations of disease.
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Affiliation(s)
- Amaya L Bustinduy
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | | | - Amy S Sturt
- Section of Infectious Diseases, Veterans Affairs Palo Alto Health Care System, Palo Alto, United States
| | - Seke A Kayuni
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; MASM Medi Clinics Limited, Blantyre, Malawi
| | - Peter D C Leustcher
- Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Lisette Van Lieshout
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Hermann Feldmeier
- Charité University Medicine Berlin, Institute of Microbiology, Infectious Diseases and Immunology, Berlin, Germany
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
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The Chagas disease study landscape: A systematic review of clinical and observational antiparasitic treatment studies to assess the potential for establishing an individual participant-level data platform. PLoS Negl Trop Dis 2021; 15:e0009697. [PMID: 34398888 PMCID: PMC8428795 DOI: 10.1371/journal.pntd.0009697] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 09/09/2021] [Accepted: 08/01/2021] [Indexed: 11/19/2022] Open
Abstract
Background Chagas disease (CD), caused by the parasite Trypanosoma cruzi, affects ~6–7 million people worldwide. Significant limitations still exist in our understanding of CD. Harnessing individual participant data (IPD) from studies could support more in-depth analyses to address the many outstanding research questions. This systematic review aims to describe the characteristics and treatment practices of clinical studies in CD and assess the breadth and availability of research data for the potential establishment of a data-sharing platform. Methodology/Principal findings This review includes prospective CD clinical studies published after 1997 with patients receiving a trypanocidal treatment. The following electronic databases and clinical trial registry platforms were searched: Cochrane Library, PubMed, Embase, LILACS, Scielo, Clintrials.gov, and WHO ICTRP. Of the 11,966 unique citations screened, 109 (0.9%) studies (31 observational and 78 interventional) representing 23,116 patients were included. Diagnosis for patient enrolment required 1 positive test result in 5 (4.6%) studies (2 used molecular method, 1 used molecular and serology, 2 used serology and parasitological methods), 2 in 60 (55.0%), 3 in 14 (12.8%) and 4 or more in 4 (3.7%) studies. A description of treatment regimen was available for 19,199 (83.1%) patients, of whom 14,605 (76.1%) received an active treatment and 4,594 (23.9%) were assigned to a placebo/no-treatment. Of the 14,605 patients who received an active treatment, benznidazole was administered in 12,467 (85.4%), nifurtimox in 825 (5.6%), itraconazole in 284 (1.9%), allopurinol in 251 (1.7%) and other drugs in 286 (1.9%). Assessment of efficacy varied largely and was based primarily on biological outcome; parasitological efficacy relied on serology in 67/85 (78.8%) studies, molecular methods in 52/85 (61.2%), parasitological in 34/85 (40.0%), microscopy in 3/85 (3.5%) and immunohistochemistry in 1/85 (1.2%). The median time at which parasitological assessment was carried out was 79 days [interquartile range (IQR): 30–180] for the first assessment, 180 days [IQR: 60–500] for second, and 270 days [IQR: 18–545] for the third assessment. Conclusions/Significance This review demonstrates the heterogeneity of clinical practice in CD treatment and in the conduct of clinical studies. The sheer volume of potential IPD identified demonstrates the potential for development of an IPD platform for CD and that such efforts would enable in-depth analyses to optimise the limited pharmacopoeia of CD and inform prospective data collection. Chagas disease, also known as American trypanosomiasis, is a neglected tropical disease transmitted by triatomine insects, first identified in 1909. Chagas disease affects approximately 6–7 million people globally and is highly prevalent in Latin America where most cases are reported. However, there is increasing evidence that Chagas disease is now an important public health issue outside the “classical” endemic countries due to population migration. Our understanding of Chagas disease, including its pathologies and factors relating to progression, remains to date limited, and is also challenged by lack of diagnosis and highly effective treatment. This systematic review aims to describe studies with Chagas patients receiving antiparasitic treatment. Databases were searched for relevant studies published after 1997, and the results of these searches were screened. Although a large volume of studies was identified in the review, heterogeneity was observed in study design, diagnostic methods, outcome assessment, and treatment regimens. While this aspect will be a limitation in pooling individual patient data, the volume of data available should allow sufficient comparison to form the basis of guidelines for future studies. The results of this review demonstrate that development of a Chagas disease data platform for clinical research would enable optimisation of existing data to strengthen evidence for the treatment and diagnosis of Chagas disease.
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Christine Masong M, Ozano K, Tagne MS, Tchoffo MN, Ngang S, Thomson R, Theobald S, Tchuenté LAT, Kouokam E. Achieving equity in UHC interventions: who is left behind by neglected tropical disease programmes in Cameroon? Glob Health Action 2021; 14:1886457. [PMID: 33641612 PMCID: PMC7919912 DOI: 10.1080/16549716.2021.1886457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background: The UN's Sustainable Development Goals (SDGs) which pledge to leave no one behind for Universal health coverage (UHC) raise the importance of ensuring equitable health outcomes and healthcare delivery. As Neglected Tropical Diseases (NTDs) affect the most disadvantaged and hard to reach populations, they are considered a litmus test for Universal health coverage.Objective: Here, we assess the challenges of implementing Mass Drug Administrations (MDAs) for schistosomiasis prevention and control, in a context of expanded treatment where both community and school-based distribution were carried out, assessing which groups are missed and developing strategies to enhance equity.Methods: This is a qualitative study applying ethnographic observations, in-depth interviews (109) and focus group discussions (6) with key informants and other community members. Participants included community drug distributors, teachers, health workers, and implementing partners across four schistosomiasis endemic regions in Cameroon. Data collected were analysed thematically.Results: Programme implementation gaps have created circumstances where indigenous farmers (originally from the region) and migrating farmers (not originally from the region known as 'strangers' and 'farm hands'), women of reproductive age and school-aged children are continuously missed in MDA efforts in Cameroon. Key implementation challenges that limit access to MDA within this context include inadequate sensitization campaigns that don't sufficiently build trust with different groups; limits in CDD training around pregnancy and reproductive health; lack of alignment between distribution and community availability and the exclusion of existing formal and informal governance structures that have established trusting community relationships.Conclusion: Through identifying key populations missed in MDAs within specific contexts, we highlight how social inclusion and equity could be increased within the Cameroonian context. A main recommendation is to strengthen trust at the community level and work with established partnerships and local governance structures that can support sustainable solutions for more equitable MDA campaigns.
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Affiliation(s)
- Makia Christine Masong
- Department of Social Sciences and Management, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Kim Ozano
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Marlene Siping Tagne
- Department of Social Sciences and Management, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Marlene Ntchinda Tchoffo
- Department of Social Sciences and Management, Catholic University of Central Africa, Yaoundé, Cameroon
| | - Sharon Ngang
- Department of Sciences, Research Center for Schistosomiasis and Parasitology, University of Yaoundé 1, Yaoundé, Cameroon
| | - Rachael Thomson
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Louis-Albert Tchuem Tchuenté
- Department of Sciences, Research Center for Schistosomiasis and Parasitology, University of Yaoundé 1, Yaoundé, Cameroon
| | - Estelle Kouokam
- Department of Social Sciences and Management, Catholic University of Central Africa, Yaoundé, Cameroon
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Nji TM, Piotrowski H, Dum-Buo N, Fung EG, Dean L, Theobald S, Thomson R, Wanji S, Ozano K. Eliminating onchocerciasis within the Meme River Basin of Cameroon: A social-ecological approach to understanding everyday realities and health systems. PLoS Negl Trop Dis 2021; 15:e0009433. [PMID: 34077416 PMCID: PMC8202923 DOI: 10.1371/journal.pntd.0009433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 06/14/2021] [Accepted: 05/02/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Onchocerciasis affects some of the world's most marginalized people, perpetuating poverty and inequalities. Mass Drug Administration (MDA) with Ivermectin has taken place within the Meme River basin region in Cameroon for over 15 years. Despite this, onchocerciasis is still prevalent in the region due to existing and emerging contextual challenges. Using a social-ecological approach we explore the everyday realities of communities, highlighting the challenges and potential solutions that could support Neglected Tropical Disease (NTD) programmes when transitioning from control to elimination of onchocerciasis in this highly endemic area and other similar communities. METHODOLOGY/PRINCIPAL FINDING In-depth interviews (71) with community members and Community Drug Distributors (CDDs) were conducted to understand current knowledge, attitudes, and behaviours in relation to transmission, prevention and treatment of onchocerciasis. Through application of the social-ecological model, four key themes were identified: 1. Contextual factors on health promotion interventions (Onchocerciasis history and understanding of the disease, prevention and mitigation strategies and MDA experience); 2. Social determinants (poverty and livelihoods, economic and social impacts on CDD volunteers and stigma); 3. Environmental determinants (exposure, housing, occupation and poverty); and 4. health seeking pathways and decision making for treatment (access, cost and preferable treatment routes). We discuss these core and cross cutting themes (gender differences and community participation/ownership) in relation to intersectoral collaboration, gender equity and health systems support, making recommendations for NTD programmes within the context of integrated and interdisciplinary approaches. These include the need for; intersectional and gender analysis at the local level, addressing environmental dimensions of onchocerciasis through integrated and regular health promotion, vector control strategies and access to safe water sources; reflection and action that embeds responses to social and economic barriers to MDA; integrated case detection and management that is responsive to onchocerciasis symptoms and related stigma and a fair and just support network for CDDs. CONCLUSION/SIGNIFICANCE NTD programmes need to respond to diverse community circumstances and behaviours. Communities are not a homogeneous risk group and treating them in this way will delay elimination. A deeper understanding of individual needs and their capacity to seek prevention and treatment must be considered if onchocerciasis is to be eliminated and the remaining impacts managed.
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Affiliation(s)
- Theobald Mue Nji
- Department of Sociology and Anthropology, Faculty of Social and Management Sciences, University of Buea, Research Foundation in Tropical Diseases and Environment, Buea, Cameroon
| | - Helen Piotrowski
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Nnamdi Dum-Buo
- Department of Sociology and Anthropology, Faculty of Social and Management Sciences, University of Buea, Research Foundation in Tropical Diseases and Environment, Buea, Cameroon
| | - Ebua Gallus Fung
- Department of Sociology and Anthropology, Faculty of Social and Management Sciences, University of Buea, Research Foundation in Tropical Diseases and Environment, Buea, Cameroon
| | - Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Rachael Thomson
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Samuel Wanji
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Research Foundation in Tropical Diseases and Environment, Buea, Cameroon
| | - Kim Ozano
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Krentel A, Gyapong M, McFarland DA, Ogundahunsi O, Titaley CR, Addiss DG. Keeping communities at the centre of efforts to eliminate lymphatic filariasis: learning from the past to reach a future free of lymphatic filariasis. Int Health 2021; 13:S55-S59. [PMID: 33349882 PMCID: PMC7753171 DOI: 10.1093/inthealth/ihaa086] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/22/2020] [Accepted: 11/19/2020] [Indexed: 01/09/2023] Open
Abstract
Since the launch of the Global Programme to Eliminate Lymphatic Filariasis (GPELF) in 2000, more than 910 million people have received preventive chemotherapy for lymphatic filariasis (LF) and many thousands have received care for chronic manifestations of the disease. To achieve this, millions of community drug distributors (CDDs), community members and health personnel have worked together each year to ensure that at-risk communities receive preventive chemotherapy through mass drug administration (MDA). The successes of 20 y of partnership with communities is celebrated, including the application of community-directed treatment, the use of CDDs and integration with other platforms to improve community access to healthcare. Important challenges facing the GPELF moving forward towards 2030 relate to global demographic, financing and programmatic changes. New innovations in research and practice present opportunities to encourage further community partnership to achieve the elimination of LF as a public health problem. We stress the critical need for community ownership in the current Covid-19 pandemic, to counter concerns in relaunching MDA programmes for LF.
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Affiliation(s)
- Alison Krentel
- School of Epidemiology and Public Health, University of Ottawa, Canada K1G 5Z3.,Bruyère Research Institute, Ottawa K1R 6M1, Canada
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences Ho, Volta Region, Ghana
| | | | | | - Christiana R Titaley
- Faculty of Medicine, Pattimura University, Maluku Province, Ambon 97233 Indonesia
| | - David G Addiss
- Focus Area for Compassion and Ethics (FACE), The Task Force for Global Health, Atlanta 30030 USA
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12
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O'Kelly B, Lambert JS. Vector-borne diseases in pregnancy. Ther Adv Infect Dis 2020; 7:2049936120941725. [PMID: 32944240 PMCID: PMC7469740 DOI: 10.1177/2049936120941725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 06/15/2020] [Indexed: 12/14/2022] Open
Abstract
Vector-borne infections cause a significant proportion of world-wide morbidity and mortality and many are increasing in incidence. This is due to a combination of factors, primarily environmental change, encroachment of human habitats from urban to peri-urban areas and rural to previously uninhabited areas, persistence of poverty, malnutrition and resource limitation in geographical areas where these diseases are endemic. Pregnant women represent the single largest ‘at risk’ group, due to immune-modulation and a unique physiological state. Many of these diseases have not benefitted from the same level of drug development as other infectious and medical domains, a factor attributing to the ‘neglected tropical disease’ title many vector-borne diseases hold. Pregnancy compounds this issue as data for safety and efficacy for many drugs is practically non-existent, precluding exposure in pregnancy to many first-line therapeutic agents for ‘fear of the unknown’ or overstated adverse pregnancy-foetal outcomes. In this review, major vector-borne diseases, their impact on pregnancy outcomes, current treatment, vaccination and short-comings of current medical practice for pregnant women will be discussed.
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Affiliation(s)
- Brendan O'Kelly
- Infectious Diseases Specialist Registrar, Mater Misericordiae University Hospital, Dublin, Ireland
| | - John S Lambert
- Consultant in Infectious Diseases, Medicine and Sexual Health (GUM), Mater, Rotunda and UCD, Mater Misericordiae University Hospital, Clinic 6, Eccles St, Inns Quay, Dublin, D07 R2WY University College Dublin Rotunda Maternity Hospital
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