Disease Burden In Countries Research Articles

Characterization of clinical trials in Ecuador and their association with disease burden: Are there research gaps?

This study offers a detailed analysis of clinical trials conducted in Ecuador from 2010 to 2022 to assess alignment with the country's disease burden as indicated by the Global Burden of Disease study. Utilizing data from five registries, including ARCSA and Clinicaltrials.gov, we analyzed characteristics and coverage of 75 CTs after removing duplicates and ineligible studies. Findings reveal a 50% research gap across disease groups, with neoplasms being the only category matching disease burden. The scarcity of clinical research highlights the disparity between CTs and prevalent diseases such as cardiovascular and kidney diseases, diabetes, and other non-communicable conditions. Our results underscore the urgent need for increased clinical research investment addressing these critical health challenges in Ecuador.

Trends in smokeless tobacco use and attributable mortality and morbidity in the South-East Asia Region: implications for policy

ObjectivesTo describe the prevalence of smokeless tobacco (SLT) use and number of users by year, in addition to trends in mortality and attributable disease burden in countries of the WHO...

Tetanus– a case report highlighting the challenges in diagnosis and treatment

Tetanus has become an increasingly rare infectious disease due to the development of successful vaccination programs in the mid-20th century. In resource-rich countries, mainly unvaccinated or partly vaccinated risk groups are affected, whereas tetanus still remains prevalent in resource-limited countries. The decreasing incidence in developed countries has hindered clinical trials evaluating the best treatment modalities for tetanus infections. Current guidelines are based on a small number of studies and case reports. So far, these studies have shown potential benefits of treating tetanus infections with benzodiazepines, magnesium sulfate and baclofen. Additionally, several treatments have been shown to be useful in stabilizing and supporting patients with tetanus. However, each treatment modality has limitations, from negative side effects to logistical challenges, especially in developing countries. Therefore, further knowledge is required to evaluate the best use of each treatment and to further optimize patient care. This knowledge can contribute to the reduction of the burden of disease in countries where tetanus remains prevalent and where resources are limited, though vaccination is the most effective method to achieve this. This case report describes the treatment of a Dutch patient with tetanus infection and illustrates the role of benzodiazepines as well as other key aspects of treating patients with tetanus.

Typhoid Conjugate Vaccine: A Boon for Endemic Regions.

Typhoid fever has the highest disease burden in countries in low- and middle-income countries, primarily located in Asia and Sub-Saharan Africa. Previous typhoid vaccines such as the live attenuated typhoid (Ty21a) vaccine and Vi (virulence) capsular polysaccharide vaccine had the limitation that they could not be administered with other standard childhood immunizations and were ineffective in children under two years of age. To address these shortcomings of the previous vaccines, typhoid conjugate vaccines (TCVs) were developed and prequalified by the World Health Organization. Cross-reacting material and tetanus toxoid are widely used as carrier proteins in TCVs. According to various studies, TCV has higher efficacy, has a more extended protection period, and is safe and immunogenic in infants as young as six months. This review article aims to comprehensively appraise the data available on TCVs' efficacy, duration of protection, safety, and immunogenicity in endemic regions.

Latin American Consensus for the Evaluation and Treatment of Patients With Metastatic/Locally Advanced Urothelial Carcinoma.

Urothelial cancer accounts for approximately 3% of new cancer cases worldwide, with a high burden of disease in countries with medium and low human development indexes where its incidence and mortality are increasing. The purpose of this consensus is to develop statements on the evaluation and treatment of locally advanced and metastatic urothelial carcinoma that would further guide the clinical practice in Latin America. A systematic review of the literature was conducted by an independent team of methodologists. Then, a modified Delphi method was developed with clinical specialists from different Latin American countries. Forty-two consensus statements, based on evidence, were developed to address the staging, the evaluation (suitability for chemotherapy, risk assessment, and biomarkers), and systemic treatment (first-line and subsequent therapies) of locally advanced or metastatic urothelial carcinoma. The statements made in this consensus are suggested practice recommendations in the Latin American context; however, the importance of a complete and individualized patient evaluation as a guide for therapeutic selection is highlighted. The availability and affordability of support tools for the evaluation of the disease, as well as specific therapies, may limit the application of the best practices suggested. Therapeutic decisions need to be tailored to the context-specific clinical setting and availability of resources. Local research is promoted to improve outcomes for patients with this challenging cancer in Latin America.

Conjunctival Melanoma in Aotearoa-New Zealand: A 21-Year Analysis of Incidence and Survival.

Conjunctival melanoma (CM) is a rare and aggressive malignancy. Global studies demonstrate increased burden of disease in countries with high rates of cutaneous melanoma. There are currently no reports on CM incidence, trends, or survival within Aotearoa-New Zealand (NZ), a country with the highest global rates of cutaneous melanoma, which this study aims to address. This was a retrospective review using the national cancer registry. Data on histologically confirmed CM diagnosed between January 1, 2000, and December 31, 2020, were obtained from the NZ Cancer Registry. Cases were identified using the International Classification of Disease, 10th edition (ICD-10) codes. Primary outcome measures were age-standardized incidence, trends, and survival. A total of 68 CM cases were identified. There was a preponderance for females (n=40, 58.8%) and CM predominantly affected European patients (n=63, 92.6%). Median follow-up was 5.0 years [interquartile range (IQR)=2.4-9.9y] and the median age at diagnosis was 68.5 years (IQR=57.0-79.0y), with non-Europeans presenting at a significantly younger age [-17.3y (95% CI: -31.3 to -3.2), P =0.019] than Europeans. The annual age-adjusted incidence(±SD) was 0.6±0.2 cases per million population per year with a stable incidence trend over 21 years. All-cause mortality was found in 28 cases (41.2%) and the median time to death was 3.76 years (IQR=2.1-5.7y). Five-year all-cause survival and disease-specific survival was 69% and 90%, respectively. This is the first report on CM incidence, trends, and mortality in NZ. The CM burden is in line with European and North American data, despite NZ having the highest rate of cutaneous melanoma. The incidence remained stable over 2 decades.

EPIDEMIOLOGY AND PHARMACOTHERAPY OF ROTAVIRUS AND IMPACT OF VACCINATION TO PREVENTION ITS MORTALITY

Rotavirus is a type of virus that primarily affects infants and young children, causing gastroenteritis, which is inflammation of the stomach and intestines. It is one of the leading reasons for server diarrhea worldwide,especially in developing lands. The virus is highly contagious and can spread through the fecal-oral route, primarily through contaminated food, water, and surfaces. The introduction of the rotavirus vaccines has had a significant impact on reducing the burden of rotavirus-related illnesses. Many countries have incorporated rotavirus vaccination into their national immunization programs. The vaccines havesignificantly reduced rotavirus-related hospitalizations, deaths, and overall disease burden in countries where vaccination coverage is high. Here, we will discuss the recent developments in epidemiology, diagnosis, and treatments of rotavirus-induced gastroenteritis. Moreover, suggestions to prevent incidences of infection have been elegantly discussed

Role of neutrophil-lymphocyte ratio as a potential marker to differentiate between pulmonary tuberculosis and community-acquired pneumonia in children

Background: This is often creating challenge to differentiate pulmonary tuberculosis (TB) with community acquired pneumonia (CAP) particularly in children. The neutrophil-lymphocyte count ratio (NLR) as an indicator of inflammation has been used in various infectious diseases. The aim of this study was to investigate the role of NLR as a possible marker in differentiating pulmonary TB from CAP.Methods: In this retrospective record based analytic study, conducted from July 2020 to Dec 2021, patient aged 2 months to 18 years diagnosed as pulmonary TB or CAP were enrolled in this study i.e., 155 children after exclusion. The diagnostic ability of NLR in differentiating between pulmonary Tb and CAP were assessed.Results: Out of 155 children, 85 (54.8%) had CAP and 70 (45.1%) had pulmonary TB. Mean values of NLR were significantly lower in patients with TB than in pneumonia (3.16±1.9 vs 5.05±1.2, p<0.000). Total WBC, neutrophil, Hb and CRP were also significantly lower in patients with pulmonary TB. On the other hand, lymphocyte count was significantly higher in children with pulmonary TB in compare to children with pneumonia (p=0.04).Conclusions: The NLR can be used as a useful simple laboratory marker in differentiating children with Pulmonary TB from CAP, especially in resource limited high TB disease burden countries.

Understanding the Status of Important Criteria Air Pollutants and Its Health Effects – A Review

In India, airborne pollutant is serious, and a growing illness cause of concern, adding considerably to the country's disease burden. Atmospheric effects are generally known to have several harmful health implications. India's air pollution has risen significantly because of population expansion, rising vehicle numbers, fuel usage, inefficient transit networks, poor land use patterns, industrialisation, and most importantly, insufficient environmental legislation. Because air pollution is a major factor, this has an impact on human health. People gradually understood that contaminated outdoor air had detrimental consequences on human health. Hypercholesterolemia, breathing problems, chronic obstructive pulmonary disease (COPD), and asthma are all connected to ambient air pollution on a global scale. The purpose of this research is to review the literature on air quality and how it impacts population livelihoods.

An observational study of incidence of metabolic syndrome among patients with controlled Grave’s disease

BackgroundGraves disease is one of the most common autoimmune diseases affecting Indians, accounting for 50–80% of hyperthyroidism cases. The major morbidities associated with Graves' disease are universally acknowledged. Thus, preventing metabolic syndrome could lead to a reduction in the country's disease burden. ObjectivesThe objectives of this study are to determine the detection of metabolic syndrome in patients who have achieved clinical and biochemical euthyroid status after treatment, as well as to evaluate the clinical and biochemical parameters that lead to metabolic syndrome in Graves' disease patients. Materials and methodsThis is a prospective observational study of 96 Graves' disease patients in a tertiary care hospital in rural Kolkata. The study participants were chosen using systemic random sampling. The clinical and biochemical parameters of the participants in the study were evaluated. The paired t tests were used. A P value of 0.05 is regarded as significant. ResultsAfter achieving euthyroid status, 36% of the study population developed metabolic syndrome according to International Diabetes Federation (IDF) criteria.93.5% of those who developed metabolic syndrome had a normal BMI at the time of Graves' disease diagnosis. ConclusionFollowing a healthy lifestyle, which includes healthy eating habits, proper drug compliance, and follow-up, may help to prevent the occurrence of metabolic syndrome. By lowering the risk of developing metabolic syndrome, patients may be able to live a healthier lifestyle by keeping the disease under control.

Global herpes zoster incidence, burden of disease, and vaccine availability: a narrative review.

Herpes zoster (HZ) is a neurocutaneous disease that causes significant morbidity worldwide. The disease is caused by the reactivation of the varicella-zoster virus (VZV), which leads to the development of a painful, vesicular rash and can cause complications such as post-herpetic neuralgia and vision loss. Globally, the incidence of HZ is increasing, and it incurs billions in cost annually to the healthcare system and to society through loss of productivity. With the advent of effective vaccines such as the live attenuated vaccine, Zostavax®, in 2006, and more recently the adjuvant recombinant subunit vaccine, Shingrix®, in 2017, HZ has become a preventable disease. However, access to the vaccines remains mostly limited to countries with developed economies, such as the United States and Canada. Even among countries with developed economies that license the vaccine, few have implemented HZ vaccination into their national immunization schedules due to cost-effectiveness considerations. In this review, we discuss the currently available HZ vaccines, landscape of HZ vaccine guidelines, and economic burden of disease in countries with developed and developing economies, as well as barriers and considerations in HZ vaccine access on a global scale.

Temporal Trends in the Burden of Non-Communicable Diseases in Countries with the Highest Malaria Burden, 1990-2019: Evaluating the Double Burden of Non-Communicable and Communicable Diseases in Epidemiological Transition

Temporal Trends in the Burden of Non-Communicable Diseases in Countries with the Highest Malaria Burden, 1990-2019: Evaluating the Double Burden of Non-Communicable and Communicable Diseases in Epidemiological Transition

Changes in Invasive Pneumococcal Disease Caused by Streptococcus pneumoniae Serotype 1 Following Introduction of PCV10 and PCV13: Findings from the PSERENADE Project.

Streptococcus pneumoniae serotype 1 (ST1) was an important cause of invasive pneumococcal disease (IPD) globally before the introduction of pneumococcal conjugate vaccines (PCVs) containing ST1 antigen. The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project gathered ST1 IPD surveillance data from sites globally and aimed to estimate PCV10/13 impact on ST1 IPD incidence. We estimated ST1 IPD incidence rate ratios (IRRs) comparing the pre-PCV10/13 period to each post-PCV10/13 year by site using a Bayesian multi-level, mixed-effects Poisson regression and all-site IRRs using a linear mixed-effects regression (N = 45 sites). Following PCV10/13 introduction, the incidence rate (IR) of ST1 IPD declined among all ages. After six years of PCV10/13 use, the all-site IRR was 0.05 (95% credibility interval 0.04–0.06) for all ages, 0.05 (0.04–0.05) for <5 years of age, 0.08 (0.06–0.09) for 5–17 years, 0.06 (0.05–0.08) for 18–49 years, 0.06 (0.05–0.07) for 50–64 years, and 0.05 (0.04–0.06) for ≥65 years. PCV10/13 use in infant immunization programs was followed by a 95% reduction in ST1 IPD in all ages after approximately 6 years. Limited data availability from the highest ST1 disease burden countries using a 3 + 0 schedule constrains generalizability and data from these settings are needed.

Developmental Status With Malnourished Children: A Cross-Sectional Observational Study

A balanced diet leads to a good state of health. In India, pediatric malnutrition accounts for 22 per cent of the country's disease burden. Nutrition has a profound effect on the development of brain structure and function, and malnutrition may contribute to disease and developmental impairment in later life. The developmental evaluation assesses individuals' skills and potential. This study aimed to determine the relationship of protein-energy malnutrition with motor development and cognition among malnourished children. The research was designed as a cross-sectional observational study in the pediatric malnourished population at Acharya Vinobha Bhave Rural Hospital, Sawangi, India. The study included the children between 6 months to 5 years with Grade II, III and IV malnutrition, who was admitted in the pediatric ward and excluded those with Neurological problems, syndromes and chronic diseases affecting development. Developmental assessment of patients was done using DASII (Developmental assessment of Indian infants) scale minimum 1 week after recovery of the child from acute illness. Pearson’s chi-square test was used for calculating the statistical significance. The developmental assessment was done using DASII scale in 273children. Only 14.80% of children had normal mental DQ in grade II, whereas motor DQ was normal in 29.78% of grade II children. None of the patients with grade III and IV had normal mental or motor DQ. Mental development is more affected due to malnutrition than motor development, and the impact increases with increasing severity.

Decision Making and Implementation of the First Public Sector Introduction of Typhoid Conjugate Vaccine-Navi Mumbai, India, 2018.

Typhoid fever prevention and control efforts are critical in an era of rising antimicrobial resistance among typhoid pathogens. India remains one of the highest typhoid disease burden countries, although a highly efficacious typhoid conjugate vaccine (TCV), prequalified by the World Health Organization in 2017, has been available since 2013. In 2018, the Navi Mumbai Municipal Corporation (NMMC) introduced TCV into its immunization program, targeting children aged 9 months to 14 years in 11 of 22 areas (Phase 1 campaign). We describe the decision making, implementation, and delivery costing to inform TCV use in other settings. We collected information on the decision making and campaign implementation in addition to administrative coverage from NMMC and partners. We then used a microcosting approach from the local government (NMMC) perspective, using a new Microsoft Excel-based tool to estimate the financial and economic vaccination campaign costs. The planning and implementation of the campaign were led by NMMC with support from multiple partners. A fixed-post campaign was conducted during weekends and public holidays in July-August 2018 which achieved an administrative vaccination coverage of 71% (ranging from 46% in high-income to 92% in low-income areas). Not including vaccine and vaccination supplies, the average financial cost and economic cost per dose of TCV delivery were $0.45 and $1.42, respectively. The first public sector TCV campaign was successfully implemented by NMMC, with high administrative coverage in slums and low-income areas. Delivery cost estimates provide important inputs to evaluate the cost-effectiveness and affordability of TCV vaccination through public sector preventive campaigns.

Association between diet quality and obesity indicators among the working-age adults in Inner Mongolia, Northern China: a cross-sectional study

BackgroundObesity is a major risk factor for the global burden of disease in countries that are economically developed or not. This study aimed to investigate the association between diet quality and obesity indicators applying DASH and aMed.MethodsThis cross-sectional study on adult nutrition and chronic disease in Inner Mongolia (n = 1320). Dietary data were collected using 24-h diet recall for 3 consecutive days and weighing method. DASH and aMed were used to assess the dietary quality. WC, BMI and WC-BMI were used as obesity indicators. Logistic regression models were used to examine the associations between diet quality and obesity indicators.ResultsHigher diet quality, assessed by DASH, was only associated with WC. The odds ratio (OR) for abdominal obesity in the highest tertile of DASH scores compared with the lowest was 0.71 (95% confidence interval (CI) 0.53, 0.96; Ptrend = 0.03). Furthermore, aMed was inversely associated with obesity indicators. OR for abdominal obesity in the highest tertile of aMed score compared with the lowest were 0.63 (95% CI 0.47, 0.87; Ptrend = 0.005) and 0.57 (95% CI 0.41, 0.77; Ptrend = 0.02) for overweight and obesity, respectively, and 0.60 (95% CI 0.44, 0.81; Ptrend = 0.02) for high obesity risk.ConclusionsOur findings suggest that dietary quality assessed using aMed is more closely associated with obesity than assessment using DASH in working-age adults in Inner Mongolia. The Mediterranean diet can be recommended as a healthy diet to control weight.

Characteristics and management of stroke in Korea: 2014-2018 data from Korean Stroke Registry.

Lifestyle changes and evolving healthcare practices in Korea have influenced disease patterns and medical care. Since strokes have high disease burden in countries with aging populations, it is necessary to evaluate the associated recent disease characteristics and patient care patterns. The Korean Stroke Registry is a nationwide, multicenter, prospective, hospital-based stroke registry in Korea used to monitor these changes across the population. We aimed to evaluate the recent status of clinical characteristics and management of stroke cases in order to identify changes in the Korean population across time. This study used Korean Stroke Registry data from patients experiencing ischemic stroke or transient ischemic attack patients, between 2014 and 2018. We analyzed data on demographics, risk factors, stroke subtypes, and treatments that included thrombolysis. A total of 39,291 patients (mean age 68.0 ± 13.0, 58.3% male) were analyzed. The proportions of hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation, and prior stroke were 63.4%, 30.9%, 27.7%, 19.4%, and 17.1%, respectively. In the stroke subtype analysis, the frequency of large artery atherosclerosis was highest (32.6%), followed by cardioembolism (21.3%) and small vessel occlusion (19.9%). Acute reperfusion therapy was conducted in 15.3% of cases (11.7% using intravenous tPA and 7.3% using intra-arterial thrombectomy). Intra-arterial thrombectomy also demonstrated a steep increasing trend over time (RR 1.095 (1.060-1.131), p < 0.001). This study provided analysis of nationwide, hospital-based, quality-controlled data from the Korean Stroke Registry database regarding changes in the characteristics, risk factors, and treatments of strokes in Korea.

Mental health financing challenges, opportunities and strategies in low- and middle-income countries: findings from the Emerald project.

Current coverage of mental healthcare in low- and middle-income countries is very limited, not only in terms of access to services but also in terms of financial protection of individuals in need of care and treatment. To identify the challenges, opportunities and strategies for more equitable and sustainable mental health financing in six sub-Saharan African and South Asian countries, namely Ethiopia, India, Nepal, Nigeria, South Africa and Uganda. In the context of a mental health systems research project (Emerald), a multi-methods approach was implemented consisting of three steps: a quantitative and narrative assessment of each country's disease burden profile, health system and macro-fiscal situation; in-depth interviews with expert stakeholders; and a policy analysis of sustainable financing options. Key challenges identified for sustainable mental health financing include the low level of funding accorded to mental health services, widespread inequalities in access and poverty, although opportunities exist in the form of new political interest in mental health and ongoing reforms to national insurance schemes. Inclusion of mental health within planned or nascent national health insurance schemes was identified as a key strategy for moving towards more equitable and sustainable mental health financing in all six countries. Including mental health in ongoing national health insurance reforms represent the most important strategic opportunity in the six participating countries to secure enhanced service provision and financial protection for individuals and households affected by mental disorders and psychosocial disabilities. D.C. is a staff member of the World Health Organization.

How can we improve priority-setting for investments in health research? A case study of tuberculosis

BackgroundAlthough enhanced priority-setting for investments in health research for development is essential to tackling inequalities in global health, there is a lack of consensus on an optimal priority-setting process. In light of the current surge in tuberculosis (TB) research investment, we use TB as a case study.MethodsWe investigated two critical aspects of a research prioritisation process, namely the criteria that should be used to rank alternative research options and which stakeholders should be involved in priority-setting. We conducted semi-structured interviews with 24 key informants purposively selected from four distinct groups – academia, funding bodies, international policy or technical agencies, and national disease control programmes. Interview transcripts were analysed verbatim using a framework approach. We also performed a systematic analysis of seven diverse TB research prioritisation processes.ResultsThere was consensus that well-defined and transparent criteria for assessing research options need to be agreed at the outset of any prioritisation process. It was recommended that criteria should select for research that is likely to have the greatest public health impact in affected countries rather than research that mainly fills scientific knowledge gaps. Some interviewees expressed strong views about the need – and reluctance – to make politically challenging decisions that place some research areas at a lower priority for funding. The importance of taking input from stakeholders from countries with high disease burden was emphasised; such stakeholders were notably absent from the majority of prioritisation processes we analysed.ConclusionsThis study indicated two critical areas for improvement of research prioritisation processes such that inequalities in health are better addressed – the need to deprioritise some research areas to generate a specific and meaningful list for investment, and greater involvement of experts working in high disease-burden countries.

Disease burden among people aged 70 years or older in countries with different developmental levels from 1990 to 2016

To examine differences in burden of disease among people aged ≥70 years old in countries with different developmental levels from 1990 to 2016. Methods: The sociodemographic index (SDI) of global burden of disease (GBD) was used to divide 195 countries into five developmental levels: high, high middle, middle, low middle and low. The results of the Global Burden of Diseases Study 2016 (GBD 2016) were extracted to examine disability-adjusted life years (DALY) and the health loss from the top 10 diseases and risk factors among the people aged ≥70 years old in countries with different SDIs. Results: Between 1990 and 2016, the age-standardized DALY rate among people aged ≥70 years old in countries with different SDIs all showed a downward trend. Different decreases in DALY rate in over-seventy old people were observed across countries with different SDI levels: -23.9% in high SDI, -21.3% in high-middle SDI, -23.4% in middle SDI, -18.8% in low-middle SDI and -16.3% in low SDI. In 1990, the age-standardized DALY rate among people aged ≥70 years old in low and low middle SDI countries was 1.67 and 1.49 times of that in high SDI countries; and the gaps rose to 1.83 and 1.59 times in 2016. The DALY rate of the aged people remained remarkably higher in low middle and low SDI countries in 2016, and the gap widened compared with that in 1990. The reduction of age-standardized DALY rate was mainly due to the decrease of years of life lost (YLL). In 2016, low SDI and low-middle SDI countries suffered much higher burden of disease from infectious diseases and chronic non-communicable diseases. Analysis of leading causes and risk factors of DALY showed significant disparities across different SDI countries; burden of disease caused by environmental pollution and adverse health conditions was much higher in the low SDI and lower-middle SDI countries than that in the other countries. Conclusion: During 1990-2016, the burden of disease in countries of all 5 SDI levels declined. But the reductions in the developing countries were less than those in the developed countries, widening health disparities for the elderly between low and high SDI countries. International organizations and individual governments should take measures to narrow health gaps among old adults across countries with different developmental levels.