Country-wide Studies Research Articles

The Determination of the Prohibited Herbicide 4,6-Dinitro-Ortho-Cresol (DNOC) in Poisoned Domestic and Wild Animals in Italy.

This study reports the determination of DNOC in the baits and gastric contents of poisoned dogs and wild canids collected in the Abruzzo region between 2014 and 2022. A total of 663 samples of the baits and carcasses of domestic and wild animals were analyzed for the determination of DNOC through GC-MS. DNOC was found to be present in 58 cases from 663 analyzed samples, with 49 poison baits and nine gastric content samples from dogs and red foxes. This study confirms for the first time that the banned pesticide DNOC still poisons both domestic and wild animals in the Abruzzo region. It should be considered that this study was carried out on a population of animals from a regional geographical area, and more detailed country-wide studies need to be carried out to obtain the incidence of poisoning from this herbicide in Italy. Furthermore, these findings emphasize the importance of considering this chemical in differential diagnosis during toxicological investigations of animal poisoning.

Prevalence of plant pathogenic nematodes in banana fields of Sylhet district, Bangladesh

Plant pathogenic nematodes pose a significant threat to banana production, causing symptoms such as root lesions, stunted growth, and reduced yield. A comprehensive study in Bangladesh’s Sylhet district aimed to assess nematode infestations in banana fields, involving interviews with farmers, soil sample collection, and microscopic examination. Results revealed the presence of multiple nematode species, with Helicotylenchus spp. being the most abundant. PCR analysis confirmed R. similis infestation in 35% of fields, highlighting its prevalence. Monoculture practices were observed among farmers, exacerbating nematode infestation risks. Limited communication between farmers and agricultural offices contributes to unawareness of nematode infestations. Country-wide studies and improved communication are crucial for implementing effective nematode mitigation strategies and safeguarding banana yield.

Research on feeding and eating disorders in India: A narrative review.

Despite growing evidence of their prevalence, research on feeding and eating disorders (FEDs) in India has been sporadic. This narrative review aimed to summarize the research on FED in India and set priorities for future research and translation of evidence. An electronic search was conducted in the MEDLINE, PsycINFO, and Google Scholar databases to identify relevant English peer-reviewed articles from April 1967 to July 2023. The extracted data from these studies included author names, publication year, research location, type of intervention (for interventional studies), nature of comparator treatments, and main outcomes or findings. We found a rising trend in the prevalence of EDs in India. Adolescent age group, female sex, higher socioeconomic status, family history of mental illness or disordered eating, and borderline personality pattern were risk factors for EDs. For feeding disorders (FDs), childhood age group, malnutrition, pregnancy, psychosis, intellectual disability (ID), and obsessive-compulsive disorder (OCD) were putative risk factors. Both physical and psychiatric comorbidities were common in FEDs. Culture appears to exert a pathoplastic effect on symptom presentation in FEDs; an illustrative example is the documented nonfat phobic variant of anorexia nervosa (AN) in India. Research on management has focused on using assessment tools, investigations to rule out medical comorbidities, psychosocial and family-based psychotherapies, nutritional rehabilitation, pharmacotherapy, and neuromodulation approaches. Whereas the publication output on FEDs in India has increased over the last decade, it remains an under-researched area, with a striking paucity of original research. Future research priorities in FEDs include conducting country-wide registry-based studies to offer real-world insights, longitudinal research to identify culturally relevant risk factors, and developing brief, culturally sensitive diagnostic instruments for FEDs in the Indian context. This will help generate locally relevant epidemiological data on FEDs and inform treatment and prevention strategies.

Advancing guideline quality through country-wide and regional quality assessment of CPGs using AGREE: a scoping review

Background and objectiveClinical practice guidelines (CPGs) are evaluated for quality with the Appraisal of Guidelines for Research and Evaluation (AGREE) tool, and this is increasingly done for different countries and regional groupings. This scoping review aimed to describe, map, and compare these geographical synthesis studies, that assessed CPG quality using the AGREE tool. This allowed a global interpretation of the current landscape of these country-wide or regional synthesis studies, and a closer look at its methodology and results.Study design and methodsA scoping review was conducted searching databases Medline, Embase, Epistemonikos, and grey literature on 5 October 2021 for synthesis studies using the later versions of AGREE (AGREE II, AGREE-REX and AGREE GRS) to evaluate country-wide or regional CPG quality. Country-wide or regional synthesis studies were the units of analysis, and simple descriptive statistics was used to conduct the analysis. AGREE scores were analysed across subgroups into one of the seven Sustainable Development Goal regions, to allow for meaningful interpretation.ResultsFifty-seven studies fulfilled our eligibility criteria, which had included a total of 2918 CPGs. Regions of the Global North, and Eastern and South-Eastern Asia were most represented. Studies were consistent in reporting and presenting their AGREE domain and overall results, but only 18% (n = 10) reported development methods, and 19% (n = 11) reported use of Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Overall scores for domains Rigor of development and Editorial independence were low, notably in middle-income countries. Editorial Independence scores, especially, were low across all regions with a maximum domain score of 46%. There were no studies from low-income countries.ConclusionThere is an increasing tendency to appraise country-wide and regionally grouped CPGs, using quality appraisal tools. The AGREE tool, evaluated in this scoping review, was used well and consistently across studies. Findings of low report rates of development of CPGs and of use of GRADE is concerning, as is low domain scores globally for Editorial Independence. Transparent reporting of funding and competing interests, as well as highlighting evidence-to-decision processes, should assist in further improving CPG quality as clinicians are in dire need of high-quality guidelines.

A Nationwide Study of GATA2 Deficiency in Italy Reveals Novel Symptoms and Genotype-phenotype Association.

GATA2 deficiency is a rare disorder encompassing a broadly variable phenotype and its clinical picture is continuously evolving. Since it was first described in 2011, up to 500 patients have been reported. Here, we describe a cohort of 31 Italian patients (26 families) with molecular diagnosis of GATA2 deficiency. Patients were recruited contacting all the Italian Association of Pediatric Hematology and Oncology (AIEOP) centers, the Hematology Department in their institution and Italian societies involved in the field of vascular anomalies, otorhinolaryngology, dermatology, infectious and respiratory diseases. Median age at the time of first manifestation, molecular diagnosis and last follow-up visit was 12.5 (age-range, 2-52years), 18 (age-range, 7-64years) and 22years (age-range, 3-64), respectively. Infections (39%), hematological malignancies (23%) and undefined cytopenia (16%) were the most frequent symptoms at the onset of the disease. The majority of patients (55%) underwent hematopoietic stem cell transplantation. During the follow-up rarer manifestations emerged. The clinical penetrance was highly variable, with the coexistence of severely affected pediatric patients and asymptomatic adults in the same pedigree. Two individuals remained asymptomatic at the last follow-up visit. Our study highlights new (pilonidal cyst/sacrococcygeal fistula, cholangiocarcinoma and gastric adenocarcinoma) phenotypes and show that lymphedema may be associated with null/regulatory mutations. Countrywide studies providing long prospective follow-up are essential to unveil the exact burden of rarer manifestations and the natural history in GATA2 deficiency.

Count Me In: an inclusive approach towards patient recruitment for clinical research studies in the NHS

BackgroundParticipation in clinical research is associated with better patient outcomes and higher staff retention and satisfaction rates. Nevertheless, patient recruitment to mental health studies is challenging due to a reliance...

Assessment of rheumatoid arthritis and associated risk factors among patients attending Kibungo level two teaching hospital

Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily affects the joints, but can affect other parts of the body causing inflammation, pain, stiffness, and joint damage. It affects approximately 1% of the global population. The objectives of this study were to assess the prevalence of rheumatoid arthritis and risk factors associated with rheumatoid arthritis among patients attending Kibungo level two teaching hospital. The retrospective study extracted data from January, 2018 to January 2023 and the cross-sectional part assessed risk factors associated to rheumatoid arthritis using questionnaire by telephone calls. Data collected were analyzed statistically using SPSS version 25. In this study the prevalence of rheumatoid arthritis was 43.20%. Across sex, females were more affected than males (44.2% and 40.0%, respectively). Binary logistic regression was used to assess the association between RA and risk factors. Age groups, C-Reactive Protein, red meat consumption showed significant association with RA (OR = 1.566, p = 0.008; OR = 1.299, p = 0.013; OR = 2.599, p < 0.001). The study was limited since it only included the participants at Kibungo Level two Teaching hospital, hence not having large population. Carrying out country wide studies regarding to the rheumatoid arthritis and associated risk factors on large population in order to establish epidemiologic data in Rwanda is highly recommended.
 Keywords: Rheumatoid arthritis, risk factors, C-Reactive Protein, Rheumatoid Factor

Long-Term Outcomes of Kidney Paired Donation Transplantation: A Single Center Retrospective Cohort Study

This study aimed to compare the kidney paired donation (KPD) program recipients with the traditional living donor kidney transplantation (LDKT) recipients regarding patient and graft survival. We retrospectively analyzed 141 recipients of the KPD program and 141 classic LDKT recipients that we matched for age and sex as controls between July 2005 and June 2019. We compared the 2 transplant groups for patient and kidney survival using the Kaplan-Maier test. We also performed Cox Regression analysis to examine factors affecting patient survival, including transplant type. The average follow-up period was 96.17 ± 44.22 months. Of the 282 patients, 88 died in the follow-up period. There was no statistically significant difference in graft and patient survival between the KPD and LDKT groups. In the Cox regression model, including the transplant type, only the serum creatinine level measured in the first month after discharge was a significant factor in predicting patient survival. The findings of this study indicate that the KPD program is an effective and reliable method to increase LDKT. Country-wide multicentric studies should confirm the results of this study. In countries where cadaver transplantation is insufficient, efforts should be made to expand the KPD program.

Utilization of health information data in Nairobi County public health facilities; lessons from the field

Background: The vital use of data and information for successful policy-making, planning, monitoring of operations, and decision-making is essential to the administration of today’s health systems. Vital health choices typically rely on political expediency, donor pressure, and rarely replicated countrywide studies that are insensitive to changes unfolding over shorter timescales because data utilization has been constrained and is inadequate.Methods: A descriptive cross-sectional research study was conducted where quantitative technique was used for a minimum of 216 respondents. The results were presented in form of tables and charts.Results: The results show that access to routine data (p=0.0001), having a working computer (p=0.023), having access to the internet (p=0.030), having a high level of education (p=0.025), the gender of the health worker (p=0.010), the cadre (p=0.001), participating in data discussion forums (p=0.013), receiving training on data use (p=0.036), collecting data (p=0.041), analysing data (p=0.032), and data management (p=0.007) were substantially correlated with the use of health information data.Conclusions: The level of education, gender of the health worker, cadre, involvement in data discussion forums, training on data utilization, data collection, data analysis, data management, overall levels of competency, access to routine data, access to functional computer and access to internet significantly influenced the utilization of health information data.

Nationwide molecular survey of Dirofilaria immitis and Dirofilaria repens in companion dogs and cats, United States of America

BackgroundHeartworms, Dirofilaria immitis, are known to be widespread in dogs and cats in the USA, but there have been no country-wide prevalence studies performed to date. There have also been no large-scale studies to determine whether the closely related species, Dirofilaria repens, occurs in the USA.MethodsTo provide this large-scale data, we examined whole blood samples (n = 2334) submitted from around the USA to the Molecular Diagnostic Laboratory at Auburn University between 2016 and 2022. Quantitative PCRs for D. immitis (targeting 16S rRNA) and D. repens (targeting cytochrome c oxidase subunit 1 gene) were performed to determine the presence of Dirofilaria DNA. DNA sequencing was performed to confirm the results.ResultsDirofilaria immitis DNA was found in 6.3% (68/1080) of the dogs from 17/39 states, and 0.3% (4/1254) of the cats from 4/42 states. None of the dogs or cats were positive for D. repens. The average 16S rRNA copy number of D. immitis in the dogs was 1,809,604 in 200 µl whole blood, while only a single copy was found in each of the four D. immitis-positive cats. The prevalence of D. immitis in dogs of different ages, sexes, and breeds did not differ significantly, but the prevalence in Southern states (7.5%, 60/803) was significantly higher than in the Western (1.7%, 1/58), Midwest (3.3%, 4/120), and Northeastern states (3.1%, 3/98) (P < 0.05). Dogs positive for D. immitis were identified in each study year (2016: 4.2%, 2/48; 2017: 9.8%, 4/41; 2018: 5.1%, 8/156; 2019: 4.9%, 15/306; 2020: 9.8%, 26/265; 2021: 4.9%, 13/264). Interestingly, dogs infected with Hepatozoon spp. (11.8%, 37/313) were significantly more likely to also be positive for D. immitis than dogs without evidence of Hepatozoon infection (3.9%, 30/760) (P < 0.0001).ConclusionsTo our knowledge, this is the first nationwide molecular survey of Dirofilaria spp. in dogs and cats in the USA, and the largest molecular survey of canine and feline dirofilariosis worldwide. Further studies are warranted to combine PCR with standard heartworm diagnostics to better understand the prevalence of Dirofilaria spp. and aid in determining the risks posed to dogs and cats in the USA.Graphical

Knowledge, attitude and practice towards hepatitis B infection among high school students in Asante Mampong, Ghana.

Hepatitis B virus (HBV) infection is a serious global public health problem, with significant morbidity and mortality from acute and chronic complications. Increasing awareness and improving knowledge of HBV helps reduce the risk of the disease. Although many studies have been conducted on HBV in Ghana, few have focused on examining knowledge, attitude and preventive practices among adolescents towards the disease. The objective of this study was to assess HBV knowledge, attitude and practice (KAP) among adolescents in high schools in the Asante Mampong Municipality in the Ashanti Region of Ghana. A descriptive cross-sectional study was conducted among 398 adolescents from six senior high schools within the Asante Mampong Municipality. Data was collected using a 30-item structured questionnaire. Each item had two response options: "Yes" and "No". A scoring system was generated and respondents were given a score on each item answered. A positive response to an item was scored 1 point and a negative response was scored 0. Scores were then summed up and averaged to give the mean knowledge, attitude and practice scores. The majority of the respondents were male (60%), between 15 and 17 years (45%), Christian (93%) and in their first year of study. The adolescents had basic knowledge, positive attitude, and poor practices towards HBV. There was no significant relationship between the demographic variables of the respondents and KAP mean scores. There is the need to introduce health education and awareness programs in schools within the Asante Mampong Municipality to improve students' level of knowledge of HBV. Countrywide studies examining KAP towards HBV infection among adolescents are also warranted.

Pattern of occlusive disease in lower extremity arteries in patients qualifying for revascularization in a North Central Province tertiary care centre in Sri Lanka

Introduction: In Sri Lanka many patients with the occlusive arterial disease [OAD] undergo revascularization. The patterns of OAD vary with the underlying risk factors, however, there is a paucity of data regarding this in Sri Lankan patients. Only one study reported the pattern of OAD among patients undergoing angioplasty in Sri Lanka. This study used conventional or catheter angiograms. There were no studies describing the patterns of OAD based on computerized tomographic angiography [CTA] imaging reported in Sri Lanka earlier. This study describes the CTA-based pattern of OAD among patients admitted for intervention at the Teaching Hospital Anuradhapura [THA]. Methods: This study was done at the vascular and transplant unit of THA. Patients with critical limb ischemia [ulcer, gangrene, rest pain] and disabling claudication were included. Data on patient demography, comorbid diseases, and the pattern of arterial occlusion were analysed. Results: 100 patients with 81 [81%] males were included. The mean age was 67.6 years [53-83].60 had ulcers, 25 gangrene, 10 rest pain and 5 had disabling claudication. 63 [63%] were smokers. diabetes mellitus, hypertension, ischemic heart disease, heart failure and chronic kidney disease were present in 65 [65%], 47, 25, 11 and 13 respectively. Distal vascular disease [anterior tibial- AT - 55 and posterior tibial - PT - 44] was present in 65 [65%]. Iliac, Femoral [common femoral – CFA and superficial femoral - SFA] disease were present in 15 [15%] and 57 [57%] respectively. 28 [28%] had isolated distal arterial disease. The distal disease was not significantly associated with diabetes mellitus [p - 0.39]. Conclusion: Distal occlusive arterial disease is the commonest followed by femoral disease. This study does not show an association between diabetes mellitus and distal disease, contrary to the popular belief. Further countrywide studies with larger study populations are needed to come to a final conclusion.

Countrywide Monitoring of Ground Deformation Using InSAR Time Series: A Case Study from Qatar

Over the past few decades the country of Qatar has been one of the fastest growing economies in the Middle East; it has witnessed a rapid increase in its population, growth of its urban centers, and development of its natural resources. These anthropogenic activities compounded with natural forcings (e.g., climate change) will most likely introduce environmental effects that should be assessed. In this manuscript, we identify and assess one of these effects, namely, ground deformation over the entire country of Qatar. We use the Small Baseline Subset (SBAS) InSAR time series approach in conjunction with ALOS Palsar-1 (January 2007 to March 2011) and Sentinel-1 (March 2017 to December 2019) synthetic aperture radar (SAR) datasets to assess ground deformation and conduct spatial and temporal correlations between the observed deformation with relevant datasets to identify the controlling factors. The findings indicate: (1) the deformation products revealed areas of subsidence and uplift with high vertical velocities of up to 35 mm/yr; (2) the deformation rates were consistent with those extracted from the continuously operating reference GPS stations of Qatar; (3) many inland and coastal sabkhas (salt flats) showed evidence for uplift (up to 35 mm/yr) due to the continuous evaporation of the saline waters within the sabkhas and the deposition of the evaporites in the surficial and near-surficial sabkha sediments; (4) the increased precipitation during Sentinel-1 period compared to the ALOS Palsar-1 period led to a rise in groundwater levels and an increase in the areas occupied by surface water within the sabkhas, which in turn increased the rate of deposition of the evaporitic sediments; (5) high subsidence rates (up to 14 mm/yr) were detected over landfills and dumpsites, caused by mechanical compaction and biochemical processes; and (6) the deformation rates over areas surrounding known sinkhole locations were low (+/−2 mm/yr). We suggest that this study can pave the way to similar countrywide studies over the remaining Arabian Peninsula countries and to the development of a ground motion monitoring system for the entire Arabian Peninsula.

The Effect of Exogenous Surfactant on Moderate and Severe Stages of COVID-19 Induced ARDS: the Pilot Study of a Clinical Trial.

COVID-19 pandemic has created a global health challenge. Many pharmaceuticals have been repurposed as potential treatments, though many have not been promising. Due to the inflammatory and destructive effects of the virus on alveolar cells, the effect of exogenous surfactant was assessed as a potential treatment of lung dysfunction in COVID-19 patients. In this pilot study of the clinical trial, 49 patients aged 35-80 years with COVID-19 admitted in ICU entered the study (22 patients intubated and 23 had face masks; 4 patients in the control arm). The treatment arm patients received two consecutive doses of surfactant. P/F ratio (based on serial blood gas analyses before and 12 hours after 2 doses of surfactant) and also, clinical outcomes were assessed.in COVID-19 adult patients, surfactant significantly improved pulmonary P/F ratio both in intubated and face mask COVID-19 patients (increasing from 119.2 ± 51.7 to 179.4 ± 115.5). The rate of extubation was much better than similar country-wide studies. Surfactant significantly alleviates the respiratory status in moderate to severe COVID-19 ARDS with two consecutive 100 mg doses of surfactant (with 6 hours’ interval) though previous studies have been controversial, regarding the effect of surfactant in general forms of ARDS. Higher doses might have better effects, mandating more trials.

Helminth Parasites among Rodents in the Middle East Countries: A Systematic Review and Meta-Analysis.

Simple SummaryThe review was conducted to establish an overview of rodent helminths in the Middle East as well as their public health importance. Following a systematic search, 65 field research were identified, studied, and analyzed. The overall prevalence of cestodes, nematodes, and trematodes were 24.88%, 32.71%, and 10.17%, respectively. The review detected 21 species of cestodes, 56 nematodes, and 23 trematodes, from which 22 have zoonotic importance. Capillaria hepatica, Hymenolepis diminuta, Hymenolepis nana, and Cysticercus fasciolaris were the most frequent and widespread zoonotic helminths. The review identified that there is an information gap on rodent helminths at the humans-animal interface level in this region. Therefore, the public health importance of rodent-borne helminth parasites is not fully recognized. Countrywide detailed studies on rodent helminths, along with the impact on public health, should be conducted in this region.Rodents can be a source of zoonotic helminths in the Middle East and also in other parts of the world. The current systematic review aimed to provide baseline data on rodent helminths to recognize the threats of helminth parasites on public health in the Middle East region. Following a systematic search on PubMed, Scopus, and Web of Science, a total of 65 research studies on rodent cestodes, nematodes, and trematodes, which were conducted in the countries of the Middle East, were analyzed. The study identified 44 rodent species from which Mus musculus, Rattus norvegicus, and Rattus rattus were most common (63%) and recognized as the primary rodent hosts for helminth infestation in this region. Cestodes were the most frequently reported (n = 50), followed by nematodes (49), and trematodes (14). The random effect meta-analysis showed that the pooled prevalence of cestode (57.66%, 95%CI: 34.63–80.70, l2% = 85.6, p < 0.001) was higher in Saudi Arabia, followed by nematode (56.24%, 95%CI: 11.40–101.1, l2% = 96.7, p < 0.001) in Turkey, and trematode (15.83%, 95%CI: 6.25–25.1, l2% = 98.5, p < 0.001) in Egypt. According to the overall prevalence estimates of individual studies, nematodes were higher (32.71%, 95%CI: 24.89–40.54, l2% = 98.6, p < 0.001) followed by cestodes (24.88%, 95%CI: 19.99–29.77, l2% = 94.9, p < 0.001) and trematodes (10.17%, 95%CI: 6.7–13.65, l2% = 98.3, p < 0.001) in the rodents of the Middle East countries. The review detected 22 species of helminths, which have zoonotic importance. The most frequent helminths were Capillaria hepatica, Hymenolepis diminuta, Hymenolepis nana, and Cysticercus fasciolaris. There was no report of rodent-helminths from Bahrain, Jordan, Lebanon, Oman, United Arab Emirates, and Yemen. Furthermore, there is an information gap on rodent helminths at the humans-animal interface level in Middle East countries. Through the One Health approach and countrywide detailed studies on rodent-related helminths along with their impact on public health, the rodent control program should be conducted in this region.

Growth and inequality at the micro scale: an empirical analysis of farm incomes within smallholder irrigation systems in Zimbabwe, Tanzania and Mozambique

ABSTRACT The mechanisms linking growth and inequality are critical for poverty reduction, yet they remain poorly understood at the micro level, as current knowledge is dominated by country-wide studies. This article evaluates farm income growth and changes in inequality among five smallholder irrigation communities in Mozambique, Tanzania and Zimbabwe. Over the period of study, the poorest sections of the population became better-off. Over an income growth spell, at low levels of growth, relative inequality increases, but it starts to drop as growth rises beyond a certain rate. Thus, careful design is required to ensure that pro-growth strategies also become inequality-reducing.

Age distribution and types of breast lesions among Afghan women diagnosed by fine needle aspiration cytology (FNAC) at a tertiary care centre in Afghanistan: a descriptive cross-sectional study

ObjectivesIn Afghanistan, breast diseases are a common reason for women to visit hospitals. This is the first study in Afghanistan aimed to describe the age distribution and types of breast...

Frequency of conjunctival epithelial dysplasia in patients with pterygium.

To determine the frequency of ocular squamous surface neoplasia associated with pterygium in an ophthalmology reference center in Central Mexico. We reviewed histopathological reports and slides of all patients who underwent pterygium surgery from 2014 to 2016 at the Instituto Mexicano de Oftalmologia in Queretaro (Mexico). We studied 177 biopsy samples; 66% were from women, and the median age was 52 years. We found ocular squamous surface neoplasias in 11.29% (n=20) of the samples. One biopsy sample revealed a poorly differentiated keratinizing and infiltrating carcinoma. The prevalence of ocular squamous surface neoplasia in our region appears to be high. Countrywide studies are necessary to determine the true prevalence of ocular squamous surface neoplasia in Mexico and to examine related risk factors.

Abstracts of Oral Presentations

Introduction: Snakebite envenoming affects 4.5-5.4 million people and kills 81,000-138,000 victims yearly according to the World Health Orga- nization (WHO), but estimates are extrapolations, and community-based country-wide studies are very scarce. Aim: To measure the impact of snakebite on human and animal health (incidence, mortality, disability) and livelihoods in Cameroon and Nepal. Methods: This epidemiological study is part of the SNAKE-BYTE project that aims at understanding the impact of snakebite in Cameroon and Nepal through one-health, health economy, and epidemiology using digital epidemiology and geo-health tools (Kobo-collect®, Stata® qGIS®, Guru-Maps®, AccesMod®). Based on minimal expected snakebite inci- dence of 100/100,000/year, 0.05% confidence limit, design effect of 2.0, 99% confidence level, 15% non-response margin, sample size was 61,000 people per country, i.e. 11,700 households in Cameroon and 13,800 in Nepal (respectively 5.2 and 4.4 persons per household). Households were preselected from satellite images, among 500 (2x250) randomly prese- lected administrative areas, where six mobile survey teams conducted the e-questionnaires. After ethical approval by Cameroonian, Nepalese, and Swiss authorities, surveys started in November 2018. Results: Interim data analysis on 5045 households in Cameroon and 10,163 in Nepal, showed respectively 120 victims per 29,537 persons- year and 141 victims per 46,888 persons-year. National snakebite inci- dence rates per 100,000 persons-year translate to 406.3 (95%CI: 338.3, 484.0) or 65,008 victims in rural Cameroon (population 16 million), and 300.7 (95%CI: 254.1, 353.5) or 39,993 victims in Nepal’s Terai lowlands (population 13.3 million). Victims were young adults (median 30/31y), often farmers, predominantly males in Cameroon (54.5%) and females in Nepal (66.4%), and 22.5% were children <15y. Snakes were seen by victims in 66%-71.2% cases, indoors or outdoors. Snakebite case-fatality ratios were high: 5.8% (n=7/120) in Cameroon, and 6.6% (n=9/141) in Nepal. About 10% received some injections, likely antivenom. Only 46.0% and 50.4% were taken to medical facilities. Multivariate analysis will model “hotspots” including demographic, clinical, ecological and socio- economic variables, and animals lost. Conclusion: This first country-wide community-based study shows very high annual snakebite incidence and mortality in rural Cameroon and Nepal. It should help health authorities to estimate antivenom needs by geographical area.

PCR-RFLP analyses of Leishmania species causing cutaneous and mucocutaneous leishmaniasis revealed distribution of genetically complex strains with hybrid and mito-nuclear discordance in Ecuador.

PCR-Restriction Fragment Length Polymorphism (RFLP) analyses targeting multiple nuclear genes were established for the simple and practical identification of Leishmania species without using expensive equipment. This method was applied to 92 clinical samples collected at 33 sites in 14 provinces of Ecuador, which have been identified at the species level by the kinetoplast cytochrome b (cyt b) gene sequence analysis, and the results obtained by the two analyses were compared. Although most results corresponded between the two analyses, PCR-RFLP analyses revealed distribution of hybrid strains between Leishmania (Viannia) guyanensis and L. (V.) braziliensis and between L. (V.) guyanensis and L. (V.) panamensis, of which the latter was firstly identified in Ecuador. Moreover, unexpected parasite strains having the kinetoplast cyt b gene of L. (V.) braziliensis and nuclear genes of L. (V.) guyanensis, L. (V.) panamensis, or a hybrid between L. (V.) guyanensis and L. (V.) panamensis were identified. This is the first report of the distribution of a protozoan parasite having mismatches between kinetoplast and nuclear genes, known as mito-nuclear discordance. The result demonstrated that genetically complex Leishmania strains are present in Ecuador. Since genetic exchanges such as hybrid formation were suggested to cause higher pathogenicity in Leishmania and may be transmitted by more species of sand flies, further country-wide epidemiological studies on clinical symptoms, as well as transmissible vectors, will be necessary.