Disease In Low-income Countries Research Articles

Post-COVID-19 health inequalities: Estimates of the potential loss in the evolution of the health-related SDGs indicators.

This study delves into the global evolution of 43 Sustainable Development Goals (SDG) indicators, spanning 7 major health themes across 185 countries to evaluate the potential progress loss due to the COVID-19 pandemic. Both the cross-country and temporal variability of the dataset are employed to estimate an empirical model based on an extended version of the Preston curve, which links well-being to income levels and other key socioeconomic health determinants. The approach reveals significant global evolution trends operating in each SDG indicator assessed. We extrapolate the model yearly between 2020 and 2030 using the IMF's pre-COVID-19 economic growth projections to show how each country in the dataset are expected to evolve in these health topics throughout the decade, assuming no other external shocks. The results of this baseline scenario are contrasted with a post-COVID-19 scenario, where most of the pandemic costs were already known. The study reveals that economic growth losses are, on average, estimated as 42% and 28% for low- and lower middle-income countries, and of 15% and 7% in high- and upper middle-income countries, respectively, according to the IMF's projections. These disproportional figures are shown to exacerbate global health inequalities revealed by the curves. The expected progress loss in infectious diseases in low-income countries, for instance, is an average of 34%, against a mean of 6% in high-income countries. The theme of Infectious diseases is followed by injuries and violence; maternal and reproductive health; health systems coverage; and neonatal and infant health as those with worse performance. Low-income countries can expect an average progress loss of 16% across all health indicators assessed, whereas in high-income countries the estimated loss is as low as 3%. The disparity across countries is even more pronounced, with cases where the estimated progress loss is as high as nine times worse than the average loss of 8%. Conversely, countries with greater fiscal capacity are likely to fare much better under the circumstances, despite their worse death count, in many cases. Overall, these findings support the critical importance of integrating the fight against inequalities into the global development agendas.

Abstract 3929: Comparative genomics of breast cancer in indigenous African and western populations first results from the E-Predict study

Abstract Breast cancer (BC) stands as the foremost female malignancy globally and is the most prevalent cancer in numerous developing countries, particularly in sub-Saharan Africa (SSA). Over the past decade, significant strides in comprehending the pathobiology of the disease and tumour dynamics have greatly enhanced treatment options, particularly in industrialized nations. Regrettably, SSA countries have witnessed only marginal, if any, improvements, with mortality rates surpassing incidence rates. Unfavourable outcome, early onset and high-grade tumours are predominant in SSA. Despite these challenging clinical phenotypes, there is currently a limited understanding of the primary molecular drivers, primarily due to a dearth of reliable data. Furthermore, there is a paucity of research conducted in, and pertinent to, the challenges of the disease in low-income countries (LICs), despite a rising incidence and higher mortality-to-incidence ratios. We thus established an international translational cancer research consortium in five distinct African countries. This initiative has contributed to the creation of a high-quality repository of biomaterials. Additionally, we have conducted whole exome sequencing on the initial 100 cases of breast cancer, comparing the molecular architecture of these tumors with data from The Cancer Genome Atlas (TCGA). We examining and compared the clinical disease phenotypes between indigenous African women and Western patients. A higher proportion of grade III tumors was observed in African patients aged between 30 to 59 years as compared to other patients within the same age group. In comparative molecular analyses, we found a significantly elevated tumor mutational burden in African patients (median of >15/MB) in contrast to other populations within the TCGA (median ~ 0.7/MB). Gene sets featuring co-occurring mutations, predicted to be associated with survival using the TCGA dataset, showed high mutation rates in the African cohort. Notably, co-occurring mutations between PIK3CA and genes linked to genomic instability, such as BIRC6 (HR: 11.7, p = 2.7e-05), KMT2C (HR: 4.7, p = 4.01e-04), NEB (HR: 3.84, p = 0.48), and PCLO (HR: 4.9, p = 0.016), among others, strongly correlated with poor overall survival and were highly mutated within the African cohort. Interestingly, within the TCGA, patients with early breast cancer onset exhibit twice as many mutations in KMT2C, a gene known for its association with DNA damage repair, genomic instability, and showed an improved response to immune checkpoint inhibition. These initial findings suggest that breast cancer genomics in indigenous African populations may exhibit substantial differences, potentially warranting consideration for distinct therapeutic modalities for these patients. Citation Format: Smiths Sengkwawoh Lueong, Pamela Derliche Tonouo Derliche Tonouo, Arnol Auvaker Tiofack, Rovaldo Nguims Kenfack, Jules Roger Kuiate, Esther Dina Mbassi, Sidonie Noa Ananga, Etienne Okobalemba Atenguena, Gustave Simo, Abdel Jelil Njouendou, Walters Ndaka, Zacharie Sando, Emmanuella Mayemi, Rachel Tayou, Gilles Gael Aghoagni, Anne Sango, Benjamin Pokam, Augustin Tozoula Bambara, Jens T. Siveke. Comparative genomics of breast cancer in indigenous African and western populations first results from the E-Predict study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3929.

Ulnar nerve mononeuropathy in a patient with Hansen's disease: Clinical and radiological features.

Leprosy is a chronic infection caused by bacteria called Mycobacterium leprae. This is a prevalent disease in low-income countries, and it has not been completely eradicated. We present the case of a 29-year-old man with a previous diagnosis of Hansen's disease, who consulted for pain in the left elbow and wrist, associated with fever with preserved mobility and pain on palpation. Diagnosis of mononeuropathy of the ulnar nerve was made by MRI of the elbow and forearm. This entity corresponds to an infrequent complication of this infection with few cases reported in the literature. Our added value with this case is to show and explain the clinical imaging correlation, which is vital to understand the presentation of symptoms and to carry out a comprehensive and rapid approach to establish adequate and timely treatment.

The realities of diagnosing and managing glomerular disease in low-income countries.

The realities of diagnosing and managing glomerular disease in low-income countries.

Development and validation of a predictive model for the diagnosis of rheumatic heart disease in low-income countries based on two cross-sectional studies

ObjectivesWe developed a questionnaire-based risk-scoring system to identify children at risk for rheumatic heart disease (RHD) in rural India. The resulting predictive model was validated in Nepal, in a population with a similar demographic profile to rural India. MethodsThe study involved 8646 students (mean age 13.0 years, 46% boys) from 20 middle and high schools in the West Midnapore district of India. The survey asked questions about the presence of different signs and symptoms of RHD. Students with possible RHD who experienced sore throat and joint pain were offered an echocardiogram to screen for RHD. Their findings were compared with randomly selected students without these symptoms. The data were analyzed to develop a predictive model for identifying RHD. ResultsBased on our univariate analyses, seven variables were used for building a predictive model. A four-variable model (joint pain plus sore throat, female sex, shortness of breath, and palpitations) best predicted the risk of RHD with a C-statistic of 0.854. A six-point scoring system developed from the model was validated among similarly aged children in Nepal. ConclusionsA simple questionnaire-based predictive instrument could identify children at higher risk for this disease in low-income countries where RHD remains prevalent. Echocardiography could then be used in these high-risk children to detect RHD in its early stages. This may support a strategy for more effective secondary prophylaxis of RHD.

Artificial intelligence assisted diagnoses of fine-needle aspiration of breast diseases: a single-center experience

Abstract: Purpose: Since 2010, physicians from Afghanistan have been uploading images of histological and cytological specimens to a telemedicine internet platform (iPath network) for expert evaluation. From this collective work, all cases with fine-needle aspirations (FNA) of mammary gland diseases were extracted and analyzed. The aim of the present retrospective feasibility study is to investigate the utility of artificial intelligence assisted diagnoses in fine-needle aspiration (FNA) of breast diseases.Material and Methods: A total of 3304 microphotographic images from 438 patients of smears from FNA of the mammary gland were available for this study. Telemedical expert diagnoses from 4 experienced cytopathologists were available in all 438 cases. Their diagnosis (malignant tumor of the mammary gland or benign mammary gland disease) was set as the gold standard. AI analysis was performed using i) clinical context data and ii) two different image recognition methods to determine the probability values for the presence of malignant breast tumor. Youden index and AUC (area under the curve) were used to evaluate test performance. Results: A score for invasive breast cancer (IBC) calculated from contextual variables agreed with the expert diagnosis (accuracy) in 85.2% and with the two image recognition systems in 78.4% and 65.2%. This simplifies health healthcare management of breast diseases in low income countries as in many patients the less expensive and less time-consuming technique of FNA may replace a histological examination.Conclusion: Image classification and analysis of context variables can be used to test the validity and plausibility of cytologic diagnoses, especially when cytologic interpretation has to be performed by people who are inexperienced in cytopathology.

Estimated Prevalence of Tuberculosis in Ruminants from Slaughterhouses in Constantine Province (Northeastern Algeria): A 10-Year Retrospective Survey (2011–2020)

Tuberculosis (TB) is considered one of the most widespread and devastating zoonotic diseases in low-income countries, with a cosmopolitan distribution. The aim of this 10-year retrospective survey (from 2011 to 2020) was to determine the frequency of bovine, ovine, and goat tuberculosis in different local slaughterhouses across Constantine Province, Algeria. The control of livestock carcasses was systematically performed by veterinarian inspectors, after each stage of the slaughter process. The routine abattoir inspection included the detection of visible abnormalities on different organs and lymph nodes. The overall prevalence of tuberculosis recorded in slaughtered animals was 0.83%, with the following distribution among species: 2.73% in cattle, 0.001% in sheep, and 0.0% in goats. During the study period, there was a strong correlation (R = 0.82) (p < 0.01) between tuberculosis occurrence and the number of slaughtered cattle. Fluctuations in monthly TB prevalence ranged from 2% to 24.8% between 2018 and 2020, although there were no statistically significant correlations between infection and the age or gender of the animals, except for the year 2020 when a significantly higher (p = 0.017) percentage of TB cases were recorded in female cattle compared to male cattle. The average monthly weight of the confiscated livers and lungs ranged significantly (p ≤ 0.05) from 150 kg to 350 kg. The study results provide baseline data regarding livestock tuberculosis monitoring in the area of Constantine, Algeria, indicating that the disease incidence is not highly alarming, yet remains a serious public and animal health issue in the screened region.

Evidence-based obstetric management of women with sickle cell disease in low-income countries

Pregnancy in women with sickle cell disease (SCD) is fraught with complications, some of which are life-threatening. Managing pregnancy in these women can be challenging, especially with poor resources, which is often the case in low-income countries. In Nigeria, for instance, up to 90% of patients pay out of pocket for medical care due to the poorly developed health insurance system, and this worsens the morbidity and mortality associated with this condition. We describe a pragmatic approach to routinely managing pregnant women with SCD in the antenatal period, showing the feasibility of effective management of these high-risk pregnancies in limited-resource settings. We also present the case of a pregnant Nigerian woman with SCD who has intrauterine growth restriction (IUGR) and acute chest syndrome (ACS), conditions that are life-threatening for the fetus and the mother, respectively, and require prompt intervention. We highlight how we successfully managed this woman in a cost-effective manner by employing relatively inexpensive tests for diagnosis and treating her effectively with oxygen, appropriate antibiotics and manual exchange blood transfusion for the ACS, and finger pulse oximeters to monitor oxygen saturation. We explore pathophysiological concepts to IUGR in women with SCD and briefly discuss the appropriate mode of delivery, including the options for pain relief in labor.

Community-level interventions for mitigating the risk of waterborne diarrheal diseases: a systematic review

BackgroundWaterborne diarrhea diseases are among the leading causes of morbidity and mortality globally. These diseases can be mitigated by implementing various interventions. We reviewed the literature to identify available interventions to mitigate the risk of waterborne diarrheal diseases.MethodsWe conducted a systematic database review of CINAHL (Cumulative Index to Nursing and Allied Health Literature), PubMed, Web of Science Core Collection, Cochrane library, Scopus, African Index Medicus (AIM), and LILACS (Latin American and Caribbean Health Sciences Literature). Our search was limited to articles published between 2009 and 2020. We conducted the review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement checklist. The identified studies were qualitatively synthesized.ResultsOur initial search returned 28 773 articles of which 56 studies met the inclusion criteria. The included studies reported interventions, including vaccines for rotavirus disease (monovalent, pentavalent, and Lanzhou lamb vaccine); enhanced water filtration for preventing cryptosporidiosis, Vi polysaccharide for typhoid; cholera 2-dose vaccines, water supply, water treatment and safe storage, household disinfection, and hygiene promotion for controlling cholera outbreaks.ConclusionWe retrieved few studies on interventions against waterborne diarrheal diseases in low-income countries. Interventions must be specific to each type of waterborne diarrheal disease to be effective. Stakeholders must ensure collaboration in providing and implementing multiple interventions for the best outcomes.Systematic review registrationPROSPERO CRD42020190411.

Mobile Surgical Teams Can Help Reduce the Surgical Burden of Disease in Low Income Countries

Introduction: 11% of the global burden of disease is attributable to surgical conditions hence more than 2 billion people have no access to surgery care. In effect there are many neglected cases in low income countries that will never achieve a normal life. The World Surgical Foundation (WSF) was formed in 1997 to help reduce the surgical burden of disease and the WSF Philippines was established in 2018 to provide surgical outreach to all regions of the Philippines who currently has 108 million population with 30% under poverty level. There is insufficient and inequitable distribution of public health resources and surgical manpower in the rural areas. Mobile Surgical Teams are formed that can provide quality multi specialty surgical services to many areas in the Philippines. Methods: This Surgical Outreach Program comprise of General Surgeons, Pediatric Surgeons, ENT Surgeons, Plastic Surgeons, Pediatricians, Internist and Pathologists and OR Nurses. Equipments brought to the missions include: Portable Anesthesia Machines, Electrosurgical Units, Monitors, Harmonic Scalpel, Surgical Instruments and Cryostat. Sterile supplies and medications are provided. The services are free. Follow up care will be done by the local surgeon. Initially, 2 missions per year are performed but it has increased to 10 per year prior to the Covid Pandemic. Results: The average surgical cases done per mission in 100 to 140 both children and adults. No mortality and minor complications. Conclusion: Mobile Surgical Teams can help reduce the surgical burden of disease in low income countries and can be duplicated in other countries.

Pediatric rheumatic carditis in Italy and Rwanda: The same disease, different socio-economic settings

BackgroundAcute Rheumatic Fever and Rheumatic Heart Disease are the leading cause of acquired heart disease in Low-Income Countries, and a common cause in High-Income Countries. We compared rheumatic carditis, its echocardiographic presentation at diagnosis and its progression in Italy and Rwanda. MethodsRetrospective study including all consecutive patients diagnosed with rheumatic carditis in an Italian (IT) and two Rwandan Hospitals (RW). Echocardiography was performed at diagnosis and three follow-up visits. Baseline characteristics, history of primary and secondary prophylaxis and cardiovascular complications data were collected. ResultsSeventy-nine and 135 patients were enrolled in IT and RW, respectively. Mitral regurgitation was the most common lesion (IT: 70%, RW: 96%) in both cohorts; mixed valve lesions and severe lesions were more prevalent in RW. Age at diagnosis (IT: 8.4 ± 2.9 yrs.; RW: 11.1 ± 2.7 yrs.; P < 0.001), adherence to secondary prophylaxis (IT: 99%; RW: 48%; P < 0.001) and history of primary prophylaxis (IT: 65%; RW: 6%; P < 0.001) were different. During the follow-up, native valve lesions completely resolved in 38% of IT and in 2% of RW patients (P < 0.001). By contrast, cardiac surgery was performed in 31% of RW and 5% of IT patients (P < 0.001). Cardiovascular complications and death were only observed in RW. ConclusionsThe more severe cardiac involvement, the higher rate of valve surgery, CV complications and deaths in RW, could be due to delayed diagnosis and treatment, scarce adherence to secondary prophylaxis and differences in social determinants of health.

Acute Coronary Syndromes in Niger: (West Africa): Epidemiological, Clinical, Para clinical and Therapeutic Aspects

Introduction: Coronary artery disease is the leader in cardiovascular disease. An estimated 7.5 million deaths from cardiovascular disease are due to coronary heart disease. WHO estimates that by 2030, nearly 23.6 million people will die from cardiovascular disease? Over 80% of deaths attributed to cardiovascular disease occur in low- and middle-income developing countries. The CORONAFRIC survey done in 1991 and which gathered 13 West African countries with 16 centers found a prevalence of coronary heart disease of 3, 17%. In Niger an over survey done in 2013 shows a prevalence of coronary heart disease at 5.60%. The main cause of coronary pathologies is atherosclerosis or atheroma and its sudden complication thrombosis. This review aims to study the local specificities of ACS through its epidemiological, clinical, Para clinical and therapeutic aspects at the level of the LAMORDE National Teaching Hospital (LNTH), in the absence of a cardiology technical platform intervention and in the absence of pre-hospital care, in order to formulate recommendations for the prevention of coronary artery diseases in low income countries. Patients and Methods: This is a retro and prospective study over a period (July 01, 2014 to December 31, 2019) of 66 months and concerns cases of ACS hospitalized in the internal medicine and cardiology department of LNTH. Were included in our study patients with angina pain, and electrocardiographic signs (ischemia, lesion or necrosis) with or without a confirmed past history of MI but admitted with biological signs. Results: At the end of our study, the prevalence of ACS is 10.67% compared to cardiovascular disease, CI 51.24%, stroke 26.24% and thromboembolic disease 2.84%. ACS is predominantly male in 63.77% of cases. The sex ratio is 1.76 -the age ≥50 years represents 86.98% of the subjects, with an average age of 60.98 years; -The months of November, December, January and February represent the favorable period for the onset of acute coronary syndromes with 23.20% of cases. - Retro sternal chest pain is by far the most common symptom with 67.63% of cases. Troponin was measured in 75 of our patients, ie 36.23% of which 35.27% had a high level.- ECG, troponin allowed us to identify forms of ACS with 70.05% of ACS ST +; 21.74% unstable angina and 8.21% Q- wave of MI. - The most affected territory was anterior with 153 cases (73.91%) followed by the lower territory 46 cases (22.22%) then the lateral territory 16 cases (7.73%) associated. In our study, hypertension was encountered in 34.48% of cases, diabetes (11.11%), hypercholesterolemia 4.35%), smoking (with 4.83%), obesity (with 2.90%), menopause (with 84.93%) were recognized as risk factors favoring the occurrence of ACS. In 96.14% of the cases, the patients were put on aspirin and clopidogrel followed by the ICE in 93.24% of the cases; Beta blocking in 92.75% of cases; statin in 89.86% of cases; of diuretics in 55.56% of cases and heparin in 52.17% of cases. In our study, 80.68% of our patients left hospital after clinical improvement. We have a high mortality rate of 19.32%. 80% of patients had HF as a complication, and conduction disorders are noted in 16% of cases and recurrence of pain in 8% of patients.

Osteomyelitis in Children with Sickle Cell Disease: A Challenging Diagnosis: Case Report from Cameroon

Introduction: Sickle Cell Disease (SCD) is the most prevalent genetic disease in the world predominantly in the African population with Sickle Cell Anaemia (SCA) being its dominant form. One of the most frequent complications of SCD is osteomyelitis. SCA is due to a point mutation in the beta globin chain of haemoglobin. This is responsible for the sickled shape of RBCs under low oxygen tension conditions leading to obstruction in the microcirculation. This leads to vaso-occlusive crises (VOC) which has a similar clinical presentation to that of osteomyelitis, another complication of SCD. Case Presentation: We present the case of a three-year-old girl with SCA who presented with an inability to bear weight in a febrile context. A diagnosis of VOC was initially made, which was later on changed to both a left chronic tibial and right distal femoral osteomyelitis following a series of biological, and imaging investigations. Surgical debridement and drainage were performed, resulting 9 weeks later in the involution of fever and leg pain. Conclusion: Osteomyelitis when associated with SCD is a dreadful and deathly disease in low income countries as it also presents like VOC therefore higher suspicion index is recommended. It is therefore important to take this into consideration at an early stage in patients with homozygous sickle cell disease so as to rapidly initiate multidisciplinary care. Appropriate investigations, appropriate antibiotic therapy, and timely surgical intervention would help to greatly reduce morbidity and mortality.

Health screening for emerging non-communicable disease burdens among the global poor: Evidence from sub-Saharan Africa

Evidence for the effectiveness of population health screenings to reduce the burden of non-communicable diseases in low-income countries remains very limited. We investigate the sustained effects of a health screening in Malawi where individuals received a referral letter if they had elevated blood pressure. Using a regression discontinuity design and a matching estimator, we find that receiving a referral letter reduced blood pressure and the probability of being hypertensive by about 22 percentage points four years later. These lasting effects are explained by a 20 percentage points increase in the probability of being diagnosed with hypertension. There is also evidence of an increase in the uptake of medication, while we do not identify improvements in hypertension-related knowledge or risk behaviors. On the contrary, we find an increase in sugar intake and a decrease in physical activity both of which are considered risky behaviors in Western contexts. The health screening had some positive effects on mental health. Overall, this study suggests that population-based hypertension screening interventions are an effective tool to improve health in low-income contexts.

Ensilicated tetanus antigen retains immunogenicity: in vivo study and time-resolved SAXS characterization

Our recently developed ensilication approach can physically stabilize proteins in silica without use of a pre-formed particle matrix. Stabilisation is done by tailor fitting individual proteins with a silica coat using a modified sol-gel process. Biopharmaceuticals, e.g. liquid-formulated vaccines with adjuvants, frequently have poor thermal stability; heating and/or freezing impairs their potency. As a result, there is an increase in the prevalence of vaccine-preventable diseases in low-income countries even when there are means to combat them. One of the root causes lies in the problematic vaccine ‘cold chain’ distribution. We believe that ensilication can improve vaccine availability by enabling transportation without refrigeration. Here, we show that ensilication stabilizes tetanus toxin C fragment (TTCF), a component of the tetanus toxoid present in the diphtheria, tetanus and pertussis (DTP) vaccine. Experimental in vivo immunization data show that the ensilicated material can be stored, transported at ambient temperatures, and even heat-treated without compromising the immunogenic properties of TTCF. To further our understanding of the ensilication process and its protective effect on proteins, we have also studied the formation of TTCF-silica nanoparticles via time-resolved Small Angle X-ray Scattering (SAXS). Our results reveal ensilication to be a staged diffusion-limited cluster aggregation (DLCA) type reaction. An early stage (tens of seconds) in which individual proteins are coated with silica is followed by a subsequent stage (several minutes) in which the protein-containing silica nanoparticles aggregate into larger clusters. Our results suggest that we could utilize this technology for vaccines, therapeutics or other biopharmaceuticals that are not compatible with lyophilization.

2173-PUB: Assessment of the Knowledge and Perception of Diabetic Symptoms among Patients in a Poor Environment

Introduction/Background: Diabetes mellitus is an endocrine disorder characterized by sustained hyperglycaemia due to loss of insulin secretion and/or impairment of insulin sensitivity at target tissues. More than 15.9 million people have diabetes accounting for more deaths in addition to infectious diseases in low income countries in Africa. Despite the alarming statistics the etiology and prognosis leading to the prevention and management of diabetes still lacks the needed attention and comprehensive education among patients in low income countries. Aim: The aim of this study is to examine the knowledge of causes and effects of diabetic symptoms among patients in a low income country. Method: A qualitative methodological framework focusing on participant’s illness experiences and personal beliefs about diabetes was used. We purposely recruited 30 diabetic patients who exhibited diabetic symptoms. After demographic information, each respondent completed the LANSS to ascertain neuropathy after which a semi structured interview guide was used to elicit each respondent’s view regarding diabetes. Data was transcribed and analyzed using a thematic approach. Results: Most respondents did not know their diabetic type and the precipitating factors for their diabetic symptoms. However some reported that their diabetes was spiritual and might have been contracted through bewitchment and other supernatural means. Others traced their condition to hereditary but the main causes of diabetes were generally lacking. Majority didn’t know their medications but requested for the need to have a much potent medication. Conclusion: Effective education and knowledge on the etiology, causes and prognosis of diabetes is generally lacking among patients living in poor countries. Disclosure V.A. Adzika: None.

Case Report: Diagnosis of COVID-19 versus Tropical Diseases in Pakistan.

.A 25-year-old medical student presented in Multan, Pakistan with a high fever, cough, myalgia, and diarrhea consistent with the typical signs and symptoms of novel coronavirus disease (COVID-19). The patient had traveled to high COVID-19–risk areas within Pakistan and had no significant medical and surgical history. Based on nasopharyngeal and oropharyngeal swab testing, the patient was found to be negative for COVID-19. He subsequently developed a diffuse rash and had serology consistent with dengue and measles. The patient was treated symptomatically, and his condition gradually improved over 7 days. This case highlights the high prevalence of many tropical diseases in low-income countries and the need for clinicians to consider alternate diagnoses in addition to testing for COVID-19 during the pandemic.

Travel-Related Typhoid Fever: Narrative Review of the Scientific Literature.

Enteric fever is a foodborne infectious disease caused by Salmonella enterica serotypes Typhi and Paratyphi A, B and C. The high incidence in low income countries can increase the risk of disease in travelers coming from high income countries. Pre-travel health advice on hygiene and sanitation practices and vaccines can significantly reduce the risk of acquiring infections. Although the majority of the cases are self-limiting, life-threatening complications can occur. Delayed diagnosis and cases of infections caused by multi-drug resistant strains can complicate the clinical management and affect the prognosis. More international efforts are needed to reduce the burden of disease in low income countries, indirectly reducing the risk of travelers in endemic settings. Surveillance activities can help monitor the epidemiology of cases caused by drug-susceptible and resistant strains.

Epidemiological transition and double burden of diseases in low-income countries: the case of Mozambique.

Epidemiological transition theory aims to describe changes in epidemiological scenarios at the global and national level. The assumption is the shift from infectious diseases (IDs) to non-communicable diseases (NCDs). Some authors argue that this theory failed to describe epidemiology in sub-Saharan Africa. We considered the case of Mozambique, where is occurring a rapid demographic change, with dramatic growth of the population. According to the data, we concluded that NCDs are increasing in Mozambique, but due to the vast predominance of IDs, a double burden of disease model is more accurate to describe the actual epidemiological context of the country. Consequently, health funding focusing on IDs should take into account the concomitant epidemiological scenario and try to encompass other health challenges.

Determinants of health seeking behavior for chronic non-communicable diseases and related out-of-pocket expenditure: results from a cross-sectional survey in northern Bangladesh

BackgroundIn spite of high prevalence rates, little is known about health seeking and related expenditure for chronic non-communicable diseases in low-income countries. We assessed relevant patterns of health seeking and related out-of-pocket expenditure in Bangladesh.MethodsWe used data from a household survey of 2500 households conducted in 2013 in Rangpur district. We employed multinomial logistic regression to assess factors associated with health seeking choices (no care or self-care, semi-qualified professional care, and qualified professional care). We used descriptive statistics (5% trimmed mean and range, median) to assess related patterns of out-of-pocket expenditure (including only direct costs).ResultsEight hundred sixty-six (12.5%) out of 6958 individuals reported at least one chronic non-communicable disease. Of these 866 individuals, 139 (16%) sought no care or self-care, 364 (42%) sought semi-qualified care, and 363 (42%) sought qualified care. Multivariate analysis confirmed that the following factors increased the likelihood of seeking qualified care: a higher education, a major chronic non-communicable disease, a higher socio-economic status, a lower proportion of chronic household patients, and a shorter distance between a household and a sub-district public referral health facility. Seven hundred fifty-four (87 %) individuals reported out-of-pocket expenditure, with drugs absorbing the largest portion (85%) of total expenditure. On average, qualified care seekers encountered the highest out-of-pocket expenditure, followed by those who sought semi-qualified care and no care, or self-care.ConclusionOur study reveals insufficiencies in health provision for chronic conditions, with more than half of all affected people still not seeking qualified care, and the majority still encountering considerable out-of-pocket expenditure. This calls for urgent measures to secure better access to care and financial protection.