Elimination Program Research Articles

Researchers’ perspectives on the integration of molecular and genomic data into malaria elimination programmes in Africa: a qualitative study

BackgroundMalaria remains a significant public health concern, despite global efforts to combat the disease with highest burden in Africa. Reports of emerging artemisinin partial- resistance in East Africa emphasize the importance of molecular data to guide policy decisions. Hence the need for researchers to collaborate with National control programmes to conduct genomics surveillance of malaria to inform malaria control and elimination policies. This study explored genomic researchers’ views on engaging with national control programmes to aid malaria elimination efforts in Africa.MethodsThis research employed an exploratory qualitative approach to investigate the views and experiences of malaria genomics researchers across 16 member countries of the Pathogen Genomic Diversity Network Africa (PDNA). In-depth interviews were conducted with each PDNA Principal Investigator, which were recorded, and transcribed verbatim. Subsequently, the data were analysed thematically with NVivo 12 qualitative data analysis software.ResultsThe study revealed that majority of malaria genomics researchers focused on understanding the genetic composition and adaptation of the malaria parasite, its vector, and human host. Their investigations delved into areas such as drug and insecticide resistance, parasite evolution, host interactions, human host susceptibility to malaria, diversity of vaccine candidates, and molecular surveillance of malaria. Challenges included limited funding, lack of interest and capacity among National Malaria Control Programmes (NMCP) to use research evidence effectively, and difficulties in communicating data implications to policymakers due to the absence of WHO-certified use cases. Despite these obstacles, researchers expressed a keen interest in forming partnerships with NMCPs to integrate genetic data into malaria control efforts in Africa. They also stressed the importance of enhancing researchers' ability to communicate findings to policymakers and local communities through policy briefs and innovative communication strategies.ConclusionThe study underscores the need to strengthen partnerships between genomic researchers and NMCPs to support malaria elimination in Africa. Furthermore, researchers should create practical frameworks for easy integration into WHO reporting formats to facilitate the use of molecular and genomic data in malaria control programme decision-making.

Waning success: a 2013–2022 spatial and temporal trend analysis of malaria in Ethiopia

BackgroundDespite consecutive decades of success in reducing malaria transmission, Ethiopia went off track towards its goal of malaria elimination by 2030, as outlined in the NMCP malaria strategy. Recent malaria outbreaks in Ethiopia are attributed to the emergence and spread of diagnostic and drug-resistant Plasmodium falciparum, increased insecticide resistance in major vectors and the spread of invasive Anopheles stephensi. The effects of the COVID-19 pandemic, environmental anomalies and internal conflicts have also potentially played a role in increasing malaria transmission. This study aimed to evaluate the contribution of environmental factors and An. stephensi to the spatiotemporal trends of recent malaria cases in Ethiopia.MethodsClinical malaria case data reported weekly between January 2013 and January 2023 were obtained from the Ethiopian Public Health Institute (EPHI), Addis Ababa. A negative binomial regression model was used to explain the variability and potential overdispersion in the weekly number of malaria cases reported across Ethiopian administrative zones. This model incorporated fixed effects for selected environmental factors and random effects to capture temporal trends, zone specific seasonal patterns, spatial trends at the zone level, and the presence of An. stephensi and its impact.ResultsOur negative binomial regression model highlighted 56% variability in the data and slightly more than half (55%) was due to environmental factors, while the remainder was captured by random effects. A significant nationwide decline in malaria risk was observed between 2013 and 2018, followed by a sharp increase in early 2022. Malaria risk was higher in western and northwestern zones of Ethiopia compared to other zones. Zone-specific seasonal patterns, not explained by environmental factors, were grouped into four clusters of seasonal behaviours. The presence of An. stephensi was not shown to have any significant impact on malaria risk.ConclusionsUnderstanding the spatial and temporal drivers of malaria transmission and therefore identifying more appropriate malaria control strategies are key to the success of any malaria elimination and eradication programmes in Ethiopia. Our study found that approximately 50% of malaria risk variability could be explained by environmental, temporal, and spatial factors included in the analysis, while the remaining variation was unexplained and may stem from other factors not considered in this study. This highlights the need for a better understanding of underlying factors driving local malaria transmission and outbreaks, to better tailor regional programmatic responses.Graphical

Cost of TB care and equity in distribution of catastrophic TB care costs across income quintiles in India

BackgroundTuberculosis (TB) poses a significant social and economic burden to households of persons with TB (PwTB). Despite free diagnosis and care under the National TB Elimination Programme (NTEP), individuals often experience significant out-of-pocket expenditure and lost productivity, causing financial catastrophe. We estimated the costs incurred by the PwTB during TB care and identified the factors associated with the costs.MethodsIn our cross-sectional study, we used multi-stage sampling to select PwTB notified under the NTEP, whose treatment outcome was declared between May 2022 and February 2023. Total patient costs were measured through direct medical, non-medical and indirect costs. Catastrophic costs were defined as expenditure on TB care > 20% of the annual household income. We determined the factors influencing the total cost of TB care using median regression. We plotted concentration curves to depict the equity in distribution of catastrophic costs across income quintiles. We used a cluster-adjusted, generalized model to determine the factors associated with catastrophic costs.ResultsThe mean (SD) age of the 1407 PwTB interviewed was 40.8 (16.8) years. Among them, 865 (61.5%) were male, and 786 (55.9%) were economically active. Thirty-four (2.4%) had Drug Resistant TB (DRTB), and 258 (18.3%) had been hospitalized for TB. The median (Interquartile range [IQR] and 95% confidence interval [CI]) of total costs of TB care was US$386.1 (130.8, 876.9). Direct costs accounted for 34% of the total costs, with a median of US$78.4 (43.3, 153.6), while indirect costs had a median of US$279.8 (18.9,699.4). PwTB < 60 years of age (US$446.1; 370.4, 521.8), without health insurance (US$464.2; 386.7, 541.6), and those hospitalized(US$900.4; 700.2, 1100.6) for TB experienced higher median costs. Catastrophic costs, experienced by 45% of PwTB, followed a pro-poor distribution. Hospitalized PwTB (adjusted prevalence ratio [aPR] = 1.9; 1.6, 2.2) and those notified from the private sector (aPR = 1.4; 1.1, 1.8) were more likely to incur catastrophic costs.ConclusionsPwTB in India incur high costs mainly due to lost productivity and hospitalization. Nearly half of them experience catastrophic costs, especially those from poorer economic quintiles. Enabling early notification of TB, expanding the coverage of health insurance schemes to include PwTB, and implementing TB sensitive strategies to address social determinants of TB may significantly reduce catastrophic costs incurred by PwTB.

Profile of triple elimination in maternal at Wangaya regional hospital in 2023

Background: Triple elimination is a program implemented by the Ministry of Health of the Republic of Indonesia, this program was adopted from the World Health Program or WHO to combat the transmission of HIV (Human immunodeficiency virus), syphilis and hepatitis B in pregnant women to their babies The aim of this study of this research is to determine the profile of pregnant women who undergo triple elimination testing. Methods: This study was a descriptive observational study with a retrospective study design. The data was collected from the medical records of pregnant women at Wangaya Regional Hospital from January 2023 to December 2023. Results: In this study involving 101 subjects, in this study, there were 65 people who underwent triple elimination examination and 36 people did not undergo triple elimination. These included HIV with 13 cases (12.8%) and hepatitis b with 4 cases (3.9%) and syphilis with 2 cases (1.98%). Conclusions: The triple elimination screening is a mandatory examination for pregnant women conducted during the first trimester of pregnancy. Pregnant women who do not undergo the triple elimination screening may lack knowledge, sufficient information and proper education and communication from healthcare providers about the triple elimination program. Improving these factors will enhance pregnant women's motivation to utilize and access healthcare services.

Exploring the potential antimalarial properties, safety profile, and phytochemical composition of Mesua ferrea Linn.

The increased resistance of Plasmodium falciparum to artemisinin and its partner drugs poses a serious challenge to global malaria control and elimination programs. This study aimed to investigate the therapeutic potential of Mesua ferrea Linn., a medicinal plant, as a source for novel antimalarial compounds. In this study, we conducted in vitro assays to evaluate the antimalarial activity and cytotoxicity of crude extracts derived from M. ferrea L. leaves and branches. Subsequently, the most promising extracts were subjected to assessments of their antimalarial efficacy and acute oral toxicity tests in mouse models. Furthermore, selected crude extracts underwent gas chromatography-mass spectrometry (GC-MS) analysis to identify their phytochemical compositions. Our findings revealed that the ethanolic extract of M. ferrea L. branches (EMFB) exhibited high antimalarial activity, with an IC50 value of 4.54 μg/mL, closely followed by the ethanolic extract of M. ferrea L. leaves (EMFL), with an IC50 value of 6.76 μg/mL. Conversely, the aqueous extracts of M. ferrea L. branches (AMFB) and leaves (AMFL) exhibited weak and inactive activity, respectively. The selected extracts, EMFB and EMFL, demonstrated significant dose-dependent parasitemia suppression, reaching a maximum of 62.61% and 54.48% at 600 mg/kg body weight, respectively. Furthermore, the acute oral toxicity test indicated no observable toxicity at a dosage of 2,000 mg/kg body weight for both extracts. GC-MS analysis revealed abundant compounds in the EMFB, such as oleamide, cis-β-farnesene, alloaromadendrene, physcion, palmitic acid, 5-hydroxymethylfurfural, and 4H-pyran-4-one, 2,3-dihydro-3,5-dihydroxy-6-methyl-, while the EMFL contained friedelin, friedelinol, betulin, β-caryophyllene, oleamide, and 5-hydroxymethylfurfural. Notably, both extracts shared several phytochemical compounds, including 4H-pyran-4-one, 2,3-dihydro-3,5-dihydroxy-6-methyl-, 5-hydroxymethylfurfural, α-copaene, cyperene, β-caryophyllene, alloaromadendrene, palmitic acid, ethyl palmitate, and oleamide. Additionally, further study is needed to isolate and characterize these bioactive compounds from M. ferrea L. leaves and branches for their potential utilization as scaffolds in the development of novel antimalarial drugs.

A study protocol for a multi-country cluster randomized controlled trial of the impact of a multi-component One Health strategy to eliminate Opisthorchis viverrini and soil transmitted helminths in the Lower Mekong Basin

BackgroundOpisthorchis viverrini (OV) and soil-transmitted helminths (STH) are two of the most common helminths contributing to the Neglected Tropical Disease (NTDs) burden in the Lower Mekong Basin. Although mass drug administration is the cornerstone of control programs to reduce morbidity caused by these infections, this approach has limitations in preventing re-infections. Elimination requires additional measures such as reservoir host treatment, improved hygiene and health education to reinforce MDA's impact. This study aims to examine the impact of a scalable multi-component One Health Helminth Elimination program in the Lower Mekong Basin (HELM) that combines human praziquantel (PZQ) and albendazole (ALB) treatment with a program that includes the “Magic Glasses” and the “Lawa Model” interventions with health promotion at their core.MethodsThis study will employ a cluster randomized controlled trial (cRCT) in 18 rural communities (with sub-district or villages as cluster units) across Cambodia, Laos and Thailand. The control arm will receive one round of PZQ/ALB treatment, while in the intervention arm, multi-component HELM program will be implemented, which includes PZQ/ALB treatment together with the Magic Glasses and Lawa Model interventions. OV and STH infections levels will be evaluated in individuals aged 5–75 years at baseline and will be repeated at follow-up (12 months after the HELM intervention), using modified formalin ethyl-acetate concentration technique and quantitative PCR. The primary outcome of the study will be cumulative incidence of human OV and STH infections. Outcomes between the study arms will be compared using generalized linear mixed models, accounting for clustering.DiscussionEvidence from this trial will quantify the impact of a multi-component One Health control strategy in interrupting Ov and STH infections in the Lower Mekong Basin.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12622000353796. Prospectively registered 28 February 2022.

Role of neutrophils in the pathogenesis of Post Kala-azar Dermal Leishmaniasis (PKDL).

Post Kala-azar Dermal Leishmaniasis (PKDL) is a dermal sequel of visceral leishmaniasis (VL), poses a significant threat to the success of ongoing kala-azar elimination program, due to its potential role in sustaining transmission cycles and complicating disease management strategies. In VL, neutrophils have been identified as the 'first line of defence', having multiple roles in disease pathogenesis, but their role in PKDL, if any, still remains elusive; presenting a critical gap in knowledge, and was the aim of this study. In a cohort of PKDL patients, CD66b+ neutrophils were quantified in skin biopsies, followed by immunostaining of FFPE sections to identify activated neutrophils (CD66b+/CD64+) and degranulated (CD66b+/MPO+), along with expression of neutrophil elastase (NE), matrix metalloprotease 9 (MMP9) and collagen I. Plasma levels of neutrophil chemo-attractants CXCL8/1/2/5, CCL2 and 20 and cytokines, (IL-6, IFN-γ, IL-4, IL-10, TNF-α, IL-17 and IL-22, 23) were evaluated by a multiplex assay, while lesional expression of IL-8, IL-10 and IL-17 was evaluated by immunohistochemistry. As compared to healthy individuals (control skin samples), PKDL cases at the lesional sites had an increased number of activated CD66b+ neutrophils (positive for CD64+, MPO+ and NE+). The plasma levels of neutrophil chemo-attractants, pro-inflammatory and regulatory cytokines were raised as was circulating and lesional IL-8, along with an enhanced lesional expression of IL-10 and IL-17A. An increase in circulatory and lesional MMP9 was accompanied by decreased collagen I, suggesting disintegration of matrix integrity. Taken together, in PKDL, activated neutrophils possibly contribute towards modulating the lesional landscape. Understanding this involvement of neutrophils in patients with PKDL, particularly in the absence of an animal model, could offer better understanding of the disease pathogenesis and provide insights into novel therapeutic strategies for the ongoing elimination program.

Relationship between Gestational Age and Examination Results Triple Elimination of Pregnant Women at UPTD Jayakerta Community Health Center

Human Immunodeficiency Virus (HIV), Syphilis, and Hepatitis B are sexually transmitted infections that pregnant women can pass to their babies. To address this, the Ministry of Health of the Republic of Indonesia has implemented the Triple Elimination program based on WHO recommendations. This study aims to evaluate the effectiveness of the Triple Elimination screening compared to gestational age. Using the Chi-Square method, the research involved 47 pregnant women examined in the first, second, and third trimesters. Data was collected from reports of initial screenings in the first trimester, followed by re-examinations in the subsequent trimesters. A questionnaire with six questions was used. Statistical analysis with a p-value of 0.06 indicated a significant correlation between sexual intercourse habits and an increase in syphilis cases in the third trimester. Additionally, habits related to genital cleaning post-intercourse also significantly impacted syphilis rates. The study highlights the need for ongoing education for pregnant women on preventing sexually transmitted infections and the importance of early detection through Triple Elimination screenings.

Real-World Evaluation of Point-of-Care Testing for Hepatitis C Antibodies: Navigating Hepatitis C Elimination Effort.

An HCV elimination program aims to diagnose more than 90% of Chronic HCV cases. We critically evaluated the performance of a point-of-care test (POCT) using an HCV Rapid Antibody Test. PWID from 4 Halfway Houses (HWH) in Singapore were recruited from March 2022 to April 2023. Participants were concurrently screened for HCV via venous blood for anti-HCV serology and using fingerstick capillary whole blood (FSWB) and oral mucosal transudates (OMT) for POCT, which were interpreted by trained personnel. A blinded study team member independently assessed images of POCTs. Of 207 participants, 37.3% were anti-HCV positive. Compared to anti-HCV serology, POCT performance on FSWB and OMT were: Sensitivity 81.8 (73.2-90.4), 74.0 (64.2-83.8), p = 0.014; Specificity 100.0 (100.0-100.0), 98.5 (96.3-100), p = 0.157. Sub-group analysis of strict 30-min pre-test nil-by-mouth instruction in 103 subjects reported Sensitivity 77.5 (64.6-90.4), 77.5 (64.6-90.4) and Specificity 100.0 (100.0-100.0) and 98.4 (95.3-100.0). OMT positivity and false-negative outcomes did not correlate with the sample analytical cutoff index signal distribution of anti-HCV Serology. Inter-class correlation between real-time and imaging readings of POCT for FSWB and OMT at 20 and 40 min were Kappa 0.9666, 0.9674; 0.8803, 0.8940. Proper preparation and patient selection enhance test performance. Differences in oral fluid immunoglobulin secretion, oral pathology, age, and sample collection can affect POCT OMT readings. POCT OMT is promising in serial and self-testing, complementing its convenience in testing.

Impact of empirical treatment in patients with extrapulmonary tuberculosis and their outcome

BackgroundTuberculosis (TB), primarily caused by mycobacterium tuberculosis (Mtb), remains a significant public health concern globally, particularly in low-resource settings. Extrapulmonary tuberculosis (EPTB), which affects organs beyond the lungs, presents diagnostic and treatment challenges, necessitating improved clinical management strategies. This work was aimed to assess the impact of empirical anti-TB treatment on the outcomes of patients with extrapulmonary tuberculosis and to analyze the demographic and risk factors associated with EPTB.MethodsA retrospective cohort study was conducted over three years (2020–2023) at PSG Hospitals, Coimbatore. Ninety-two subjects, all with negative microbiological results but symptoms indicative of EPTB, were carefully selected.ResultsA total of 92 patients were included in the study, all of whom had negative microbiological diagnosis with symptoms suggestive of EPTB. The mean age of patients was 58.14 years, with a male predominance (59.78%). Pleural effusion was the most common EPTB site, with many patients having no co-morbidities. Occupational factors, such as cotton millwork, and lifestyle factors, including alcohol use and malnutrition, were prominent risk factors. Clinical manifestations varied, with fever being the most common symptom. Treatment completion was 65.22%, falling below National Tuberculosis Elimination Program (NTEP) guidelines, with notable loss to follow-up and mortality rates.ConclusionEmpirical treatment for EPTB showed notable improvement in the patient's symptoms and overall health. However, challenges persist in treatment completion, especially among socioeconomically disadvantaged populations. Early detection, prompt treatment initiation, and comprehensive management are essential to address the multifaceted challenges posed by EPTB effectively.

Exploring patient perspectives on the impact of resuming cost sharing: a qualitative analysis

IntroductionThe ACCESS trial showed that those who received a copayment elimination benefit had a modest improvement in their adherence to medications, but no improvement in clinical outcomes. This is consistent with other studies that have demonstrated that time-limited copayment elimination was welcomed by participants. However, the removal of such benefits can be problematic, as participants may have become accustomed to receiving the benefit, and made changes to their spending that would need to be reconsidered. We aimed to explore participants’ experience with resuming cost sharing for their medications at the end of the ACCESS trial and if this experience influenced their willingness to participate in future trials like ACCESS.MethodsWe conducted semi-structured interviews with 21 former participants of the ACCESS trial who were receiving the copayment elimination intervention, with discussions focused on the loss of the copayment elimination. The interviews were recorded, transcribed, and analyzed in duplicate using thematic analysis.ResultsFour primary themes emerged from the analysis, including emotionality regarding loss of benefits; notification of benefit termination, describing tangible losses from coverage ending, but resistance to acknowledging negative impacts; and acceptability of receiving a temporary financial benefit. Many participants described negative emotions around the loss of coverage and concern about affording care for their chronic diseases. Despite negative emotions about the end of their study benefit, participants generally had a positive view of the study and would participate again in a future study of this nature.ConclusionThe positive tangible and emotional benefits of the copayment elimination over 3 years outweighed the negative emotions and impacts associated with having to become reaccustomed to life without it.Patient and public contributionWithin the ACCESS trial, participants were involved in the design, modification, and implementation of the program using multiple focus groups. The current study aimed to engage patients to provide input on their experience and engagement with the copayment elimination program.

Clinical profile, risk factors, disease severity, and outcome for COVID-19 disease in patients with tuberculosis on treatment under the National Tuberculosis Elimination Program: a cohort of 1400 patients.

COVID-19 affected millions of people worldwide, and tuberculosis (TB) continues to affect millions of people each year. The combined pandemic of COVID-19 and TB had a catastrophic effect on healthcare policies and healthcare setups around the globe. The clinical profile and factors affecting the outcome of COVID-19 disease in TB patients on treatment in field conditions have not been studied in detail. The present study attempted to study the occurrence of COVID-19 among patients on TB treatment in terms of severity of COVID-19 disease and outcome of both COVID-19 and TB in patients at National Tuberculosis Elimination Program treatment centers over a period of one year during peak COVID-19 times. Out of 1400 TB patients enrolled, 65 (5%) suffered from COVID-19 disease. Of the 65 TB patients with COVID-19 disease, 37 (57%) were male and under 45 years old, 33 (51%) had a TB diagnosis after first receiving a COVID-19 diagnosis, 29 (45%) had a TB diagnosis first, and received anti-TB treatment before receiving a COVID-19 diagnosis, and only 3 patients (5%) had a COVID-19 and TB diagnosis concurrently. The majority of 59 (91%) patients had mild COVID-19 disease. The outcome of TB treatment was available in 25 patients out of these 65 COVID-19-positive patients, with 21 (84%) patients having a favorable outcome. Out of the 65 COVID-19-positive patients, 4/25 (16%) had unfavorable outcomes, with one patient (4%) failing TB treatment and two patients (8%) dying. This is the first study from India that studied the occurrence and course of COVID-19 among a large number of TB patients taking anti-TB treatment under programmatic conditions. Due to the similarity in symptoms of TB and certain viral respiratory illnesses, a protocol should be established for health care to check patients for both illnesses.

Atypical cutaneous leishmaniasis: a new challenge to VL elimination in South-East Asia.

Visceral leishmaniasis (VL) caused by L. donovani in South-East Asian endemic countries including India, Nepal and Bangladesh has been the primary focus of the ongoing VL elimination program. With a major reduction in VL cases resulting from the elimination program during the last two decades, the efforts are now focused on the challenges posed by potential reservoirs within the asymptomatic cases, HIV-co-infection VL cases and Post Kala-azar Dermal Leishmaniasis (PKDL) cases that continue to sustain the parasite transmission cycle in known and newer endemic zones. This article brings attention to a new potential parasite reservoir in the form of atypical cutaneous leishmaniasis (ACL) cases caused by novel L. donovani genetic variants. L. donovani mediated ACL is an emerging phenomenon in recent endemic sites that now justify a need for implementing molecular surveillance tools to identify region-specific L. donovani variants with dermotropic capabilities and potential to revert to visceral disease. A timely detection of novel ACL causing L. donovani genetic lineages in South-East Asian endemic regions is necessary to halt the spread of ACL and is potentially crucial for the sustainability of the advances made by the VL elimination.

Bridging the "know-do" gap to improve active case finding for tuberculosis in India: A qualitative exploration into national tuberculosis elimination program staffs' perspectives.

In 2022, India's national tuberculosis (TB) elimination program (NTEP) commissioned a national level evaluation of active case finding (ACF) for TB to guide evidence-based strategic planning. As part of this evaluation, based on secondary data analysis we observed that the quality of ACF was suboptimal in 2021. Hence, this study aimed to understand the enablers, barriers, and suggested solutions to improve ACF for TB in India from NTEP staff (provider) perspective. This was a descriptive qualitative study involving key informant interviews from six districts and eight states, conducted between February and August 2023. We purposively selected key state- district- and sub-district-level program managers and implementers who were experienced and vocal. The interviews were audio recorded and transcribed verbatim by research interns and investigators. Two investigators independently did manual descriptive thematic analysis, and a third investigator resolved inconsistencies. The themes and categories emerged by collating together the results of the coding process. A total of 34 key informant interviews were conducted and of these, four were repeat interviews. Adequate budgets for ACF including incentives, performance review mechanism, engagement of all stakeholders, adopting a community friendly approach, use of rapid diagnostic tests and digitalization were the perceived enablers. In some states ACF was implemented in general population (not restricted to high-risk population) following directives at state level. There were limited mechanisms to ensure ACF quality indicators were met before disbursing incentives and cross-verification of the aggregate ACF care cascade numbers that were reported in Ni-kshay (electronic TB information management system under NTEP). In addition to the state and district level implementers having limited understanding of concepts around ACF (quality indicators, number needed to screen and yield), we also inferred the presence of a 'know-do' gap for many activities under ACF. The suggested solutions were around capacity building and quality improvement strategies. The existing national ACF guidance should be revised to emphasize capacity building, need to carry out ACF in high-risk (not general) population, quality control-linked incentives, and regular implementation monitoring of the activities. This should contribute towards better coverage and improved quality translating into better ACF outcomes.

Risk factors for schistosomiasis

ABSTRACT In this review, I describe the progress in a study that focused on the risk factors for schistosomiasis around the globe for the purposes of the review. Human schistosomiasis affects 229 million people; at least 90% are in sub-Saharan Africa, and 54% are school-aged children. Schistosoma haematobium infects 112 million people, Schistosoma japonicum infects 3.1 million people, and Schistosoma mansoni infects 54 million people. Schistosomiasis can occur in endemic and non-endemic areas. A high risk of schistosomiasis can occur in, for example, preschool-aged children, school-aged children, and workers in endemic schistosomiasis areas. These people make contact with infested freshwater day by day. In addition, environmental factors and socioeconomic factors can affect the transmission of schistosomiasis. Various factors can cause the transmission of schistosomiasis, for example, climate changes and proximity to infested freshwater bodies. People with high risks for schistosomiasis need great attention for treatment and/or prevention programs. Risk factors for schistosomiasis, for example, human behavior and socioeconomic status, can affect the transmission of schistosomiasis. Many developing countries in Africa, Asia, and South America are at risk of this disease. High-risk people need special attention in programs for schistosomiasis elimination.

Sociodemographic factors affecting knowledge levels of tuberculosis patients in New Delhi

ABSTRACT Background: Sociodemographic factors can significantly influence the knowledge level of tuberculosis (TB) patients, affecting the overall health outcomes. Due to lack of awareness and the stigma associated with TB, Indian TB elimination efforts are facing challenges. Patients with less information are more likely to experience delays in diagnosis and proper care. Method: A cross-sectional study was conducted in New Delhi across 26 operational National TB Elimination Program districts, involving 200 adult pulmonary TB patients receiving treatment from April to August 2020. A structured questionnaire guided the interviews, followed with bivariate analysis and descriptive statistics used for analysis. Results: Predominantly, residents of semiurban regions accounted for the highest proportion (70.5%), followed by urban areas (20.5%), with rural areas/slums comprising a minority (9%). Notably, a significant majority (94.5%) reported residing in individually owned dwellings, with shared accommodations limited to a minority (5.5%). Sanitary facilities varied, with 77% possessing personal toilets, 18.5% utilizing private facilities, and only 4.5% relying on public toilets. Awareness levels about TB reflected moderate awareness among 56% of participants, good knowledge among 41%, and minimal awareness (poor knowledge) among only 3% of respondents. Conclusion: Age, sex, socioeconomic level, kind of lodgings, malnutrition, and personal cleanliness should all be taken into account for TB treatment adherence. A new set of frameworks should be developed to enhance the living circumstances of high-risk populations and patients who are living in crowded locations since sharing a room or a house in a populated region increases the risk of TB transmission.

Secreting Male Breast: A Clinical Oddity

A 34-year-old male who had been diagnosed with pulmonary tuberculosis 5 months ago and was started on National TB Elimination Program (NTEP) standard regimen-based antitubercular therapy came for Outpatient consultation regarding new onset swelling and discharge from bilateral breasts for the last 15 days. On clinical examination, he was found to have bilateral gynecomastia. Routine and hormone laboratory investigations were performed to rule out other causes, and isoniazid exposure was determined to be the underlying cause. The patient was allowed to complete his course of antitubercular therapy (ATT) which was simultaneously managed with pyridoxine supplementation. On follow-up 2 months after completion of ATT, the gynecomastia decreased significantly, and there was no discharge either. It is highly unusual for a male patient to develop a fully functional gynecomastia following isoniazid exposure. There is no guideline-directed management for this condition, and rapid resolution following pyridoxine supplementation encourages its use in future cases.

Identifying Predictors of Unfavorable Treatment Outcomes in Tuberculosis Patients.

In South Korea, there has been a continuous decrease in the incidence of tuberculosis (TB) attributable to a national TB elimination program; however, TB still poses a significant socioeconomic burden. This study aimed to analyze factors associated with successful TB treatment and to identify refractory patient groups with unfavorable outcomes. We analyzed anonymized data on 89,150 patients with TB provided by the Korea Disease Control and Prevention Agency. Specifically, we collected independent variables, which were categorized as individual, regional, and medical facility factors. Individual factors included age, sex, nationality, TB type, drug-resistant status, category of TB, housing type, underlying disease status, number of referrals, and smoking status. Regional factors referred to the region where the TB case was reported. Medical facility factors included the first visit to a medical facility, categorized by hospital type and the distinction between private-public mix (PPM) and non-PPM depending on the presence or absence of dedicated TB nurses. These factors were analyzed in relation to treatment success to identify refractory patient groups with unfavorable outcomes. Multivariable logistic regression analysis revealed the following significant factors associated with successful TB treatment: sex, nationality, status of drug-resistant TB, category of TB, number of referrals, region of TB registry, underlying diseases, and smoking status. Specifically, compared with their relevant counterparts, male patients had a lower rate of successful treatment (adjusted odds ratio [aOR]: 0.66, reference [Ref.]: women); Korean nationals had a higher rate of treatment success (aOR: 7.20, Ref. foreign residents in Korea); resistant TB was associated with a lower rate of treatment success (aOR: 0.35, Ref.: non-resistant TB status); newly treated patients had a higher rate of treatment success (aOR: 1.75, Ref.: retreatment patient); switching hospitals once (aOR: 1.78), never (aOR: 1.41), or twice (aOR: 1.37) was associated with increased treatment success (Ref.: three or more times); having zero (aOR: 1.45), one (aOR: 1.31), or two (aOR: 1.24) underlying diseases was associated with a higher rate of treatment success (Ref. three or more underlying diseases); and past smokers (aOR: 1.40) and non-smokers (aOR: 1.35) had a higher rate of treatment success (Ref.: current smokers). Our study identified several factors contributing to unfavorable treatment outcomes in tuberculosis patients, including male patients, foreign residents in Korea, drug-resistant TB, retreatment patients, frequent hospital switching, multiple underlying diseases, and current smoking status. These research findings could inform the development of efficient management strategies and policies for improving the treatment success rate among patients with TB.

A randomized controlled trial of the effectiveness of a community-based rabies vaccination strategy.

Approximately 60,000 people die from dog-mediated rabies annually. Low and heterogeneous coverage reduces the effectiveness of dog vaccination campaigns that can eliminate rabies. Campaigns typically involve teams travelling annually to villages to deliver cold chain stored vaccines from centralized headquarters. Thermotolerant vaccines enable novel decentralized delivery of locally-stored vaccines by communities throughout the year. We compared the effectiveness of annual team-based versus continuous community-based dog vaccination strategies. We conducted a cluster randomized controlled trial across Mara region, Tanzania. Trial clusters were administrative wards (112, on average four villages each). For the team-based arm vaccinators hosted annual static-point clinics, whilst for the community-based arm, a ward-based animal health officer with a village community leader managed vaccinations using vaccines stored within the ward. We measured vaccination coverage, the primary outcome, twice annually per cluster (month 1 and 11) through household surveys over three years (November 2020 to October 2023) and examined spatial and temporal coverage variations as secondary outcomes. Community-based delivery achieved significantly higher coverage (49-62%) than team-based delivery (22-46%), and consistently exceeded the critical threshold for herd immunity (40%), Odds ratio (OR): 1.48-3.49. The lower less uniform coverage achieved through team-based delivery had a higher monthly probability of falling below the critical threshold (0.6, 95% CI: 0.38-0.81) vs 0.18 (95% CI: 0.04-0.40). Greater declines in coverage over the year were recorded in the team-based arm compared to the community-based. Community-based mass dog vaccination achieves higher more consistent coverage than team-based delivery across settings typical of many sub-Saharan African countries. This approach could play an important role in national rabies elimination programmes aiming to end human rabies deaths by 2030 as part of the global 'zero by 30' strategy. Department of Health and Human Services of the National Institutes of Health (R01AI141712), Wellcome Trust (207569/Z/17/Z, 224520/Z/21/Z) and MSD Animal Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

The Medical Professional Elimination Program and the Ideology and Motivation of Nazi Physicians.

The appointment of a new chancellor in 1933 marked the beginning of the Third Reich in Germany. The ideology of the Nazi Party focused on establishing a pure Aryan state characterized by nationalism and racial superiority. Their goals would be achieved through a totalitarian form of government that enforced the subjugation, exclusion, and elimination of those they defined as inferior minorities, particularly Jews, who were depicted as non-human. Implementation of the Nazi ideology required the exclusion of Jewish people and other dissenters, particularly Jewish physicians, from their professions. The exclusion of Jewish physicians, referred to herein as a "Medical Professional Elimination Program," was gradually imposed on other Jewish professions in nations absorbed by the Third Reich, and particularly enforced by incorporated Austria. Why did German and Austrian doctors support the Nazi racial ideology, the removal of Jewish physicians from every possible sphere of influence, and subsequently participate in criminal medical research and experimentation, as well as euthanasia of perceived non-contributors to society, and become involved in refining the effectiveness of the death camps? Was the Medical Professional Elimination Program an opportunistic political concept, or was it part of an entrenched ideology? With these questions in mind, the lives of four key Nazi physicians and two institutions are examined.