Neglected Tropical Diseases Research Articles

Virtual Screening of Benzimidazole Derivatives as Potential Triose Phosphate Isomerase Inhibitors with Biological Activity against Leishmania mexicana.

Leishmania mexicana (L. mexicana) is a causal agent of cutaneous leishmaniasis (CL), a "Neglected disease", for which the search for new drugs is a priority. Benzimidazole is a scaffold used to develop antiparasitic drugs; therefore, it is interesting molecule against L. mexicana. In this work, a ligand-based virtual screening (LBVS) of the ZINC15 database was performed. Subsequently, molecular docking was used to predict the compounds with potential binding at the dimer interface of triosephosphate isomerase (TIM) of L. mexicana (LmTIM). Compounds were selected on binding patterns, cost, and commercial availability for in vitro assays against L. mexicana blood promastigotes. The compounds were analyzed by molecular dynamics simulation on LmTIM and its homologous human TIM. Finally, the physicochemical and pharmacokinetic properties were determined in silico. A total of 175 molecules with docking scores between -10.8 and -9.0 Kcal/mol were obtained. Compound E2 showed the best leishmanicidal activity (IC50 = 4.04 µM) with a value similar to the reference drug pentamidine (IC50 = 2.23 µM). Molecular dynamics analysis predicted low affinity for human TIM. Furthermore, the pharmacokinetic and toxicological properties of the compounds were suitable for developing new leishmanicidal agents.

Clinical Implications for the Comprehensive Interpretation of Radiologic and Immunodiagnostic Tests in Patients Suspected of Parasitic Hepatic Cyst, a Rare Case in Korea

Cystic echinococcosis (CE) is a representative neglected tropical disease (NTD) with increased morbidity and mortality but is ignored and overlooked in developed countries. Serological and radiographic findings are helpful in distinguishing these parasites; however, conflicting results of these can make it difficult to diagnose if medical knowledge of hepatic parasitic disease, including the etiology, features of imaging, and immunodiagnostic test, is not acquired. We report the case of a male patient with dyspepsia and right epigastric pain who had positive results for cysticercosis antibodies on immunodiagnostic examination. Abdominal ultrasonography revealed two huge communicating cystic lesions measuring 8-11 cm. Further evaluations for cysticercosis of the brain (neurocysticercosis) and eyes (intraocular cysticercosis) were unremarkable throughout the brain imaging test and fundus examination. A laparoscopic right hemi-hepatectomy was performed for diagnosis and treatment. On histopathological examination, diverse stages of Echinococcus granulosus were identified. Albendazole was administered postoperatively, and the patient was also followed up. We should be aware of the etiologies that have been prevalent in parasite infection thought to be the cause of hepatic cysts. Moreover, we make an effort to ascertain the patient's nationality, past travel experiences, and immediate environment, including any animals and pets. We present the case of a patient who was worried about the possibility of liver invasion of cysticercus due to the positivity of the cysticercosis antibody and was ultimately diagnosed with CE.

Barriers and enablers of community engagement practices for the prevention of snakebite envenoming in South Asia: A qualitative exploratory study.

Snakebite envenoming (SBE) is a grossly neglected tropical disease (NTD) that predominantly affects those living in rural settings in low-and-middle income countries. South Asia currently accounts for the highest global SBE-related mortality, and substantial morbidity rates. To alleviate the high burden in the region, community engagement (CE) is considered to be an integral component for optimizing SBE prevention and control. To better understand existing CE practices for SBE in the region, the experiences of SBE-CE actors concerning the barriers to, and enablers of CE practices were captured through semi-structured interviews. Fifteen key informants from India, Bangladesh and Nepal participated in the study. Important enablers included providing innovative, inclusive and continuous methods and materials, carefully planning of programs, performing monitoring and evaluation, SBE data availability, motivated and trained staff members, good organizational reputations, communication with other SBE-actors, collaborations, and the involvement of the government. Substantial barriers comprised a lack of SBE data, lack of innovative methods and materials for educational purposes, a shortage of human and physical resources, community resistance, untrained health care workers (HCWs), and ineffective traditional healing practices. In order to optimize and sustain SBE-CE practices, context-sensitive, multi-faceted approaches are needed that incorporate all these factors which influence its sustainable implementation.

WASH and NTDs: Outcomes and lessons learned from the implementation of a formative research study in NTD skin co-endemic communities in Benin.

Neglected Tropical Diseases (NTDs) are a diverse group of bacterial, viral, parasitic and fungal diseases affecting people, most of whom live below the poverty threshold. Several control strategies are defined against these diseases, including chemotherapy and Water, Hygiene and Sanitation (WASH). This study assesses the effect of promoting hygiene and sanitation on soil-transmitted helminthiasis s and NTDs of the skin. It took place in the communes of Ze, Lalo, and Zangnanado, three municipalities located in the south of Benin. This is a formative research that took place in three phases. The first phase entailed a baseline informations and situational analysis of the state of hygiene and health, using soil-transmitted helminthiasis and wound hygiene practices as cases studies. In the second phase, interventions to promote improved hygiene and sanitation were implemented. The third phase was devoted to post-intervention evaluation. The situation analysis showed that the prevalence of soil-transmitted helminthiasis was 6.43 and 7.10% in the municipalities of Ze and Lalo, respectively. In the communes of Zangnanado, the most common wound management practices identified were: putting sand or ashes in the wounds to keep flies away, the use of medicinal plants and the application of powder from antibiotic capsules for wound dressing. The post-intervention evaluation showed a decrease in the prevalence of soil-transmitted helminthiasis from 6.43 to 1.19% in the municipality of Lalo and from 7.10 to 1.75% in the municipality of Ze. In the commune of Zangnanado, a significant shift in wound management practices was noted, which led to the healing of several chronic wounds. This research supports the evidence that WASH-based interventions are very important to tackle neglected tropical diseases NTDs in addition to specific diseases based interventions.

Buruli-RifDACC: Evaluation of the efficacy and cost-effectiveness of high-dose versus standard-dose rifampicin on outcomes in Mycobacteriumulcerans disease, a protocol for a randomised controlled trial in Ghana.

Buruli ulcer (BU) can lead to disfiguring ulcers and permanent disability. The 2030 World Health Organization (WHO) road map for Neglected Tropical Diseases (NTDs) calls for major scaling up in diagnosis and management to eliminate disability due to the disease. Current treatment for BU is with daily oral rifampicin (10mg/kg dose) and clarithromycin (15mg/kg dose) for eight weeks, combined with standard gauze wound dressings. Dialkylcarbamoyl chloride (DACC)-coated dressings have been shown to irreversibly bind bacteria on wound surfaces resulting in their removal when dressings are changed. This trial aims to determine whether combining a high-dose oral rifampicin regimen with DACC dressings can improve the rate of wound healing relative to standard-dose oral rifampicin combined with DACC dressings. This is an individual, multi-centre Phase 3 randomised controlled trial, which will be conducted in three clinical sites in Ghana. The primary outcome measure will be the mean time to clearance of viable mycobacteria. Cost and health-related quality of life data will be collected, and a cost-effectiveness analysis will be performed. The findings from this trial could lead to a change in how BU is treated. A shorter but more efficacious regimen would lead to improved treatment outcomes and potentially substantial financial and economic savings. Pan African Clinical Trials Repository (registration number; PACTR202011867644311). Registered on 30 th November 2020.

Challenges of implementation of the preventive chemotherapy neglected tropical diseases programme in Ghana.

The Neglected Tropical Diseases programme since its implementation has improved the lives of many in the tropical and sub-tropical areas. Though witnessed many successes, the programme is continually facing challenges thus, preventing the attainment of various objectives. This study seeks to assess the challenges of implementation of the neglected tropical diseases programme in Ghana. The thematic analysis approach was used to analyze qualitative data collected from 18 key public health managers selected through purposive and snowballing procedures from the national, regional and district levels of Ghana Health Service. Data collection was done through in-depth interviews using semi-structured interview guides in line with the objective of the study. The Neglected Tropical Diseases Programme though received funding from external sources, faces multiple challenges which cut across financial, human and capital resources to external control. Specifically, inadequate resources, dwindling volunteerism, poor social mobilization, weak governmental commitment and weak monitoring were major challenges to implementation. These factors work individually and in combination to impede effective implementation. Ensuring state ownership, re-structuring implementation approaches to include top-down and bottom-up approaches and building capacity in monitoring and evaluation are recommended in order to meet the programme objectives and ensure sustainability. This study forms part of an original study on Implementation of the NTDs programme in Ghana. Aside the key issues discussed, it presents first-hand information on major implementation challenges that are relevant to researchers, students, practitioners and the general public and will apply widely to vertically implemented programmes in Ghana.

Challenges and strategies for the uptake of mass drug administration among pastoralist communities in South Sudan

Preventive chemotherapy through mass drug administration (MDA) to control and eliminate neglected tropical diseases (NTDs) requires the active participation of communities living with NTDs, or at risk of NTD infections. Despite considerable progress by national control and elimination programs, achieving consistent and sustainable treatment campaigns that reach pastoralist communities remains challenging, which in turn delays the achievement of global disease elimination goals. The challenges of accessing pastoralist communities for treatment also hinder the achievement of the UN’s Sustainable Development Goals’ (SDGs) pledge to “leave no one behind“. Elimination targets cannot be achieved if significant proportions of endemic populations, such as pastoralists, are missed out during treatment campaigns. In South Sudan, close to 70% of the population is categorized as pastoralist, with previous data on MDA showing low access to and acceptance of MDA among the pastoralist community, as well as inconsistent treatment coverage. To address this challenge, a cross-sectional study design was conducted in five counties, with 239 pastoralist community respondents participating in in-depth interviews (IDIs), key informant interviews (KIIs), and focus group discussions (FGDs). Our findings show that, in the pastoralist community, high mobility, lay perceptions about the causes of NTDs and methods of treating them, limited awareness of MDA, and suboptimal health-seeking behaviors are the major factors that limit accessibility and participation. Our results suggest that improved uptake of MDA in these communities may be achieved by timing treatment campaigns to take account of pastoralists’ seasonal migration patterns, by involving pastoralist leaders in planning and social mobilization activities, by engaging community members as community drug distributors (CDDs), by using participatory behavior change approaches to design NTD interventions, and by addressing negative perceptions around the medicines involved, including those related to drug expiry and drugs causing impotence or other side effects. The results from this study could enable national programs to address the challenges of implementing treatment campaigns through the enhanced involvement and representation of pastoralist communities.

Determinants of Uptake of Mass Drug Administration for Schistosomiasis Control in Butiaba Sub-county, Uganda

Introduction: Schistosomiasis is one of the Neglected Tropical Diseases (NTDs) targeted for elimination in Uganda by 2025 through Mass Drug Administration (MDA) using praziquantel. To achieve this, WHO estimates indicate that MDA coverage and uptake of 75% is required. However, coverage remains suboptimal with insufficient knowledge and inadequate drug supply often cited as key reasons. There is a need to add to the body of knowledge in various settings to enable more robust mitigation measures. This study aimed to assess the uptake of praziquantel for MDA and associated factors in Butiaba sub-county along the shores of Lake Albert in Uganda.
 Methods: A cross-sectional study was conducted in five randomly selected villages within Butiaba sub-county between July and September 2021 using quantitative and qualitative approaches. Semi-structured questionnaires were administered to 450 adults, with additional two Focus Group Discussions and Key Informant interviews held with implementation structures from the village to district level.
 Results: Self-reported uptake of praziquantel within twelve months of the most recent MDA exercise was 71.56% (95% CI: 67.14 – 75.68). Of all the participants, 5.78% reported have never swallowed praziquantel in their lifetime, and 75% (96/128) of participants who didn’t swallow praziquantel in the last twelve months reported having at least swallowed the drug in the last ten years. Respondents were less likely to have swallowed praziquantel if they had no knowledge about schistosomiasis signs (AOR= 0.18, 95% CI: 0.08–0.39) and more likely if they were between the ages 30-39years (AOR= 2.31, 95% CI: 1.35–3.95) or 40 years and above (AOR= 2.86, 95% CI: 1.45 – 4.95). Operational challenges such as the inadequate supply of praziquantel and financial constraints also influence the uptake of praziquantel during MDA in Butiaba sub-county.
 Conclusion: The uptake of praziquantel during MDA in Butiaba sub-county was high but still below the WHO target of 75%. People with limited knowledge of schistosomiasis symptoms and those aged 18 – 29 years were less likely to take Praziquantel. Irregular drug supply was also a key challenge.
 Recommendation: Rigorous health education and ensuring a continuous supply of Praziquantel are key to improving MDA uptake.

Profiling the knowledge of female medical/para-medical students, and expertise of health care professionals on female genital schistosomiasis in Anambra, South Eastern Nigeria.

Female genital schistosomiasis (FGS) is a largely neglected tropical disease (NTD), with little or no attention in the primary health care unit. Towards building momentum to address this challenge, we investigated the perception of medical and para-medical students about FGS, as well as the expertise of health care professionals in Anambra State, Nigeria. We conducted a cross-sectional survey among 587 female medical and para-medical university students (MPMS), and 65 health care professionals (HCPs) saddled with the responsibility of delivering care for schistosomiasis-affected persons. Pretested questionnaires were administered to document the awareness and knowledge about the disease. In addition, the expertise of HCPs vis-à-vis suspicion of FGS and management of FGS patients during routine health care service were documented. Data were subjected to descriptive, chi-square tests and regression analysis in R software. Over half of the students recruited; 54.2% for schistosomiasis and 58.1% for FGS, were not aware of the disease. Knowledge about schistosomiasis was associated with student's year of study, with those in 2nd (OR: 1.66, 95% CI: 1.0, 2.7), 4th (OR: 1.97, 95% CI: 1.2, 3.2), and 6th (OR: 5.05, 95% CI: 1.2, 34.2) year having higher likelihoods of been more informed about schistosomiasis. For HCPs, we observed a contrastingly high knowledge about schistosomiasis (96.9%), but low knowledge about FGS (61.9%). Knowledge for both schistosomiasis and FGS was not associated with year of practice and expertise (95% OR included 1, p > 0.05). A considerable proportion (>40%) of the HCPs never suspected schistosomiasis during routine clinical diagnosis of patients who presented probable FGS symptoms (p < 0.05). Similarly, only 20% were certain about the use of praziquantel for treating FGS, and about 35% were uncertain of the eligibility criteria and dosage regimens. Commodities for managing FGS were also largely unavailable in about 39% of the health facilities where the HCPs operate. Awareness and knowledge about FGS among MPMS and HCPs were poor in Anambra, Nigeria. It is therefore important to invest in innovative methods of building capacity of MPMS and HCPs, with complementary provision of necessary diagnostics to perform colposcopy, as well as competence to diagnose pathognomonic lesions using diagnostic atlas or Artificial Intelligence (AI).

Synchrotron-Infrared Microspectroscopy of Live Leishmania major Infected Macrophages and Isolated Promastigotes and Amastigotes.

The prevalence of neglected tropical diseases (NTDs) is advancing at an alarming rate. The NTD leishmaniasis is now endemic in over 90 tropical and sub-tropical low socioeconomic countries. Current diagnosis for this disease involves serological assessment of infected tissue by either light microscopy, antibody tests, or culturing with in vitro or in vivo animal inoculation. Furthermore, co-infection by other pathogens can make it difficult to accurately determine Leishmania infection with light microscopy. Herein, for the first time, we demonstrate the potential of combining synchrotron Fourier-transform infrared (FTIR) microspectroscopy with powerful discrimination tools, such as partial least squares-discriminant analysis (PLS-DA), support vector machine-discriminant analysis (SVM-DA), and k-nearest neighbors (KNN), to characterize the parasitic forms of Leishmania major both isolated and within infected macrophages. For measurements performed on functional infected and uninfected macrophages in physiological solutions, the sensitivities from PLS-DA, SVM-DA, and KNN classification methods were found to be 0.923, 0.981, and 0.989, while the specificities were 0.897, 1.00, and 0.975, respectively. Cross-validated PLS-DA models on live amastigotes and promastigotes showed a sensitivity and specificity of 0.98 in the lipid region, while a specificity and sensitivity of 1.00 was achieved in the fingerprint region. The study demonstrates the potential of the FTIR technique to identify unique diagnostic bands and utilize them to generate machine learning models to predict Leishmania infection. For the first time, we examine the potential of infrared spectroscopy to study the molecular structure of parasitic forms in their native aqueous functional state, laying the groundwork for future clinical studies using more portable devices.

Genome-wide exploration reveals distinctive northern and southern variants of Clonorchis sinensis in the Far East.

Clonorchis sinensis is a carcinogenic liver fluke that causes clonorchiasis-a neglected tropical disease (NTD) affecting ~35 million people worldwide. No vaccine is available, and chemotherapy relies on one anthelmintic, praziquantel. This parasite has a complex life history and is known to infect a range of species of intermediate (freshwater snails and fish) and definitive (piscivorous) hosts. Despite this biological complexity and the impact of this biocarcinogenic pathogen, there has been no previous study of molecular variation in this parasite on a genome-wide scale. Here, we conducted the first extensive nuclear genomic exploration of C.sinensis individuals (n=152) representing five distinct populations from mainland China, and one from Far East Russia, and revealed marked genetic variation within this species between "northern" and "southern" geographical regions. The discovery of this variation indicates the existence of biologically distinct variants within C.sinensis, which may have distinct epidemiology, pathogenicity and/or chemotherapic responsiveness. The detection of high heterozygosity within C.sinensis specimens suggests that this parasite has developed mechanisms to readily adapt to changing environments and/or host species during its life history/evolution. From an applied perspective, the identification of invariable genes could assist in finding new intervention targets in this parasite, given the major clinical relevance of clonorchiasis. From a technical perspective, the genomic-informatic workflow established herein will be readily applicable to a wide range of other parasites that cause NTDs.

African institutions will lead on the road to end neglected tropical diseases

Globally, more than one billion people suffer from one or more neglected tropical diseases (NTDs). These diseases create enormous suffering, rob individuals of social and economic opportunities, and set-back countries’ development efforts. It is now clear that transmission and elimination of many NTDs is attainable in our lifetime. The elimination of NTDs will not happen without a concerted effort and plan to ensure that the most affected countries have a robust clinical, public health, laboratory, pharmaceutical, and research capacity to ensure that the last mile towards reaching elimination is not only reached, but sustained. This means increasing strategic investments to develop and strengthen the NTD health workforce, develop and integrate innovative diagnostic approaches, effective treatments, and responsive surveillance systems. Equally important is ensuring that people living with lifelong disabilities resulting from NTDs receive the care and support they need to live healthy, productive, and fulfilling lives. African-based national non-governmental organizations, the private sector, research institutions, and governments play a vital role as they work to attain ambitious NTD elimination and control goals put forward by the global health community. The recent elimination of onchocerciasis in Niger, trachoma in Burundi and Malawi as well as ongoing progress to eliminate lymphatic filiariasis in Kenya and other sub-Saharan Africa countries demonstrate the capacity of African leadership in NTD control and elimination efforts.

Leishmaniasis: Recent epidemiological studies in the Middle East.

Leishmaniasis, one of the most neglected tropical diseases (NTDs), is the third most important vector-borne disease worldwide. This disease has a global impact and severity of the infection and is greatest in the Middle East. The agent of infection is a protozoan parasite of the genus, Leishmania, and is generally transmitted by blood-sucking female sandflies. In humans, there are three clinical forms of infection: (1) cutaneous (CL), (2) mucocutaneous (ML), and (3) visceral leishmaniasis (VL). This review aims to discuss the current epidemiological status of leishmaniasis in Saudi Arabia, Iraq, Syria, and Yemen with a consideration of treatment options. The elevated risk of leishmaniasis is influenced by the transmission of the disease across endemic countries into neighboring non-infected regions.

Accuracy Study of Kato-Katz and Helmintex Methods for Diagnosis of Schistosomiasis Mansoni in a Moderate Endemicity Area in Sergipe, Northeastern Brazil.

Schistosomiasis is a neglected tropical disease (NTD) caused by blood flukes from the genus Schistosoma. Brazil hosts the main endemic area in the Americas, where Schistosoma mansoni is the only species causing the disease. Kato-Katz (KK) thick smear is the WHO recommended screening test for populational studies, but there is growing evidence for the sensitivity limitations associated with KK, especially in areas with low parasite loads. Helmintex (HTX) is another highly sensitive egg-detection method, based on the magnetic properties of S. mansoni eggs and their isolation in a magnetic field. The objective of this study is to evaluate both KK and HTX in a moderate endemic locality, Areia Branca, located in the municipality of Pacatuba, in the state of Sergipe in northeastern Brazil. From 234 individual fecal samples, two KK thick smears were prepared and evaluated for each sample. Similarly, 30 g of each fecal sample was processed by HTX protocol. Eggs were detected in 80 (34.18%) residents. Twenty-three (9.83%) samples were positive for eggs (only by KK), and 77 (32.91%) samples showed positive for eggs (only by HTX). Sensitivity, specificity, and accuracy estimates gave values of 28.75%, 100% and 75.64%, respectively, for KK, and 96.25%, 100% and 98.72% respectively, for HTX. The positive predictive value was 100% for both methods, while the negative predictive value was 72.99% for KK and 98.09% for HTX. Overall, HTX presented a superior performance compared to the one sample, two slides KK examination. The study confirms the role of HTX as a reference method for the definition of true-positive samples in comparative accuracy studies and its potential role in the late stages when the certification of schistosomiasis transmission interruption is required. Diagnostic tests are important tools for the elimination of this NTD, besides the effective implementation of safe water, basic sanitation, snail control, and the treatment of infected populations.

La telemedicina como herramienta para abordaje la salud mental de personas con enfermedades tropicales desatendidas

Neglected tropical diseases (NTDs) have been linked to poor socioeconomic conditions. In addition, its sequelae can cause chronic affectations, from physical disability to psycho-emotional, associated with social and individual stigma, due to physical appearance. Therefore, a descriptive study was carried out to assess the impact of the use of technologies in the mental health (SM) approach in 182 patients with EDT from endemic areas. Data was collected using mobile and landline phones. A survey was used to assess mental well-being (both subjective and objective), as well as their familiarity with and perspectives on ICTs. After establishing a baseline for the SM status of the community and linking the stigmas surrounding WBS. Patients were asked to complete a survey to express their feelings about the impact of stigma on MS in the community. The results showed that people living with EDT are more concerned about the limiting conditions of living and do not value the emotional and mental aspects as part of health and well-being, probably because they consider more relevant the organic alterations and physical sequelae they suffer from of their illness that limits and incapacitates them to work. However, the female sex turned out to be more vulnerable to presenting psychological alterations. In conclusion, the participants consider telemedicine a good tool that will help them face social stigma and reduce self-esteem; It will improve therapist-patient communication by providing them with adequate and timely treatment.

Overview of Snakebite Cases in a Hospital Situated in the Rural Area of Navsari District of Gujarat, India

Background: Snakebite envenoming is a greatly underreported neglected tropical disease (NTD) responsible for up to 138,000 deaths and 400,000 permanently disabled victims worldwide every year. More than a third of the global deaths, about 46,000 annually, are estimated to occur in India with not much known about other aspects of burden or risk factors in the country. Objective: To gather evidence on the burden and epidemiological aspects for snakebite in rural pocket of Navsari district of South Gujarat, India. Materials &amp; Methods: a structured data collection tool was developed &amp; patients hospitalized due to snakebite from year 2009 to 2020 were studied. Results: Total 1108 lab confirmed patients of snakebite were admitted to the Hospital for the mentioned period out of which 239 (21.6%) patients had bite of poisonous snakes. Majority i.e. 55.7% of the snake bite cases were seen amongst men. Most of the cases were reported during the monsoon season. Local pain at the site of bite was reported by 100% of cases admitted. 24 (2.2 %) cases had developed complications. Cellulitis and Respiratory distress were major complications that were found. Conclusion: Less bite to hospitalization time, awareness about snake bite and its consequences amongst community, availability and appropriate use of Anti Snake Venom, close monitoring of patients, availability of ventilator support are key measures that needs to be in practice in any institution. Keywords: Snake Bite, Anti Snake Venom, Monsoon season, South Gujarat

Epidemiology of pediatric schistosomiasis in hard-to-reach areas and populations: A scoping review protocol.

Background: Schistosomiasis is a neglected tropical disease (NTD) that affects millions of people. Children are the most vulnerable group to developing overt disease. An estimated 779 million people are at risk of schistosomiasis and 50 million preschool-age children (PSAC) need treatment. PSAC are not currently targeted by national chemotherapy campaigns due to a lack of suitable pediatric formulations of praziquantel. The Pediatric Praziquantel Consortium has developed an orally dispersible praziquantel formulation (arpraziquantel) and is facilitating its adoption for schistosomiasis control by endemic countries through the ADOPT program - an implementation research program that paves the way for the large-scale delivery of the child-friendly formulation to treat schistosomiasis in preschool-aged children in endemic countries. A key challenge for comprehensive NTD control including schistosomiasis is reaching all at-risk populations, including those hard to reach. Main access barriers include geographic, social and economic conditions. Objective : This scoping literature review aims to document the epidemiology of schistosomiasis in children under 6 years of age living in hard-to-reach areas and populations. Methods : This review will adopt the five-stage scoping review process of identifying the research question, identifying relevant studies, study selection, charting data and collating, summarizing and reporting results. Electronic databases including Medline, Web of Science, Embase (Ovid), LILACS and African Journals OnLine (AJOL) will be searched for relevant articles. Two independent reviewers will screen identified articles using a two-stage approach of reviewing the title/abstract and then the full text of provisionally retained articles. Relevant literatures will be downloaded into EndNote X9 to maintain and manage citation and facilitate the overall review process. A meta-analysis will be conducted if indicated. Relevance : The results will provide insights into the burden of schistosomiasis among marginalized PSAC, aiming to produce evidence on the need for inclusion of this population when designing the expansion of preventive chemotherapy programs.

‘Because people here are ignorant’: The failure of a community intervention to prevent mycetoma in Sudan

Background: This study is based on fieldwork conducted amongst a community in Sudan where the neglected tropical disease (NTD), mycetoma, is endemic. In 2018 government officials attempted an unsuccessful intervention and we examine what caused this to fail. This intervention was a collaborative project building animal enclosures, designed specifically to counteract some principal causes of mycetoma, i.e., scratches and cuts common in disease transmission. It was a carefully researched, privately funded, and government-endorsed project, which was almost unequivocally rejected by the community. Methods: Data collection took place in July 2018. Eight interviews and two focus group discussions (FGDs) were conducted with village residents. One FGD was conducted with government officials in charge of the implementation and enforcement of the project; three key-informant interviews with officials from the State Ministry of Health and three interviews with community leaders in the village were conducted, including those responsible for allocation of the new enclosures. The data was analysed using framework analysis. Results: The village residents explained that they didn’t use the enclosures for three reasons: (1) it interferes with the relationship they have with their livestock, (2) the function and design are not practical, and (3) they continually feel let down by government officials. The government officials and representatives from the State Ministry of Health identified two reasons the project failed: (1) ignorance of the people in the village, and (2) poor enforcement. Conclusions: This study shows that government enforcement isn’t a viable intervention to reduce disease burden without considering community ways of life, values, and priorities. We revealed that government officials and villagers have contrasting views on the failure and original necessity of the project. Future behaviour-change interventions need to show respect for different ways of life and the values, beginning with the open facilitation of communication between divergent perspectives.

The United States Food and Drug Administration (FDA) regulatory response to combat neglected tropical diseases (NTDs): A review.

The availability and accessibility of safe and effective drugs, vaccines, and diagnostics are essential to reducing the immense global burden of neglected tropical diseases (NTDs). National regulatory authorities, such as the United States Food and Drug Administration (FDA), play an essential role in this effort to ensure access to safe and effective medical products by working within a set of legal frameworks and regulatory functions. However, medical product development for NTDs remains neglected, as combating NTDs is not a viable commercial market for pharmaceutical companies. To spur research and development (R&D) of NTD products, the US government has authorized various programs and policies to engage pharmaceutical companies, many of which provide FDA with the legal authority to implement NTD programs and pathways. Thus, this review provides a clear overview of the various regulatory pathways and programs employed by the FDA to increase the availability of NTD drugs, vaccines, and diagnostics. The review assesses the available information on various regulatory considerations and their impact on NTD product development as a first step in estimating the importance of such programs. Next, findings related to currently approved NTD products through these programs are discussed. Lastly, gaps in NTD R&D are identified and suggestions on how to address these are presented. The available data shows that while such incentive programs are factored into companies' decisions to pursue NTD R&D, approved products for NTDs remains vastly insufficient. Most approved products that utilize these NTD regulatory pathways and programs are overwhelmingly for tuberculosis and malaria-both of which are not considered NTDs by the World Health Organization (WHO). Dedicated efforts are needed to facilitate and accelerate NTD product including employing multiple incentive programs, regular assessment of such programs, and leveraging on public-private partnerships.

Wicked-Schisto: The wicked public health problem of Schistosomiasis and the interdisciplinary research helping to control it

Wicked-Schisto: The wicked public health problem of Schistosomiasis and the interdisciplinary research helping to control it Over 240 million people have schistosomiasis, a neglected tropical disease (NTD), caused by parasitic worms called Schistosoma. Over 90% of infected people live in sub-Saharan Africa. Most have long-term subtle morbidities such as abdominal pain, fatigue and diahorrea. Symptoms often overlap with other diseases found in the same areas, including malaria and intestinal worms. This results in complex, hard-to-monitor illnesses, making it difficult to know when a drug treatment or other intervention is successfully improving population health. The disease also reduces physical and cognitive development, school and work attendance and productivity, exacerbating the poverty cycle. Chronic infections cause severe organ damage, cancer and ~200,000 deaths a year. Despite 1 in 33 people in the world being infected and these devastating effects, control efforts lag behind diseases such as malaria, HIV and TB. Here Poppy Lamberton, Professor of Global Health at the University of Glasgow, explores how she is leading an interdisciplinary team aiming to identify cost-effective, sustainable interventions for schistosomiasis, a devastating neglected tropical disease.