Poverty-related Diseases Research Articles

THE NINTH FORUM OF THE EUROPEAN & DEVELOPING COUNTRIES CLINICAL TRIALS PARTNERSHIP

THE NINTH FORUM OF THE EUROPEAN & DEVELOPING COUNTRIES CLINICAL TRIALS PARTNERSHIP

Brief history of occupational health in Italy

Italy is a relatively young nation, no more than 160 years old. From the 1860s and for many decades the country remained mainly rural with little industrial activity. Nevertheless, the latter constituted the seeds for the Italian “economic miracle” of the 1960s–1970s, and, today, Italy is one of the world's largest advanced economies. Occupational health has followed a similar pace as the country's industrial development, cultural growth, and historical events. Over the time, the nature of the most common occupational health problems changed from poverty-related diseases (infectious diseases, acute and chronic poisonings, severe pneumoconiosis, etc.) to occupational cancer and other noncommunicable diseases. Ergonomic and psychosocial disorders have a more recent origin, and it should be noted that today there has also been a non-negligible resurgence of illnesses related to poor conditions among small groups of workers.

Rethinking Global Health Governance in a Changing World Order for Achieving Sustainable Development: The Role and Potential of the ‘Rising Powers’

The idea of this paper is inspired by the dismal experience and lessons from the initially ineffective global (WHO-led) response to the 2014–2016 West African Ebola virus epidemic. It charts the evolution of global health policy and governance in the post-World War II international order to the current post-2015 UN Sustainable Development Goals era. In order to respond adequately existing and emerging health and development challenges across developing regions, the paper argues that global health governance and related structures and institutions must adapt to changing socio-economic circumstances at all levels of decision-making. Against the background of a changing world order characterised by the decline of US-led Western international liberalism and the rise of the emerging nations in the developing world, it identifies the ‘Rising Powers’ (RPs) among the emerging economies and their soft power diplomacy and international development cooperation strategy as important tools for responding to post-2015 global health challenges. Based on analysis of illustrative examples from the ‘BRICS’, a group of large emerging economies—Brazil, Russia, India, China and South Africa—the paper develops suggestions and recommendations for the RPs with respect to: (1) stimulating innovation in global health governance and (2) strengthening health systems and health security at country and regional levels. Observing that current deliberations on global health focus largely, but rather narrowly, on what resource inputs are needed to achieve the SDG health targets, this paper goes further and highlights the importance of the ‘how’ in terms of a leadership and driving role for the RPs: How can the RPs champion global governance reform and innovation aimed at producing strong, resilient and equitable global systems? How can the RPs use soft power diplomacy to enhance disease surveillance and detection capacities and to promote improved regional and international coordination in response to health threats? How can they provide incentives for investment in R&D and manufacturing of medicines to tackle neglected and poverty-related diseases in developing countries?

Computational Identification of Chemical Compounds with Potential Activity against Leishmania amazonensis using Nonlinear Machine Learning Techniques.

Leishmaniasis is a poverty-related disease endemic in 98 countries worldwide, with morbidity and mortality increasing daily. All currently used first-line and second-line drugs for the treatment of leishmaniasis exhibit several drawbacks including toxicity, high costs and route of administration. Consequently, the development of new treatments for leishmaniasis is a priority in the field of neglected tropical diseases. The aim of this work is to develop computational models those allow the identification of new chemical compounds with potential anti-leishmanial activity. A data set of 116 organic chemicals, assayed against promastigotes of Leishmania amazonensis, is used to develop the theoretical models. The cutoff value to consider a compound as active one was IC50≤1.5μM. For this study, we employed Dragon software to calculate the molecular descriptors and WEKA to obtain machine learning (ML) models. All ML models showed accuracy values between 82% and 91%, for the training set. The models developed with k-nearest neighbors and classification trees showed sensitivity values of 97% and 100%, respectively; while the models developed with artificial neural networks and support vector machine showed specificity values of 94% and 92%, respectively. In order to validate our models, an external test-set was evaluated with good behavior for all models. A virtual screening was performed and 156 compounds were identified as potential anti-leishmanial by all the ML models. This investigation highlights the merits of ML-based techniques as an alternative to other more traditional methods to find new chemical compounds with anti-leishmanial activity.

Dilemma in the Brazilian Tropical Medicine: 'Is speed more important than direction?'

With the recent changes in the epidemiology of infectious diseases in Brazil, research funding has been changing in a manner that does not properly consider biodiversity and poverty-related diseases. The burden of disease and the affected neglected populations need to be part of the equation in developeding countries with limited funding.

The different clinical guideline standards in Brazil: High cost treatment diseases versus poverty-related diseases.

Each year, evidence-based clinical guidelines gain more space in the health professionals’ practice and in services organization. Due to the scarcity of scientific publications focused on diseases of poverty, the development of well-founded clinical guidelines becomes more and more important. In view of that, this paper aims to evaluate the quality of Brazilian guidelines for those diseases. The AGREE II method was used to evaluate 16 guidelines for poverty-related diseases (PRD) and 16 guidelines for global diseases whose treatment require high-cost technologies (HCD), with the ultimate aim of comparing the results. It was found that, in general, the guideline development quality standard is higher for the HCD guidelines than for the PRD guidelines, with emphasis on the "rigour of development" (48% and 7%) and "editorial independence" (43% and 1%) domains, respectively, which had the greatest discrepancies. The HCD guidelines showed results close to or above international averages, whereas the PRD guidelines showed lower results in the 6 domains evaluated. It can be concluded that clinical protocol development priorities need some redirecting in order to qualify the guidelines that define the healthcare organization and the care of vulnerable populations.

Scientific impact increases when researchers publish in open access and international collaboration: A bibliometric analysis on poverty-related disease papers.

BackgroundThe European & Developing Countries Clinical Trials Partnership (EDCTP), like many other research funders, requires its grantees to make papers available via open access (OA). This article investigates the effect of publishing in OA journals and international collaboration within and between European and sub-Saharan African countries on citation impact and likelihood of falling into the top 1% and top 10% most cited papers in poverty-related disease (PRD) research.MethodsDisease-specific research publications were identified in the Web of Science™ and MEDLINE using Medical Subject Heading (MeSH) terms. Data on the open accessibility of scientific literature were derived from 1science oaFindr. Publication data, including relative citation counts, were extracted for 2003–2015. Regression models were applied to quantify the relationship between relative citations and presence in the 1% and top 10% most cited papers versus OA and international collaboration.ResultsThe results show that since 2003 papers on PRDs have become increasingly available in OA. Among all PRD areas, malaria research is most frequently published in OA and in international collaboration. The adjusted regression analyses show that holding other factors constant, publishing research in OA and in international collaboration has a significant and meaningful citation advantage over non-OA or non-international collaborative research. Publishing papers as part of a European-wide or European- sub-Saharan African collaboration increases research impact. In contrast, such collaboration advantage is not observed for research output involving sub-Saharan Africa only which seems to decrease research impact.ConclusionsOur results indicate that there is a real, measurable citation advantage for publishing PRD research in OA and international collaboration. However, the international collaboration advantage seems to be region-specific with increased research impact for European-wide and European-sub-Saharan African collaborations but a decrease in research impact of collaborations confined to sub-Saharan African research institutions. Further research is required to further verify this finding and to understand the underlying factors related to this observed decrease in research impact. To target future research capacity building activities in sub-Saharan Africa it is important to assess whether the observed decreased impact reflects the scientific competencies and geographic distribution of individual researchers or institutional-, national- or funder-specific research requirements.

Vaccines for Leprosy and Tuberculosis: Opportunities for Shared Research, Development, and Application.

Tuberculosis (TB) and leprosy still represent significant public health challenges, especially in low- and lower middle-income countries. Both poverty-related mycobacterial diseases require better tools to improve disease control. For leprosy, there has been an increased emphasis on developing tools for improved detection of infection and early diagnosis of disease. For TB, there has been a similar emphasis on such diagnostic tests, while increased research efforts have also focused on the development of new vaccines. Bacille Calmette–Guérin (BCG), the only available TB vaccine, provides insufficient and inconsistent protection to pulmonary TB in adults. The impact of BCG on leprosy, however, is significant, and the introduction of new TB vaccines that might replace BCG could, therefore, have serious impact also on leprosy. Given the similarities in antigenic makeup between the pathogens Mycobacterium tuberculosis (Mtb) and M. leprae, it is well possible, however, that new TB vaccines could cross-protect against leprosy. New TB subunit vaccines currently evaluated in human phase I and II studies indeed often contain antigens with homologs in M. leprae. In this review, we discuss pre-clinical studies and clinical trials of subunit or whole mycobacterial vaccines for TB and leprosy and reflect on the development of vaccines that could provide protection against both diseases. Furthermore, we provide the first preclinical evidence of such cross-protection by Mtb antigen 85B (Ag85B)-early secretory antigenic target (ESAT6) fusion recombinant proteins in in vivo mouse models of Mtb and M. leprae infection. We propose that preclinical integration and harmonization of TB and leprosy research should be considered and included in global strategies with respect to cross-protective vaccine research and development.

Poverty-related diseases: factors that predict coping in two Cameroonian settings.

In this paper, we explore the connection between poverty and health (poverty-related diseases: PRDs) by investigating the factors that play a role in how two groups of people in Cameroon cope with health challenges: workers in a large agro-industrial organization (living in 'camps') and students in two major universities (living on 'campuses'). We investigated factors reported in the literature as being associated with coping, summarized under the 'salutogenic umbrella', as well as demographic, social and environmental factors. A total of 509 respondents from camps and campuses participated in this study. We used a combination of standardized and un-standardized survey instruments to measure coping. We used χ2 and ANOVA tests to investigate bivariate differences and multiple logistic regression analysis to determine which significant survey factors predicted coping. Our results showed expected and unexpected differences between the settings. Individual dispositional factors such as sense of coherence (SOC), self-efficacy (SE), subjective wellbeing and self-rated health differed significantly between the settings. Expected coping resources such as income and SE did not differ between non-copers and copers. Two factors emerged as predictors of coping: living environment (setting) and SOC. Our results highlight the need for a multidimensional perspective on poverty and also the need to apply the salutogenic approach in PRD research. In particular, the emphasis this approach puts on stressors and the capacity to employ a variety of resources to overcome stressors is a fruitful way to better understand PRDs and the importance of location-specific circumstances where poverty, health and diseases are connected.

Poverty and health among CDC plantation labourers in Cameroon: Perceptions, challenges and coping strategies.

Creating better access to good quality healthcare for the poor is a major challenge to development. In this study, we examined inter-linkages between poverty and disease, referred to as poverty-related diseases (PRDs), by investigating how Cameroon Development Corporation (CDC) camp dwellers respond to diseases that adversely affect their health and wellbeing. Living in plantation camps is associated with poverty, overcrowding, poor sanitation and the rapid spread of diseases. In a survey of 237 CDC camp dwellers in Cameroon, we used the health belief model to understand the drivers (perceived threats, benefits and cues for treatment seeking) of reported responses. Using logistic regression analysis, we looked for trends in people’s response to malaria. We calculated the odds ratio of factors shown to have an influence on people’s health, such as food, water, sanitation challenges and seeking formal healthcare for malaria. Malaria (40.3%), cholera (20.8%) and diarrhoea (17.7%) were the major PRDs perceived by camp dwellers. We found a strong link between what respondents perceived as PRDS and hygiene conditions. Poverty for our respondents was more about living in poor hygiene conditions than lack of money. Respondents perceived health challenges as stemming from their immediate living environment. Moreover, people employed self-medication and other informal health practices to seek healthcare. Interestingly, even though respondents reported using formal healthcare services as a general response to illness (84%), almost 90% stated that, in the case of malaria, they would use informal healthcare services. Our study recommends that efforts to curb the devastating effects of PRDs should have a strong focus on perceptions (i.e. include diseases that people living in conditions of poverty perceive as PRDs) and on hygiene practices, emphasising how they can be improved. By providing insights into the inter-linkages between poverty and disease, our study offers relevant guidance for potentially successful health promotion interventions.

Design of prospective antiparasitic metal-based compounds including selected organometallic cores

Abstract A group of seventeen communicable and poverty-related diseases are considered neglected by the World Health Organization due to the restricted development of diagnostic methods, therapeutic treatments and/or control strategies. Among them three parasitic diseases caused by genetically related protozoa belonging to the trypanosomatid genus and kinetoplastida order are major health concerns in the developing world: American Trypanosomiasis (Chagas disease), Human African Trypanosomiasis and Leishmaniasis. This review focuses on efforts carried out to develop bioorganometallic compounds as prospective agents for the treatment of these diseases. It is divided in sections devoted to efforts grouped by type of organometallic core. Those series of compounds for which efforts have been done to modify structures through rational design, to get at least qualitative structure–activity relationships and to identify molecular targets and mode of action will be preferentially highlighted. Comments on potentialities, perspectives and tasks of bioorganometallic chemistry for the field of development of drugs against trypanosomatid parasites are also included.

New Biomarkers and Diagnostic Tools for the Management of Fever in Low- and Middle-Income Countries: An Overview of the Challenges.

A lack of simple, inexpensive, and rapid diagnostic tests for febrile illnesses other than malaria leads to overtreatment with antibiotics for those who test negative for malaria, and contributes to the global rise in antimicrobial resistance. New tests for the detection of host biomarkers provide promising tools to differentiate bacterial from non-bacterial infections in febrile patients. However, most available biomarker tests are not currently used in resource-limited settings, and very few evaluations have been performed in low- and middle-income country populations with non-severe febrile illness. As a result, our knowledge of the performance of these tests in settings with high prevalence of infectious and poverty-related diseases such as malaria, HIV, malnutrition and intestinal parasites is poor. This paper describes challenges faced during the process of getting to an approved test, including difficulties in selecting the most appropriate fever biomarkers; suitable study designs and sites for test evaluations; lack of available reference tests to evaluate the performance of new tests; and lack of clear regulatory pathways to introduce such tests. As many new biomarker assays are in development, understanding these challenges will better enable those working in this area to address them during product development.

Lessons from the Heart of Soweto Study and future directions

South Africa is concurrently experiencing epidemiological transition with diseases of lifestyle on the increase, while still burdened by poverty related diseases. Chronic diseases of lifestyle such as CVD are rapidly becoming major causes of death in developing countries and by all predictions, will continue rising.(4,7,8,9) Of concern is the fact that in developing countries, CVD is occurring in younger individuals than in the developed countries and as the epidemic evolves, the poor are affected the most in both developed and developing countries.(1) The Heart of Soweto (HOS) study aimed to investigate and describe this emerging problem of CVD, and especially heart disease, amongst the urban African population in Soweto, who presented for the first time to a tertiary-care centre. Overall we found multiple challenges to the community of Soweto and surrounding regions from a combination of high levels of modifiable CV risk factors (with the exception of lipid disorders) and surprisingly high levels of advanced and deadly forms of heart disease affecting predominantly younger cases and women. Lessons learned from the HOS include, (1) building partnerships, (2) establish clear objectives with achievable goals, (3) think big and assume nothing, (4) provide an enabling environment, (5) be innovative and (6) never compromise on quality. The prevention of CVD other chronic diseases of lifestyle, as well as the management thereof, needs to be a multidisciplinary effort with all the necessary healthcare workers involved, implemented at the primary, as well secondary level. Our goal is the development of specific community based intervention programmes directed towards prevention and management of chronic diseases of lifestyle in Soweto and to document the aetiology, presentation and management thereof. Our data collection will be not only meaningful for the population in Soweto, but also in other areas of South Africa and the broader Africa. It will be indicative of any urban African population in transition.

THE ROLE OF LOCAL CONTRACT RESEARCH ORGANISATIONS IN BUILDING GCP-COMPLIANT CLINICAL RESEARCH IN POVERTY-RELATED DISEASES IN AFRICA: A CASE OF CLINWIN RESEARCH SERVICES

BackgroundAfrica carries the largest burden of the poverty-related diseases in the world. Most of her populations live in resource-limited settings. These act as catalysts for poverty-related diseases in those populations....

DEFEATING POVERTY-RELATED AND NEGLECTED DISEASES IN AFRICA: HARNESSING RESEARCH FOR EVIDENCE-INFORMED POLICIES

DEFEATING POVERTY-RELATED AND NEGLECTED DISEASES IN AFRICA: HARNESSING RESEARCH FOR EVIDENCE-INFORMED POLICIES

ROAD TO BUILDING AND SUSTAINING NOVEL CLINICAL RESEARCH CAPACITY IN RESOURCE-LIMITED SETTINGS: LESSONS LEARNT SO FAR FROM RWANDA

BackgroundHarnessing research for enhancing capacity for evidence-informed policies is key for sustainability in countries that are still facing poverty-related diseases. During current customised medicine and drug-resistance era, priority has shifted...

Poverty-related diseases (PRDs): unravelling complexities in disease responses in Cameroon

BackgroundIn Cameroon, poverty-related diseases (PRDs) are a major public health concern. Research and policies addressing PRDs are based on a particular understanding of the interaction between poverty and disease, usually an association between poverty indicators and health indicators for a specific country or region. Such indicators are useful but fail to explain the nature of the linkages between poverty and disease or poverty and health. This paper presents results of a study among university students, unravelling how they perceive diseases, the linkages with poverty, their responses to diseases and the motivations behind reported responses.Based on the health belief model, this cross-sectional study was carried out among 272 students at the universities of Buea and Yaoundé in Cameroon. Data were collected using questionnaires containing items matching the research objectives. The questionnaires were self-completed.ResultsMalaria was considered as the most common disease perceived and also a major PRD. Contrary to official rankings of HIV/AIDS and TB, cholera and diarrhoea were considered as other major PRDs. Also, typhoid fever was perceived to be more common and a PRD than HIV/AIDS and TB combined. The most prominently attributed cause for disease was (lack of) hygiene. In response, students deployed formal and/or informal healthcare strategies, depending on factors like available money, perceived severity of the disease and disease type. Discrepancies were observed in respondents’ response to diseases generally and to malaria in particular. Even though, overall, respondents pre-dominantly reported a formal healthcare response toward diseases in general, for malaria, informal responses dominated. There was an overall strong awareness and (pro)activity among students for dealing with diseases.ConclusionsAlthough the high use of informal facilities and medication for malaria may well be a reason why eradication is problematic, this seems to be a deliberate strategy linked to an awareness of the limitations of the formal health system. In any intervention intended to foster health, it is therefore vital to consider people’s perceptions toward diseases and their response strategies. Our results give important leads to health promotion interventions to develop group-specific programs.

Health-Seeking Behaviour towards Poverty-Related Disease (PRDs): A Qualitative Study of People Living in Camps and on Campuses in Cameroon.

Poverty-Related Diseases (PRDs) emphasize poverty as a ‘breeding-ground’ for a range of diseases. The study presented here starts from the premise that poverty is a general condition that can limit people’s capacity to prevent, mitigate or treat diseases. Using an interpretation of health seeking behaviour (HSB), inspired by the salutogenic approach, we investigated how people deal with PRDs, their ability and strategies put in place to cope. We collected HSB data from two groups of respondents in Cameroon: labourers of the Cameroon Development Corporation (CDC) living in settlements called camps and students of the state universities of Buea and Yaoundé living in settlements we refer to as campuses. By selecting these groups, the study offers a unique view of how different people cope with similar health challenges. We carried out semi-structured interviews with 21 camp dwellers and 21 students in a cross-sectional study. Our findings revealed 1) respondents use multiple resources to cope with PRDs. 2) Respondents’ perceptions of diseases and connection with poverty closely ties to general hygienic conditions of their living environment. 3) Utilisation of health facilities is not strongly dependent on financial resources. 4) Volatile health facilities are a major challenge and reason for people to revert to other health resources. The study brings out the need for organisations (governmental and non-governmental) to strengthen people’s capacities to cope with health situations through better health and housing policies geared at incorporating practices currently used by the people and supporting pro-hygienic initiatives.

Bibliometric analysis of medicine-related publications on poverty (2005-2015).

BackgroundPoverty is a global problem. The war against poverty requires not only financial support, but also poverty-related research to pinpoint areas of high need of intervention. In line with international efforts to fight poverty and negative consequences, we carried out this study to give a bibliometric overview of medicine-related literature on poverty. Such a s study is an indicator of the extent of interaction of various international key players on the war against poverty-related health problems.MethodsScopus was used to achieve the objective of this study. The time span set for this study was 2005–2015. Poverty-related articles under the subject area “Medicine” were used to give bibliometric indicators such as annual growth of publications, international collaboration, highly cited articles, active countries, institutions, journals, and authors.ResultsThe total number of retrieved articles was 1583. The Hirsh-index of retrieved articles was 56. A modest and fluctuating increase was seen over the study period. Visualization map of retrieved articles showed that “HIV”, infectious diseases, mental health, India, and Africa were most commonly encountered terms. No significant dominance of any particular author or journal was observed in retrieved articles. The United States of America had the largest share in the number of published articles. The World Health Organization and Centers for Disease Prevention and Control were among top active institutions/organizations. International collaboration was observed in less than one third of publications. Top cited articles focused on three poverty-related health issues, mainly, infectious diseases, malnutrition, and child development/psychology. Most of top articles were published in high impact journals.ConclusionsData indicated that articles on poverty were published in high influential medical journals indicative of the importance of poverty as a global health problem. However, the number publications and the extent of international collaborations was lower than expected given the huge burden of poverty-related health problems.

The impact of unemployment cycles on child and maternal health in Argentina.

The purpose of this study is to examine the effects of economic cycles in Argentina on infant and maternal health between 1994 and 2006, a period that spans the major economic crisis in 1999-2002. We evaluate the effects of province-level unemployment rates on several infant health outcomes, including birth weight, gestational age, fetal growth rate, and hospital discharge status after birth in a sample of 15,000 infants born in 13 provinces. Maternal health and healthcare outcomes include acute and chronic illnesses, infectious diseases, and use of prenatal visits and technology. Regression models control for hospital and year fixed effects and province-specific time trends. Unemployment rise reduces fetal growth rate particularly among high educated parents. Also, maternal poverty-related infectious diseases increase, although reporting of acute illnesses declines (an effect more pronounced among low educated parents). There is also some evidence for reduced access to prenatal care and technology among less educated parents with higher unemployment. Unemployment rise in Argentina has adversely affected certain infant and maternal health outcomes, but several measures show no evidence of significant change.