Underreporting Of Cases Research Articles

Epidemiology of Viral Infectious Diseases Reported in Saudi Arabia.

Efficient epidemiological monitoring of virus diseases is crucial in evaluating general public health, the prevalence of specific diseases, the pattern of spread, and implementing preventative and control strategies into action. This study analyzed data obtained from the Field Epidemiology Program (FETP) which is part of the Ministry of Health (MOH) in Saudi Arabia, which contained reported cases of infectious diseases over four years, from January 2018 to December 2021, to investigate and highlight the significant trend and incidence rate for each viral infectious disease. Of the reported viral infectious diseases, hepatitis B and C, dengue fever (DF), influenza, chickenpox, and measles were the highest reported viral cases over four years. For the aforementioned diseases, males were often more susceptible to viral infections than females. Except for DF, this viral infection was more common in Saudi citizens. Viral illnesses like hand, foot, and mouth disease were less prevalent, while neurological viral disorders such as acute flaccid paralysis were rarely detected. There was an overall reduction in viral cases recorded during 2020-2021, which may be attributed to the implementation of preventive measures during the Coronavirus Disease 2019 (COVID-19) pandemic or an underreporting of cases during the lockdown of that time. The prevalence of these common viral infections in the Saudi population suggests that understanding the mechanisms influencing changes in these viruses, methods of transmission, and the burden of these diseases is a priority for health policy. This understanding is necessary to develop effective intervention and preventive strategies.

Epidemiological evolution of dengue in the pre-pandemic to post-pandemic periods in the Americas and Brazil

Introduction: Dengue is an asymptomatic infection or present symptoms like low fever to disabling high fever, severe headache, retroocular, muscle and joint pain, in addition to skin rashes, and if associated with COVID-19, it can worsen the illness condition. Objective: investigate the epidemiological evolution of dengue in the pre-pandemic, pandemic and post-pandemic periods from an American and Brazilian perspective. Methodology: descriptive study, based on the search for information in epidemiological bulletins, data from DATASUS and the Pan American Health Organization/World Health Organization, in addition to articles available in databases provided by SciELO, ScienceDirect and Pubmed. Results: In the period before the pandemic, the high number of notifications was due to the DENV2 serotype, causing a large epidemic. In the years 2020-2021 there was a drop in the number of notifications due to the introduction of social and public health measures, misdiagnosis between the signs/symptoms of dengue and COVID-19, inaccurate serological tests and underreporting. In 2022 and 2023, the epidemiological scenario again points to increasing notification of dengue cases, mainly due to changes in routine vector control during the pandemic, combined with favorable environmental factors, such as increased rainfall. Conclusion: the neglect of both dengue fever and other diseases has negatively impacted the population today, since in order to mitigate the damage caused by the pandemic, actions to promote and prevent the health of endemic diseases in our territory, when placed in the background, have caused the underreporting of cases, influenced by changes in the political, economic and health spheres of society.

Prevalence, under-reporting, and epidemiological surveillance of COVID-19 in the Araguaína City of Brazil.

Asymptomatic and underreported individuals remain a source of coronafig disease 2019 (COVID-19) transmission to others. Data on the prevalence and epidemiological factors influencing transmission are fundamental for establishing control measures, especially in vulnerable regions such as the Amazon. This study aimed to determine the point prevalence and active infection of COVID-19 among the population in Araguaína, a Brazilian city located in the Amazon region, analyzed the socioeconomic and behavioral variables of a statistically representative sample of this population using an epidemiological survey, and identify the viral genomic diversity in the region. During the sixth epidemiological week of 2021 (February 8 to 12), samples of 497 inhabitants of the municipality asymptomatic for respiratory syndromes underwent reverse transcription-quantitative polymerase chain reaction and serological tests (immunoglobulin M and immunoglobulin G). A questionnaire collated data on socioeconomic factors, prevention measures, and health status history. The active infection rate was 6.2%, and the prevalence was 13.5% of the study population. Active infection cases were under-reported; each reported positive case represented 14-28 under-reported cases. Lineages P.2, P.1, and B.1.1 were detected. Working from home was a protective factor against the infection, and clinical signs of fever, dry cough, and loss of taste or smell were associated with testing positive (p <0.05). A descriptive analysis of the indicators revealed that the entire population was susceptible to the disease. Intensified vaccination strategies are required regardless of socioeconomic factors, health conditions, and preventive measures. Implementation of objective, comprehensive, and efficient management tools to minimize the spread of COVID-19 in this municipality can serve as a model for other regions of Brazil.

Awareness and management practices against rabies among dog owners in livestock farming communities, Plateau State: A preliminary report

Rabies remains a significant public health concern, especially in endemic regions like Africa and Asia, with likely underreported cases. Primarily transmitted through dog bites, rabies poses a substantial risk in Nigeria, where dogs are the main carriers. This study investigated rabies awareness and control practices among dog owners in livestock farming communities in Plateau State, Nigeria. This was done using structured questionnaire interviews with 50 respondents from five Local Government Areas. Data analysis revealed that 78% were aware of rabies, but few recognized its severity. Only 46% knew about rabies vaccination, and merely 16% sought clinical assistance post-dog bite. Despite relatively high awareness, gaps exist in understanding susceptible hosts, proper management, prevention, and health-seeking behaviours. Findings underscore the necessity of bolstering awareness and management, including vaccinations, to encourage effective rabies control measures among vulnerable populations within remote communities and nationwide.

Clinical characteristics and risk factors analysis of 505 cases of infusion reactions in a tertiary hospital.

Background: The clinical characteristics and risk factors of infusion reactions (IRs) are inadequately described in clinical practice due to underreported cases. In the present study, we reported the current status of IRs based on an in-hospital pharmacovigilance database of a tertiary care hospital. Methods: Our study conducted a retrospective analysis of drug-induced IRs recorded at an in-hospital pharmacovigilance center between January 2015 to December 2019. The descriptive statistical analysis encompassed main causative agents, clinical manifestations, organ/system involvement and outcome. The severity of IRs was assessed with reference to the CTCAE version 5.0 criteria and we investigated risk factors associated with severe IRs. Results: During the study period, a total of 505 cases of inpatient drug-induced IRs were detected, of which 79.2% (400 cases) were classified as general IRs and 20.8% (105 cases) were categorized as severe IRs. The primary drugs responsible for these reactions were antibiotics (23%, 116 cases), with piperacillin sodium-sulbactam sodium being the most prevalent, followed by antineoplastic agents (18.4%, 93 cases) and traditional Chinese medicine injections (TCMIs) (12.9%, 65 cases). The administration of cefoperazone - sulbactam, mannatide, Shenqi Fuzheng, elemene, and diterpene ginkgolides meglumine resulted in a higher incidence of critical IRs. Among all cases of IRs, 43.2%, 41.2%, and 23.4% showed signs and symptoms of circulation, skin mucosa, and respiratory organs/systems, respectively. 9.1% of cases experienced systemic damage, while 7.1% and 5.9% of cases reported neurological and gastrointestinal related adverse reactions, respectively. The multivariate analysis revealed that alcohol consumption (OR = 2.389%, 95% CI 1.141-5.002, p = 0.021), age over 65 (OR = 1.814%, 95% CI 1.052-3.127, p = 0.032) and the utilization of contrast media (OR = 4.072%, 95% CI 1.903-8.713, p < 0.001) were identified as risk factors for the development of severe IRs. Conclusion: Understanding the clinical characteristics of IRs helps to implement effective pharmaceutical monitoring and appropriate preventive measures for susceptible populations with risk factors.

A ten-year review of antimicrobial resistance among human Campylobacter jejuni isolates

Campylobacter jejuni is a major pathogen responsible for a significant number of reported campylobacteriosis cases in the European Union. Due to underdiagnosed and underreported cases, there are no existing studies on this pathogen. Fluoroquinolones have been the primary treatment for campylobacteriosis for many years. Fluoroquinolone resistance is causing an increase, which means that a new class of antibiotics must be introduced. The treatment of campylobacteriosis is currently based on macrolides, but with the increasing rates of resistance, active surveillance for antibiotic resistance is required. The aim of this study was to track the increasing prevalence of AMR in clinical isolates of C. jejuni across Bulgaria for a period of 10 years.

Hydroureteronephrosis Caused by a Retrocaval Ureter

A rare congenital abnormality of the inferior vena cava is known as the retrocaval ureter. During embryogenesis, the ureter descendsposteriorly to the inferior vena cava. While this anomaly can occur in pediatric patients, it most frequently presents symptoms in individuals during their third and fourth decades of life, such as hydronephrosis, typically caused by ureteric obstruction. Retrocaval ureter may also be asymptomatic, which could explain its low occurrence worldwide and underreporting of cases. In this particular case, we reviewed the medical record of a 21-year-old male patient who had right Pelviureteric junction obstruction (PUJO) due to a right retrocaval ureter. This condition was clinically managed through a right pyeloplasty procedure and the placement of a double J stent. Introduction Since its first description in 1893, the circumcaval ureter, also referred to as the retrocaval ureter, has been documented in fewer than 200 cases [1]. This anomaly leads to the proximal ureter inserting posteriorly to the inferior vena cava (IVC) and subsequently at the renal pelvis. The abnormal development of the infrarenal IVC is attributed to the ventrally positioned subcardinal vein, which confines the ureter posteriorly. Typically, between weeks four and eight of fetal development, the infrarenal IVC grows dorsally from the supra cardinal vein [1]. Prior to reaching the bladder, the distal ureter typically passes superficially alongside the common iliac vessels [2]. Patients with IVC compression of the proximal ureter, resulting in hydronephrosis or hydroureteronephrosis, often remain asymptomatic until their third or fourth decades of life, despite the anomaly being present from birth [3].

Sexual workplace violence in the health sector in Saudi Arabia: a cross sectional study

BackgroundSexual workplace violence occurs worldwide with increasing prevalence, causing psychological and physical injuries. However, only few reports from the Kingdom of Saudi Arabia have investigated the most involved health specialty and its association with other factors, such as working and sociodemographic conditions. The aim of this study was to determine the prevalence of workplace sexual violence over 12 months, from May 2018 to May 2019, circumstances related to the event, and consequences for the perpetrator and survivor and to identify associated factors among all healthcare workers (HCWs) in Saudi Arabia.MethodsThis cross-sectional study included all HCWs registered with the Saudi Commission for Health Specialties who worked for > 1 year in the health sector (government or private) in Saudi Arabia until May 2019. A non-probability convenient sampling technique was used. A modified self-administered questionnaire sent via email was utilized to assess workplace violence. Descriptive statistics were used to report percentages and frequencies, while advanced statistics, such as bivariate analysis, were used to determine associations. Multivariate logistic binary regression analysis was used to assess the combined and individual associations between relevant predictors of exposure of HCWs to recent sexual violence at the workplace.ResultsIn total, 7,398 (male, 51.3%; female, 48.7%) HCWs were electively enrolled in the study (mean age 40 ± 8.62 years). Most were non-Saudi (60%). Overall, 3.9% were sexual violence survivors. Approximately 60.7%, 51.4%, 48.3%, and 65.9% of female workers, nurses, Saudi natives, and night shift workers (18:00 to 07:00), respectively, were significantly exposed to sexual violence. Furthermore, approximately 54.8% of those with direct physical contact with patients had a higher rate of exposure to sexual harassment (p = 0.001).ConclusionsThe prevalence of sexual violence is low but remains a risk to HCWs, especially those working night shifts and having direct physical contact with patients. Thus, more support, specific strategies, and policies are needed to reduce the rate of occurrence, protect HCWs, and prevent such events. The underreporting of cases may be skewing the magnitude of the problem; thus, more education and additional research in Saudi Arabia are needed regarding sexual violence experienced by HCWs.

Evaluation of Mpox Knowledge, Stigma, and Willingness to Vaccinate for Mpox: Cross-Sectional Web-Based Survey Among Sexual and Gender Minorities.

The 2022 multicountry mpox outbreak positioned the condition as a public health emergency of international concern. By May 2023, Brazil ranked second globally in the cumulative number of mpox cases and deaths. The higher incidence of mpox among gay and other men who have sex with men in the current mpox outbreak deepens the stigma and discrimination against sexual and gender minorities (SGM). This might worsen the structural barriers impacting access to health services, which ultimately leads to undertesting and underreporting of cases. There are no data available on mpox knowledge and stigma in Latin America. We aimed to evaluate mpox knowledge, stigma, and willingness to vaccinate for mpox among SGM, and to describe sociodemographic and behavioral characteristics according to self-reported mpox diagnosis. A cross-sectional, internet-based survey was conducted in a convenience sample of adults (aged >18 years) living in Brazil recruited through advertisements on dating apps, social media, referral institutions for infectious diseases websites, and mass media (October-November 2022). We compared participants' characteristics according to self-reported mpox diagnosis using chi-square test or Fisher exact test for qualitative variables and Kruskal-Wallis test for quantitative variables. We enrolled 6236 participants: 5685 (91.2%) were cisgender men; 6032 (96.7%) were gay, bisexual, or pansexual; 3877 (62.2%) were White; 4902 (78.7%) had tertiary education; and 4070 (65.2%) reported low or middle income. Most participants (n=5258, 84.4%) agreed or strongly agreed that "LGBTQIA+ individuals are being discriminated and stigmatized due to mpox." Mpox awareness was 96.9% (n=6044), and 5008 (95.1%) were willing to get vaccinated for mpox. Overall, 324 (5.2%) reported an mpox diagnosis. Among these, 318 (98.1%) reported lesions, 178 (56%) local pain, and 316 (99.4%) sought health care. Among participants not reporting a diagnosis, 288 (4.9%) had a suspicious lesion, but only 158 (54.9%) of these had sought health care. Compared to participants with no diagnosis, those reporting an mpox diagnosis were younger (P<.001), reported more sex partners (P<.001), and changes in sexual behavior after mpox onset (P=.002). Moreover, participants diagnosed with mpox reported more frequently being tested for HIV in the prior 3 months (P<.001), living with HIV (P<.001), currently using HIV pre-exposure prophylaxis (P<.001), and previous sexually transmitted infection diagnosis (P<.001). Our results point to high mpox knowledge and willingness to vaccinate among SGM in Brazil. Participants self-reporting mpox diagnosis more frequently reported to be living with HIV, STI diagnosis, and current pre-exposure prophylaxis use, highlighting the importance of an mpox assessment that includes comprehensive sexual health screenings. Efforts to decrease stigma related to mpox among SGM are necessary to avoid mpox underdiagnosis.

Under-Reporting Cases and Deaths from Melioidosis: A Retrospective Finding in Songkhla and Phatthalung Province of Southern Thailand, 2014-2020.

Melioidosis, caused by Burkholderia pseudomallei, is a notifiable disease associated with a high mortality rate in Thailand. The disease is highly endemic in northeast Thailand, while its prevalence in other parts of the country is poorly documented. This study aimed at improving the surveillance system for melioidosis in southern Thailand, where the disease was believed to be underreported. Two adjacent southern provinces, Songkhla and Phatthalung, were selected as the model provinces to study melioidosis. There were 473 individuals diagnosed with culture-confirmed melioidosis by clinical microbiology laboratories at four tertiary care hospitals in both provinces from January 2014 to December 2020. The median age was 54 years (IQR 41.5-64), 284 (60%) of the patients were adults ≥50 years of age, and 337 (71.2%) were male. We retrospectively analyzed 455 patients treated at either Songklanarind Hospital, Hatyai Hospital, Songkhla Provincial Hospital, or Phatthalung Provincial Hospital, of whom 181 (39.8%) patients died. The median duration from admission to death was five days (IQR 2-17). Of the 455 patients, 272 (57.5%) had at least one clinical risk factor, and 188 (39.8%) had diabetes. Two major clinical manifestations, bacteremia and pneumonia, occurred in 274 (58.1%) and 166 (35.2%) patients, respectively. In most cases, 298 (75%) out of 395 local patients were associated with rainfall. Over the seven years of the study, the average annual incidence was 2.87 cases per 100,000 population (95% CI, 2.10 to 3.64). This study has confirmed that these two provinces of southern Thailand are endemic to melioidosis; even though the incidence rate is much lower than that of the Northeast, the mortality rate is comparably high.

Investigation and analysis of late reporting and under-reporting of occupational diseases from 2018 to 2020 in China

Objective: To understand the late reporting and the under-reporting of occupational disease from 2018 to 2020 in China and analyze the causes, so as to provide scientific evidence for improving the quality of occupational disease reports in China, timely acquiring the incidence of occupational disease, and assessing the occupational hazards. Methods: From May to December 2021, A total of 320 occupational disease diagnostic institutions were selected for investigation. The original documents of occupational disease diagnosis cases from 2018 to 2020 were compared with the online reported cases, and late reported and under-reported cases of occupational disease were analyzed. Results: A total of 32207 diagnosed cases from 2018 to 2020 were investigated, including 28934 confirmed cases and 3273 cases without occupational disease. The overall late reported rate and under-reported rate of confirmed cases were 20.2% and 2.1%, respectively. There were significant differences in the rate of late reporting and under-reporting of occupational diseases in different regions and different types of diagnostic institutions (P<0.001). The southwest region had the highest rates of late reporting and under-reporting, 61.6% and 7.9% respectively. The late reported rate of all kinds of occupational diseases was about 15.0%, and the under-reported rate was from 1.5.0% to 5.0%. Conclusion: At present, the phenomenon of late reporting and under-reporting occupational diseases is still obvious. It is necessary to strengthen the inspection of occupational disease reporting, improve the quality of occupational disease reporting, and provide scientific basis for the formulation of occupational disease prevention and control policies.

The influence of the COVID-19 pandemic on identifying HIV/AIDS cases in China: an interrupted time series study

The COVID-19 pandemic has caused significant global public health challenges, and impacted HIV testing and reporting worldwide. We aimed to estimate the impact of COVID-19 polices on identifying HIV/AIDS cases in China from 2020 to2022. We used an interrupted time series (ITS) design and seasonal autoregressive integrated moving average intervention (SARIMA Intervention) model. Monthly reported data on HIV/AIDS cases were extracted from the National Bureau of Disease Control and Prevention of China from January 2004 to August 2022. Data on Stringency Index (SI) and Economic Support Index (ESI) from January 22, 2020 to August 31, 2022 were extracted from the Oxford COVID-19 Government Response Tracker (OxCGRT). Using these, a SARIMA-Intervention model was constructed to evaluate the association between COVID-19 polices and monthly reported HIV/AIDS case numbers from January 2004 to August 2022 using auto.arima () function from R. The absolute percentage errors (APEs) compared the expected numbers generated by the SARIMA-Intervention model with actual numbers of HIV/AIDS, and was the primary outcome of this study. A second counterfactual model estimated HIV/AIDS case numbers if COVID-19 hadn't occurred in December 2019, and the mean difference between actual and predicted numbers were calculated. All statistical analyses were performed in R software (version 4.2.1) and EmpowerStats 2.0 and a P<0.05 was considered statistically significant. The SARIMA-Intervention model indicated HIV/AIDS monthly reported cases were inversely and significantly correlated with stricter lockdown and COVID-19 related polices (Coefficient for SI=-231.24, 95% CI:-383.17,-79.32) but not with economic support polices (Coefficient for ESI=124.27, 95% CI:-309.84, 558.38). APEs of the SARIMA-Intervention model for prediction of HIV/AIDS cases from January 2022 through August 2022, were-2.99, 5.08,-13.64,-34.04,-2.76,-1.52,-1.37 and-2.47 respectively, indicating good accuracy and underreporting of cases during COVID-19. The counterfactual model estimates between January 2020 and August 2022 an additional 1314 HIV/AIDS cases should have been established monthly if COVID-19 hadn't occurred. The COVID-19 pandemic influenced the allocation and acquisition of medical resources which impacted accurate monthly reporting of HIV in China. Interventions that promote continuous HIV testing and ensure the adequate provision of HIV services including remote delivery of HIV testing services (HIV self-testing) and online sexual counseling services are necessary during pandemics in future. Ministry of Science and Technology of the People's Republic of China (The grant number: 2020YFC0846300) and Fogarty International Center, National Institutes of Health, USA (The grant number: G11TW010941).

A Review on McKusick-Kaufman Syndrome

McKusick-Kaufman syndrome is one of the most underdiagnosed and underreported cases in the world. In family with no previous history, the condition is not at all suspected and is often diagnosed only during postnatal examination. As a cause of multiple malformations, the prognosis of which can be improved by risk assessment and genetic counselling, the condition demands early detection and identification. Also, it is vital to differentiate MKKS from Bardet- Biedl syndrome which has similar clinical presentation. Keywords: McKusick Kaufman syndrome, Bardet- Biedl Syndrome, Hydrometrocolpos, polydactyly.

Policy and programmatic directions for the Lesotho tuberculosis programme: Findings of the national tuberculosis prevalence survey, 2019.

The Kingdom of Lesotho has one of the highest burdens of tuberculosis (TB) in the world. A national TB prevalence survey was conducted to estimate the prevalence of bacteriologically confirmed pulmonary TB disease among those ≥15 years of age in 2019. A multistage cluster-based cross-sectional survey where residents ≥15 years in 54 clusters sampled from across the country were eligible to participate. Survey participants were screened using a symptom screen questionnaire and digital chest X-ray (CXR). Respondents who acknowledged cough of any duration, fever, weight loss, night sweats and/or had any CXR abnormality in the lungs were asked to provide two spot sputum specimens. All sputum testing was conducted at the National TB Reference Laboratory (NTRL), where samples underwent Xpert MTB/RIF Ultra (1st sample) and MGIT culture (2nd sample). HIV counselling and testing was offered to all survey participants. TB cases were those with Mycobacterium tuberculosis complex-positive samples with culture; and where culture was not positive, Xpert MTB/RIF Ultra (Xpert Ultra) was positive with a CXR suggestive of active TB and no current or prior history of TB. A total of 39,902 individuals were enumerated, and of these, 26,857 (67.3%) were eligible to participate; 21,719 (80.9%) participated in the survey of which 8,599 (40%) were males and 13,120 (60%) were females. All 21,719 (100%) survey participants underwent symptom screening and a total of 21,344 participants (98.3%) had a CXR. Of the 7,584 (34.9%) participants who were eligible for sputum examination, 4,190 (55.2%) were eligible by CXR only, 1,455 (19.2%) by symptom screening, 1,630 by both, and 309 by CXR exemption. A total of 6,780 (89.4%) submitted two sputum specimens, and 311 (4.1%) submitted one sample only. From the 21,719 survey participants, HIV counseling and testing was offered to 17,048, and 3,915 (23.0%) were documented as HIV-positive. The survey identified 132 participants with bacteriologically confirmed pulmonary TB thus providing an estimated prevalence of 581 per 100,000 population (95% CI 466-696) for those ≥15 years in 2019. Using the survey results, TB incidence was re-estimated to be 654 per 100,000 (95% CI 406-959), which was comparable to the 2018 TB incidence rate of 611 per 100,000 (95% CI 395-872) reported by the World Health Organization (WHO). The highest TB burden was found in those ≥55 years and among men. The ratio of prevalence to case notification was estimated at 1.22. TB/HIV coinfection was identified in 39 (29.6%) participants. Out of the 1,825 participants who reported a cough, 50% of these participants, mostly men, did not seek care. Those who sought care predominantly went to the public health facilities. The TB prevalence survey results confirmed that burden of TB and TB/HIV coinfection remains very high in Lesotho. Given that TB prevalence remains high, and there is a significant proportion of participants with confirmed TB that did not report TB suggestive symptoms. The National TB Programme will need to update its TB screening and treatment algorithms to achieve the End TB targets. A major focus will need to be placed on finding the "missing cases" i.e., undiagnosed or under-reported TB cases, or ensuring that not only TB symptomatic but also those who do not present with typical TB symptoms are promptly identified to reduce further onward transmission.

Exploring geographical differences and disparities of COVID-19 cases and understand the gaps in responses in South Asian countries: A three-month analysis of cases and responses

Background and Aim: Response in a beginning of an infection is important to prevent and control any infectious disease. It has never been studied how the countries in South Asia responded in the beginning of COVID-19 infections. The aim of this study was to explore the gap in responses by geographical variations and inequalities of COVID-19 cases in South Asian Countries.Methods: Covid-19 cases, geographic and demographic data for South-Asian countries were abstracted from the news medias, Johns Hopkins University dashboard, and countries government websites. The coverage period was until May 7, 2020. Descriptive analyses of COVID-19 cases were stratified by gender and age group. Clustering and spatial analysis was performed to show the COVID-19 case distribution.Results: Over 100000 confirmed cases were found in South-Asian countries until May 7, 2020, and 95% of them are in India, Pakistan, and Bangladesh. Alarmingly, a sharp increase in new cases was observed in Bangladesh and India in early May. In this region, India reported 56% of total cases, with the highest case fatality rate of 3.4%. Approximately 70% of infected cases in this region were found in men. Approximately 42% of confirmed cases were found between the ages of 20-40, and about 20% of infected cases were found over 50 years or older. All big, economically important cities in this region were mainly infected. Bangladesh and Afghanistan reported a slow rate of recovery with 16% and 13%, respectively while India reported 29%. Afghanistan used only four tests to detect a case while India used 25 tests to detect a case showing poor numbers and insufficient test facilities in Afghanistan. Conclusion: The biggest and most economically-important cities in every South-Asian country were infected with COVID-19, where returning the migrant workers to work was a significant challenge after lifting the restrictions. Data from India, Pakistan, and Bangladesh suggest that these countries did not show the peak in the first six months. In South Asia, men were at higher risk for both infection and death, regardless of age. There were many underreported cases in these regions. Scale up services to improve the testing facilities and start a surveillance system to identify the cases rapidly especially from the marginalized population and women could reduce the burden of any infections.

Detection of gender-based violence in primary care in Central Catalonia: a descriptive cross-sectional study

BackgroundViolence against women is a serious public health problem. Primary care could be one of the ideal places for the detection of gender-based violence (GBV), since women come into contact with PC at some point in their lives to look after their sexual and reproductive health. The increase in initiatives promoted by the health authorities regarding GBV offers the possibility of observing its evolution over the last few years.MethodsA descriptive cross-sectional study of reported cases of GBV in the region of Central Catalonia, during the period from 2017 to 2021, was carried out. All women of legal age, belonging to the specified health region and suffering episodes of GBV, were included. The variables analysed were age, area of residence, health diagnoses related to GBV, whether or not they were pregnant at the time of the attack, and mental health history.ResultsOf the total number of women studied, 1,467 presented some type of diagnosis of GBV, with a total of 3,452 episodes reported. We found an increase in the detection of cases, although it must be noted that there is an underreporting of cases in PC. The prevalence according to the total number of women assigned per year over the period studied was 0.42% in 2017 and 0.48% in 2021. It has also been observed that the average number of episodes per woman increased from 1.03 in 2017 to 1.15 in 2021. During the 5 years analysed, the minimum number of episodes per woman was 1 and the maximum was 10. In reference to the duration of the episodes, the minimum was 1 day, and the maximum was 32 years. The mean age of the women was 42.10 years, the most frequent nationality was Spanish (46.60%), and 54.15% of them lived in rural areas.ConclusionsDespite the established protocols and procedures, it seems that primary health care is not the most frequent place for its detection. It is necessary to continue working to raise awareness and train professionals, and to ensure coordination among all the parties involved in accompanying women in these processes.Trial registrationCEIm: 21/278-P.

Suicide attempts by adolescents assisted in an emergency department: a cross-sectional study.

to identify and characterize the care provided to adolescents admitted to an emergency department due to a suicide attempt. an observational, cross-sectional, descriptive study with a retrospective approach, carried out with medical records of adolescents aged 10 to 19 admitted for suicide attempts, between January 2015 and July 2020, in an emergency department. Data were subjected to descriptive and inferential analysis. eighty-eight service occurrences were identified, mainly to females, exposed to multiple risk factors. Exogenous intoxication was the main method used, occurring at home and on weekdays. There were systemic repercussions, requiring multiple interventions and hospitalizations. Only 26% of cases were notified. adolescents treated for suicide attempts were exposed to multiple risk factors, with intoxication as the main means used. There is concern about the underreporting of cases and the logic of clinical care and medicalization.

Therapeutic Options for Chlamydia trachomatis Infection: Present and Future.

Sexually transmitted infections (STIs), such as Chlamydia trachomatis (Ct) infection, have serious consequences for sexual and reproductive health worldwide. Ct is one of the most common sexually transmitted bacterial infections in the world, with approximately 129 million new cases per year. C. trachomatis is an obligate intracellular Gram-negative bacterium. The infection is usually asymptomatic, notwithstanding, it could also be associated with severe sequels and complications, such as chronic pain, infertility, and gynecologic cancers, and thus there is an urgent need to adequately treat these cases in a timely manner. Consequently, beyond its individual effects, the infection also impacts the economy of the countries where it is prevalent, generating a need to consider the hypothesis of implementing Chlamydia Screening Programs, a decision that, although it is expensive to execute, is a necessary investment that unequivocally will bring financial and social long-term advantages worldwide. To detect Ct infection, there are different methodologies available. Nucleic acid amplification tests, with their high sensitivity and specificity, are currently the first-line tests for the detection of Ct. When replaced by other detection methods, there are more false negative tests, leading to underreported cases and a subsequent underestimation of Ct infection's prevalence. Ct treatment is based on antibiotic prescription, which is highly associated with drug resistance. Therefore, currently, there have been efforts in line with the development of alternative strategies to effectively treat this infection, using a drug repurposing method, as well as a natural treatment approach. In addition, researchers have also made some progress in the Ct vaccine development over the years, despite the fact that it also necessitates more studies in order to finally establish a vaccination plan. In this review, we have focused on the therapeutic options for treating Ct infection, expert recommendations, and major difficulties, while also exploring the possible avenues through which to face this issue, with novel approaches beyond those proposed by the guidelines of Health Organizations.

Cost-Utility Analysis of Universal Maternal Pertussis Immunisation in Thailand: A Comparison of Two Model Structures.

This study aimed to assess the cost-effectiveness of introducing universal maternal pertussis immunisation under the national vaccine programme in Thailand. We conducted a cost-utility analysis from a societal perspective to compare maternal vaccination with (1) TdaP vaccine, (2) Td vaccine and aP vaccine, and (3) Td vaccine only. We constructed two decision-tree models with Markov elements, each following a different clinical pathway, to allow us to examine structural uncertainty. Costs were converted to 2021 Thai Baht (THB) and a discount rate of 3% was applied to health and cost outcomes, with sensitivity analysis at 0% and 6%. Parameter uncertainty was investigated through deterministic and probabilistic sensitivity analysis, with expected value of perfect information analysis. Maternal pertussis vaccination would avert 27 cases and up to one death per year. The incremental cost-effectiveness ratio (ICER) for adding aP to the maternal immunisation schedule is 2,184,025 THB/QALY and the ICER for replacing maternal Td vaccination with TdaP is 3,198,101 THB/QALY. Maternal pertussis vaccination only becomes favourable in the probabilistic sensitivity analysis at cost-effectiveness thresholds above 6,000,000 THB/QALY, far above the Thai threshold of 160,000 THB/QALY. If incidence is less than 397 cases per 100,000, maternal pertussis vaccination will not be cost-effective in Thailand, within the plausible range for vaccine effectiveness and probability of hospitalisation. Budget impact is dominated by vaccination costs, which represent 12% and 18% of the 2021 national vaccine programme budget for introducing aP vaccine or for switching Td with TdaP vaccine, respectively. We have found that maternal pertussis immunisation is not cost-effective in Thailand. Although there may be substantial under-reporting of pertussis cases, comparison with hospital data suggests that most under-reported cases are not hospitalised and therefore have negligible impact on our results. However, considerations such as affordability and local manufacturing may also be important for national immunisation programme decision-making.

Assessment of health staff's proficiency and quality of key malaria indicators in rural district of Ghana.

Routine Health Information Systems (RHIS) are important for not just sure enough control of malaria, but its elimination as well. If these systems are working, they can extensively provide accurate data on reported malaria cases instead of presenting modelled approximations of malaria burden. Queries are raised on both the quality and use of generated malaria data. Some issues of concern include inaccurate reporting of malaria cases as well as treatment plans, wrongly categorizing malaria cases in registers used to collate data and misplacing data or registers for reporting. This study analyses data quality concerning health staff's proficiency, timeliness, availability and data accuracy in the Sissala East Municipal Health Directorate (MHD). A cross-sectional design was used to collect data from 15 facilities and 50 health staff members who offered clinical related care for malaria cases in the Sissala East MHD from 24th August 2020 to 17th September 2020. Fifteen health facilities were randomly selected from the 56 health facilities in the municipality that were implementing the malarial control programme, and they were included in the study. On the question of when did staff receive any training on malaria-related health information management in the past six months prior to the survey, as minimal as 13 out of 50(26%) claimed to have been trained, whereas the majority 37 out of 50 (74%) had no training. In terms of proficiency in malaria indicators (MI), the majority (68% - 82%) of the respondents could not demonstrate the correct calculations of the indicators. Nevertheless, the MHD recorded monthly average timeliness of the 5th day [range: 4.7-5.7] within the reporting year. However, the MHD had a worse average performance of 5.4th and 5.7th days in July and September respectively. Furthermore, results indicated that 14 out of 15(93.3%) facilities exceeded the target to accomplish report availability (> = 90%) and data completeness (> = 90%). However, the verification factor (VF) of the overall malaria indicator showed that the MHD neither over-reported nor under-reported actual cases, with the corresponding level of data quality as Good (+/-5%). The Majority of staff had not received any training on malaria-related RHIS. Some staff members did not know the correct definitions of some of MI used in the malaria programme, while the majority of them could not demonstrate the correct calculations of MI. Timeliness of reporting was below the target, nevertheless, copies of data that were submitted were available and completed. There should be training, supervision and monitoring to enhance staff proficiency and improve the quality of MI.