RESUMO
BACKGROUND: Schistosomiasis is an acute and chronic disease caused by parasitic worms, that can take two main forms: intestinal or urogenital. If left untreated, the urogenital form can lead to female genital schistosomiasis (FGS) in women and girls; frequently resulting in severe reproductive health complications which are often misdiagnosed as sexually-transmitted infections (STIs) or can be confused with cervical cancer. Despite its impact on women's reproductive health, FGS is typically overlooked in medical training and remains poorly recognized with low awareness both in affected communities and in health professionals. FGS has been described as the one of the most neglected sexual and reproductive health issues in sub-Saharan Africa (Swai in BMC Infect Dis 6:134, 2006; Kukula in PLoS Negl Trop Dis 13:e0007207; Joint United Nations Programme on HIV/AIDS (UNAIDS) 2019). Increased knowledge and awareness of FGS is required to end this neglect, improve women's reproductive health, and decrease the burden of this preventable and treatable neglected tropical disease. METHODS: We conducted interactive virtual workshops, in collaboration with the World Health Organization (WHO), engaging 64 participants with medical and public health backgrounds from around the world to establish standardized skills (or competencies) for prevention, diagnosis, and treatment of FGS at all levels of the health system. The competencies were drafted in small groups, peer-reviewed, and finalized by participants. RESULTS: This participatory process led to identification of 27 skills needed for FGS prevention, diagnosis, and management for two categories of health workers; those working in a clinical setting, and those working in a community setting. Among them, ten relate to the diagnosis of FGS including three that involve a pelvic exam and seven that do not. Six constitute the appropriate behaviors required to treat FGS in a clinical setting. Eleven address the community setting, with six relating to the identification of women at risk and five relating to prevention. CONCLUSION: Defining the skills necessary for FGS management is a critical step to prepare for proper diagnosis and treatment of women and girls in sub-Saharan Africa by trained health professionals. The suggested competencies can now serve as the foundation to create educative tools and curricula to better train health care workers on the prevention, diagnosis, and management of FGS.
Assuntos
Saúde Reprodutiva , Esquistossomose , Feminino , Genitália Feminina , Pessoal de Saúde , Humanos , Comportamento SexualRESUMO
Female genital schistosomiasis (FGS) affects approximately 56 million women and girls across sub-Saharan Africa and is associated with up to a threefold increased prevalence of HIV. Integrating FGS with HIV programmes as part of comprehensive sexual and reproductive health (SRH) services may be one of the most significant missed opportunities for preventing HIV incidence among girls and women. A search of studies published until October 2021 via Scopus and ProQuest was conducted using PRISMA guidelines to assess how FGS can be integrated into HIV/SRH and neglected tropical diseases (NTDs) programmes and services. Data extraction included studies that integrated interventions and described the opportunities and challenges. A total of 334 studies were identified, with 22 eligible for analysis and summarised conducting a descriptive numerical analysis and qualitative review. We adapted a framework for integrated implementation of FGS, HIV, and HPV/cervical cancer to thematically organise the results, classifying them into five themes: awareness and community engagement, diagnosis, treatment, burden assessment, and economic evaluation. Most activities pertained to awareness and community engagement (n = 9), diagnosis (n = 9) and were primarily connected to HIV/AIDS (n = 8) and school-based services and programming (n = 8). The studies mainly described the opportunities and challenges for integration, rather than presenting results from implemented integration interventions, highlighting an evidence gap on FGS integration into HIV/SRH and NTD programmes. Investments are needed to realise the potential of FGS integration to address the burden of this neglected disease and improve HIV and SRH outcomes for millions of women and girls at risk.
Assuntos
Infecções por HIV , Esquistossomose , Feminino , Humanos , Saúde Reprodutiva , Infecções por HIV/prevenção & controle , Doenças Negligenciadas , Genitália FemininaRESUMO
BACKGROUND: 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. METHODOLOGY: 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. RESULTS: 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. CONCLUSION: 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).
Assuntos
Doenças dos Genitais Femininos , Esquistossomose , Estudantes de Medicina , Humanos , Feminino , Nigéria , Estudos Transversais , Inteligência Artificial , Esquistossomose/diagnóstico , Genitália Feminina , Pessoal de Saúde , Doenças NegligenciadasRESUMO
The traditional timeline for a new innovation in public health to move from initial proof of concept to introduction into national programs is sequential and can take decades. Here, we discuss the development of a new drug therapy for lymphatic filariasis (LF) to help progress toward elimination as a public health problem and how this process was accelerated by a group of partners working together. This article documents the way that these partners worked together and made decisions that made it possible to accelerate the process of the development and introduction of the triple-drug therapy involving ivermectin, diethylcarbamazine, and albendazole (IDA). The partners were able to condense the development timeline from the first clinical efficacy data to delivery in a country program for the triple-drug therapy from a projected â¼28 years to less than 5 years while maintaining all of the safety standards. The approach required understanding stakeholders, their roles, need for data to inform decisions, and then looking at timelines focused on prioritizing activities that inform decision-making. This process relied on a close engagement of all stakeholders and good communication. Through this exercise, additional early data review points were added to study designs, studies were run in parallel not sequentially, and a plan put in place to engage all stakeholders necessary for adoption and uptake throughout the process, so they were prepared to make decisions as data became available. This process could provide some insights into how global health can work together in new ways to accelerate the availability of interventions and strategies to promote health and well-being.
Assuntos
Filariose Linfática , Filaricidas , Humanos , Filariose Linfática/tratamento farmacológico , Filariose Linfática/prevenção & controle , Filaricidas/uso terapêutico , Promoção da Saúde , Quimioterapia Combinada , Dietilcarbamazina/uso terapêutico , Albendazol/uso terapêutico , Ivermectina/uso terapêuticoRESUMO
For developing countries and partners to accelerate the availability of new innovations to communities in need of intervention, it is necessary to find improved ways to work together that challenge today's status quo in global health. By adopting new approaches and accepting shared risk and reward, diverse partners can work together to accelerate progress toward a common global health goal. A symphony orchestra-with a conductor who recruits, arranges, harmonizes, and orchestrates diverse musicians to work together to create something not possible by individual musicians on their own-provides an apt metaphor for successful global health initiatives. In such settings, stakeholders must be engaged and harmonized, workplans composed, and partnerships conducted such that all stakeholder roles progress from workplans that are sequential and independent to those that are integrated and interactive. Reflecting on the successful global health partnerships discussed here and beyond, we use this orchestral metaphor to illustrate the elements needed to make partnerships increasingly successful.
Assuntos
Saúde Global , Música , Humanos , Participação dos InteressadosRESUMO
We used the introduction of the Japanese encephalitis (JE) vaccine in India as an example to understand more fully the process of introducing any new clinical product in India. We discuss the key decision-making points as well as the many activities involved in introducing a new clinical product in India's public health program. We write from our experience in supporting the government of India to introduce new products successfully-namely, vaccines-to India's health system. In India, the process begins with identifying the public health problem (e.g., an outbreak of JE), deciding to take action, prioritizing where action is needed, securing a supply and price of the intervention (the vaccine; in this case, the live, attenuated SA 14-14-2 vaccine), and determining how to ensure effective rollout of the intervention (the vaccination program). Reflecting on the experience of the JE vaccination program helped to inform the introduction of the triple-drug therapy of ivermectin, diethylcarbamazine, and albendazole in India as a new treatment protocol for lymphatic filariasis.
Assuntos
Filariose Linfática , Encefalite Japonesa , Filaricidas , Vacinas contra Encefalite Japonesa , Humanos , Dietilcarbamazina/uso terapêutico , Albendazol/uso terapêutico , Filariose Linfática/tratamento farmacológico , Filariose Linfática/epidemiologia , Filariose Linfática/prevenção & controle , Ivermectina/uso terapêutico , Índia/epidemiologia , Encefalite Japonesa/tratamento farmacológico , Encefalite Japonesa/epidemiologia , Encefalite Japonesa/prevenção & controle , Filaricidas/uso terapêuticoRESUMO
Triple therapy with ivermectin, diethylcarbamazine, and albendazole (IDA) for the elimination of lymphatic filariasis (LF) represents a compelling example of accelerating the timeline from development to introduction and impact. Previous articles outlined how the clinical development process was able to compress timelines and provide the evidence needed for the WHO to issue guidelines on the use of IDA for mass drug administration for LF. We explored the drivers for the rapid and successful introduction of IDA in the early-adopter countries. Lessons from this experience highlight five key elements for moving from WHO recommendations to program uptake after the publication of the guideline: 1) early engagement with stakeholders to create partnerships to coordinate and plan for implementation; 2) recognition by countries and partners of the potential of IDA to improve efforts to eliminate LF; 3) high-level commitment and coordination at regional levels and, most importantly, at the country level; 4) understanding of the perspectives among people living in LF-endemic communities where mass drug administration is warranted; and 5) affirmation of the feasibility of IDA through sharing lessons learned.
Assuntos
Filariose Linfática , Filaricidas , Humanos , Dietilcarbamazina/uso terapêutico , Albendazol/uso terapêutico , Ivermectina/uso terapêutico , Administração Massiva de Medicamentos , Quimioterapia Combinada , Filariose Linfática/tratamento farmacológico , Filariose Linfática/epidemiologia , Filariose Linfática/prevenção & controle , Organização Mundial da Saúde , Filaricidas/uso terapêuticoRESUMO
The right to health was enshrined in the constitution of the World Health Organization in 1946 and in the Universal Declaration of Human Rights in 1948, which also guaranteed women's fundamental freedoms and dignity. The Declaration of Human Rights was signed by almost every country in the world. Nonetheless, gender inequalities in health and health systems continue to persist, especially in lower and middle income countries that are disproportionately affected by a litany of neglected diseases. In this paper, we focus on one of the most neglected human rights, development, and reproductive health issues globally, female genital schistosomiasis (FGS), which imposes enormous unacknowledged suffering on an estimated 56 million women and girls in Sub-Saharan Africa. Despite increasing calls for attention to FGS, no country has fully incorporated it into its health system. An appropriate response will require a comprehensive approach, guided by human rights mandates and the redress of FGS-related gender inequalities. In this paper, we propose the application of existing human rights and its clients, women, and girls affected by FGS as rights holders. Within the different components or building blocks of the health system, we propose elements of an appropriate health system response using the four components identified within the FGS Accelerated Scale Together (FAST) Package-awareness raising, prevention of infection, training of health personnel, and diagnosis and treatment. The framework is aspirational, its recommended elements and actions are not exhaustive, and countries will need to adapt it to their own situations and resource availability. However, it can be a useful guide to help health systems define how to begin to incorporate FGS into their programming in a way that responds to their human rights obligations in a gender- and culturally sensitive manner.
RESUMO
Helminths are parasitic worms. They are the most common infectious agents of humans in developing countries and produce a global burden of disease that exceeds better-known conditions, including malaria and tuberculosis. As we discuss here, new insights into fundamental helminth biology are accumulating through newly completed genome projects and the nascent application of transgenesis and RNA interference technologies. At the same time, our understanding of the dynamics of the transmission of helminths and the mechanisms of the Th2-type immune responses that are induced by infection with these parasitic worms has increased markedly. Ultimately, these advances in molecular and medical helminth biology should one day translate into a new and robust pipeline of drugs, diagnostics, and vaccines for targeting parasitic worms that infect humans.
Assuntos
Helmintíase/parasitologia , Clima Tropical , Animais , Genoma de Protozoário/genética , Genômica , Helmintíase/epidemiologia , Helmintíase/imunologia , Helmintíase/prevenção & controle , Helmintos/genética , Helmintos/imunologia , Humanos , Interferência de RNARESUMO
OBJECTIVE: To update the estimated global incidence of Japanese encephalitis (JE) using recent data for the purpose of guiding prevention and control efforts. METHODS: Thirty-two areas endemic for JE in 24 Asian and Western Pacific countries were sorted into 10 incidence groups on the basis of published data and expert opinion. Population-based surveillance studies using laboratory-confirmed cases were sought for each incidence group by a computerized search of the scientific literature. When no eligible studies existed for a particular incidence group, incidence data were extrapolated from related groups. FINDINGS: A total of 12 eligible studies representing 7 of 10 incidence groups in 24 JE-endemic countries were identified. Approximately 67,900 JE cases typically occur annually (overall incidence: 1.8 per 100,000), of which only about 10% are reported to the World Health Organization. Approximately 33,900 (50%) of these cases occur in China (excluding Taiwan) and approximately 51,000 (75%) occur in children aged 0-14 years (incidence: 5.4 per 100,000). Approximately 55,000 (81%) cases occur in areas with well established or developing JE vaccination programmes, while approximately 12,900 (19%) occur in areas with minimal or no JE vaccination programmes. CONCLUSION: Recent data allowed us to refine the estimate of the global incidence of JE, which remains substantial despite improvements in vaccination coverage. More and better incidence studies in selected countries, particularly China and India, are needed to further refine these estimates.
Assuntos
Surtos de Doenças/estatística & dados numéricos , Encefalite Japonesa/epidemiologia , Saúde Global/estatística & dados numéricos , Adolescente , Fatores Etários , Criança , Proteção da Criança , Pré-Escolar , Surtos de Doenças/prevenção & controle , Encefalite Japonesa/prevenção & controle , Feminino , Saúde Global/tendências , Humanos , Incidência , Lactente , Recém-Nascido , Vacinas contra Encefalite Japonesa , Masculino , Pediatria , Vigilância da População , Medição de Risco , Organização Mundial da SaúdeRESUMO
A cohort of Japanese encephalitis (JE) survivors in Cambodia and Viet Nam were assessed at least 4 months after hospital discharge in order to understand the extent of disability after JE. We used a simple assessment tool which focuses on the impact on daily life. In total, 64 disability assessments were conducted: 38 in Cambodia and 26 in Viet Nam. In Cambodia, 4 (11%) children had severe sequelae, suggesting the children would likely be dependent, 15 (39%) had moderate sequelae and 17 (45%) had mild sequelae. In Viet Nam, two (8%) persons had severe sequelae, five (19%) had moderate sequelae and eight (31%) had mild sequelae. In many JE-endemic areas there are no multi-disciplinary teams with sophisticated equipment to assess patients after JE disease. This assessment tool can assist with patient management and generate data to support the need for programmes to prevent disease and improve outcomes for survivors.
Assuntos
Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/etiologia , Crianças com Deficiência , Encefalite Japonesa/complicações , Encefalite Japonesa/diagnóstico , Qualidade de Vida , Adolescente , Camboja/epidemiologia , Criança , Transtornos do Comportamento Infantil/diagnóstico , Transtornos do Comportamento Infantil/etiologia , Pré-Escolar , Transtornos Cognitivos/mortalidade , Estudos de Coortes , Avaliação da Deficiência , Crianças com Deficiência/estatística & dados numéricos , Encefalite Japonesa/mortalidade , Feminino , Seguimentos , Humanos , Lactente , Masculino , Prognóstico , Medição de Risco , Vigilância de Evento Sentinela , Índice de Gravidade de Doença , Vietnã/epidemiologiaRESUMO
Compassion-the awareness of suffering coupled with the desire to relieve that suffering-is an evolved human capacity that offers significant benefits for individuals and organizations. While the relief of suffering is central to tropical medicine and global health, compassion is more often assumed than explicit. Global health leaders participating in a compassionate leadership program recently reported that the most common personal barriers to compassionate leadership include inability to regulate workload, perfectionism, and lack of self-compassion; while the most common external challenges include excessive work-related demands, the legacy of colonialism, and the lack of knowledge on how to lead with compassion. These barriers can be surmounted. Within organizations, leaders are the primary shapers of compassionate cultures. Now is the time to bring our core compassionate values to bear in addressing the "unfinished business" of ensuring global health equity and deconstructing colonialist structures in global health and tropical medicine. Compassionate leadership offers us tools to complete this unfinished business.
Assuntos
Empatia , Saúde Global , Liderança , Medicina Tropical , HumanosRESUMO
Neglected tropical diseases (NTDs) are targeted for global control or elimination. Recognising that the populations most in need of medicines to target NTDs are those least able to support and sustain them financially, the pharmaceutical industry created mechanisms for donating medicines and expertise to affected countries through partnerships with the WHO, development agencies, non-governmental organisations and philanthropic donors. In the last 30 y, companies have established programmes to donate 17 different medicines to overcome the burden of NTDs. Billions of tablets, capsules, intravenous and oral solutions have been donated, along with the manufacturing, supply chains and research necessary to support these efforts. Industry engagement has stimulated other donors to support NTDs with funds and oversight so that the 'heath benefit' return on investment in these programmes is truly a 'best value in public health'. Many current donations are 'open-ended', promising support as long as necessary to achieve defined health targets. Extraordinary global health advances have been made in filariasis, onchocerciasis, trachoma, trypanosomiasis, leishmaniasis, schistosomiasis, intestinal parasites and others; and these advances are taking place in the context of strengthening health systems and meeting the global development goals espoused by the WHO. The pharmaceutical manufacturers, already strong collaborators in initiating or supporting these disease-targeted programmes, have committed to continuing their partnership roles in striving to meet the targets of the WHO's new NTD roadmap to 2030.
Assuntos
Oncocercose , Esquistossomose , Medicina Tropical , Saúde Global , Humanos , Doenças Negligenciadas/prevenção & controleRESUMO
Scabies is a neglected tropical disease (NTD) that causes a significant health burden, particularly in disadvantaged communities and where there is overcrowding. There is emerging evidence that ivermectin-based mass drug administration (MDA) can reduce the prevalence of scabies in some settings, but evidence remains limited, and there are no formal guidelines to inform control efforts. An informal World Health Organization (WHO) consultation was organized to find agreement on strategies for global control. The consultation resulted in a framework for scabies control and recommendations for mapping of disease burden, delivery of interventions, and establishing monitoring and evaluation. Key operational research priorities were identified. This framework will allow countries to set control targets for scabies as part of national NTD strategic plans and develop control strategies using MDA for high-prevalence regions and outbreak situations. As further evidence and experience are collected and strategies are refined over time, formal guidelines can be developed. The control of scabies and the reduction of the health burden of scabies and associated conditions will be vital to achieving the targets set in WHO Roadmap for NTDs for 2021 to 2030 and the Sustainable Development Goals.
Assuntos
Antiparasitários/uso terapêutico , Administração em Saúde Pública , Escabiose/prevenção & controle , Antiparasitários/administração & dosagem , Atenção à Saúde , Surtos de Doenças , Humanos , Ivermectina/uso terapêutico , Administração Massiva de Medicamentos , Doenças Negligenciadas , Prevalência , Pesquisa , Medicina Tropical , Populações VulneráveisRESUMO
The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) was established in late 2008 to conduct operational research that would inform practices related to the control and elimination of schistosomiasis. This article traces SCORE's beginnings and underpinnings. These include an emphasis on openness and contributing to the development of a cohesive schistosomiasis control community, building linkages between researchers and national programs, and focusing on answering questions that will help Neglected Tropical Disease program managers to better control and eliminate schistosomiasis. It describes the development and implementation of SCORE's multiple projects. SCORE began by drawing on advice from a broad range of experts by holding wide-ranging meetings that informed the priorities and protocols for SCORE research. SCORE's major efforts included large, multicountry field studies comparing multiple strategies for mass drug administration with praziquantel, assessment of approaches to elimination, evaluation of a point-of-care assay for field mapping Schistosoma mansoni, and increasing the sensitivity of a laboratory-based diagnostic. SCORE also supported studies on morbidity due to schistosomiasis, quantification of vector snails and the detection of schistosome infections in snails, and changes in schistosome population genetics under praziquantel drug pressure. SCORE data and specimens are archived and will remain available for future research. Although much remains to be carried out, our hope is that through the already published articles and SCORE results described in this supplement, we will have provided a body of evidence to assist policy makers in the development of judicious guidelines for the control and elimination of schistosomiasis.
Assuntos
Esquistossomose mansoni , Esquistossomose , Animais , Reservatórios de Doenças , Vetores de Doenças , História do Século XXI , Humanos , Administração Massiva de Medicamentos , Morbidade , Doenças Negligenciadas/diagnóstico , Doenças Negligenciadas/tratamento farmacológico , Doenças Negligenciadas/epidemiologia , Doenças Negligenciadas/prevenção & controle , Parasitologia/história , Praziquantel/uso terapêutico , Prevalência , Schistosoma haematobium , Schistosoma mansoni , Esquistossomose/diagnóstico , Esquistossomose/tratamento farmacológico , Esquistossomose/epidemiologia , Esquistossomose/prevenção & controle , Esquistossomose mansoni/diagnóstico , Esquistossomose mansoni/tratamento farmacológico , Esquistossomose mansoni/epidemiologia , Esquistossomose mansoni/prevenção & controle , Caramujos/parasitologiaRESUMO
The Global Programme to Eliminate Lymphatic Filariasis (LF) is using mass drug administration (MDA) of antifilarial medications to treat filarial infections, prevent disease and interrupt transmission. Almost 500 million people receive these medications each year. Clinical trials have recently shown that a single dose of a triple-drug combination comprised of ivermectin, diethylcarbamazine and albendazole (IDA) is dramatically superior to widely used two-drug combinations for clearing larval filarial parasites from the blood of infected persons. A large multicenter community study showed that IDA was well-tolerated when it was provided as MDA. IDA was rapidly advanced from clinical trial to policy and implementation; it has the potential to accelerate LF elimination in many endemic countries.
Assuntos
Filariose Linfática , Filaricidas , Preparações Farmacêuticas , Albendazol/uso terapêutico , Dietilcarbamazina/uso terapêutico , Quimioterapia Combinada , Filariose Linfática/tratamento farmacológico , Filariose Linfática/prevenção & controle , Filaricidas/uso terapêutico , Humanos , Ivermectina/uso terapêuticoRESUMO
In the context of stalling progress against malaria, resistance of mosquitoes to insecticides, and residual transmission, mass drug administration (MDA) of ivermectin, an endectocide used for neglected tropical diseases (NTDs), has emerged as a promising complementary vector control method. Ivermectin reduces the life span of Anopheles mosquitoes that feed on treated humans and/or livestock, potentially decreasing malaria parasite transmission when administered at the community level. Following the publication by WHO of the preferred product characteristics for endectocides as vector control tools, this roadmap provides a comprehensive view of processes needed to make ivermectin available as a vector control tool by 2024 with a completely novel mechanism of action. The roadmap covers various aspects, which include 1) the definition of optimal dosage/regimens for ivermectin MDA in both humans and livestock, 2) the risk of resistance to the drug and environmental impact, 3) ethical issues, 4) political and community engagement, 5) translation of evidence into policy, and 6) operational aspects of large-scale deployment of the drug, all in the context of a drug given as a prevention tool acting at the community level. The roadmap reflects the insights of a multidisciplinary group of global health experts who worked together to elucidate the path to inclusion of ivermectin in the toolbox against malaria, to address residual transmission, counteract insecticide resistance, and contribute to the end of this deadly disease.
Assuntos
Antiparasitários/farmacologia , Inseticidas/farmacologia , Ivermectina/farmacologia , Malária/prevenção & controle , Mosquitos Vetores/efeitos dos fármacos , África , Animais , Antiparasitários/uso terapêutico , Doenças Endêmicas/prevenção & controle , Humanos , Inseticidas/uso terapêutico , Ivermectina/uso terapêutico , Dose Letal Mediana , Malária/tratamento farmacológico , Malária/transmissão , Administração Massiva de Medicamentos , Segurança , Espanha , Organização Mundial da SaúdeRESUMO
PROBLEM: Recent progress in vaccine availability and affordability has raised prospects for reducing death and disability from neurological infections in children. In many Asian countries, however, the epidemiology and public health burden of neurological diseases such as Japanese encephalitis and bacterial meningitis are poorly understood. APPROACH: A sentinel surveillance system for Japanese encephalitis was developed and embedded within the routine meningoencephalitis syndromic surveillance system in Cambodia in 2006. The sentinel surveillance system was designed so surveillance and laboratory testing for other etiologies of neurological infection could be incorporated. LOCAL SETTING: The Communicable Disease Control department of the Ministry of Health in Cambodia worked with partners to establish the sentinel surveillance system. RELEVANT CHANGES: The sentinel surveillance system has provided important information on the disease burden of Japanese encephalitis in Cambodia and is now providing a platform for expansion to incorporate laboratory testing for other vaccine-preventable neurological infections in children. LESSONS LEARNED: Sentinel surveillance systems, when linked to syndromic reporting systems, can characterize the epidemiology of meningoencephalitis and identify the proportion of hospital-based neurological infection in children that is vaccine preventable. Integrated systems enable consistency in data collection, analysis and information dissemination, and they enhance the capacity of public health managers to provide more credible and integrated information to policy-makers. This will assist decision-making about the potential role of immunization in reducing the incidence of childhood neurological infections.
Assuntos
Encefalite Japonesa/epidemiologia , Meningoencefalite/epidemiologia , Camboja/epidemiologia , Criança , Encefalite Japonesa/microbiologia , Encefalite Japonesa/prevenção & controle , Humanos , Vacinas contra Encefalite Japonesa/uso terapêutico , Meningoencefalite/microbiologia , Meningoencefalite/prevenção & controle , Vigilância de Evento SentinelaRESUMO
BACKGROUND: Japanese encephalitis (JE) is the most important form of viral encephalitis in Asia. Surveillance for the disease in many countries has been limited. To improve collection of accurate surveillance data in order to increase understanding of the full impact of JE and monitor control programs, World Health Organization (WHO) Recommended Standards for JE Surveillance have been developed. To aid acceptance of the Standards, we describe the process of development, provide the supporting evidence, and explain the rationale for the recommendations made in the document. METHODS: A JE Core Working Group was formed in 2002 and worked on development of JE surveillance standards. A series of questions on specific topics was initially developed. A literature review was undertaken and the findings were discussed and documented. The group then prepared a draft document, with emphasis placed on the feasibility of implementation in Asian countries. A field test version of the Standards was published by WHO in January 2006. Feedback was then sought from countries that piloted the Standards and from public health professionals in forums and individual meetings to modify the Standards accordingly. RESULTS: After revisions, a final version of the JE surveillance standards was published in August 2008. The supporting information is presented here together with explanations of the rationale and levels of evidence for specific recommendations. CONCLUSION: Provision of the supporting evidence and rationale should help to facilitate successful implementation of the JE surveillance standards in JE-endemic countries which will in turn enable better understanding of disease burden and the impact of control programs.
Assuntos
Encefalite Japonesa/epidemiologia , Prática de Saúde Pública/normas , Organização Mundial da Saúde , Encefalite Japonesa/diagnóstico , Guias como Assunto , HumanosRESUMO
Most well established neglected tropical disease (NTD) programs have seen great progress towards disease control or elimination. Areas in conflict, however, are a looming challenge to reaching control and elimination targets. To be successful, programs and partners need to creatively adapt to local circumstances and embrace new colleagues not traditionally seen as NTD implementers.