ABSTRACT
BACKGROUND: Community engagement (CE) interventions include a range of approaches to involve communities in the improvement of their health and wellbeing. Working with communities defined by location or some other shared interest, these interventions may be important in assisting equity and reach of communicable disease control (CDC) in low and lower-middle income countries (LLMIC). We conducted an umbrella review to identify approaches to CE in communicable disease control, effectiveness of these approaches, mechanisms and factors influencing success. METHODS: We included systematic reviews that: i) focussed on CE interventions; ii) involved adult community members; iii) included outcomes relevant to communicable diseases in LLMIC; iv) were written in English. Quantitative results were extracted and synthesised narratively. A qualitative synthesis process enabled identification of mechanisms of effect and influencing factors. We followed guidance from the Joanna Briggs Institute, assessed quality with the DARE tool and reported according to standard systematic review methodology. RESULTS: Thirteen systematic reviews of medium-to-high quality were identified between June and July 2017. Reviews covered the following outcomes: HIV and STIs (6); malaria (2); TB (1); child and maternal health (3) and mixed (1). Approaches included: CE through peer education and community health workers, community empowerment interventions and more general community participation or mobilisation. Techniques included sensitisation with the community and involvement in the identification of resources, intervention development and delivery. Evidence of effectiveness of CE on health outcomes was mixed and quality of primary studies variable. We found: i) significantly reduced neonatal mortality following women's participatory learning and action groups; ii) significant reductions in HIV and other STIs with empowerment and mobilisation interventions with marginalised groups; iii) significant reductions in malaria incidence or prevalence in a small number of primary studies; iv) significant reductions in infant diarrhoea following community health worker interventions. Mechanisms of impact commonly occurred through social and behavioural processes, particularly: changing social norms, increasing social cohesion and social capacity. Factors influencing effectiveness of CE interventions included extent of population coverage, shared leadership and community control over outcomes. CONCLUSION: Community engagement interventions may be effective in supporting CDC in LLMIC. Careful design of CE interventions appropriate to context, disease and community is vital.
Subject(s)
Communicable Disease Control/organization & administration , Community Participation/methods , Developing Countries , Community Health Workers/organization & administration , Health Education/organization & administration , Humans , Incidence , Malaria/prevention & control , Maternal-Child Health Services/organization & administration , Poverty , Systematic Reviews as Topic , Tuberculosis/prevention & controlABSTRACT
The physical, psychological and financial burden of skin disease in low- to middle-income countries, where access to skincare is limited, is poorly understood. A group that we know very little about in this regard are refugees. There are limited data on the range of skin diseases and skincare needs of this group. To better understand the skincare needs of the displaced Rohingya population residing in the Kutupalong refugee camp, Bangladesh, we collected data on demographics, living conditions and range of dermatoses. In the 380 patients assessed, fungal skin infections, predominantly dermatophytes, were by far the most common skin disease seen (n = 215), followed by dermatitis (n = 81). Skin disease can be the presenting feature in many systemic conditions and may cause significant secondary complications itself. Developing a better understanding of the skincare needs of the refugee population is essential for future healthcare planning for this vulnerable group.
Subject(s)
Needs Assessment/economics , Refugee Camps/statistics & numerical data , Refugees/psychology , Skin Diseases/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Arthrodermataceae/pathogenicity , Bangladesh/epidemiology , Child , Child, Preschool , Dermatitis/epidemiology , Dermatitis/pathology , Dermatomycoses/epidemiology , Dermatomycoses/microbiology , Dermatomycoses/pathology , Female , Health Services Needs and Demand , Humans , Infant , Infant, Newborn , Male , Middle Aged , Myanmar/ethnology , Needs Assessment/statistics & numerical data , Refugees/statistics & numerical data , Skin Diseases/pathology , Young AdultABSTRACT
Inter-morph pollen transfer and its dependence on herkogamy and reciprocity are not completely understood in species with stigma-height dimorphism. We asked whether total stigmatic pollen loads, inter-morph fraction of pollen load and reproductive success differed between morphs in Jasminum malabaricum, a species exhibiting stigma-height dimorphism. We tested whether higher herkogamy and reciprocity resulted in higher inter-morph pollen deposition and reproductive success. We quantified individual-level estimates of herkogamy, reciprocity, total stigmatic pollen load, inter-morph stigmatic pollen fraction and fruit set for both morphs in naturally occurring populations of J. malabaricum. Total pollen load was higher in the long-styled morph, inter-morph pollen fraction was higher in the short-styled morph, but fruit set did not differ between morphs. Higher herkogamy resulted in a higher inter-morph fraction of pollen load and fruit set in the long-styled morph of one population. In the other population, only reciprocity was found to be related to inter-morph pollen deposition. This study is the first to quantify and report natural inter-morph stigmatic pollen load in a species with stigma-height dimorphism. Morph-specific differences in pollen load were similar to patterns commonly observed in heterostylous species. The results highlight the importance of both herkogamy and reciprocity in facilitating inter-morph pollen transfer. Population-specific patterns indicate that local environmental factors determine the relative functional importance of herkogamy and reciprocity.
Subject(s)
Flowers , Jasminum/physiology , Pollen , Flowers/physiology , Fruit , Pollen/physiology , ReproductionABSTRACT
Studies of floral polymorphisms have focused on heterostyly, while stigma-height dimorphism has received considerably less attention. Few studies have examined the reproductive biology of species with stigma-height dimorphism to understand how factors influencing mate availability and pollen transfer are related to morph ratios in populations. Floral morphological traits, especially herkogamy and reciprocity, pollinator visitation, breeding system and spatiotemporal mate availability, are known to affect inter-morph pollination and morph ratios in species with stigma-height dimorphism. In this study, we investigated the presence of stigma-height dimorphism and estimated morph ratios in four naturally occurring populations of Jasminum malabaricum. We quantified morph- and population-specific differences in the abovementioned factors in these populations to understand the observed morph ratios. The positions of anthers and stigmas were characteristic of stigma-height dimorphism, the first report of this polymorphism in the genus. All study populations were isoplethic, implying equal fitness of both morphs. Herkogamy was higher in the short-styled morph, while reciprocity was higher between the long-styled stigma and short-styled anthers. Long- and short-tongued pollinators were common floral visitors, and we observed no differences between morphs in spatiotemporal mate availability or pollinator visitation. Neither morph exhibited self- or heteromorphic incompatibility. The short-styled stigma had lower reciprocity but likely receives sufficient inter-morph pollen from long-tongued pollinators, and also by avoiding self-pollination due to higher herkogamy. These results highlight the importance of sufficient effective pollinators and floral morphological features, particularly herkogamy, in maintaining isoplethy in species with stigma-height dimorphism.
Subject(s)
Jasminum , Flowers/anatomy & histology , Jasminum/anatomy & histology , Jasminum/physiology , Pollination , Reproduction/physiologyABSTRACT
Serum from one hundred and ten breast cancer patients and thirty healthy female volunteers, were prospectively collected and evaluated for serum levels of Shh and IL-6 using human Shh and IL-6 specific enzyme-linked immunoassays. All patients were regularly monitored for event free survival (EFS) and overall survival (OS). Overall outcome analysis was based on serum Shh and IL-6 levels. In patients with progressive metastatic BC, both serum Shh and IL-6 concentrations were elevated in 44% (29 of 65) and 63% (41 of 65) of patients, respectively, at a statistically significant level [Shh (p = 0.0001) and IL-6 (p = 0.0001)] compared to the low levels in healthy volunteers. Serum levels tended to increase with metastatic progression and lymph node positivity. High serum Shh and IL-6 levels were associated with poor EFS and OS opposite to the negative or lower levels in serum Shh and IL-6. The elevated levels of both serum Shh and IL-6 were mainly observed in BC patients who had a significantly higher risk of early recurrence and bone metastasis, and associated with a worse survival for patients with progressive metastatic BC. Further studies are warranted for validating these biomarkers as prognostic tools in a larger patient cohort and in a longer follow-up study.
Subject(s)
Breast Neoplasms/blood , Breast Neoplasms/diagnosis , Hedgehog Proteins/blood , Interleukin-6/blood , Biomarkers, Tumor , Bone Neoplasms/secondary , Breast Neoplasms/mortality , Case-Control Studies , Disease Progression , Female , Humans , Neoplasm Metastasis , Neoplasm Staging , Prognosis , ROC Curve , Whole Body ImagingABSTRACT
Dysregulation of Hedgehog (Hh) signaling pathway has been documented in mammary gland development and breast cancer (BC) progression. Despite the remarkable progress in therapeutic interventions, BC related mortality in Bangladesh increased in the last decade. Triple negative breast cancer (TNBC) still presents a critical therapeutic challenge. Thus effective targeted therapy is urgently needed. In this study, we report the clinicopathological characteristics and prognosis of BC patients from Bangladesh. Routine immunohistochemical analysis and high throughput RNA-Seq data from the TCGA library were used to analyze the expression pattern and association of high and low level of Shh expression in a collection of BC patients with a long-term follow-up. High levels of Shh were observed in a subset of BC tumors with poor prognostic pathological features. Higher level of Shh expression correlated with a significantly poorer overall survival of patients compared with patients whose tumors expressed a low level of Shh. These data support the contention that Shh could be a novel biomarker for breast cancer that is involved in mediating the aggressive phenotype of BC. We propose that BC patients exhibiting a higher level of Shh expression, representing a subset of BC patients, would be amenable to Shh targeted therapy.
Subject(s)
Hedgehog Proteins/metabolism , Triple Negative Breast Neoplasms/metabolism , Adult , Bangladesh , Biomarkers, Tumor , Female , Follow-Up Studies , Gene Expression , Hedgehog Proteins/genetics , Humans , Immunohistochemistry , Kaplan-Meier Estimate , Middle Aged , Mortality , Neoplasm Grading , Neoplasm Metastasis , Neoplasm Staging , Prognosis , Proportional Hazards Models , Reproducibility of Results , Risk Factors , Triple Negative Breast Neoplasms/diagnosis , Triple Negative Breast Neoplasms/genetics , Triple Negative Breast Neoplasms/mortality , Young AdultABSTRACT
The appearance of cholera caused by multiply antibiotic resistant Vibrio cholerae in Bangladesh provided an opportunity to compare epidemiological features of infection caused by resistant and by sensitive V. cholerae. A prospective study was carried out using 46 families of hospital in-patient cholera cases due to resistant V. cholerae and 11 families of hospital cases due to sensitive V. cholerae and nine cases of cholera due to resistant and six cases due to sensitive V. cholerae detected in the neighbourhoods of hospital patients. All families were visited daily during ten days for cultures of rectal swabs, samples of domestic water and for history of diarrhoea. The results showed no significant difference in secondary infection and case rates in contacts of hospital cholera cases due to resistant and sensitive V. cholerae. However, the secondary infection rate (57%) in contacts of cases due to resistant V. cholerae detected from the neighbourhoods of hospital cases was significantly higher (p less than 0.05), than in the neighbourhood case-contacts (29%) of cases due to sensitive V. cholerae. The mean duration of diarrhoea in untreated resistant V. cholerae cases who were contacts of hospital cases (3.3 days) was significantly longer (p less than 0.05) than that of untreated sensitive V. cholerae (2.2 days). Higher isolation rates of V. cholerae were obtained from water sources used by cholera cases due to resistant V. cholerae, than from sources used by cases due to sensitive V. cholerae, but the differences were not statistically significant (p greater than 0.05). The study suggests that resistant V. cholerae poses an additional threat through a higher secondary infection rate and by causing illnesses of longer duration.
Subject(s)
Cholera/epidemiology , Anti-Bacterial Agents/pharmacology , Bangladesh , Cholera/microbiology , Drug Resistance, Microbial , Furazolidone/pharmacology , Humans , Vibrio cholerae/drug effectsABSTRACT
The incidence of shigellosis and the death rate have increased and the resistance of shigellae to antibiotics has changed in Dhaka during our experiences. In 1980, we investigated the secondary infection and case rates, infection to case ratio, duration of illness, excretion of shigellae and antibiotic sensitivity pattern in 100 families with cases of shigellosis, culturing rectal swabs obtained by home visits for a 10-day period. Standard methods were used for culture and sensitivity tests. The over-all secondary infection rate in contacts was 27.3% and the case rate 10.7%. The rates were higher for Shigella flexneri than for Sh. dysenteriae. When the index cases were nought to four years old the secondary infection and case rates were higher than when index cases were older. Contacts aged nought to four years had highest attack rates. The average duration of excretion of Sh. flexneri was 4.5 and Sh. dysenteriae 2.6 days. Illness was one day longer for Sh. dysenteriae than for Sh. flexneri. Cases of shigellosis in hospital had higher rates of fever and blood in stool than those who were not in-patients. 40% of Sh. dysenteriae and 14% of Sh. flexneri were sensitive to tetracycline, 0 to 5% to streptomycin and 100% to sulphamethoxazole, trimethoprim and gentamicin. Incidence of Sh. flexneri had increased in 1980 but that of Sh. dysenteriae remained the same as in 1973 although Sh. dysenteriae type 1 appeared to be less infective in 1980 than in 1973.
Subject(s)
Dysentery, Bacillary/epidemiology , Adolescent , Anti-Bacterial Agents/pharmacology , Bangladesh , Child , Child, Preschool , Dysentery, Bacillary/genetics , Dysentery, Bacillary/transmission , Humans , Infant , Microbial Sensitivity Tests , Shigella dysenteriae/drug effects , Shigella flexneri/drug effects , Time FactorsABSTRACT
Intestinal infarction is a rare complication of systemic lupus erythematosus (SLE). A 26-year-old Papua New Guinean female who developed such a complication and underwent emergency laparotomy is described. The pathological changes in the mesenteric vessels and possible pathogenetic mechanisms are discussed. The relevant literature is briefly reviewed.
Subject(s)
Ileum/blood supply , Infarction/etiology , Lupus Erythematosus, Systemic/complications , Adult , Colic/etiology , Coma/etiology , Elastic Tissue/pathology , Fatal Outcome , Female , Fibromuscular Dysplasia/pathology , Gangrene/pathology , Gastrointestinal Hemorrhage/pathology , Humans , Infarction/pathology , Laparotomy , Lupus Erythematosus, Systemic/pathology , Mesenteric Arteries/pathology , Mesenteric Vascular Occlusion/pathologySubject(s)
Helminthiasis/prevention & control , Intestinal Diseases, Parasitic/prevention & control , Pyrantel/therapeutic use , Adolescent , Child , Child, Preschool , Helminthiasis/drug therapy , Helminthiasis/epidemiology , Humans , India , Infant , Infant, Newborn , Intestinal Diseases, Parasitic/epidemiology , Poverty Areas , Prospective Studies , Protozoan Infections/epidemiology , Protozoan Infections/prevention & controlABSTRACT
Yersinia enterocolitica serotype IX has been found to stimulate the production of vibriocidal antibody against Vibrio cholerae, particularly in Inaba serotype, in experimental rabbits and infected man to a significant degree. This activity could be absorbed by both Inaba and Yersinia antigens from anti-yersinia sera, but Yersinia antigen could not absorb vibriocidal activity from the anti-cholera sera, indicating a unilateral relation.Vibrio agglutinating antibody, particularly against Ogawa, in anti-yersinia rabbit or human sera was found to be less liable to non-specific stimulation.V. cholerae, while removing vibriocidal antibody, could not absorb the Yersinia agglutinin from anti-yersinia sera, suggesting that there is a different determinant for these two types of antibody activities.The non-specific production of vibriocidal antibody by Y. enterocolitica type IX indicates the need for caution in the interpretation of the results of vibriocidal tests where such organisms are prevalent.
Subject(s)
Antibody Formation , Pasteurella/immunology , Vibrio/immunology , Agglutination Tests , Animals , Antibodies/analysis , Antigens , Cross Reactions , Humans , Pasteurella Infections/immunology , RabbitsABSTRACT
The ABO blood group of 87 bacteriologically proven cases of cholera and 33 bacteriologically negative cholera-like diarrhoea cases was determined. When compared with the normal blood group distribution in the population of the Philippines of the same racial group to which the patients belonged, a relatively larger number of cases were found to occur in individuals of group O and a lesser number in those of group A. A plea is made for further studies on these lines to explain the host susceptibility in cholera and other acute enterotoxigenic diarrhoeas.
Subject(s)
ABO Blood-Group System , Cholera/blood , ABO Blood-Group System/genetics , Cholera/genetics , Diarrhea/blood , Diarrhea/genetics , Gene Frequency , HumansABSTRACT
During its early years, WHO was primarily concerned with epidemic control, standardization and quality control of vaccines, and administration of the International Sanitary Regulations. Among the acute enteric infections, cholera received the greatest attention because of its propensity for rapid epidemic spread. When the seventh pandemic of cholera began in 1961, WHO responded with a greatly expanded programme of activities which included cooperation with countries in training and control efforts, and research on treatment and prevention, especially vaccine development. At the same time, numerous training courses were held on enteric infections and a series of controlled field trials established the degree of protection conferred by existing typhoid and paratyphoid vaccines. In 1970, when the cholera pandemic spread to Africa, the emergency assistance programme was reactivated, with increasing attention to the provision of appropriate treatment, especially oral rehydration therapy, rather than the supply of ineffective vaccines. The requirement of cholera vaccination for international travel in the International Health Regulations was abolished in 1973 by the World Health Assembly. Another public health problem of importance during the 1970s was the increase in antibiotic resistance of enteric bacteria, especially Shigella dysenteriae 1 and Salmonella typhi, first in Central America and Mexico and later in Asia. There was a notable acceleration in research on diarrhoeal disease and especially on cholera during this period, with the discovery of several new viral and bacterial agents of diarrhoea, advances in knowledge of intestinal immunity indicating that better protection might be achieved with oral vaccines, and the demonstration of the effectiveness of a single formulation of oral rehydration salts (ORS) in the treatment of all diarrhoeas including cholera.(ABSTRACT TRUNCATED AT 250 WORDS)
PIP: This article traces the history of the worldwide struggle to control diarrheal diseases. When the 7th pandemic of cholera began in 1961, WHO responded with a greatly expanded program of activities which included cooperation with countries in training and control efforts, and research on treatment and prevention. In 1970, when the cholera pandemic spread to Africa, the emergency assistance program was reactivated, with increasing attention to the provision of appropriate treatment, especially oral rehydration therapy. Another public health problem of importance during the 1970s was the increase in antibiotic resistance of enteric bacteria. The demonstration of the effectiveness of a single formulation of oral rehydration salts (ORS) in the treatment of all diarrheas was instrumental in convincing public health administrators that diarrheal diseases control should become an essential component of primary health care and led to the creation of a global Diarrheal Diseases Control program. The Program, which has the objective of reducing childhood mortality and morbidity due to diarrheal diseases and their associated ill effects, especially malnutrition, consists of 2 main components: a health services and control component and research component. If the targets set by the Program for 1989 can be attained, it is expected that by then at least 1.5 million childhood deaths due to diarrhea will be prevented annually.
Subject(s)
Diarrhea/prevention & control , Cholera/prevention & control , Developing Countries , Disease Outbreaks/prevention & control , Drug Resistance, Microbial , Enterobacteriaceae/drug effects , Enterobacteriaceae Infections/prevention & control , Fluid Therapy/methods , Humans , Research , World Health OrganizationABSTRACT
Vibriocidal antibody titre in excess of 1:40 occurred within two weeks of cholera infection, both in severe hospitalized cases, contact cases and in asymptomatic infected contacts. These levels, considered to be indicative of protection, persisted for six months or longer in more than half of the subjects irrespective of presence and severity of symptoms. Approximately 40% of infected family contacts had similar titres implying recent infection and subsequent protection. The use of antibiotics to treat acute cases, and whether infection was due to antibiotic resistant or sensitive Vibrio cholerae had no effect on the response of vibriocidal titre. Endemicity of cholera was higher than previously observed in Dhaka. Screening populations to obtain positive titre rates permits retrospective assessment of cholera infection and provides an indicator of future susceptibility.
Subject(s)
Antibodies, Bacterial/analysis , Cholera/immunology , Vibrio cholerae/immunology , Acute Disease , Anti-Bacterial Agents/pharmacology , Bangladesh , Child , Child, Preschool , Cholera/epidemiology , Disease Susceptibility , Evaluation Studies as Topic , Humans , Urban Population , Vibrio cholerae/drug effectsABSTRACT
Fifteen patients hospitalized with acute, watery diarrhea and with enterotoxigenic Escherichia coli (ETEC) detected from stool samples were studied to evaluate the extent to which natural ETEC diarrhea induces local and systemic antibody responses to E. coli heat-labile toxin (LT), homologous lipopolysaccharide (LPS), and colonization factors (CFA/I and CFA/II). Specific IgA and IgG antibodies to LT, CFA I and II, and each patient's homologous LPS were determined by ELISA in serum, saliva, breastmilk, and intestinal lavage fluid. The majority of patients had greater than a twofold rise in local levels of IgA antibodies in the intestine: 80% of LT+ patients responded to LT, 63% of CFA+ patients responded to CFA, and 78% of all toxin-positive patients responded to the LPS of their infecting strain. Local antibody responses in the intestine were associated with responses in breastmilk and saliva, but relationships were not clear-cut, and the usefulness of these secretions as proxy measures of local intestinal antibody production remains unclear. Antibody responses in serum also occurred in most patients and were significantly more frequent in cases than in controls. This study demonstrates that natural ETEC disease results in local IgA responses to LT, CFA, and LPS in the gut and also in immune responses in breastmilk, saliva, and serum.
Subject(s)
Antibody Formation , Diarrhea/immunology , Escherichia coli Infections/immunology , Escherichia coli Proteins , Fimbriae Proteins , Adult , Antigens, Bacterial/immunology , Bacterial Toxins/immunology , Diarrhea/microbiology , Enterotoxins/immunology , Enzyme-Linked Immunosorbent Assay , Escherichia coli , Feces/microbiology , Female , Humans , Immunoglobulin G/analysis , Lipopolysaccharides/immunology , Male , Milk, Human/analysis , Saliva/analysisABSTRACT
Malignant tumors registered with the Tumour Registry of Papua New Guinea (PNG) from 1958-1988 were analyzed with emphasis on the variation of incidence with time and different regions. Cancer incidence was generally low in PNG. During this period, carcinoma of oral cavity, cervix, breast, and skin, hepatoma, and lymphoma were the most common types of malignant lesions detected. The incidence of carcinoma of the oral cavity has increased. Currently, it is more common in the Highlands region and is associated with the spread of betel nut chewing. A threefold increase in cervical carcinoma registration was observed nationally, with a sixfold increase in the Highlands region; this was attributed both to social changes and improved registration. The incidence of breast cancer has doubled, in keeping with better registration, but there is little interregional variation. The decline in registrations of hepatocellular carcinoma is artifactual. PNG is a high-incidence area for Burkitt lymphoma, but Hodgkin disease is rare. Both Burkitt and other non-Hodgkin lymphomas are uncommon in the Highlands. A decline in the incidence of squamous carcinoma of skin was observed that was associated with improved control of tropical ulcers. The incidence of stomach cancer is falling. The registered cancer incidence in PNG is low, even when compared with that in native people from other Pacific nations, such as Fijians and New Caledonian Melanesians. Preventive measures have been hitherto ineffective, with the exception of squamous carcinoma of skin.
Subject(s)
Neoplasms/epidemiology , Adult , Breast Neoplasms/epidemiology , Burkitt Lymphoma/epidemiology , Female , Hodgkin Disease/epidemiology , Humans , Liver Neoplasms/epidemiology , Lymphoma, Non-Hodgkin/epidemiology , Male , Middle Aged , Mouth Neoplasms/epidemiology , Ovarian Neoplasms/epidemiology , Papua New Guinea/epidemiology , Registries , Skin Neoplasms/epidemiology , Stomach Neoplasms/epidemiology , Uterine Cervical Neoplasms/epidemiologyABSTRACT
In Dhaka, Bangladesh, fresh isolates of Escherichia coli from 197 patients with diarrhea were investigated for production of enterotoxin and possession of colonization factor antigen (CFA) I or II. Enterotoxigenic E. coli (ETEC) was isolated from 34% of the patients, and of the 67 enterotoxin-positive strains, 75% carried CFAs. Among 68 healthy control persons no strains positive for both enterotoxin and CFA were found. The CFAs in general were restricted to certain serotypes of E. coli. In a subgroup of patients, part of an ongoing surveillance study, mixed infection was seen in 23% of those from whom recognized pathogens were identified. There was a tendency to more severe dehydration when the two virulence factors, enterotoxin and CFA, were simultaneously present.