Assessment of integrated patterns of human-animal-environment health: a holistic and stratified analysis.

BACKGROUND: Data-driven research is a very important component of One Health. As the core part of the global One Health index (GOHI), the global One Health Intrinsic Drivers index (IDI) is a framework for evaluating the baseline conditions of human-animal-environment health. This study aims to assess the global performance in terms of GOH-IDI, compare it across different World Bank regions, and analyze the relationships between GOH-IDI and national economic levels. METHODS: The raw data among 146 countries were collected from authoritative databases and official reports in November 2021. Descriptive statistical analysis, data visualization and manipulation, Shapiro normality test and ridge maps were used to evaluate and identify the spatial and classificatory distribution of GOH-IDI. This paper uses the World Bank regional classification and the World Bank income groups to analyse the relationship between GOH-IDI and regional economic levels, and completes the case studies of representative countries. RESULTS: The performance of One Health Intrinsic Driver in 146 countries was evaluated. The mean (standard deviation, SD) score of GOH-IDI is 54.05 (4.95). The values (mean SD) of different regions are North America (60.44, 2.36), Europe and Central Asia (57.73, 3.29), Middle East and North Africa (57.02, 2.56), East Asia and Pacific (53.87, 5.22), Latin America and the Caribbean (53.75, 2.20), South Asia (52.45, 2.61) and sub-Saharan Africa (48.27, 2.48). Gross national income per capita was moderately correlated with GOH-IDI (R2 = 0.651, Deviance explained = 66.6%, P < 0.005). Low income countries have the best performance in some secondary indicators, including Non-communicable Diseases and Mental Health and Health risks. Five indicators are not statistically different at each economic level, including Animal Epidemic Disease, Animal Biodiversity, Air Quality and Climate Change, Land Resources and Environmental Biodiversity. CONCLUSIONS: The GOH-IDI is a crucial tool to evaluate the situation of One Health. There are inter-regional differences in GOH-IDI significantly at the worldwide level. The best performing region for GOH-IDI was North America and the worst was sub-Saharan Africa. There is a positive correlation between the GOH-IDI and country economic status, with high-income countries performing well in most indicators. GOH-IDI facilitates researchers' understanding of the multidimensional situation in each country and invests more attention in scientific questions that need to be addressed urgently.

Contributions and achievements on schistosomiasis control and elimination in China by NIPD-CTDR.

Being a zoonotic parasitic disease, schistosomiasis was widely spread in 12 provinces of Southern China in the 1950s, severly harming human health and hindering economic development. The National Institute of Parasitic Diseases at the Chinese Center for Diseases Control and Prevention, and Chinese Center for Tropical Diseases Research (NIPD-CTDR), as the only professional institution focussing on parasitic diseases at the national level, has played an important role in schistosomiasis control in the country. In this article, we look back at the changes of schistosomiasis endemicity and the contribution of NIPD-CTDR to the national schistosomiasis control programme. We review NIPD-CTDR's activities, including field investigations, design of control strategies and measures, development of diagnostics and drugs, surveillance-response of endemic situation, and monitoring & evaluation of the programme. The NIPD-CTDR has mastered the transmission status of schistosomiasis, mapped the snail distribution, and explored strategies and measures suitable for different types of endemic areas in China. With a good understanding of the life cycle of Schistosoma japonicum and transmission patterns of the disease, advanced research carried out in the NIPD-CTDR based on genomics and modern technology has made it possible to explore highly efficient and soft therapeutic drugs and molluscicides, making it possible to develop new diagnostic tools and produce vaccine candidates. In the field, epidemiological studies, updated strategies and targeted intervention measures developed by scientists from the NIPD-CTDR have contributed significantly to the national schistosomiasis control programme. This all adds up to a strong foundation for eliminating schistosomiasis in China in the near future, and recommendations have been put forward how to reach this goal.

[Cost-effectiveness evaluation on comprehensive control measures carrying out in schistosomiasis endemic areas with regard to different layers of administrative villages stratified by infection situation of human and domestic animals. II Correlation analysis of costs and inputs with changes of schistosomiasis endemic situation in inner embankment of marshland and lake regions from 2006 to 2013].

OBJECTIVE: To investigate the correlations between inputs and costs and endemic situation of schistosomiasis in inner embankment, so as tb provide the references for the strategy optimization of schistosomiasis control. METHODS: Jiangling County was selected as the study field. The correlatibn and regression analyses were applied to analyze the endemic situation of schistosomiasis in Jiangling County from 2006 to 2013. The methods of two-stages least squares and path analysis were applied to analyze the impacts between costs and inputs and endemic situation of schistosomiasis. RESULTS: The adjusted infection rate of population, number of bovines and Oncomelania hupensis snail areas reduced by 77.42%, 76.34% and 19.43%, respectively in Jiangling County from 2006 to 2013. The correlations between the infection rate of snails and the population positive rates of blood and fecal exams, and the infection rate of bovines were significant (all P < 0.05); and there was a significant linear regression between the infection rates of snails and bovines (P < 0.05). There were statistically significant regressions between inputs at different levels and the population positive rates of blood and fecal exams, and the infection rates of bovines and snails, as well as between the costs and the population positive rate of fecal exams and the infection rates of bovines and snails (all P < 0.05), whereas there was no statistically significant regression between the costs and the population positive rate by blood exams (P > 0.05). The inputs at county level had an impact on the population positive rate of blood exams; the costs of comprehensive treatment had an impact on the population positive rate of fecal exams; the costs of human labor and measures for exams and treatments had an impact on the infeiction rate of bovines; the inputs at national level and the costs of measures for exams and treatments had an impact on the infection rate of snails (all P < 0.05). CONCLUSION: The inputs and costs of schistosomiasis control were related to the epidemic situation of schistosomiasis in Jiangling County from 2006 to 2013; therefore, it is necessary to develop a comprehensive surveillance system as substitute for the current indexes on schistosomiasis control.

Schistosomiasis in a migrating population in the lake region of China and its potential impact on control operation.

Coverage of migrating people in schistosomiasis control program is a growing concern in China. Schistosomiasis caused by Schistosoma japonicum is still one of the major infectious diseases of public health importance in China though tremendous efforts have been made to control the transmission over the past decades. Along with the rapid social-economic development, migrant population has been remarkably increasing across the country. The infected migrants may introduce a new souse of infection to endemic areas or the areas where the transmission had been controlled or interrupted but the intermediate host Oncomelania snail is still present. Preliminary studies for surveillance on schistosomiasis prevalence in migrants were reported, but there is little basic information provided. We carried out an investigation on the prevalence in immigrants, emigrants and permanent residents in three villages of Hunan province located in the main endemic area of lake region, and analyzed the potential impact of migration on control practice. In the study villages, the migrant population accounts for 53.6% of the total. Schistosoma infection was detected by modified Kato-Katz method and miracidium hatching test. Questionnaire survey was conducted comprising knowledge of disease and its transmission, water contact, personal protective measures, and whether examined and treated after water contact. The survey indicated that the migrants and permanent residents had similar life style, and the majority of them experienced water contact in agricultural work or routine life activities. However, the infection rate in immigrants was significantly higher than that in permanent residents. It was also found that the migrants had significantly less knowledge about the disease than the permanent residents, and took no personal protective measures. This is due to that the control program could not cover the migrants when they were absent at the time the program being implemented. The present study suggested that the surveillance and intervention for migrants, immigrants in particular, should be included and strengthened in schistosomiasis control program and a feasible scheme be developed.

[Assessment on the effect of joint effort for schistosomiasis control in Hubei Province].

OBJECTIVE: To analyze the progress of implementation of integrated strategy with emphasis on the control of infectious sources and effectiveness for joint-project of schistosomiasis control in Hubei province. METHODS: Data on the endemic status and implementation of each integrated intervention in 6 collaborated counties including Gongan, Hanchuan, Honghu, Jiangling, Xiantao and Yangxin during 2009-2013 were collected and analyzed. 18 administrative villages with a history of endemic schistosomisis from 6 counties were selected for field survey. Individuals aged 6-65 years received screening test by IHA, and feces of antibody positive inhabitants were collected and tested by miracidia hatching technique. Hatching technique was conducted to determine the infection rate of schistosomiasis in cattle if there was any cattle existed. RESULTS: Various interventions were conducted with adaption to the local situation by the Departments of Agriculture, Water Conservancy, Forestry, and Health. The total number of cattle decreased from 75 388 at the beginning of 2009 to 1 805 at the end of 2013 in 6 counties with a reduction rate of 97.5%, while the prevalence in cattle reduced to 0-0.3% in 2013. Snail-infested areas were stable but areas with infected snails decreased significantly, and no infected snails were found in 2012-2013. Meanwhile, the infection rate of human beings on county level were less than 1%. No infected snails and cattle were found in 18 selected villages and the prevalence in inhabitants was in the range of 0-0.8%. CONCLUSION: Cooperation between provincial government and the Ministries of Health and Agruiculture accelerates the process to reach the criteria of transmission control of schistosomiasis in Hubei Province. However, sustainable effort in needed as the current endemic situation of schistosomiasis is stillunstable.

[Establishment and application of rapid assessment system of environment with high transmission risk of schistosomiasis in marshland and lake regions. I. Establishment of an index system with Delphi method].

OBJECTIVE: To establish an index system for rapid assessment of environment with high transmission risk of schistosomiasis in marshland and lake regions. METHODS: The alternative indices were established preliminarily by the documentary method, and then the Delphi method was used two rounds to select the indices and establish the index system. The degree of familiar and authority of the experts as well as the weights of all indices were assessed. RESULTS: A total of 3 primary indices namely morbidity in domestic animals, morbidity in humans and Oncomelania snail status were established, among which the weight of morbidity in domestic animals (0.68) was the highest. Totally 16 secondary indices were established, among which the combinative weights of the positive rate of wild feces (0.09), the infection rate of livestock (0.09), the infection rate of humans (0.07), the number of cases with acute schistosomiasis (0.07), the area with infected snails (0.07), and the density of infected snails (0.07) were the highest. The coefficients of familiar degree and authority degree of the experts of the primary indices were 0.79-0.85 and 0.88-0.91, and those of the secondary indices were 0.68-0.86 and 0.77-0.91, respectively. CONCLUSIONS: The index system for rapid assessment of environment with high transmission risk of schistosomiasis in marshland and lake regions is established preliminarily. Using this system, we can assess the key endemic indices of humans, domestic animals and snails to understand the endemic situation in the investigated sites.

[Establishment and application of rapid assessment system of environment with high transmission risk of schistosomiasis in marshland and lake regions II establishment and application of measures for field survey].

OBJECTIVE: To establish the measures of schistosomiasis field survey and evaluate the efficacy of their application according to the content of indexes of rapid assessment system to high transmission risks in schistosomiasis endemic areas of lake regions. METHODS: In 2012, based on the analysis of Oncomelania hupensis snail situation, and schistosomiasis epidemic data of human and cattle from 2008-2010, 60 villages from Hunan, Hubei, Jiangxi and Anhui provinces were selected and investigated, and the content of the investigation included the field feces, snail status, and epidemic situation of human and cattle. The systemic sampling was applied for snail investigation; the feces collected from snail investigation field were examined by the hatching test (3 bottles for 1 sample). A cluster random sampling was carried out with more than 300 people in each village. By using the hatching test (3 bottles for 1 sample) , the human stool examination was carried out for the identification of the infected persons who were positive in the immunity test screening. The hatching test was applied for cattle of all the villages (3 bottles for 1 sample). RESULTS: A total of 65 field feces spots were surveyed in 60 villages, field feces were found in 78.46% (51/65) of spots, and the positive rate of field feces was 1.07% (9/842). There were 73.33% (44,160)of villages with cattle, and the largest amount cattle with 329 was found in Wufeng Village, Jiangxi Province. The cattle infection rate was 1.5 1% (4,913,242) in 3242 investigated cattle. The highest cattle infection rate was 4% in Tongxin Village, Jiangxi Province. The population of 47 099 was surveyed, the infection rate was 0.77% (364/47 099), and the highest was 4.37% in Xumuchang Village, Hunan Province. The infection rate was 0 in 43.33% (26/60) of villages. No acute schistosomiasis cases were reported in all the villages in 2011 and 2012. Totally, 77 snail spots in 60 villages were investigated, and 51 spots were marshland and 26 spots were ditches. The schistosome-infected snails were detected in 5.88% (3/51 )of the marshland spots and the living snails were found in 80.39%(41/51) of the spots. The highest density of living snails was 3.20/0.1 m2 in Xumuchang Village, Hunan Province. The average density of infected snails was 0.00045/0.1 m2 (4/8942). The infected snail spots were distributed in Liujiadi Village and Liuhe Village of Hubei Province, and Jiangkou Village of Anhui Province. No infected snails were detected in 26 ditches spots. The living snails were detected in 53.85% (14/26) of the ditches spots. The highest average density of living snails was 3.76/0.1 m2 in Huakou Village, Hubei Province. CONCLUSIONS: The measures of field survey for rapid assessment system of high transmission risks in schistosomiasis endemic areas of lake regions are established and applied with scientific, impersonal and rapid characteristics.

[Cost-effectiveness evaluation and investigation of control measure changes in areas of schistosomiasis transmission control in hilly regions of mountain areas I epidemiological investigation and analysis of prevalence factors of schistosomiasis].

OBJECTIVE: To investigate and analyze the schistosomiasis endemic status and influencing factors in areas of schistosomiasis transmission control in hilly regions of mountain areas, so as to provide the reference for establishing the strategy and measures to achieve the target of schistosomiasis transmission-interrupted in the similar areas. METHODS: Dongpo District of Meishan City, Sichuan Province, which was appropriate to the standards of schistosomiasis transmission controlled by national evaluation in 2008, was selected as a study area. The data of schistosomiasis control from 2008 to 2010 were collected. A survey for epidemiological factors was carried out from April to November in 2011. The survey of Oncomelania snails was performed with the systematic sampling combined with environmental method. The schistosome infection status of residents was investigated by the seroimmunological test and fecal hatching examination. The schistosome infection status of cattle was investigated by the plastic cup with top tube hatching method. The infested water contact of residents was investigated with questionnaire. At the same time, in 2011, a simple random sampling combined with rapid field assessment method was used to investigate the distribution of outdoor feces, outdoor feces containing schistosome eggs, snails and infected snails in two spots of Jingyang District, Deyang City and Renshou County, Meishan City which had been appropriate to the standards of schistosomiasis transmission controlled in 2006 and 2007 respectively. RESULTS: From 2008 to 2010, 182.6 thousand-213.3 thousand local residents were examined in Dongpo District, the positive rate of sero-immunological tests of population was 6.30% - 6.81%, and the infection rate of population was 0.02% -0.07% by estimated calculation. Totally 2 835-7 260 heads of cattle were examined and no positive cases were found. The areas of snail habits were 190.00-232.00 hm2, the intensities of living snails were 0.02-0.19 snails/0.1 m2, and no infected snails were found. In 2011, totally 204.4 thousand residents were examined and the positive rate of sero-immunological tests of population was 4.98% but no positive cases were founded through the parasitological tests. A total of 1 735 heads of cattle were examined and no positive cases were found. The areas of snail habits were 99.00 hm2, the intensity of living snails was 0.18 snails/ 0.1 m2, and no infected snails were found. Questionnaire analyses of a total of 537 residents in 4 villages showed that ditch, channel, pond, and paddy field were the major environments of the infested water contact of the residents. In the ditches and paddy fields, the average annual median values of water contact of residents were 15 and 20 person-times respectively before the area was appropriate to the standards of schistosomiasis transmission controlled, and 20 and 30 person-times respectively after the area was appropriate to the standards of schistosomiasis transmission controlled, and there were no significant differences (chi(ditch2) = 1.61, chi(padd field2) = 0.03, both P > 0.05). Whereas, in the channels and ponds, the average annual median values of water contact were 15 and 30 person-times respectively before the area was appropriate to the standards of schistosomiasis transmission controlled, but they were significantly reduced after the area was appropriate to the standards of schistosomiasis transmission controlled (chi(channel2) =10.35, chi(pond2) =18.69, both P < 0.01). In 2011, the rapid field investigation and assessment showed that the average appearance rates of snails through screening were 60.15% and 12.12% respectively in the 2 villages. The average densities of living snails were 1.19 snails/0.1m2 and 0.20 snails/0.1m2 respectively in the 2 villages, and there were no infected snails. A total of 78 outdoor feces of cattle and sheep were collected and the fecal hatching examinations showed that there were no positives. CONCLUSIONS: After the schistosomiasis endemic areas in hilly regions of mountain areas are appropriate to the standards of schistosomiasis transmission controll, the achievements have been consolidated. However, the potential schistosomiasis endemic factors still exist, such as the high positive rate of schistosome sero-immunological tests in population, frequently bovine flowing, and no obviously decrease of the snail area and density of living snails. Therefore, it is an urgent need to develop more suitable new technologies and measures to accelerate the process of schistosomiasis prevention and control.

Five-year longitudinal assessment of the downstream impact on schistosomiasis transmission following closure of the Three Gorges Dam.

BACKGROUND: Schistosoma japonicum is a major public health concern in the Peoples' Republic of China (PRC), with about 800,000 people infected and another 50 million living in areas at risk of infection. Based on ecological, environmental, population genetic and molecular factors, schistosomiasis transmission in PRC can be categorised into four discrete ecosystems or transmission modes. It is predicted that, long-term, the Three Gorges Dam (TGD) will impact upon the transmission of schistosomiasis in the PRC, with varying degree across the four transmission modes. METHODOLOGY/PRINCIPAL FINDINGS: We undertook longitudinal surveillance from 2002 to 2006 in sentinel villages of the three transmission modes below the TGD across four provinces (Hunan, Jiangxi, Hubei and Anhui) to determine whether there was any immediate impact of the TGD on schistosomiasis transmission. Eight sentinel villages were selected to represent both province and transmission mode. The primary end point measured was human incidence. Here we present the results of this five-year longitudinal cohort study. Results showed that the incidence of human S. japonicum infection declined considerably within individual villages and overall mode over the course of the study. This is also reflected in the yearly odds ratios (adjusted) for infection risk that showed significant (P<0.01) downward trends in all modes over the follow-up period. CONCLUSIONS/SIGNIFICANCE: The decrease in human S. japonicum incidence observed across all transmission modes in this study can probably be attributed to the annual human and bovine PZQ chemotherapy. If an increase in schistosome transmission had occurred as a result of the TGD, it would be of negligible size compared to the treatment induced decline seen here. It appears therefore that there has been virtually no immediate impact of the TGD on schistosomiasis transmission downstream of the dam.

The role of health education and health promotion in the control of schistosomiasis: experiences from a 12-year intervention study in the Poyang Lake area.

The objectives of this study were to examine the short-term effects of health education and health promotion in the control of schistosomiasis, and to monitor the long-term impact on re-infection patterns. The study was carried out in six Schistosoma japonicum-endemic villages located in the Poyang Lake area. Three different interventions were implemented, namely (i) health education by means of video tapes, training in prevention of infection, and a 'rewards/punishment' programme for schoolchildren, (ii) promotion of an understanding of schistosomiasis and its control plus training in prevention of infection for women, and (iii) encouragement of compliance with regard to chemotherapy plus training in prevention of infection for men. The 1-year post-intervention follow-up showed that both awareness and appropriate behaviour were strengthened in all three study groups along with a significant increase in the level of knowledge on how to avoid schistosomiasis. For example, the majority of women had abandoned the practice of washing clothes in schistosome-infested water and re-infection rates were sharply reduced as a consequence. In addition, the frequency of water contact among schoolchildren decreased and remained so for the long term. Overall, the approach emphasising health education and health promotion in combination with chemotherapy was highly successful in reducing re-infection rates among inhabitants of S. japonicum-endemic villages and people's compliance with regard to chemotherapy increased significantly over the course of the study.

The role of 'passive chemotherapy' plus health education for schistosomiasis control in China during maintenance and consolidation phase.

In order to explore the possibility of further optimising schistosomiasis control during the maintenance and consolidation phase in China, two highly endemic villages were selected to compare the strategy of 'passive chemotherapy' plus health education to that of mass chemotherapy singly. Emphasis was placed on treatment coverage with praziquantel among individuals infected with Schistosoma japonicum and costs incurred for treating an infected person. The results show that the former strategy was almost as good as the latter producing treatment coverage rates among egg-positives of 96.2-97.1% during 2 years, while corresponding rates of 100% were achieved in the village where mass chemotherapy was employed. Importantly, the cost of the former strategy was only about half that of mass chemotherapy, i.e. 49.0% in the first year and 54.6% in the following. Moreover, 'passive chemotherapy' together with health education can conveniently be integrated into the primary health care system making it an attractive strategy for schistosomiasis control during the maintenance and consolidation phase.