Ámbito biológico, social, tecnológico, económico, normativo y político del plan hacia la eliminación de la malaria en el Perú 2022-2030 / Biological, social, technological, economic, regulatory and political scope of the plan towards the elimination of malaria in Peru 2022-2030

La malaria es producida por parásitos del género Plasmodium y transmitida por Anopheles. Es considerada un problema de salud pública; a pesar de la reducción significativa de los casos, a nivel mundial, persisten tasas de morbi-mortalidad elevadas. En las Américas, recientemente, se registró brotes palúdicos importantes en seis países, el Perú fue uno de ellos, generando la iniciativa para crear el Plan hacia la Eliminación de la Malaria en el Perú (PEMP), partiendo de la experiencia en el Departamento de Loreto en marco del Plan Malaria Cero. El PEMP, tiene la finalidad de reducir el 90% los casos de malaria antes de 2030, con un enfoque comunitario. El objetivo de este estudio fue evaluar la integralidad del PEMP referidas a los ámbitos biológico, social, tecnológico, económico, normativo y político. Se conformó un grupo de expertos, quienes realizaron la validez aparente de cada uno de los conceptos (DDP< 2,4). Posteriormente, la congruencia de causas por ámbitos y, la contribución por objetivos específicos dentro de cada ámbito. Encontrándose coherencias entre los objetivos específicos, planes y/o acciones dentro de cada ámbito. Se corroboró el enfoque integral del PEMP, encaminando en trabajo multidisciplinario y de comprensión integral de los desafíos actuales para la eliminación de la malaria. Se identifica como debilidad la falta de abordaje de los reservorios de malaria; se recomienda realizar búsqueda activa de casos e investigaciones en hospedadores no humano, especialmente en zonas de alta transmisión; e implementarse un diseño de enfoque holístico como parte del abordaje integral(AU)

Malaria is produced by parasites of the genus Plasmodium and transmitted by Anopheles. It is considered a public health problem; Despite the significant reduction in cases, worldwide, high morbidity and mortality rates persist. In the Americas, important malaria outbreaks were recently registered in six countries, Peru was one of them, generating the initiative to create the Plan for the Elimination of Malaria in Peru (PEMP), based on the experience in the Department of Loreto within the framework of the Zero Malaria Plan. The PEMP aims to reduce malaria cases by 90% before 2030, with a community approach. The objective of this study was to evaluate the integrality of the PEMP referring to the biological, social, technological, economic, regulatory and political fields. A group of experts was formed, who carried out the apparent validity of each one of the concepts (DDP < 2.4). Subsequently, the congruence of causes by areas and the contribution by specific objectives within each area. Finding coherence between the specific objectives, plans and/or actions within each area. The integral approach of the PEMP was confirmed, leading to multidisciplinary work and a comprehensive understanding of the current challenges for the elimination of malaria. The lack of approach to malaria reservoirs is identified as a weakness; It is recommended to carry out active search for cases and investigations in non-human hosts, especially in areas of high transmission; and a holistic approach design implemented as part of the comprehensive approach(AU)

Combining epidemiology and economics to assess control of a viral endemic animal disease: Porcine Reproductive and Respiratory Syndrome (PRRS).

Porcine reproductive and respiratory syndrome (PRRS) is an extremely contagious disease that causes great damage to the U.S. pork industry. PRRS is not subject to official control in the U.S., but most producers adopt control strategies, including vaccination. However, the PRRS virus mutates frequently, facilitating its ability to infect even vaccinated animals. In this paper we analyze how increased vaccination on sow farms reduces PRRS losses and when vaccination is profitable. We develop a SIR model to simulate the spread of an outbreak between and within swine farms located in a region of Minnesota. Then, we estimate economic losses due to PRRS and calculate the benefits of vaccination. We find that increased vaccination of sow farms increases the private profitability of vaccination, and also transmits positive externalities to farms that do not vaccinate. Although vaccination reduces industry losses, a low to moderate vaccine efficacy implies that large PRRS losses remain, even on vaccinated farms. Our approach provides useful insight into the dynamics of an endemic animal disease and the benefits of different vaccination regimens.

The cost of tsetse control using 'Tiny Targets' in the sleeping sickness endemic forest area of Bonon in Côte d'Ivoire: Implications for comparing costs across different settings.

BACKGROUND: Work to control the gambiense form of human African trypanosomiasis (gHAT), or sleeping sickness, is now directed towards ending transmission of the parasite by 2030. In order to supplement gHAT case-finding and treatment, since 2011 tsetse control has been implemented using Tiny Targets in a number of gHAT foci. As this intervention is extended to new foci, it is vital to understand the costs involved. Costs have already been analysed for the foci of Arua in Uganda and Mandoul in Chad. This paper examines the costs of controlling Glossina palpalis palpalis in the focus of Bonon in Côte d'Ivoire from 2016 to 2017. METHODOLOGY/PRINCIPAL FINDINGS: Some 2000 targets were placed throughout the main gHAT transmission area of 130 km2 at a density of 14.9 per km2. The average annual cost was USD 0.5 per person protected, USD 31.6 per target deployed of which 12% was the cost of the target itself, or USD 471.2 per km2 protected. Broken down by activity, 54% was for deployment and maintenance of targets, 34% for tsetse surveys/monitoring and 12% for sensitising populations. CONCLUSIONS/SIGNIFICANCE: The cost of tsetse control per km2 of the gHAT focus protected in Bonon was more expensive than in Chad or Uganda, while the cost per km2 treated, that is the area where the targets were actually deployed, was cheaper. Per person protected, the Bonon cost fell between the two, with Uganda cheaper and Chad more expensive. In Bonon, targets were deployed throughout the protected area, because G. p. palpalis was present everywhere, whereas in Chad and Uganda G. fuscipes fuscipes was found only the riverine fringing vegetation. Thus, differences between gHAT foci, in terms of tsetse ecology and human geography, impact on the cost-effectiveness of tsetse control. It also demonstrates the need to take into account both the area treated and protected alongside other impact indicators, such as the cost per person protected.

A Model of Care Optimized for Marginalized Remote Population Unravels Migration Pattern in India.

BACKGROUND AND AIMS: Access to basic health needs remains a challenge for most of world's population. In this study, we developed a care model for preventive and disease-specific health care for an extremely remote and marginalized population in Arunachal Pradesh, the northeasternmost state of India. APPROACH AND RESULTS: We performed patient screenings, performed interviews, and obtained blood samples in remote villages of Arunachal Pradesh through a tablet-based data collection application, which was later synced to a cloud database for storage. Positive cases of hepatitis B virus (HBV) were confirmed and genotyped in our central laboratory. The blood tests performed included liver function tests, HBV serologies, and HBV genotyping. HBV vaccination was provided as appropriate. A total of 11,818 participants were interviewed, 11,572 samples collected, and 5,176 participants vaccinated from the 5 westernmost districts in Arunachal Pradesh. The overall hepatitis B surface antigen (HBsAg) prevalence was found to be 3.6% (n = 419). In total, 34.6% were hepatitis B e antigen positive (n = 145) and 25.5% had HBV DNA levels greater than 20,000 IU/mL (n = 107). Genotypic analysis showed that many patients were infected with HBV C/D recombinants. Certain tribes showed high seroprevalence, with rates of 9.8% and 6.3% in the Miji and Nishi tribes, respectively. The prevalence of HBsAg in individuals who reported medical injections was 3.5%, lower than the overall prevalence of HBV. CONCLUSIONS: Our unique, simplistic model of care was able to link a highly resource-limited population to screening, preventive vaccination, follow-up therapeutic care, and molecular epidemiology to define the migratory nature of the population and disease using an electronic platform. This model of care can be applied to other similar settings globally.

Integração do agente de combate às endemias na Estratégia Saúde da Família, Campo Grande, Mato Grosso do Sul, 2017* / Integración del agente de combate a las endemias en la Estrategia Salud Familiar, Campo Grande, Mato Grosso do Sul, Brasil, 2017 / Integration of endemic disease control workers in the Family Health Strategy, Campo Grande, Mato Grosso do Sul, Brazil, 2017

Objetivo: Descrever o processo de integração do agente de combate às endemias (ACE) na Estratégia Saúde da Família (ESF). Métodos: Estudo transversal descritivo. Os dados foram coletados por questionário semiestruturado autoaplicável, de fevereiro a maio de 2017, em quatro unidades de Saúde da Família na região urbana de Campo Grande, Mato Grosso do Sul, Brasil. Resultados: Participaram 57 agentes comunitários de saúde (ACS) e 8 ACEs. Todos os participantes informaram realizar orientações ao morador e 58 realizavam controle mecânico durante a vistoria de imóveis, visando evitar e eliminar possíveis criadouros do Aedes aegypti. Quanto à integração dos ACEs na ESF, 18 participantes destacaram o trabalho em equipe como aspecto positivo, enquanto 15 referiram falta de autonomia para intervenções legais como aspecto negativo. Conclusão: A integração do ACE na ESF é viável; contudo, ajustes devem ser realizados para potencializar as atividades, na perspectiva do trabalho compartilhado em uma mesma base territorial.

Objetivo: Describir el proceso de integración del Agente de Combate a las Endemias (ACE) en la Estrategia de Salud Familiar (ESF). Métodos: Estudio descriptivo transversal. Los datos se recopilaron por un cuestionario semiestructurado autoadministrado, de febrero a mayo de 2017, en cuatro Unidades de Salud Familiar en la región urbana de Campo Grande, Mato Grosso do Sul, Brasil. Resultados: Participaran 57 Agentes de Salud Comunitaria (ACS) y 8 ACE. Todos informaron que proporcionaron orientación a los habitantes y 58 realizaron control mecánico durante la inspección de las propiedades, buscando evitar y eliminar posibles sitios de reproducción para Aedes aegypti. En cuanto a la integración de los ACE en la ESF, 18 participantes destacaron el trabajo en equipo como un aspecto positivo, y 15, la falta de autonomía para las intervenciones legales como un aspecto negativo. Conclusión: La integración de los ACE en la ESF es factible, sin embargo, son necesarios ajustes para mejorar las actividades en la perspectiva del trabajo compartido sobre la misma base territorial.

Objective: To describe the process of Endemic Disease Control Worker (EDCW) integration into the Family Health Strategy. Methods: This was a descriptive cross-sectional study. Data were collected through a self-administered semi-structured questionnaire, from February to May 2017, in four Family Health centers in the urban region of Campo Grande, Mato Grosso do Sul, Brazil. Results: 57 Community Health Agents (CHW) and eight EDCWs participated. All participants reported providing guidance to property dwellers and 58 carried out mechanical vector control during the inspection of properties, in order to avoid and eliminate possible Aedes aegypti breeding sites. With regard to EDCW integration in the Family Health Strategy, 18 participants highlighted teamwork as a positive aspect; while 15 highlighted lack of autonomy to undertake legal interventions as a negative aspect. Conclusion: EDCW integration in the Family Health Strategy is feasible, however, adjustments need to be made to optimize activities within the perspective of shared work in the same territorial area.

Integration of endemic disease control workers in the Family Health Strategy, Campo Grande, Mato Grosso do Sul, Brazil, 2017. / Integração do agente de combate às endemias na Estratégia Saúde da Família, Campo Grande, Mato Grosso do Sul, 2017.

OBJECTIVE: To describe the process of Endemic Disease Control Worker (EDCW) integration into the Family Health Strategy. METHODS: This was a descriptive cross-sectional study. Data were collected through a self-administered semi-structured questionnaire, from February to May 2017, in four Family Health centers in the urban region of Campo Grande, Mato Grosso do Sul, Brazil. RESULTS: 57 Community Health Agents (CHW) and eight EDCWs participated. All participants reported providing guidance to property dwellers and 58 carried out mechanical vector control during the inspection of properties, in order to avoid and eliminate possible Aedes aegypti breeding sites. With regard to EDCW integration in the Family Health Strategy, 18 participants highlighted teamwork as a positive aspect; while 15 highlighted lack of autonomy to undertake legal interventions as a negative aspect. CONCLUSION: EDCW integration in the Family Health Strategy is feasible, however, adjustments need to be made to optimize activities within the perspective of shared work in the same territorial area.

Addressing budget reduction and reallocation on health-related resources during COVID-19 pandemic in malaria-endemic countries.

The global COVID-19 pandemic has been affecting the maintenance of various disease control programmes, including malaria. In some malaria-endemic countries, funding and personnel reallocations were executed from malaria control programmes to support COVID-19 response efforts, resulting mainly in interruptions of disease control activities and reduced capabilities of health system. While it is principal to drive national budget rearrangements during the pandemic, the long-standing malaria control programmes should not be left behind in order to sustain the achievements from the previous years. With different levels of intensity, many countries have been struggling to improve the health system resilience and to mitigate the unavoidable stagnation of malaria control programmes. Current opinion emphasized the impacts of budget reprioritization on malaria-related resources during COVID-19 pandemic in malaria endemic countries in Africa and Southeast Asia, and feasible attempts that can be taken to lessen these impacts.

Study design and operational framework for a community-based Malaria Elimination Demonstration Project (MEDP) in 1233 villages of district Mandla, Madhya Pradesh.

BACKGROUND: In the past decade substantial reduction in malaria morbidity and mortality has been observed through well-implemented case management and vector control strategies. India has also achieved a significant reduction in malaria burden in 2018 and has committed to eliminate malaria by 2030. The Mandla Malaria Elimination Demonstration Project (MEDP) was started in 2017 in 1233 villages of District Mandla to demonstrate malaria elimination in a tribal district with hard-to-reach areas was possible using active and passive surveillance, case management, vector control, and targeted information, education and communication campaigns. An operational plan was developed to strengthen the existing surveillance and malaria elimination systems, through fortnightly active case detection to ensure that all cases including those that are introduced into the communities are rapidly identified and treated promptly. The plan also focused on the reduction of human-mosquito contact through the use of Long-Lasting Insecticial Nets (LLINs) and Indoor Residual Spray (IRS). The operational plan was modified in view of the present COVID-19 pandemic by creating systems of assistance for the local administration for COVID-related work while ensuring the operational integrity of malaria elimination efforts. RESULTS: The use of MEDP study design and operational plan, with its built-in management control systems, has yielded significant (91%) reduction of indigenous cases of malaria during the period from June 2017 to May 2020. The malaria positivity rate was 0.33% in 2017-18, 0.13% in 2018-19, and 0.06% in 2019-20. Mass screening revealed 0.18% malaria positivity in September-October 2018, followed by 0.06% in June 2019, and 0.03% in December 2019, and these were mostly asymptomatic cases in the community. The project has been able to sustain the gains of the past three years during the ongoing COVID-19 pandemic. CONCLUSION: This paper provides the study design and the operational plan for malaria elimination in a high-burden district of Central India, which presented difficulties of hard to reach areas, forest malaria, and complex epidemiology of urban and rural malaria. The lessons learned could be used for malaria elimination efforts in rest of the country and other parts of South Asia with comparable demography and epidemiology.

Hepatitis C Virus (HCV) Care Continuum Outcomes and HCV Community Viral Loads Among Patients in an Opioid Treatment Program.

BACKGROUND: Hepatitis C virus (HCV) remains endemic among people who use drugs (PWUD). Measures of HCV community viral load (CVL) and HCV care continuum outcomes may be valuable for ascertaining unmet treatment need and for HCV surveillance and control. METHODS: Data from patients in an opioid treatment program during 2013-2016 were used to (1) identify proportions of antibody and viral load (VL) tested, linked-to-care, and treated, in 2013-2014 and 2015-2016, and pre- and postimplementation of qualitative reflex VL testing; (2) calculate engaged-in-care HCV CVL and "documented" and "estimated" unmet treatment need; and (3) examine factors associated with linkage-to-HCV-care. RESULTS: Among 11 267 patients, proportions of HCV antibody tested (52.5% in 2013-2014 vs 73.3% in 2015-2016), linked-to-HCV-care (15.7% vs 51.8%), and treated (12.0% vs 44.7%) all increased significantly. Hispanic ethnicity was associated with less linkage-to-care, and Manhattan residence was associated with improved linkage-to-care. The overall engaged-in-care HCV CVL was 4 351 079 copies/mL (standard deviation = 7 149 888); local HCV CVLs varied by subgroup and geography. Documented and estimated unmet treatment need decreased but remained high. CONCLUSIONS: After qualitative reflex VL testing was implemented, care continuum outcomes improved, but gaps remained. High rates of unmet treatment need suggest that control of the HCV epidemic among PWUD will require expansion of HCV treatment coverage.

Mathematical Model for Optimal Control of Soil-Transmitted Helminth Infection.

In this paper, we study the dynamics of soil-transmitted helminth infection. We formulate and analyse a deterministic compartmental model using nonlinear differential equations. The basic reproduction number is obtained and both disease-free and endemic equilibrium points are shown to be asymptotically stable under given threshold conditions. The model may exhibit backward bifurcation for some parameter values, and the sensitivity indices of the basic reproduction number with respect to the parameters are determined. We extend the model to include control measures for eradication of the infection from the community. Pontryagian's maximum principle is used to formulate the optimal control problem using three control strategies, namely, health education through provision of educational materials, educational messages to improve the awareness of the susceptible population, and treatment by mass drug administration that target the entire population(preschool- and school-aged children) and sanitation through provision of clean water and personal hygiene. Numerical simulations were done using MATLAB and graphical results are displayed. The cost effectiveness of the control measures were done using incremental cost-effective ratio, and results reveal that the combination of health education and sanitation is the best strategy to combat the helminth infection. Therefore, in order to completely eradicate soil-transmitted helminths, we advise investment efforts on health education and sanitation controls.

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.

The cost of a school based mass treatment of schistosomiasis in Ugu District, KwaZulu Natal, South Africa in 2012.

INTRODUCTION: The Neglected Tropical Diseases Roadmap of the WHO set targets for potential elimination as a "public health problem" for the period 2012-2020 in multiple countries in Africa, with the aim of global elimination of schistosomiasis as a "public health problem" by 2025. AIM: The purpose of the study was to estimate the cost from a provider's perspective of the Department of Health's Schistosomiasis Mass Drug Administration (MDA) in Ugu District, KwaZulu-Natal in 2012, with a view to project the costs for the entire KwaZulu Natal Province. METHODS: A total of 491 public schools and 16 independent schools in Ugu District, a predominantly rural district in KwaZulu-Natal with a total of 218 242 learners, were included in the schistosomiasis control programme. They were randomly selected from schools situated below an altitude of 300 meters, where schistosomiasis is endemic. A retrospective costing study was conducted using the provider's perspective to cost. Cost data were collected by reviewing existing records including financial statements, invoices, receipts, transport log books, equipment inventories, and information from personnel payroll, existing budget, and the staff diaries. RESULTS: A total of 15571 children were treated in 2012, resulting in a total cost of the MDA programme of ZAR 2 137 143 and a unit cost of ZAR 137. The three main cost components were Medication Costs (37%), Human Resources Cost (36%) and Capital items (16%). The total cost for treating all eligible pupils in KwaZulu-Natal will be ZAR 149 031 888. However, should the capital cost be excluded, then the unit cost will be ZAR 112 per patient and this will translate to a total cost of ZAR 121 836 288. CONCLUSIONS: Low coverage exacerbates the cost of the programme and makes a decision to support such a programme difficult. However, a normative costing study based on the integration of the programme within the Department of Health should be conducted.

Cost-effective analysis of childhood malaria vaccination in endemic hotspots of Bangladesh.

INTRODUCTION: Bangladesh has a history of endemic malaria transmission, with 17.5 million people at risk. The objective of this study was to assess the cost-effectiveness of universal childhood malaria vaccination in Chittagong Hill Tracts (CHT) of Bangladesh with newly developed RTS,S/AS01 malaria vaccines. METHODS: A decision model was been developed using Microsoft® Excel to examine the potential impact of future vaccination in Bangladesh. We estimated the economic and health burden due to malaria and the cost-effectiveness of malaria vaccination from the health system and societal perspective. The primary outcomes include the incremental cost per Disability-Adjusted Life Year (DALY) averted, incremental cost per case averted, and the incremental cost per death averted. RESULTS: Introducing childhood malaria vaccination in CHT in Bangladesh for a single birth cohort could prevent approximately 500 malaria cases and at least 30 deaths from malaria during the first year of vaccination. The cost per DALY averted of introducing the malaria vaccine compared to status quo is US$ 2,629 and US$ 2,583 from the health system and societal perspective, respectively. CONCLUSIONS: Introduction of malaria vaccination in CHT region is estimated to be a cost-effective preventive intervention and would offer substantial future benefits particularly for young children vaccinated today. Policies should, thus, consider the operational advantages of targeting these populations, particularly in the CHT area, with the vaccine along with other malaria control initiatives.

A model for the assessment of bluetongue virus serotype 1 persistence in Spain.

Bluetongue virus (BTV) is an arbovirus of ruminants that has been circulating in Europe continuously for more than two decades and has become endemic in some countries such as Spain. Spain is ideal for BTV epidemiological studies since BTV outbreaks from different sources and serotypes have occurred continuously there since 2000; BTV-1 has been reported there from 2007 to 2017. Here we develop a model for BTV-1 endemic scenario to estimate the risk of an area becoming endemic, as well as to identify the most influential factors for BTV-1 persistence. We created abundance maps at 1-km2 spatial resolution for the main vectors in Spain, Culicoides imicola and Obsoletus and Pulicaris complexes, by combining environmental satellite data with occurrence models and a random forest machine learning algorithm. The endemic model included vector abundance and host-related variables (farm density). The three most relevant variables in the endemic model were the abundance of C. imicola and Obsoletus complex and density of goat farms (AUC 0.86); this model suggests that BTV-1 is more likely to become endemic in central and southwestern regions of Spain. It only requires host- and vector-related variables to identify areas at greater risk of becoming endemic for bluetongue. Our results highlight the importance of suitable Culicoides spp. prediction maps for bluetongue epidemiological studies and decision-making about control and eradication measures.

The effects of dog management on Echinococcus spp. prevalence in villages on the eastern Tibetan Plateau, China.

BACKGROUND: The pastoral area of the eastern Tibetan Plateau is highly endemic for human echinococcosis. Domestic dogs are the main definitive host for the transmission of both Echinococcus granulosus (sensu lato) and E. multilocularis to humans. To control the infection risks, a national-level canine echinococcosis prevention and control programme has been implemented since 2015 in Shiqu County, Ganze Tibetan Autonomous Prefecture, Sichuan, China. The objective of this study was to evaluate its effect on Echinococcus spp. prevalence in dogs. METHODS: We surveyed 69 households with 84 owned dogs, for dog fecal samples and dog keeping information in the villages of Rizha and Eduoma. A total of 105 dog fecal samples (75 from owned dogs and 30 unknown dog fecal samples) were collected between 2015-2017 to determine Echinococcus spp. prevalence using copro-PCR. Eight variables based on household surveys were included into a logistic regression model for significant risk factors to canine echinococcosis prevalence in dogs. RESULTS: Between 2015-2017, the overall Echinococcus spp. copro-DNA prevalence decreased significantly in dogs from 51.2% (2015) to 20.0% (2017) in Rizha, and insignificantly from 11.5% (2016) to 4.3% (2017) in Eduoma. Echinococcus multilocularis was the most prevalent species continually copro-DNA detected during the entire study period, while E. granulosus was rare and not detected in 2017. Echinococcus shiquicus copro-DNA prevalence (a probable non-zoonotic wildlife species) was as high in dogs as that of E. multilocularis, although only detected in 2015 in Rizha. Unleashed dog feces were mainly collected in Rizha in 2015. Although 93.2% of owned dogs were leashed, and the monthly praziquantel dosing rate reached 97%, E. multilocularis infection could still be detected in 11.1% of owned dogs in 2017. Monthly deworming, leashing dogs 24 h per day, and the avoidance of dogs feeding on livestock viscera were significant measures to prevent canine echinococcosis infection in owned dogs. CONCLUSIONS: Carrying out a canine echinococcosis prevention and control programme can significantly decrease Echinococcus spp. prevalence. The potential contact between leashed dogs and wild small mammals is still a risk for re-infection of owned dogs with E. multilocularis. This study shows that the long-term application of regular dog treatment with praziquantel in the vast and remote echinococcosis endemic areas of the eastern Tibetan Plateau can reduce transmission in dogs but remains a challenging intervention.

Chagas disease: Historic perspective.

This review is a perspective on the history of Chagas disease, and it adopts a novel approach from literary studies, historical documents and the science and epidemiology of the nature of the disease. From this analysis, comes the review's working definition of the Contact Zone (CZ): "the space in which geographically and historically separated people come into contact with each other and establish long-lasting relationships, which usually involve coercive conditions, radical inequality and intolerable conflict." In the Patient-Physician CZ, we verified the triple transition phenomena: the American trypanosomiasis shifted from a rural, acute, and vectorial transmitted disease to an urban, chronic and non-vectorial disease. In the Academic CZ, we describe the original disagreements which denied the existence of the disease and the current controversies about pathogenic mechanisms and etiological treatment. From the News from Latin America, and in the Original CZ, we will review the evolution of different forms of transmission. As in any good story, research across broad disciplines is necessary to reveal historical perspectives, scientific approaches, and the epidemiology of the disease, which has a prequel of 9000 years and an open ending: thus, we explore across the Global CZ, with its multiple and unexpected actors.

Integrating evidence from research into decision-making for controlling endemic tropical diseases in South East Nigeria: perceptions of producers and users of evidence on barriers and solutions.

BACKGROUND: Endemic tropical diseases (ETDs) constitute a significant health burden in resource-poor countries. Weak integration of research evidence into policy and practice poses a major challenge to the control of ETDs. This study was undertaken to explore barriers to the use of research evidence in decision-making for controlling ETDs. It also highlights potential strategies for addressing these barriers, including the gaps in research generation and utilisation in the context of endemic disease control. METHODS: Information on barriers and solutions to integrating research evidence into decision-making for controlling ETDs in Anambra State, Nigeria, was collected from 68 participants (producers and users of evidence) during structured discussions in a workshop. Participants were purposively selected and allocated to groups based on their current involvement in endemic disease control and expertise. Discussions were facilitated with a topic guide and detailed notes were taken by an appointed recorder. Outputs from the discussions were synthesised and analysed manually. RESULTS: Cross-cutting barriers include a weak research linkage between producers and users of evidence and weak capacity to undertake health policy and systems research (HPSR). Producers of evidence were purported to conceptualise and frame their research questions based on their academic interests and funders' focus without recourse to the decision-makers. Conversely, poor demand for research evidence was reported among users of evidence. Another user barrier identified was moribund research units of the Department of Planning Research and Statistics within the State Ministry of Health. Potential solutions for addressing these barriers include creation of knowledge networks and partnerships between producers and users of evidence, institutionalisation of sustainable capacity-building of both parties in HPSR and revival of State research units. CONCLUSIONS: Evidence-informed decision-making for controlling ETDs is limited by constraints in the interactions of some factors between the users (supply side) and producers (demand side) of evidence. These constraints could be solved through stronger research collaborations, institutionalisation of HPSR, and frameworks for getting research into policy and practice.

Endemic diseases of geochemical origin and methodological approaches toward their prevention and elimination.

A new approach to the study of diseases of geochemical origin is presented, which is based on the hypothesis that all such geochemical endemias were not possible in conditions of virgin biosphere and are products of human civilization. Two genetically different types of endemic diseases of geochemical origin are distinguished, each having a specifically spatial structure: (1) diseases of natural origin due to natural element deficiency or excess in the particular zones or areas; (2) diseases of anthropogenic origin related to chemical transformation of the environment in the course of agricultural or industrial production. Anthropogenically provoked diseases of geochemical nature always occur in conditions of already formed natural geochemical heterogeneity. As each type of the endemic disease has a peculiar structure of spatial distribution, the present health risk can be mapped as a genetically two-layer structure, characterizing deviation of the existing geochemical conditions from those ideal for specific species. Parameters of geochemical conditions, which are ideal for humans and domesticated species, should be sought within the areas with undisturbed soil cover, where these species have been formed in their present form. The hypothesis is tested on example of thyroid diseases observed in iodine-deficient areas affected by a nuclear accident with 131I fallout. The developed approach is believed to serve as a practical tool for monitoring and prevention of endemic diseases of geochemical origin.