The effect of conditional cash transfers on the control of neglected tropical disease: a systematic review.

BACKGROUND: Neglected tropical diseases (NTDs) are diseases of poverty and affect 1·5 billion people globally. Conditional cash transfer (CCTs) programmes alleviate poverty in many countries, potentially contributing to improved NTD outcomes. This systematic review examines the relationship between CCTs and screening, incidence, or treatment outcomes of NTDs. METHODS: In this systematic review we searched MEDLINE, Embase, Lilacs, EconLit, Global Health, and grey literature websites on Sept 17, 2020, with no date or language restrictions. Controlled quantitative studies including randomised controlled trials (RCTs) and observational studies evaluating CCT interventions in low-income and middle-income countries were included. Any outcome measures related to WHO's 20 diseases classified as NTDs were included. Studies from high-income countries were excluded. Two authors (AA and TH) extracted data from published studies and appraised risk of biases using the Risk of Bias in Non-Randomised Studies of Interventions and Risk of Bias 2 tools. Results were analysed narratively. This study is registered with PROSPERO, CRD42020202480. FINDINGS: From the search, 5165 records were identified; of these, 11 studies were eligible for inclusion covering four CCTs in Brazil, the Philippines, Mexico, and Zambia. Most studies were either RCTs or quasi-experimental studies and ten were assessed to be of moderate quality. Seven studies reported improved NTD outcomes associated with CCTs, in particular, reduced incidence of leprosy and increased uptake of deworming treatments. There was some evidence of greater benefit of CCTS in lower socioeconomic groups but subgroup analysis was scarce. Methodological weaknesses include self-reported outcomes, missing data, improper randomisation, and differences between CCT and comparator populations in observational studies. The available evidence is currently limited, covering a small proportion of CCTs and NTDs. INTERPRETATION: CCTs can be associated with improved NTD outcomes, and could be driven by both improvements in living standards from cash benefits and direct health effects from conditionalities related to health-care use. This evidence adds to the knowledge of health-improving effects from CCTs in poor and vulnerable populations. FUNDING: None.

Nursing in a Community With Leprosy at the Center: A Conversation With Remi Kalnime.

Donna Wright, a consultant with Creative Health Care Management who has wide experience in international nursing, interviews Remi Kalnime, a nurse who cares for patients who have had Hansen's Disease, at Foubarka Leprosarium in Cameroon, Africa. They discuss the challenges these patients and their families face in dealing with the residual effects of untreated leprosy and in facing stigmatization and discrimination from their communities, within the socioeconomic context of a developing country.

Socioeconomic risk markers of leprosy in high-burden countries: A systematic review and meta-analysis.

Over 200,000 new cases of leprosy are detected each year, of which approximately 7% are associated with grade-2 disabilities (G2Ds). For achieving leprosy elimination, one of the main challenges will be targeting higher risk groups within endemic communities. Nevertheless, the socioeconomic risk markers of leprosy remain poorly understood. To address this gap we systematically reviewed MEDLINE/PubMed, Embase, LILACS and Web of Science for original articles investigating the social determinants of leprosy in countries with > 1000 cases/year in at least five years between 2006 and 2016. Cohort, case-control, cross-sectional, and ecological studies were eligible for inclusion; qualitative studies, case reports, and reviews were excluded. Out of 1,534 non-duplicate records, 96 full-text articles were reviewed, and 39 met inclusion criteria. 17 were included in random-effects meta-analyses for sex, occupation, food shortage, household contact, crowding, and lack of clean (i.e., treated) water. The majority of studies were conducted in Brazil, India, or Bangladesh while none were undertaken in low-income countries. Descriptive synthesis indicated that increased age, poor sanitary and socioeconomic conditions, lower level of education, and food-insecurity are risk markers for leprosy. Additionally, in pooled estimates, leprosy was associated with being male (RR = 1.33, 95% CI = 1.06-1.67), performing manual labor (RR = 2.15, 95% CI = 0.97-4.74), suffering from food shortage in the past (RR = 1.39, 95% CI = 1.05-1.85), being a household contact of a leprosy patient (RR = 3.40, 95% CI = 2.24-5.18), and living in a crowded household (≥5 per household) (RR = 1.38, 95% CI = 1.14-1.67). Lack of clean water did not appear to be a risk marker of leprosy (RR = 0.94, 95% CI = 0.65-1.35). Additionally, ecological studies provided evidence that lower inequality, better human development, increased healthcare coverage, and cash transfer programs are linked with lower leprosy risks. These findings point to a consistent relationship between leprosy and unfavorable economic circumstances and, thereby, underscore the pressing need of leprosy control policies to target socially vulnerable groups in high-burden countries.

Guidelines for management of rheumatic diseases in developing countries from basics to real-world situation: relevance, need, and processes for development.

Guidelines or recommendations help to provide uniform standards in medical practice. The development of guidelines requires adherence to pre-defined norms prescribed by different international organizations such as the European League against Rheumatism (EULAR). We searched Pubmed and LILACS to identify published papers in five major rheumatic diseases (rheumatoid arthritis, systemic lupus erythematosus, spondyloarthropathies, osteoarthritis, and scleroderma) from different countries based on their economic prosperity and could find a lack of published literature from most economically weaker regions. Similarly, published guidelines in these rheumatic diseases were sparse from Asia and Africa, which are economically developed to a lesser extent than other regions of the world. Considering differing economic realities driving patient care in different regions of the world, unique challenges in certain geographic areas such as musculoskeletal manifestations of infectious diseases like leprosy and tuberculosis, as well as distinct risk of malignancies and other comorbid conditions, National Rheumatology societies should work towards developing more guidelines for rheumatic diseases from regions such as Asia and Africa, while following strictly the prescribed norms for the same. With a paucity of guidelines for such regions currently, an alternative (although less preferable) suggestion would be that major international societies, whose guidelines are widely read and followed the world over, should consider inputs from experts from diverse regions of the world while developing these guidelines.

Tropical Skin Diseases in Children: A Review-Part II.

Tropical skin diseases are infectious conditions influenced by factors such as nutrition, housing, and the environment. Migration patterns have caused these conditions to be seen all around the world, not only in developing countries. Many of these diseases have a different presentation in childhood, which changes the diagnostic approach and management options. In this article, we review some of the most common tropical mycobacterial, protozoan, parasitic, and viral dermatologic conditions in children, including their epidemiologic, clinical, diagnostic, and therapeutic aspects.

Who Neglects Neglected Tropical Diseases? - Korean Perspective.

Neglected tropical diseases (NTDs) are a group of tropical infectious diseases of poorest people. Of 17 NTDs managed by WHO, two, guinea worm disease (by 2015) and yaws (by 2020) are targeted for eradication, and four (blinding trachoma, human African trypanosomiasis, leprosy, and lymphatic filariasis) for elimination by 2020. The goals look promising but 11 others are still highly prevalent. Soil-transmitted helminths (STHs) are one NTD which prevail over the world including temperate zones. They had been highly prevalent in Korea but are mostly disappearing at present through systematic and sustainable control activity. The successful experience of STH control enables Korean experts to develop many programs of NTD control in developing countries. Several programs of both official development aid and non-governmental organizations are now targeting NTDs. Most NTDs are low in health priority compared to their health threats because they are chronic, insidious, and of low mortality. No one, including the victims, raised priority of NTD control with a loud voice in the endemic field of the diseases. After the millennium development goals declared disease control over the world, NTDs are becoming less neglected globally. Even with limited resources, beginning a sustainable national program is the key for the control and elimination of NTDs. No more neglect, especially no more self-neglect, can eliminate diseases and upgrade quality of life of the neglected people.

Ocupação do espaço e sua relação com a progressão da hanseníase no nordeste de Minas Gerais - século XIX / Space occupation and its relationship to the progression of leprosy in the northeast of Minas Gerais, Brazil - 19th century

A hanseníase é prevalente em países subdesenvolvidos, uma vez que as precárias condições de vida da população favorecem seu aparecimento. Tem grande importância para a saúde pública devido a sua magnitude e a seu alto poder incapacitante, atingindo, sobretudo, os indivíduos na faixa etária economicamente ativa. No Nordeste de Minas Gerais, há um padrão de alta endemicidade para essa doença; por isso, há muito tempo a região é alvo de políticas públicas de controle. Entretanto, tais medidas não causaram o impacto desejado para reduzir sua expressão na região, tornando imprescindível compreender melhor o fenômeno em suas várias dimensões, inclusive a histórica. Este artigo tem como objetivo analisar a ocupação do espaço e a progressão da hanseníase no Nordeste de Minas Gerais, no século XIX. Para tanto, optou-se pelo estudo documental de natureza histórica que possibilitou a interpretação dos fenômenos sociais ligados à hanseníase. A análise histórica permitiu concluir que a chegada e a progressão da hanseníase no nordeste mineiro estiveram ligadas aos movimentos econômicos e sociais de descoberta e desenvolvimento da região, ocasionando o ciclo de transmissão da doença.

Leprosy is prevalent in underdeveloped countries, as the precarious living conditions of the population favor its emergence. It is of great importance to public health due to its magnitude and high disabling power, affecting mainly the economically active age group. In the Northeast of the State of Minas Gerais, this disease has a pattern of high endemicity; due to this, the region has long been the target of public control policies. However, such measures have not had the desired impact to reduce its expression in the region, which makes it imperative to better understand the phenomenon in its various dimensions, including the historical one. This article aims to analyze space occupation and the disease's progression in the Northeast of Minas Gerais in the 19th century. We decided to conduct a historical documental study, which allowed us to interpret social phenomena connected with leprosy. The historical analysis showed that the emergence and progression of the disease in the Northeast of Minas Gerais were linked to the economic and social movements of discovery and development of the region, which caused the disease transmission cycle.

Histopathological study of cutaneous manifestations in HIV and AIDS patients.

OBJECTIVES: Most human immunodeficiency virus (HIV)-infected patients develop various skin diseases. These skin manifestations not only act as markers but also reflect the patient's underlying immune status. Investigating CD4 counts is costly and not always possible. Thus, the potential value to be gained by using skin manifestations as predictors of low CD4 counts and disease progression should be explored. The present study attempted to correlate the association of various cutaneous disorders found in HIV patients with CD4 and CD8 counts, the CD4 : CD8 ratio and stage of HIV infection. METHODS: This was a prospective study involving 61 patients who were HIV-positive and demonstrated skin lesions. Punch biopsies of skin were taken for histopathological diagnosis. CD4 and CD8 T cell counts were performed. RESULTS: The study sample included a majority of male patients, most of whom were aged 21-40 years. Pruritic papular dermatitis was the most common skin manifestation, followed by molluscum contagiosum, eosinophilic folliculitis, and Hansen's disease. Most of the lesions were associated with CD4 counts of <220/µl (n = 38). All skin lesions associated with HIV or acquired immune deficiency syndrome (AIDS) showed a CD4 : CD8 ratio of <0.50. CONCLUSIONS: The study findings demonstrate an inverse relationship between CD4 counts and the occurrence of skin lesions. The majority of lesions were associated with stage 3 or stage 4 infection. Thus, specific cutaneous manifestations can be considered as good clinical indicators for predicting underlying immune status in resource-poor countries.

Dermatopathology practice in ethiopia.

CONTEXT: Dermatologic diseases are extremely common among the Ethiopian population and are a significant cause of morbidity. However, few studies exist in the literature that describe the incidence and clinical and histologic features of biopsied cutaneous lesions. OBJECTIVES: To categorize the cutaneous diseases observed in skin biopsies at the All African Leprosy Rehabilitation and Training Center (ALERT) in Addis Ababa, Ethiopia, and to describe the clinical and histologic features of dermatopathologic diagnoses most frequently encountered in this practice setting. DATA SOURCES: Pathology reports of 2342 cutaneous specimens received at ALERT in Addis Ababa, Ethiopia, were reviewed to determine the range and frequency of cutaneous diseases and dermatoses diagnosed from January 2007 through December 2010. CONCLUSIONS: The range of cutaneous diseases observed in skin biopsies at ALERT was varied and included inflammatory dermatoses (27%), infectious diseases (24%), and malignant and benign cutaneous neoplasms (22% and 20%, respectively). The most common conditions observed in this study were squamous cell carcinoma (8% of total cases), eczema (6% of total cases), leishmaniasis (6% of total cases), tuberculosis (6% of total cases), and benign nevi (4% of total cases).

Primeiro relatório da OMS sobre doenças tropicais negligenciadas: Avanços para superar o impacto global de doenças tropicais negligenciadas / First WHO report on neglected tropical diseases: working to overcome the global impact of neglected tropical diseases

[Resumo Executivo]. Doenças tropicais negligenciadas (DTN) afligem a vida de um bilhão de pessoas em todo o mundo e ameaçam a saúde de outros milhões. Essas companheiras antigas da pobreza enfraquecem populações já empobrecidas, frustram a realização dos Objetivos de Desenvolvimento do Milênio e prejudicam os resultados do desenvolvimento global. Uma avaliação mais confiável de sua importância para a saúde pública e para as economias convenceu governos, doadores, indústria farmacêutica e outras agências – entre as quais organizações não governamentais (ONGs) – a investirem na prevenção e no controle desse grupo diversificado de doenças. Os esforços globais para controlar doenças “ocultas” – tais como dracunculíase (infecção pelo verme da Guiné), lepra, esquistossomose, filariose linfática e bouba – resultaram em ganhos progressivos na área da saúde, incluindo a erradicação iminente da dracunculíase. Desde 1989 – quando a maioria dos países endêmicos passou a relatar mensalmente a situação de cada localidade infectada – o número de novos casos de dracunculíase caiu de 892.055, em 12 países endêmicos, para 3.190, em quatro países, em 2009: uma redução de mais de 99%. A Organização Mundial da Saúde (OMS) recomenda cinco estratégias de saúde pública para a prevenção e o controle das DTN: medicação preventiva; intensificação da gestão de casos; controle de vetores; provimento de água limpa, saneamento e higiene; e saúde pública animal – isso é, aplicação da ciência veterinária para garantir a saúde e o bem-estar de seres humanos. Embora uma abordagem possa predominar no controle de uma doença específica ou de um grupo de doenças, as evidências sugerem que são melhores os resultados no controle quando as cinco abordagens são associadas e aplicadas localmente... Este relatório identifica também os desafios que precisarão ser enfrentados para que sejam mantidas e ampliadas as atuais conquistas na prevenção e controle das DTN. Apesar das restrições econômicas globais, será preciso manter o apoio da Espanha, dos Estados Unidos, do Reino Unido e de outros países, agências e ONGs. Esses compromissos devem estimular outros agentes a aumentar seu apoio para o desenvolvimento dos serviços necessários para a superação das DTN.

Primeiro relatório da OMS sobre doenças tropicais negligenciadas: Avanços para superar o impacto global de doenças tropicais negligenciadas / First WHO report on neglected tropical diseases: working to overcome the global impact of neglected tropical diseases

[Resumo Executivo]. Doenças tropicais negligenciadas (DTN) afligem a vida de um bilhão de pessoas em todo o mundo e ameaçam a saúde de outros milhões. Essas companheiras antigas da pobreza enfraquecem populações já empobrecidas, frustram a realização dos Objetivos de Desenvolvimento do Milênio e prejudicam os resultados do desenvolvimento global. Uma avaliação mais confiável de sua importância para a saúde pública e para as economias convenceu governos, doadores, indústria farmacêutica e outras agências – entre as quais organizações não governamentais (ONGs) – a investirem na prevenção e no controle desse grupo diversificado de doenças. Os esforços globais para controlar doenças “ocultas” – tais como dracunculíase (infecção pelo verme da Guiné), lepra, esquistossomose, filariose linfática e bouba – resultaram em ganhos progressivos na área da saúde, incluindo a erradicação iminente da dracunculíase. Desde 1989 – quando a maioria dos países endêmicos passou a relatar mensalmente a situação de cada localidade infectada – o número de novos casos de dracunculíase caiu de 892.055, em 12 países endêmicos, para 3.190, em quatro países, em 2009: uma redução de mais de 99%. A Organização Mundial da Saúde (OMS) recomenda cinco estratégias de saúde pública para a prevenção e o controle das DTN: medicação preventiva; intensificação da gestão de casos; controle de vetores; provimento de água limpa, saneamento e higiene; e saúde pública animal – isso é, aplicação da ciência veterinária para garantir a saúde e o bem-estar de seres humanos. Embora uma abordagem possa predominar no controle de uma doença específica ou de um grupo de doenças, as evidências sugerem que são melhores os resultados no controle quando as cinco abordagens são associadas e aplicadas localmente... Este relatório identifica também os desafios que precisarão ser enfrentados para que sejam mantidas e ampliadas as atuais conquistas na prevenção e controle das DTN. Apesar das restrições econômicas globais, será preciso manter o apoio da Espanha, dos Estados Unidos, do Reino Unido e de outros países, agências e ONGs. Esses compromissos devem estimular outros agentes a aumentar seu apoio para o desenvolvimento dos serviços necessários para a superação das DTN.

Measuring leprosy-related stigma - a pilot study to validate a toolkit of instruments.

PURPOSE: Stigma negatively affects the quality of life of leprosy-affected people. Instruments are needed to assess levels of stigma and to monitor and evaluate stigma reduction interventions. We conducted a validation study of such instruments in Tamil Nadu and West Bengal, India. METHODS: Four instruments were tested in a 'Community Based Rehabilitation' (CBR) setting, the Participation Scale, Internalised Scale of Mental Illness (ISMI) adapted for leprosy-affected persons, Explanatory Model Interview Catalogue (EMIC) for leprosy-affected and non-affected persons and the General Self-Efficacy (GSE) Scale. We evaluated the following components of validity, construct validity, internal consistency, test-retest reproducibility and reliability to distinguish between groups. Construct validity was tested by correlating instrument scores and by triangulating quantitative and qualitative findings. Reliability was evaluated by comparing levels of stigma among people affected by leprosy and community controls, and among affected people living in CBR project areas and those in non-CBR areas. RESULTS: For the Participation, ISMI and EMIC scores significant differences were observed between those affected by leprosy and those not affected (p = 0.0001), and between affected persons in the CBR and Control group (p < 0.05). The internal consistency of the instruments measured with Cronbach's α ranged from 0.83 to 0.96 and was very good for all instruments. Test-retest reproducibility coefficients were 0.80 for the Participation score, 0.70 for the EMIC score, 0.62 for the ISMI score and 0.50 for the GSE score. CONCLUSION: The construct validity of all instruments was confirmed. The Participation and EMIC Scales met all validity criteria, but test-retest reproducibility of the ISMI and GSE Scales needs further evaluation with a shorter test-retest interval and longer training and additional adaptations for the latter.

[Amputation in low-income countries: particularities in epidmiological features and management practices]. / Les amputations dans les pays à faibles revenus: particularités de l'épidémiologie, de l'appareillage et de la rééducation.

The epidemiological features and management practices associated with amputation in low-income countries, generally synonymous with the tropics, are different from those observed in Western countries. Unlike developed countries, amputation most frequently involves traumatic injury in young active people. However, Westernization of the lifestyle is leading to an increasing number of cases involving diabetes and atherosclerotic disease. In the developing world, leprosy and Buruli ulcer are still significant etiologic factors for amputation. In war-torn countries, use of antipersonnel landmines is another major cause of amputation with characteristic features. Management of amputees in the developing world is hindered by the lack of facilities for rehabilitation and prosthetic fitting. Many international organizations are supporting national programs to develop such facilities. In addition to being affordable, prosthetics and orthotics must be adapted to the living conditions of a mostly rural amputee population, i.e., heat, humidity, and farm work. The rehabilitation process must be part of a global handicap policy aimed at changing attitudes about disability and reintegrating amputees both socially and professionally.

Distúrbios metabólicos em doenças infecciosas emergentes e negligenciadas / Metabolic disorders in emerging and neglected infectious diseases

A substituição gradual e progressiva das doenças infecciosas e parasitárias pelas doenças crônico-degenerativas como causas de morbidade e mortalidade, caracterizando o processo de transição epidemiológica, não tem sido observada em várias populações, em especial em países subdesenvolvidos ou em desenvolvimento, verificando-se, na realidade, uma sobre-posição desses perfis (transição incompleta). Além do aumento da prevalência de distúrbios metabólicos, várias doenças infecciosas permanecem endêmicas em diversas regiões, como é o caso da hanseníase, da tuberculose, da leishmaniose, das hepatites virais, entre outras, assim como condições emergentes nas últimas décadas, como a infecção pelo HIV/Aids. Nesse contexto, nos últimos anos tem sido dada uma maior atenção para a ocorrência de distúrbios metabólicos, principalmente a partir da observação de elevada incidência dessas anormalidades associadas à infecção pelo HIV/Aids e à sua terapia com as drogas antirretrovirais. Nesta revisão são abordados aspectos clínico-epidemiológicos dos distúrbios metabólicos reportados em algumas enfermidades infectoparasitárias de relevância mundial e local (no Brasil), assim como possíveis mecanismos e fatores envolvidos nessas associações.

The gradual and progressive replacement of infectious and parasitic by chronic diseases as causes of morbidity and mortality, characterizing the process of epidemiological transition hasn't been observed in various populations, especially in underdeveloped or developing countries characterizing a superposition of these profiles (incomplete transition). Besides the increased prevalence of metabolic disorders, various infectious diseases remain endemic in several regions, such as leprosy, tuberculosis, leishmaniasis, viral hepatitis, among others, as well as emerging diseases in recent decades, as HIV infection/Aids. In this context, more attention has been given to the occurrence of metabolic disturbances in the recent years, mainly from the observation of a high incidence of metabolic disorders associated with HIV infection/Aids, and its therapy with antiretroviral drugs. This review addresses clinical and epidemiological aspects of metabolic disturbances reported in some infectious and parasitic diseases with worldwide and local (Brazil) relevance, as well as possible mechanisms and factors involved in these associations.

[Novel method for simple detection of mutations conferring drug resistance in Mycobacterium leprae, based on a DNA microarray, and its applicability in developing countries].

The simple method to detect mutations conferring resistant to dapsone, rifampicin, and quinolone was exploited in Mycobacterium. leprae on the basis of reverse DNA hybridization with capture probe fixed to the glass slide. Mutations were discriminated by a series of oligonucleotide probes corresponding to each mutation in the folP1, rpoB, and gyrA genes of M. leprae. The method was transferred to two laboratories in developing countries. The results obtained with the kit at those laboratories were highly concordant with results of sequencing. The method is feasible for the testing by local person in areas with high prevalence of leprosy.