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1.
J Glob Health ; 9(2): 020408, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31360448

RESUMO

Background: The epidemiology of sexually transmitted infections (STIs) and the role of commercial heterosexual sex networks in driving STI transmission in the Middle East and North Africa (MENA) region remain largely unknown. Objective: To characterize the epidemiology of Treponema pallidum (syphilis), Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and herpes simplex virus type 2 (HSV-2) among female sex workers (FSWs) in MENA using an in-depth quantitative assessment. Methods: A systematic review on ten international, regional, and country-level databases was conducted, and reported following PRISMA guidelines. Pooled prevalences of current and/or ever infection for each STI were estimated using random-effects meta-analyses. Sources of between-study heterogeneity were investigated through random-effects meta-regressions. Results: One T. pallidum incidence study and 144 STI prevalence studies were identified for 45 812 FSWs in 13 MENA countries. The pooled prevalence of current infection was 12.7% (95% confidence interval (CI) = 8.5%-17.7%) for T. pallidum, 14.4% (95% CI = 8.2%-22.0%) for C. trachomatis, 5.7% (95% CI = 3.5%-8.4%) for N. gonorrhoeae, and 7.1% (95% CI = 4.3%-10.5%) for T. vaginalis. The pooled prevalence of ever infection (seropositivity using antibody testing) was 12.8% (95% CI = 9.4%-16.6%) for T. pallidum, 80.3% (95% CI = 53.2%-97.6%) for C. trachomatis, and 23.7% (95% CI = 10.2%-40.4%) for HSV-2. The multivariable meta-regression for T. pallidum infection demonstrated strong subregional differences, with the Horn of Africa and North Africa showing, respectively 6-fold (adjusted odds ratio (AOR): 6.4; 95% CI = 2.5-16.7) and 5-fold (AOR = 5.0; 95% CI = 2.5-10.6) higher odds of infection than Eastern MENA. There was also strong evidence for declining T. pallidum odds of infection at 7% per year (AOR = 0.93; 95% CI = 0.88-0.98). Study-specific factors including diagnostic method, sample size, sampling methodology, and response rate, were not associated with syphilis infection. The multivariable model explained 48.5% of the variation in T. pallidum prevalence. Conclusions: STI infection levels among FSWs in MENA are considerable, supporting a key role for commercial heterosexual sex networks in transmission dynamics, and highlighting the health needs of this neglected and vulnerable population. Syphilis prevalence in FSWs appears to have been declining for at least three decades. Gaps in evidence persist for multiple countries.


Assuntos
Profissionais do Sexo/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/epidemiologia , África do Norte/epidemiologia , Infecções por Chlamydia/epidemiologia , Feminino , Gonorreia/epidemiologia , Herpes Genital/epidemiologia , Humanos , Oriente Médio/epidemiologia , Sífilis/epidemiologia , Vaginite por Trichomonas/epidemiologia
2.
High Blood Press Cardiovasc Prev ; 26(3): 227-237, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31228169

RESUMO

INTRODUCTION: Contribution of risk factors for cardiovascular-related deaths in the Eastern Mediterranean Region Organization (EMRO) is not estimated quantitatively. AIM: To determine the avoidable burden of cardiovascular diseases (CVDs) due to hypertension, diabetes, smoking, overweight, and obesity in countries of EMRO of the WHO. METHODS: The comparative risk assessment methodology was used to calculate the potential impact fraction (PIF) and percentage of the avoidable burden of CVD-related death due to associated risk factors. Population exposure levels for CVDs and corresponding measures of association were extracted from published studies. The attributable burden was calculated by multiplying the Disability-Adjusted Life-Years (DALYs) for CVDs by the estimated impact fraction of risk factors. DALYs of the CVDs in all countries of the EMRO were extracted from the GBD official website in 2016. RESULTS: Following reduction of the current prevalence of smoking, obesity, hypertension, diabetes, and overweight to a feasible minimum risk exposure level in Lebanon, about 12.4%, 4.2%, 10.2%, 3.8%, and 5.7% of the burden of CVD-related mortality could be avoidable, respectively. The corresponding values of avoidable burden in selected EMRO countries were 5.1%, 3.5%, 9.4%, 5.9% and 5.3% in Iran and 9.5%, 4.1%, 11%, 8.2% and 5.4% in Egypt. CONCLUSIONS: Findings suggest that health policy makers of all EMRO countries should take into account the attributable burden of CVD-related mortality due to associated risk factors to effectively develop preventive interventions.


Assuntos
Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Hipertensão/epidemiologia , Obesidade/epidemiologia , Fumar/epidemiologia , África do Norte/epidemiologia , Ásia/epidemiologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/mortalidade , Diabetes Mellitus/terapia , Estilo de Vida Saudável , Humanos , Hipertensão/diagnóstico , Hipertensão/mortalidade , Hipertensão/terapia , Obesidade/diagnóstico , Obesidade/mortalidade , Obesidade/terapia , Prevalência , Serviços Preventivos de Saúde , Prognóstico , Fatores de Proteção , Medição de Risco , Fatores de Risco , Comportamento de Redução do Risco , Fumar/efeitos adversos , Fumar/mortalidade , Abandono do Hábito de Fumar
3.
Afr Health Sci ; 19(1): 1329-1337, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31148958

RESUMO

Background: Cutaneous and visceral forms of leishmaniasis are the most important protozoan infection in the Middle East and North Africa (MENA). Objectives: Review the current knowledge on leishmaniasis in the MENA. Methods: The data presented in this review are gathered primarily from WHO reports and from an extensive literature search on PubMed. Results: There are four cycles of transmission of leishmaniasis: zoonotic cutaneous leishmaniasis (ZCL), induce by Leishmania (L.) major, transmitted by Phlebotomus (P.) papatasi, with rodent species of Psammomys obesus, Meriones libycus, Nesokia indica, and Rhombomys opimus are considered as host reservoirs. Zoonotic visceral leishmaniasis (ZVL) is inducing by L. infantum, transmitted by several Phlebotomus spp. of the sub-genus Larroussius and mainly P. perniciosus in more than one-half of the MENA countries and the dog species of Canis familiaris are considered as the main reservoirs. Anthroponotic cutaneous leishmaniasis (ACL), induce by L. tropica and transmitted by P. sergenti, without any non-human reservoir in most cases. Anthroponotic visceral leishmaniasis (AVL) induces by L. donovani spreads through P. alexandri, circulates exclusively in humans. Conclusion: There are many challenges facing the successful control of leishmaniasis. However, there is continuing research into the treatment of leishmaniasis and potentially vaccinations for the disease.


Assuntos
Leishmania/classificação , Leishmania/isolamento & purificação , Leishmaniose/epidemiologia , África do Norte/epidemiologia , Animais , Reservatórios de Doenças/parasitologia , Cães/parasitologia , Gerbillinae/parasitologia , Humanos , Insetos Vetores/parasitologia , Leishmaniose/transmissão , Leishmaniose Cutânea/epidemiologia , Leishmaniose Cutânea/transmissão , Leishmaniose Visceral/epidemiologia , Leishmaniose Visceral/transmissão , Oriente Médio/epidemiologia , Prevalência , Zoonoses
4.
BMC Infect Dis ; 19(1): 314, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30971204

RESUMO

BACKGROUND: Influenza surveillance is necessary for detection of emerging variants of epidemiologic and clinical significance. This study describes the epidemiology of influenza types A and B, and molecular characteristics of surface glycoproteins (hemagglutinin [HA] and neuraminidase [NA]) of influenza A subtypes: pH1N1 and H3N2 circulated in Arabian Gulf, Levant and North Africa regions during 2009-2017. METHODS: Analysis of phylogenetics and evolution of HA and NA genes was done using full HA and NA sequences (n = 1229) downloaded from Influenza Research Database (IRD). RESULTS: In total, 130,354 influenza positive cases were reported to WHO during study period. Of these, 50.8% were pH1N1 positive, 15.9% were H3N2 positives and 17.2% were influenza B positive. With few exceptions, all three regions were showing the typical seasonal influenza peak similar to that reported in Northern hemisphere (December-March). However, influenza activity started earlier (October) in both Gulf and North Africa while commenced later during November in Levant countries. The molecular analysis of the HA genes (influenza A subtypes) revealed similar mutations to those reported worldwide. Generally, amino acid substitutions were most frequently found in head domain in H1N1 pandemic viruses, while localized mainly in the stem region in H3N2 viruses. Expectedly, seasons with high pH1N1 influenza activity was associated with a relatively higher number of substitutions in the head domain of the HA in pH1N1 subtype. Furthermore, nucleotide variations were lower at the antigenic sites of pH1N1 viruses compared to H3N2 viruses, which experienced higher variability at the antigenic sites, reflecting the increased immunological pressure because of longer circulation and continuous vaccine changes. Analysis of NA gene of pH1N1 viruses revealed sporadic detections of oseltamivir-resistance mutation, H275Y, in 4% of reported sequences, however, none of NAI resistance mutations were found in the NA of H3N2 viruses. CONCLUSIONS: Molecular characterization of H1N1 and H3N2 viruses over 9 years revealed significant differences with regard to position and function of characterized substitutions. While pH1N1 virus substitutions were mainly found in HA head domain, H3N2 virus substitutions were mostly found in HA stem domain. Additionally, more fixed substitutions were encountered in H3N2 virus compared to larger number of non-fixed substitutions in pH1N1.


Assuntos
Vírus da Influenza A Subtipo H1N1/genética , Vírus da Influenza A Subtipo H3N2/genética , Influenza Humana/epidemiologia , Mutação , África do Norte/epidemiologia , Substituição de Aminoácidos , Evolução Molecular , Glicoproteínas de Hemaglutininação de Vírus da Influenza/genética , Humanos , Vírus da Influenza A Subtipo H1N1/imunologia , Vírus da Influenza A Subtipo H3N2/imunologia , Influenza Humana/virologia , Oriente Médio/epidemiologia , Neuraminidase/genética , Filogenia , Estações do Ano
5.
Math Biosci Eng ; 16(2): 967-989, 2019 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-30861674

RESUMO

As Malaria represents one of the major health burdens in Africa, there is a risk of reappearance of this vector-borne disease in malaria-free or low risk countries such as those in North Africa. One of the factors that can lead to this situation is the flow of sub-Saharan immigrants trying to reach Europe through North Africa. In this work, we investigate such a possibility via a mathematical model. We assume that the immigrant (non-locals) population has a carrying capacity that limits their numbers in the host country, and we study how they might contribute to the disease spread. Our analysis gave conditions of the persistence of the disease and showed that the non-local population could have a positive effect by reducing the spread of Malaria.


Assuntos
Emigrantes e Imigrantes , Malária/epidemiologia , Malária/transmissão , África , África do Norte/epidemiologia , Algoritmos , Animais , Controle de Doenças Transmissíveis , Saúde Global , Humanos , Incidência , Modelos Teóricos , Risco , Viagem , Organização Mundial da Saúde
6.
Parasit Vectors ; 12(1): 113, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30876439

RESUMO

BACKGROUND: The zoonotic parasite Taenia saginata utilizes bovines as an intermediate host (causing cysticercosis) and humans as the definitive host (causing taeniosis). The public health burden of T. saginata is assumed to be low, but the economic burden is large, due to the resources utilized in the detection and condemnation of infected carcasses and carcass parts. As part of a collaborative effort to synthesize worldwide epidemiological data on this parasite, we present here the results of a systematic review on the distribution of T. saginata taeniosis and bovine cysticercosis in the Middle East and North Africa (MENA). METHODS: Information on the occurrence and prevalence of T. saginata taeniosis and cysticercosis in the MENA region was obtained through a systematic review of published and grey literature, including OIE reports, published between January 1st, 1990 and December 31st, 2017. RESULTS: A total of 63 publications were retrieved across the 21 MENA countries. Taenia saginata taeniosis was reported in 11 of these countries, whereas unspecified taeniosis was reported for a further seven. Microscopy-based prevalence values ranged between 0.02-8.6%. Bovine cysticercosis prevalence estimates based on meat inspection were only reported for Egypt and Israel, with prevalence data ranging between 0.2-20% and 0.1-9.1% for cattle and buffaloes, respectively. The presence of bovine cysticercosis could be confirmed for 10 additional countries through OIE reports. CONCLUSIONS: Human taeniosis occurrence was confirmed for 86% (18/21) of the countries in the MENA region, although in several of these countries the species responsible was not specified. Religious prohibitions on the consumption of pork and the limited extent of pig farming across much of this region, however, suggest that many reported taeniosis cases are likely to be attributable to T. saginata rather than Taenia solium or Taenia asiatica. There was a paucity of data regarding both the prevalence and economic impact of bovine cysticercosis. More detailed epidemiological data on both T. saginata taeniosis and bovine cysticercosis could be obtained by adopting an integrated "One Health" approach, considering the characteristics (e.g. ecosystem related and sociopolitical aspects) of the MENA region. Compared with more conventional approaches, this could lead to an enhanced performance and cost-effectiveness of surveillance systems.


Assuntos
Doenças dos Bovinos/epidemiologia , Cisticercose/veterinária , Teníase/epidemiologia , África do Norte/epidemiologia , Animais , Bovinos , Cisticercose/epidemiologia , Humanos , Oriente Médio/epidemiologia , Prevalência , Taenia saginata
7.
PLoS One ; 14(2): e0211054, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30763326

RESUMO

BACKGROUND: Hypertension is dramatically increasing in Africa with evidence of increased severity and resistance to treatment. Although angiotensin converting enzyme gene polymorphism is associated with higher prevalence of hypertension, the evidence is inconclusive on its influence on the emerging pattern in Africa. This meta-analysis is conducted to pool the available evidence to inform future research and interventions. METHODS: Articles published through May 2018 were systematically searched in PubMed, Scopus and EMBASE databases. Studies were assessed for inclusion by two independent researchers. Six models were used to assess the effect of angiotensin converting enzyme deletion-insertion gene polymorphism. Heterogeneity and publication bias were tested and sensitivity analysis was carried out. Odds ratio and 95% confidence intervals were measured for pooled effect. Both random effect and fixed effect models were used, whilst the frequency of DD, II and DI genotypes were computed and compared. RESULT: Patients with D allele were 1.49 times more likely to develop essential hypertension compared with patients who carry the I allele (OR:1.49; CI:1.07, 2.07). Similarly, patients who had homozygous co-dominance genotype DD (i.e., DD vs II) were at a 2.17 times higher risk of essential hypertension compared to the co-dominant genotype II (OR:2.17, CI:1.79, 3.18), dominant model (I.e., DD+ID vs II) (OR:1.48; CI:1.03, 2.12), and recessive model (OR:1.64; CI:1.03, 2.61). On subgroup analysis, participants from Sub-Saharan Africa were more genetically susceptible to hypertension compared to their North Africa counterparts. There was no publication bias found, but there was high to moderate heterogeneity. CONCLUSION: ACE I/D polymorphism is associated with essential hypertension in Africa in the allele contrast model, as well as the dominant, recessive and homozygous codominance model. On subgroup analysis, ACE I/D was associated with essential hypertension in patients from Sub-Saharan Africa but not in North Africa. A future large scale study, which includes different ethnic groups, is recommended.


Assuntos
Hipertensão/genética , Modelos Genéticos , Peptidil Dipeptidase A/genética , Polimorfismo Genético , África ao Sul do Saara/epidemiologia , África do Norte/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Masculino
8.
Parasite ; 26: 6, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30767889

RESUMO

Toxoplasmosis is an important zoonosis caused by an obligate intracellular parasitic protozoan, Toxoplasma gondii. The disease is distributed worldwide and can affect all warm-blooded vertebrates, including humans. The present review aimed to collect, compile and summarize the data on the prevalence of T. gondii infection in humans and animals in the five North African countries (Morocco, Algeria, Tunisia, Libya and Egypt). Published data from national and international databases were used. Distribution patterns and risk factors for T. gondii infection are discussed, focusing on biotic and abiotic factors. This review is a comprehensive epidemiological analysis of T. gondii infection in North Africa and will therefore be a useful tool for researchers. It can also be used to propose or enhance appropriate national toxoplasmosis control programs.


Assuntos
Toxoplasmose Animal/epidemiologia , Toxoplasmose/epidemiologia , Zoonoses/epidemiologia , África do Norte/epidemiologia , Argélia/epidemiologia , Animais , Animais Selvagens/parasitologia , Anticorpos Antiprotozoários/sangue , Egito/epidemiologia , Feminino , Humanos , Líbia/epidemiologia , Gado/parasitologia , Marrocos/epidemiologia , Gravidez , Prevalência , Fatores de Risco , Toxoplasma/fisiologia , Toxoplasmose/transmissão , Tunísia/epidemiologia , Zoonoses/parasitologia
10.
J Cancer Res Clin Oncol ; 144(11): 2219-2229, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30105512

RESUMO

PURPOSE: Soft tissue sarcomas (STS) are a heterogeneous group of rare mesenchymal neoplasms, accounting for < 1% of all newly diagnosed malignancies. These tumors can occur in almost any anatomic site though they most frequently occur in the extremities. The objective of the study was to describe the epidemiology, treatment paradigm, and real-world outcomes in the clinical management of metastatic STS (mSTS) in the Middle East and North Africa (MEA) region. METHODS: MOON was an observational, multicenter, retrospective patient chart review study which included 200 patients with mSTS in the final analysis. The primary objective of the study is exploratory, so it is presented using descriptive statistics. RESULTS: At the time of presentation, 62.0% patients had metastatic disease, 27.5% had received only their primary diagnosis and 10.0% had experienced a local recurrence. The most frequent STS localizations were lower extremities (74%), trunk (28.5%) and upper extremities (10.5%). Primary tumor was staged as T2b in the majority (60%) of patients. Surgical treatment was performed most often for the primary disease, whereas radiation therapy and chemotherapy were predominantly administered with palliative intent. A total of 38 patients received treatment with pazopanib. Thirteen adverse events (AEs) were attributed to pazopanib in eight patients. CONCLUSION: Adult patients treated for STS have al most equal gender ratio and mostly are middle aged. The majority of patients have metastatic disease and disease progression, and half of the patients died from the disease during the period of evaluation. This study obtained real-life data on the clinical management of STS in MEA countries which could be shared with the medical community.


Assuntos
Sarcoma/epidemiologia , Sarcoma/terapia , Adulto , África do Norte/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Tratamento Farmacológico/métodos , Tratamento Farmacológico/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oriente Médio/epidemiologia , Metástase Neoplásica , Pirimidinas/efeitos adversos , Pirimidinas/uso terapêutico , Radioterapia/métodos , Radioterapia/estatística & dados numéricos , Estudos Retrospectivos , Sarcoma/patologia , Sulfonamidas/efeitos adversos , Sulfonamidas/uso terapêutico , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos
11.
Viruses ; 10(8)2018 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-30127258

RESUMO

In the context of long-term screening for viruses on Western Palaearctic bats, we tested for the presence of adenovirus 1392 oropharyngeal swabs and 325 stool samples taken from 27 bat species. Adenoviruses were detected in 12 species of the Vespertilionidae and the Rhinolophidae families. Fifty positive respiratory and 26 positive stool samples were studied. Phylogenetic analyses of partial hexon protein and partial DNA-dependent DNA polymerase genes indicate that all these bat adenoviruses belong to the genus Mastadenovirus but without constituting a monophyletic cluster. According to genetic identities, the new groups are distinct to the previously described Bat mastadenovirus A and B species and contribute with potentially new members. Our data support that diversity of bat mastadenovirus is host-dependent and increase the knowledge of potentially pathogenic virus from bats. Due to the active role of bats as viral reservoirs, the characterization of these viruses is relevant for Public Health.


Assuntos
Infecções por Adenoviridae/veterinária , Quirópteros/virologia , Genoma Viral , Mastadenovirus/genética , Filogenia , Proteínas Virais/genética , Infecções por Adenoviridae/epidemiologia , Infecções por Adenoviridae/virologia , África do Norte/epidemiologia , Animais , Ásia/epidemiologia , Proteínas do Capsídeo/genética , DNA Polimerase Dirigida por DNA/genética , Europa (Continente)/epidemiologia , Fezes/virologia , Expressão Gênica , Mastadenovirus/classificação , Mastadenovirus/isolamento & purificação , Orofaringe/virologia , Filogeografia
12.
Lancet ; 392(10148): 673-684, 2018 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-30017551

RESUMO

BACKGROUND: Snakebite envenoming is a frequently overlooked cause of mortality and morbidity. Data for snake ecology and existing snakebite interventions are scarce, limiting accurate burden estimation initiatives. Low global awareness stunts new interventions, adequate health resources, and available health care. Therefore, we aimed to synthesise currently available data to identify the most vulnerable populations at risk of snakebite, and where additional data to manage this global problem are needed. METHODS: We assembled a list of snake species using WHO guidelines. Where relevant, we obtained expert opinion range (EOR) maps from WHO or the Clinical Toxinology Resources. We also obtained occurrence data for each snake species from a variety of websites, such as VertNet and iNaturalist, using the spocc R package (version 0.7.0). We removed duplicate occurrence data and categorised snakes into three groups: group A (no available EOR map or species occurrence records), group B (EOR map but <5 species occurrence records), and group C (EOR map and ≥5 species occurrence records). For group C species, we did a multivariate environmental similarity analysis using the 2008 WHO EOR maps and newly available evidence. Using these data and the EOR maps, we produced contemporary range maps for medically important venomous snake species at a 5 × 5 km resolution. We subsequently triangulated these data with three health system metrics (antivenom availability, accessibility to urban centres, and the Healthcare Access and Quality [HAQ] Index) to identify the populations most vulnerable to snakebite morbidity and mortality. FINDINGS: We provide a map showing the ranges of 278 snake species globally. Although about 6·85 billion people worldwide live within range of areas inhabited by snakes, about 146·70 million live within remote areas lacking quality health-care provisioning. Comparing opposite ends of the HAQ Index, 272·91 million individuals (65·25%) of the population within the lowest decile are at risk of exposure to any snake for which no effective therapy exists compared with 519·46 million individuals (27·79%) within the highest HAQ Index decile, showing a disproportionate coverage in reported antivenom availability. Antivenoms were available for 119 (43%) of 278 snake species evaluated by WHO, while globally 750·19 million (10·95%) of those living within snake ranges live more than 1 h from population centres. In total, we identify about 92·66 million people living within these vulnerable geographies, including many sub-Saharan countries, Indonesia, and other parts of southeast Asia. INTERPRETATION: Identifying exact populations vulnerable to the most severe outcomes of snakebite envenoming at a subnational level is important for prioritising new data collection and collation, reinforcing envenoming treatment, existing health-care systems, and deploying currently available and future interventions. These maps can guide future research efforts on snakebite envenoming from both ecological and public health perspectives and better target future estimates of the burden of this neglected tropical disease. FUNDING: Bill & Melinda Gates Foundation.


Assuntos
Mordeduras de Serpentes/tratamento farmacológico , Mordeduras de Serpentes/epidemiologia , Serpentes/classificação , Populações Vulneráveis/estatística & dados numéricos , África do Norte/epidemiologia , Animais , Antivenenos/uso terapêutico , Mapeamento Geográfico , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/normas , Humanos , Indonésia/epidemiologia , Doenças Negligenciadas/tratamento farmacológico , Doenças Negligenciadas/epidemiologia , Doenças Negligenciadas/prevenção & controle , Saúde Pública/educação , Qualidade da Assistência à Saúde/normas , Mordeduras de Serpentes/mortalidade , Mordeduras de Serpentes/prevenção & controle , Serpentes/lesões
13.
World J Gastroenterol ; 24(27): 3038-3054, 2018 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-30038471

RESUMO

AIM: To assess the quality of and to critically synthesize the available data on hepatitis C infections in the Middle East and North Africa (MENA) region to map evidence gaps. METHODS: We conducted an overview of systematic reviews (SRs) following an a priori developed protocol (CRD42017076736). Our overview followed the preferred reporting items for systematic reviews and meta-analyses guidelines for reporting SRs and abstracts and did not receive any funding. Two independent reviewers systematically searched MEDLINE and conducted a multistage screening of the identified articles. Out of 5758 identified articles, 37 SRs of hepatitis C virus (HCV) infection in populations living in 20 countries in the MENA region published between 2008 and 2016 were included in our overview. The nine primary outcomes of interest were HCV antibody (anti-) prevalences and incidences in different at-risk populations; the HCV viremic (RNA positive) rate in HCV-positive individuals; HCV viremic prevalence in the general population (GP); the prevalence of HCV co-infection with the hepatitis B virus, human immunodeficiency virus, or schistosomiasis; the HCV genotype/subtype distribution; and the risk factors for HCV transmission. The conflicts of interest declared by the authors of the SRs were also extracted. Good quality outcomes reported by the SRs were defined as having the population, outcome, study time and setting defined as recommended by the PICOTS framework and a sample size > 100. RESULTS: We included SRs reporting HCV outcomes with different levels of quality and precision. A substantial proportion of them synthesized data from mixed populations at differing levels of risk for acquiring HCV or at different HCV infection stages (recent and prior HCV transmissions). They also synthesized the data over long periods of time (e.g., two decades). Anti-HCV prevalence in the GP varied widely in the MENA region from 0.1% (study dates not reported) in the United Arab Emirates to 2.1%-13.5% (2003-2006) in Pakistan and 14.7% (2008) in Egypt. Data were not identified for Bahrain, Jordan, or Palestine. Good quality estimates of anti-HCV prevalence in the GP were reported for Algeria, Djibouti, Egypt, Iraq, Morocco, Pakistan, Syria, Sudan, Tunisia, and Yemen. Anti-HCV incidence estimates in the GP were reported only for Egypt (0.8-6.8 per 1000 person-year, 1997-2003). In Egypt, Morocco, and the United Arab Emirates, viremic rates in anti-HCV-positive individuals from the GP were approximately 70%. In the GP, the viremic prevalence varied from 0.7% (2011) in Saudi Arabia to 5.8% (2007-2008) in Pakistan and 10.0% (2008) in Egypt. Anti-HCV prevalence was lower in blood donors than in the GP, ranging from 0.2% (1992-1993) in Algeria to 1.7% (2005) in Yemen. The reporting quality of the outcomes in blood donors was good in the MENA countries, except in Qatar where no time framework was reported for the outcome. Some countries had anti-HCV prevalence estimates for children, transfused patients, contacts of HCV-infected patients, prisoners, sex workers, and men who have sex with men. CONCLUSION: A substantial proportion of the reported outcomes may not help policymakers to develop micro-elimination strategies with precise HCV infection prevention and treatment programs in the region, as nowcasting HCV epidemiology using these data is potentially difficult. In addition to providing accurate information on HCV epidemiology, outcomes should also demonstrate practical and clinical significance and relevance. Based on the available data, most countries in the region have low to moderate anti-HCV prevalence. To achieve HCV elimination by 2030, up-to-date, good quality data on HCV epidemiology are required for the GP and key populations such as people who inject drugs and men who have sex with men.


Assuntos
Coinfecção/epidemiologia , Hepacivirus/imunologia , Anticorpos Anti-Hepatite C/sangue , Hepatite C/epidemiologia , Viremia/epidemiologia , África do Norte/epidemiologia , Coinfecção/sangue , Coinfecção/imunologia , Coinfecção/virologia , Erradicação de Doenças/métodos , Hepacivirus/isolamento & purificação , Hepacivirus/patogenicidade , Hepatite C/sangue , Hepatite C/transmissão , Hepatite C/virologia , Anticorpos Anti-Hepatite C/imunologia , Humanos , Incidência , Oriente Médio/epidemiologia , Prevalência , Fatores de Risco , Viremia/imunologia , Viremia/virologia
14.
AIDS Rev ; 20(2): 83-93, 2018 Apr-Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29938702

RESUMO

Middle East and North Africa (MENA) region is lagging far behind the global average to reach 90-90-90 targets. This study uses the UNAIDS 90-90-90 program to evaluate the HIV current situation in MENA countries, and understand the challenges that exist in the way of approaching the program goals. All articles and publications were searched based on the 90-90-90 program indexes among national and international data resources such as official national reports and online scientific databases such as PubMed, Medline, and Scopus up to December 2017. The data were categorized into four main stages: (1) estimated number of HIV-positive people (people living with HIV [PLWH]); (2) PLWH who know their status; (3) PLWH receiving antiretroviral therapy (ART); and (4) virally suppressed PLWH. A total of 41 papers were included in the study. 19 out of 24 MENA countries have met the inclusion criteria. The proportion of diagnosed people ranges from 6% in Pakistan to 76% in Algeria. The percentage of diagnosed people receiving ART ranges between 7% in Pakistan and 86% in Algeria. Viral suppression levels vary from 4% to 72% in Pakistan and Kuwait, respectively. Lack of appropriate surveillance systems, low access to HIV-care facilities along with complicated socioeconomic and geopolitical situation of the region have made it challenging for MENA countries to reach 90-90-90 goals by 2020. To achieve these goals, the foremost strategy is global effort to establish peace in this region and rebuild the infrastructure in the countries involved in war and to setup comprehensive surveillance systems in the majority of the MENA countries.


Assuntos
Síndrome de Imunodeficiência Adquirida/epidemiologia , Infecções por HIV/epidemiologia , África do Norte/epidemiologia , Humanos , Oriente Médio/epidemiologia
15.
Travel Med Infect Dis ; 24: 51-58, 2018 Jul - Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29751133

RESUMO

The Hajj and Umrah mass gatherings represent many of the risk factors for meningococcal disease and have historically been associated with both local and international outbreaks of the disease. The implementation of strict preventative measures including mandatory meningococcal vaccination with the quadrivalent (A,C,Y,W) vaccine has prevented pilgrimage-associated meningococcal outbreaks and significantly reduced the incidence of the disease at these events. However, meningococcal disease remains an important public health threat at the Hajj and Umrah due in part to the evolving nature of the disease, characterized with diverse and varying geographic trends, fluctuations in incidence and shifts in serogroups and genotypes. In addition, the current Hajj and Umrah meningococcal disease preventative measure do not protect against all invasive serogroups and do not necessarily affect carriage and transmission as the polysaccharide vaccine is still widely used. As a consequence, these events are still susceptible to outbreaks of the disease including those due to serogroups not included in the required vaccines such as serogroups B and X. In this context, despite the global decline in incidence of meningococcal disease, including that cause by serogroup B, the increased predominance of serogroup B disease in many countries, including countries with large Muslim populations, and the emergence of serogroup X in the African meningitis belt, are particularly concerning. Continued and strict surveillance of meningococcal diseases nationally and globally, especially in Muslim countries, is essential in detecting, understanding, and predicting the changes in the epidemiology of the disease and informing appropriate prevention and control strategies during these events. The current meningococcal disease preventative measures for Hajj and Umrah should continue to be strictly implemented, reviewed regularly and updated in accordance with changes in the epidemiology of meningococcal disease and availability of new preventative tools including new vaccines.


Assuntos
Aglomeração , Surtos de Doenças/prevenção & controle , Islamismo , Meningite Meningocócica/prevenção & controle , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/prevenção & controle , África do Norte/epidemiologia , Antígenos de Bactérias/imunologia , Humanos , Incidência , Meningite Meningocócica/epidemiologia , Meningite Meningocócica/microbiologia , Meningite Meningocócica/transmissão , Infecções Meningocócicas/microbiologia , Infecções Meningocócicas/transmissão , Vacinas Meningocócicas/administração & dosagem , Oriente Médio/epidemiologia , Neisseria meningitidis/isolamento & purificação , Saúde Pública , Fatores de Risco , Arábia Saudita/epidemiologia , Sorogrupo , Viagem
16.
Rev Environ Health ; 33(2): 205-212, 2018 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-29664734

RESUMO

There is considerable concern on the rise in the incidence of asthma worldwide with statistics in the United Arab Emirates (UAE) indicating that at least 13% of schoolchildren, particularly of Emirati descent, suffer from asthma. With its high rates of hospital admissions, negative socioeconomic impact and significant morbidity, this is a disease that requires optimal guidelines for control and awareness. In this article, we review the current knowledge of asthma in the UAE and draw on studies, especially from the surrounding region, to identify its contributing factors within this population. The most frequently identified agents pertinent to the UAE include outdoor and indoor environmental causes exacerbated by the country's rapid urbanization, genetic factors aided in transmission by consanguineous marriage, the patient's socioeconomic status and a rise in vitamin D deficiencies. This evidence aims to inform healthcare professionals and governmental agencies in order to best create guidelines for controlling the burden of this debilitating disease.


Assuntos
Poluição do Ar/efeitos adversos , Asma/epidemiologia , Meio Ambiente , Fatores Socioeconômicos , Deficiência de Vitamina D/complicações , África do Norte/epidemiologia , Asma/induzido quimicamente , Asma/genética , Humanos , Oriente Médio/epidemiologia , Prevalência , Emirados Árabes Unidos/epidemiologia
17.
PLoS One ; 13(3): e0194573, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29566088

RESUMO

This work develops a methodology for estimating risk of wind-borne introduction of flying insects into a country, identifying areas and periods of high risk of vector-borne diseases incursion. This risk can be characterized by the role of suitable temperatures and wind currents in small insects' survival and movements, respectively. The model predicts the number density of introduced insects over space and time based on three processes: the advection due to wind currents, the deposition on the ground and the survival due to climatic conditions. Spanish livestock has suffered many bluetongue outbreaks since 2004 and numerous experts point to Culicoides transported by wind from affected areas in North Africa as a possible cause. This work implements numerical experiments simulating the introduction of Culicoides in 2004. The model identified southern and eastern Spain, particularly between June and November, as being at greatest risk of wind-borne Culicoides introduction, which matches field data on bluetongue outbreaks in Spain this year. This validation suggests that this model may be useful for predicting introduction of airborne pathogens of significance to animal productivity.


Assuntos
Vírus Bluetongue/patogenicidade , Bluetongue/epidemiologia , Ceratopogonidae/virologia , Surtos de Doenças/veterinária , Insetos Vetores/patogenicidade , Modelos Biológicos , Vento , África do Norte/epidemiologia , Agricultura/métodos , Animais , Bluetongue/transmissão , Bluetongue/virologia , Insetos Vetores/virologia , Medição de Risco/métodos , Estações do Ano , Ovinos , Espanha/epidemiologia , Temperatura Ambiente
18.
Ticks Tick Borne Dis ; 9(3): 543-555, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29398602

RESUMO

The genus Anaplasma belonging to the Anaplasmataceae family (order Rickettsiales) comprises obligate intracellular Gram-negative bacteria of veterinary and public health importance. Six species and five types of strains genetically related are currently assigned to the genus Anaplasma including Anaplasma marginale, A. centrale, A. bovis, A. phagocytophilum, A. ovis and A. platys as classified species, and "A. capra", A. odocolei sp. nov., A. phagocytophilum-like 1 (Anaplasma sp.-Japan), A. phagocytophilum-like 2 (Anaplasma sp.-China) and A. platys-like (also named Candidatus Anaplasma camelii) as unclassified strains. Most of these Anaplasma species and strains have been molecularly identified in several animal and/or tick species in the north of Africa. The aim of this review is to summarize the current knowledge about molecular epidemiology, associated risk factors and genetic diversity of Anaplasma species and related strains infecting animals and/or their incriminated tick vectors in North Africa. All these data should be considered when establishing of common management and control programs for anaplasmosis infecting humans and different animal species in North African countries.


Assuntos
Anaplasma/genética , Anaplasmose/epidemiologia , Doenças dos Bovinos/epidemiologia , Filogenia , África do Norte/epidemiologia , Anaplasma marginale/genética , Anaplasmose/microbiologia , Anaplasmose/prevenção & controle , Anaplasmose/transmissão , Animais , Bovinos , Doenças dos Bovinos/microbiologia , Doenças dos Bovinos/prevenção & controle , Controle de Doenças Transmissíveis , DNA Bacteriano/genética , Variação Genética , Doenças das Cabras/epidemiologia , Doenças das Cabras/microbiologia , Doenças das Cabras/prevenção & controle , Doenças das Cabras/transmissão , Cabras/microbiologia , RNA Ribossômico 16S/genética , Fatores de Risco , Ovinos/microbiologia , Doenças dos Ovinos/epidemiologia , Doenças dos Ovinos/microbiologia , Doenças dos Ovinos/prevenção & controle , Doenças dos Ovinos/transmissão , Carrapatos/microbiologia
20.
Trop Anim Health Prod ; 50(3): 459-467, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29302776

RESUMO

The Food and Agricultural Organization (FAO) defined transboundary animal diseases (TADs) as those that are of significant economic, trade, and food security importance for a considerable number of countries. TADs can easily spread to other countries, reach epidemic proportions, and where control, management, or exclusion is required cooperation between several countries. The North African countries are vulnerable to several TADs by virtue of its geographical location, its borders with the Sahel region, and peculiar control constraints on the budgets of the national veterinary services of each country and on the livelihoods of livestock owners across the region. In a narrative approach, we comprehensively described the epidemiology of TADs in North African countries, eradication constraints and control measures adopted to conclude with a proposition of a regional control strategy. Our review uncovered foot-and-mouth disease, peste des petites ruminants, bluetongue, sheep/goats pox, brucellosis, West Nile and Rift Valley fever, as the major TADs in this region, while the major constraints identified were illegal animal movement, communal clashes, unreported outbreaks, poor vaccination coverage, and other factors peculiar to each etiology. Therefore, the establishment of early warning systems and proper implementation of control measures at regional level are highly recommended to the relevant stakeholders involved in TADs control in the region.


Assuntos
Controle de Doenças Transmissíveis , Surtos de Doenças/veterinária , Febre Aftosa/epidemiologia , Febre do Vale de Rift/epidemiologia , África do Norte/epidemiologia , Doenças dos Animais , Animais , Bluetongue/epidemiologia , Brucelose/epidemiologia , Brucelose/veterinária , Brucelose Bovina/epidemiologia , Bovinos , Abastecimento de Alimentos , Cabras , Humanos , Gado , Peste dos Pequenos Ruminantes/epidemiologia , Infecções por Poxviridae/epidemiologia , Infecções por Poxviridae/veterinária , Ovinos , Febre do Nilo Ocidental/epidemiologia , Febre do Nilo Ocidental/veterinária , Zoonoses/epidemiologia
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