Control programs for strongyloidiasis in areas of high endemicity: an economic analysis of different approaches

Abstract Background Implementation of control programmes for Strongyloides stercoralis infection is among the targets of the World Health Organization Roadmap to 2030. Aim of this work was to evaluate the possible impact in terms of economic resources and health status of two different strategies of preventive chemotherapy (PC) compared to the current situation (strategy A, no PC): administration of ivermectin to school-age children (SAC) and adults (strategy B) versus ivermectin to SAC only (strategy C). Methods The study was conducted at the IRCCS Sacro Cuore Don Calabria hospital, Negrar di Valpolicella, Verona, Italy, at the University of Florence, Italy, and at the WHO, Geneva, Switzerland, from May 2020 to April 2021. Data for the model were extracted from literature. A mathematical model was developed in Microsoft Excel to assess the impact of strategies B and C in a standard population of 1 million subjects living in a strongyloidiasis endemic area. In a case base scenario, 15% prevalence of strongyloidiasis was considered; the 3 strategies were then evaluated at different thresholds of prevalence, ranging from 5 to 20%. The results were reported as number of infected subjects, deaths, costs, and Incremental-Effectiveness Ratio (ICER). A 1-year and a 10-year horizons were considered. Results In the case base scenario, cases of infections would reduce dramatically in the first year of implementation of PC with both strategy B and C: from 172 500 cases to 77 040 following strategy B and 146 700 following strategy C. The additional cost per recovered person was United States Dollar (USD) 2.83 and USD 1.13 in strategy B and C, respectively, compared to no treatment in the first year. For both strategies, there was a downtrend in costs per recovered person with increasing prevalence. The number of adverted deaths was larger for strategy B than C, but cost to advert one death was lower for strategy C than B. Conclusions This analysis permits to estimate the impact of two PC strategies for the control of strongyloidiasis in terms of costs and adverted infections/deaths. This could represent a basis on which each endemic country can evaluate which strategy can be implemented, based on available funds and national health priorities.

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Associations between infection intensity categories and morbidity prevalence in school-age children are much stronger for Schistosoma haematobium than for S. mansoni

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009444 ◽

2021 ◽

Vol 15 (5) ◽

pp. e0009444

Author(s):

Ryan E. Wiegand ◽

W. Evan Secor ◽

Fiona M. Fleming ◽

Michael D. French ◽

Charles H. King ◽

...

Keyword(s):

Ultrasound Image ◽

Infection Intensity ◽

Control Program ◽

Monitoring And Evaluation ◽

World Health ◽

Current Status ◽

School Age Children ◽

School Age ◽

Preventive Chemotherapy ◽

Urogenital Schistosomiasis

Background World Health Organization (WHO) guidelines for measuring global progress in schistosomiasis control classify individuals with Schistosoma spp. infections based on the concentration of excreted eggs. We assessed the associations between WHO infection intensity categories and morbidity prevalence for selected S. haematobium and S. mansoni morbidities in school-age children. Methodology A total of 22,488 children aged 6–15 years from monitoring and evaluation cohorts in Burkina Faso, Mali, Niger, Uganda, Tanzania, and Zambia from 2003–2008 were analyzed using Bayesian logistic regression. Models were utilized to evaluate associations between intensity categories and the prevalence of any urinary bladder lesion, any upper urinary tract lesion, microhematuria, and pain while urinating (for S. haematobium) and irregular hepatic ultrasound image pattern (C-F), enlarged portal vein, laboratory-confirmed diarrhea, and self-reported diarrhea (for S. mansoni) across participants with infection and morbidity data. Principal findings S. haematobium infection intensity categories possessed consistent morbidity prevalence across surveys for multiple morbidities and participants with light infections had elevated morbidity levels, compared to negative participants. Conversely, S. mansoni infection intensity categories lacked association with prevalence of the morbidity measures assessed. Conclusions/significance Current status infection intensity categories for S. haematobium were associated with morbidity levels in school-age children, suggesting urogenital schistosomiasis morbidity can be predicted by an individual’s intensity category. Conversely, S. mansoni infection intensity categories were not consistently indicative of childhood morbidity at baseline or during the first two years of a preventive chemotherapy control program.

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Development of a public geographical information system-based website to follow the impact of control activities of soil-transmitted helminths in endemic countries

Geospatial health ◽

10.4081/gh.2021.1049 ◽

2021 ◽

Vol 16 (2) ◽

Author(s):

Maria Paola Maurelli ◽

Paola Pepe ◽

Antonio Montresor ◽

Denise Mupfasoni ◽

Martina Nocerino ◽

...

Keyword(s):

Neglected Tropical Diseases ◽

Mortality Rates ◽

Geographical Information ◽

World Health ◽

High Morbidity ◽

Preventive Chemotherapy ◽

The World ◽

Pharmaceutical Industries ◽

Health Organization ◽

The Impact

Soil-transmitted helminth (STH) infections are among the most common neglected tropical diseases worldwide causing high morbidity and mortality rates in endemic areas. Preventive chemotherapy (PC) programmes and health education are recommended by the World Health Organization (WHO) to reduce the impact of STH in endemic countries. Following our role as WHO collaborating centre (WHO CC ITA-116), we have developed a WebGIS and a dataset to support PC programmes to monitor the impact of STH control. This vHealth presentation shows the potentiality of these tools in improving communication among WHO’s regional and country offices, Ministries of Health, pharmaceutical industries and other partners.

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Accuracy of acupuncture point location among first-year acupuncture students: A pilot study evaluating the impact of training and use of an adjustable ruler

Acupuncture in Medicine ◽

10.1177/0964528420920302 ◽

2020 ◽

pp. 096452842092030

Author(s):

Debra R Godson ◽

Jonathan L Wardle

Keyword(s):

Pilot Study ◽

Acupuncture Point ◽

Ease Of Use ◽

World Health ◽

Acupuncture Points ◽

First Year ◽

Point Location ◽

Regional Office ◽

Comparative Accuracy ◽

The Impact

Background The proportional method of acupuncture point location (APL) currently taught at Endeavor College of Natural Health and advocated by the World Health Organization Regional Office for the Western Pacific (WPRO) was found to be imprecise and/or inaccurate in previous student studies. The ruler and elastic methods of APL were identified as more accurate or precise than the proportional method of APL but were not well received by student participants. Use of an adjustable ruler may overcome barriers to uptake of the more accurate APL methods. This pilot study was the first to evaluate the comparative accuracy of the adjustable ruler and the proportional methods of APL in first-year students at a major Australian acupuncture training college. Methods After 10 weeks of in-class instruction in both proportional and adjustable ruler methods of APL, student participants (n = 14) attempted location of three acupuncture points (LI10, SP6 and ST38) on a volunteer using both APL methods of interest. A self-administered questionnaire and lecturer field notes elucidated attitudes to implementation of both APL methods. Results Points marked using the adjustable ruler were closer to the correct location than those marked using the proportional method across all three acupuncture points. Students and lecturers rated the adjustable ruler more highly than the proportional method for ease of learning and ease of use. Conclusion Encouraging results with the adjustable ruler method warrant further larger scale studies. Use of the adjustable ruler method of APL should be considered for use in point location training at educational institutions teaching traditional acupuncture.

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Sustained preventive chemotherapy for soil-transmitted helminthiases leads to reduction in prevalence and anthelminthic tablets required

Infectious Diseases of Poverty ◽

10.1186/s40249-019-0589-6 ◽

2019 ◽

Vol 8 (1) ◽

Cited By ~ 2

Author(s):

Denise Mupfasoni ◽

Mathieu Bangert ◽

Alexei Mikhailov ◽

Chiara Marocco ◽

Antonio Montresor

Keyword(s):

Impact Assessment ◽

Control Strategies ◽

Epidemiological Data ◽

World Health ◽

School Age Children ◽

Infection Prevalence ◽

Preventive Chemotherapy ◽

Effective Coverage ◽

Control Programmes ◽

Hookworm Infections

Abstract Background The goal of soil-transmitted helminthiases (STH) control programmes is to eliminate STH-associated morbidity in the target population by reducing the prevalence of moderate- and heavy-intensity infections and the overall STH infection prevalence mainly through preventive chemotherapy (PC) with either albendazole or mebendazole. Endemic countries should measure the success of their control programmes through regular epidemiological assessments. We evaluated changes in STH prevalence in countries that conducted effective PC coverage for STH to guide changes in the frequency of PC rounds and the number of tablets needed. Methods We selected countries from World Health Organization (WHO)‘s Preventive Chemotherapy and Transmission control (PCT) databank that conducted ≥5 years of PC with effective coverage for school-age children (SAC) and extracted STH baseline and impact assessment data using the WHO Epidemiological Data Reporting Form, Ministry of Health reports and/or peer-reviewed publications. We used pooled and weighted means to plot the prevalence of infection with any STH and with each STH species at baseline and after ≥5 years of PC with effective coverage. Finally, using the WHO STH decision tree, we estimated the reduction in the number of tablets needed. Results Fifteen countries in four WHO regions conducted annual or semi-annual rounds of PC for STH for 5 years or more and collected data before and after interventions. At baseline, the pooled prevalence was 48.9% (33.1–64.7%) for any STH, 23.2% (13.7–32.7%) for Ascaris lumbricoides, 21.01% (9.7–32.3%) for Trichuris trichiura and 18.2% (10.9–25.5%) for hookworm infections, while after ≥5 years of PC for STH, the prevalence was 14.3% (7.3–21.3%) for any STH, 6.9% (1.3–12.5%) for A. lumbricoides, 5.3% (1.06–9.6%) for T. trichiura and 8.1% (4.0–12.2%) for hookworm infections. Conclusions Countries endemic for STH have made tremendous progress in reducing STH-associated morbidity, but very few countries have data to demonstrate that progress. In this study, the data show that nine countries should adapt their PC strategies and the frequency of PC rounds to yield a 36% reduction in drug needs. The study also highlights the importance of impact assessment surveys to adapt control strategies according to STH prevalence.

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A year in lockdown

Communications of the ACM ◽

10.1145/3465212 ◽

2021 ◽

Vol 64 (7) ◽

pp. 101-108

Author(s):

Anja Feldmann ◽

Oliver Gasser ◽

Franziska Lichtblau ◽

Enric Pujol ◽

Ingmar Poese ◽

...

Keyword(s):

Internet Traffic ◽

World Health ◽

The Internet ◽

First Year ◽

Traffic Data ◽

The Core ◽

Global Pandemic ◽

Health Organization ◽

Work Education ◽

The Impact

In March 2020, the World Health Organization declared the Corona Virus 2019 (COVID-19) outbreak a global pandemic. As a result, billions of people were either encouraged or forced by their governments to stay home to reduce the spread of the virus. This caused many to turn to the Internet for work, education, social interaction, and entertainment. With the Internet demand rising at an unprecedented rate, the question of whether the Internet could sustain this additional load emerged. To answer this question, this paper will review the impact of the first year of the COVID-19 pandemic on Internet traffic in order to analyze its performance. In order to keep our study broad, we collect and analyze Internet traffic data from multiple locations at the core and edge of the Internet. From this, we characterize how traffic and application demands change, to describe the "new normal," and explain how the Internet reacted during these unprecedented times.

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Preventive chemotherapy for the control of strongyloidiasis in school-age children: Estimating the ivermectin need

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009314 ◽

2021 ◽

Vol 15 (4) ◽

pp. e0009314

Author(s):

Donal Bisanzio ◽

Antonio Montresor ◽

Michael French ◽

Richard Reithinger ◽

Paola Rodari ◽

...

Keyword(s):

Normal Approximation ◽

Specific Treatment ◽

Control Program ◽

Strongyloides Stercoralis ◽

School Age Children ◽

School Age ◽

Endemic Country ◽

Loa Loa ◽

Preventive Chemotherapy ◽

Potential Market

Background Strongyloides stercoralis is a soil-transmitted helminth (STH) that affects approximately 600 million people worldwide. Interventions targeting S. stercoralis have not been implemented yet. Specific treatment (ivermectin) could be included in already ongoing preventive chemotherapy (PC) campaigns targeting other STHs. The aim of this study was to estimate the quantity of ivermectin needed for an integrated STH/S. stercoralis control program. Methododology/Principal findings Our study estimates the number of school- age children (SAC) (the main focus of STH deworming campaigns) in need of PC with ivermectin. The normal approximation of the binomial distribution was adopted to calculate the hypothetical prevalence distribution in each endemic country. Considering prevalence thresholds for PC equal to 10%, 15%, and 20%, we estimated the number of SAC in need of treatment. We adjusted the estimates accounting for ivermectin distributed in lymphatic filariasis and onchocerciasis elimination programs and excluded from our calculation areas where Loa loa is endemic. The global number of SAC that should be targeted in PC campaigns was estimated at 283.9 M (95% CI: 163.4–368.8), 207.2 M (95% CI: 160.9–380.7), and 160.7 M (95% CI: 86.6–225.7) when the threshold for intervention was set to 10%, 15%, and 20%, respectively. India, China, Indonesia, Bangladesh, and Nigeria accounted for about 50% of the global SAC would have to be covered by PC intervention. Conclusions/Significance Our analysis may support endemic countries to evaluate the ivermectin quantity needed for integrating strongyloidiasis in the existing STH programs. These estimates might also show to generic drug manufacturers the size of the potential market for ivermectin and encourage its production.

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An evaluation of health information and wellness priorities among socioeconomically disadvantaged students

Health Education Journal ◽

10.1177/0017896916670690 ◽

2016 ◽

Vol 76 (3) ◽

pp. 271-281 ◽

Cited By ~ 2

Author(s):

Angela A Morris-Paxton ◽

Johanna M Van Lingen ◽

Diane Elkonin

Keyword(s):

Higher Education ◽

Health Information ◽

Critical Evaluation ◽

Education Programme ◽

Health Priorities ◽

First Year ◽

Positive Thinking ◽

Socioeconomically Disadvantaged ◽

Wellness Education ◽

The Impact

Objective: A critical evaluation of a salutogenic, wellness education programme was conducted with a group of first-year socioeconomically disadvantaged higher education students, in order to assess the value they placed on health information and wellness priorities. Methods: This study took a mixed-methods approach utilising a quantitative–qualitative design. Quantitative analysis regarding the values placed by the students on 22 aspects of health-related information and qualitative analysis of their health priorities drew on findings from a semi-structured researcher-generated questionnaire, administered pre-, post- and 15-week post-post-intervention. Setting: The setting was a higher education institution in the Eastern Cape Province of South Africa. Participants were 34 first-year consumer science students, who engaged in a year-long, salutogenic wellness programme. Results: Findings revealed an increase in the participants’ value of health information for a number of wellness variables. Future planning, positive thinking and nutrition ranked high among wellness priorities, the reasons for which were disease prevention, as well as the impact of various aspects of health on participants’ future success. Conclusion: A holistic, salutogenic, wellness education programme increased student values for information with regard to a number of health variables.

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Age-based targeting of biannual azithromycin distribution for child survival in Niger: an adaptive cluster-randomized trial protocol (AVENIR)

BMC Public Health ◽

10.1186/s12889-021-10824-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kieran S. O’Brien ◽

◽

Ahmed M. Arzika ◽

Abdou Amza ◽

Ramatou Maliki ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Randomized Trial ◽

Child Survival ◽

Cluster Randomized Trial ◽

Macrolide Resistance ◽

World Health ◽

First Year ◽

Genetic Determinants ◽

Cluster Randomized ◽

The Impact

Abstract Background Biannual distribution of azithromycin to children 1–59 months old reduced mortality by 14% in a cluster-randomized trial. The World Health Organization has proposed targeting this intervention to the subgroup of children 1–11 months old to reduce selection for antimicrobial resistance. Here, we describe a trial designed to determine the impact of age-based targeting of biannual azithromycin on mortality and antimicrobial resistance. Methods AVENIR is a cluster-randomized, placebo-controlled, double-masked, response-adaptive large simple trial in Niger. During the 2.5-year study period, 3350 communities are targeted for enrollment. In the first year, communities in the Dosso region will be randomized 1:1:1 to 1) azithromycin 1–11: biannual azithromycin to children 1–11 months old with placebo to children 12–59 months old, 2) azithromycin 1–59: biannual azithromycin to children 1–59 months old, or 3) placebo: biannual placebo to children 1–59 months old. Regions enrolled after the first year will be randomized with an updated allocation based on the probability of mortality in children 1–59 months in each arm during the preceding study period. A biannual door-to-door census will be conducted to enumerate the population, distribute azithromycin and placebo, and monitor vital status. Primary mortality outcomes are defined as all-cause mortality rate (deaths per 1000 person-years) after 2.5 years from the first enrollment in 1) children 1–59 months old comparing the azithromycin 1–59 and placebo arms, 2) children 1–11 months old comparing the azithromycin 1–11 and placebo arm, and 3) children 12–59 months in the azithromycin 1–11 and azithromycin 1–59 arms. In the Dosso region, 50 communities from each arm will be followed to monitor antimicrobial resistance. Primary resistance outcomes will be assessed after 2 years of distributions and include 1) prevalence of genetic determinants of macrolide resistance in nasopharyngeal samples from children 1–59 months old, and 2) load of genetic determinants of macrolide resistance in rectal samples from children 1–59 months old. Discussion As high-mortality settings consider this intervention, the results of this trial will provide evidence to support programmatic and policy decision-making on age-based strategies for azithromycin distribution to promote child survival. Trial registration This trial was registered on January 13, 2020 (clinicaltrials.gov: NCT04224987).

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The Anticipated Future of Public Health Services Post COVID-19: Viewpoint (Preprint)

10.2196/preprints.26267 ◽

2020 ◽

Author(s):

Haitham Bashier ◽

Aamer Ikram ◽

Mumtaz Ali Khan ◽

Mirza Baig ◽

Magid Al Gunaid ◽

...

Keyword(s):

Public Health ◽

Health Services ◽

Health Systems ◽

World Health ◽

Health Priorities ◽

Public Health Services ◽

The Public ◽

The Future ◽

Health Organization ◽

The Impact

UNSTRUCTURED In March 2020, the World Health Organization declared COVID-19 as a global pandemic. The COVID-19 pandemic has affected various public health functions and essential services in different ways and magnitudes. Although all countries have witnessed the effect of COVID-19, the impact differed based on many factors including the integrity and resiliency of the countries’ health systems. This paper presents opinions and expectations of the authors about the anticipated changes in the future of public health at the global, regional, and national levels. The viewpoint is based on the current efforts and challenges that various stakeholders have carried out to control COVID-19 and the contribution from the literature on the future of public health. Numerous agencies and actors are involved in the fight against COVID-19 with variations in their effectiveness. The public health services showed weaknesses in most of the countries, in addition to the lack of adequate curative medicine settings. The pandemic highlighted the need for better governance and stronger and more resilient health systems and capacities. The COVID-19 experience has also emphasized the importance of coordination and collaboration among the countries and stakeholders. The COVID-19 pandemic might lead to a wide discussion to improve international and national approaches to prepare for and respond to similar events in terms of preparedness and response mechanisms and tools. Public health will not be the same as before COVID-19. New health priorities, approaches, and new agendas will be on the table of the global platforms and initiatives. More investment in research and technology to meet the demand for new vaccines and medicines, innovative methods like distance learning and working, more respect and remuneration to health professionals, and normalization of the public health and social measures that were induced during the COVID-19 pandemic are expected to be seen in future.

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The effect of emotional ventilation on the psychosocial development of school age children during the Covid-19 Pandemic

Media Keperawatan Indonesia ◽

10.26714/mki.4.4.2021.298-303 ◽

2021 ◽

Vol 4 (4) ◽

pp. 298

Author(s):

Mariyam Mariyam ◽

Eni Hidayati ◽

Titik Suerni

Keyword(s):

Psychosocial Development ◽

Emotional Problems ◽

World Health ◽

Behavioural Problems ◽

School Age Children ◽

P Value ◽

Prosocial Behaviour ◽

School Age ◽

Relationship Problems ◽

The Impact

The World Health Organization has officially declared the coronavirus as a pandemic The impact of the pandemic is also experienced by children. Children experience major changes in their lives, one of which is child psychosocial. Psychosocial support needs for the children. This study aims to determine the effect of emotional ventilation on the psychosocial development of school-age children during the Covid-19 pandemic. This research design is a quasi-experiment with a one-group pretest and posttest design approach. Respondents were 43 school-age children. Psychosocial development was assessed using the Strengths and Difficulties Questionnaire (SDQ). Emotional ventilation is done once a week and twice a week. a week after the second intervention, a post-test was performed. The results showed that before the intervention prosocial behaviour, emotional problems and hyperactivity were mostly normal, behavioural problems and relationship problems with peers before the intervention showed mostly abnormal. After prosocial behaviour intervention, emotional problems, behavioural problems and hyperactivity were mostly normal and only peer relationship problems were still mostly abnormal. There are differences between emotional problems, behavioural problems, hyperactivity before and after emotional ventilation with a p-value ≤ 0.05.

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