Irrational use of azithromycin in typhoid endemic areas: A challenge on multidrug-resistant typhoid treatment

Typhoid is a food-borne fatal disease caused by Salmonella typhi. It causes inflammation of the intestine, resulting in diarrhoea, fever, headache, cough, and muscle pain. Improved hygiene has resulted in a marked decline in typhoid fever cases in many developed countries. However, significant typhoid cases emerge in low and middle-income countries annually, including Pakistan. Typhoid fever accounts for a larger percentage of acute febrile illnesses in Pakistan. Azithromycin is the only effective drug used in multidrug-resistant typhoid. The emergence of drug resistance typhoid has been of more significant concern in recent years due to its irrational use of azithromycin. It is considered the last antibiotic to eradicate multidrug-resistant typhoid fever from Pakistan. In this article, we express our concern of the irrational use of azithromycin in Pakistan and its effect on typhoid in the country.

Download Full-text

Why Is Eradicating Typhoid Fever So Challenging: Implications for Vaccine and Therapeutic Design

Vaccines ◽

10.3390/vaccines6030045 ◽

2018 ◽

Vol 6 (3) ◽

pp. 45 ◽

Cited By ~ 6

Author(s):

Yi-An Yang ◽

Alexander Chong ◽

Jeongmin Song

Keyword(s):

Typhoid Fever ◽

Treatment Strategies ◽

Significant Risk ◽

Multidrug Resistant ◽

Middle Income ◽

Salmonella Enterica Serovar Typhi ◽

Middle Income Countries ◽

Extensively Drug Resistant ◽

Typhoid Vaccines ◽

Do So

Salmonella enterica serovar Typhi (S. Typhi) and S. Paratyphi, namely typhoidal Salmonellae, are the cause of (para) typhoid fever, which is a devastating systemic infectious disease in humans. In addition, the spread of multidrug-resistant (MDR) and extensively drug-resistant (XDR) S. Typhi in many low and middle-income countries poses a significant risk to human health. While currently available typhoid vaccines and therapeutics are efficacious, they have some limitations. One important limitation is the lack of controlling individuals who chronically carry S. Typhi. However, due to the strict host specificity of S. Typhi to humans, S. Typhi research is hampered. As a result, our understanding of S. Typhi pathogenesis is incomplete, thereby delaying the development and improvement of prevention and treatment strategies. Nonetheless, to better combat and contain S. Typhi, it is vital to develop a vaccine and therapy for controlling both acutely and chronically infected individuals. This review discusses how scientists are trying to combat typhoid fever, why it is so challenging to do so, which approaches show promise, and what we know about the pathogenesis of S. Typhi chronic infection.

Download Full-text

Infectious diseases acquired by international travellers visiting the USA†

Journal of Travel Medicine ◽

10.1093/jtm/tay053 ◽

2018 ◽

Vol 25 (1) ◽

Cited By ~ 4

Author(s):

Rhett J Stoney ◽

Douglas H Esposito ◽

Phyllis Kozarsky ◽

Davidson H Hamer ◽

Martin P Grobusch ◽

...

Keyword(s):

Infectious Diseases ◽

Descriptive Analysis ◽

Low Frequency ◽

Developed Countries ◽

Middle Income ◽

Middle Income Countries ◽

International Tourist ◽

Clinical Diagnoses ◽

The Usa ◽

Systemic Infections

Abstract Background Estimates of travel-related illness have focused predominantly on populations from highly developed countries visiting low- or middle-income countries, yet travel to and within high-income countries is very frequent. Despite being a top international tourist destination, few sources describe the spectrum of infectious diseases acquired among travellers to the USA. Methods We performed a descriptive analysis summarizing demographic and travel characteristics, and clinical diagnoses among non-US-resident international travellers seen during or after travel to the USA at a GeoSentinel clinic from 1 January 1997 through 31 December 2016. Results There were 1222 ill non-US-resident travellers with 1393 diagnoses recorded during the 20-year analysis period. Median age was 40 (range 0–86 years); 52% were female. Patients visited from 63 countries and territories, most commonly Canada (31%), Germany (14%), France (9%) and Japan (7%). Travellers presented with a range of illnesses; skin and soft tissue infections of unspecified aetiology were the most frequently reported during travel (29 diagnoses, 14% of during-travel diagnoses); arthropod bite/sting was the most frequently reported after travel (173 diagnoses, 15% after-travel diagnoses). Lyme disease was the most frequently reported arthropod-borne disease after travel (42, 4%). Nonspecific respiratory, gastrointestinal and systemic infections were also among the most frequently reported diagnoses overall. Low-frequency illnesses (<2% of cases) made up over half of diagnoses during travel and 41% of diagnoses after travel, including 13 cases of coccidioidomycosis and mosquito-borne infections like West Nile, dengue and Zika virus diseases. Conclusions International travellers to the USA acquired a diverse array of mostly cosmopolitan infectious diseases, including nonspecific respiratory, gastrointestinal, dermatologic and systemic infections comparable to what has been reported among travellers to low- and middle-income countries. Clinicians should consider the specific health risks when preparing visitors to the USA and when evaluating and treating those who become ill.

Download Full-text

HIV drug resistance in low-income and middle-income countries

The Lancet HIV ◽

10.1016/s2352-3018(18)30173-5 ◽

2018 ◽

Vol 5 (10) ◽

pp. e588-e596 ◽

Cited By ~ 24

Author(s):

Raph L Hamers ◽

Tobias F Rinke de Wit ◽

Charles B Holmes

Keyword(s):

Drug Resistance ◽

Low Income ◽

Middle Income ◽

Hiv Drug Resistance ◽

Middle Income Countries

Download Full-text

Characteristics and circumstances of falls leading to severe fractures in elderly people in Rio de Janeiro, Brazil

Cadernos de Saúde Pública ◽

10.1590/s0102-311x2009000200024 ◽

2009 ◽

Vol 25 (2) ◽

pp. 455-459 ◽

Cited By ~ 12

Author(s):

Evandro Silva Freire Coutinho ◽

Kátia Vergetti Bloch ◽

Laura C. Rodrigues

Keyword(s):

Risk Factors ◽

Elderly People ◽

Rio De Janeiro ◽

Developed Countries ◽

Case Control ◽

Demographic Variables ◽

Case Control Studies ◽

Middle Income ◽

Middle Income Countries ◽

Gender And Age

The circumstances associated with falls among elderly people have been well described in some developed countries, but little is known about such accidents in middle-income countries. The aim of this paper is to report the circumstances and characteristics associated with falls leading to severe fractures among elderly people living in Rio de Janeiro, Brazil. Cases were obtained from two case-control studies on risk factors for severe fractures due to falls among individuals 60 years or older. Fallers were stratified according to clinical and socio-demographic variables and circumstances of the accident. Women comprised three-fourths of the sample. The femur was the most frequently fractured bone, more common among individuals over 70 years of age. Most falls occurred at home, between 6:00 AM and 6:00 PM, but the rooms where they occurred differed according to gender and age. Most individuals did not attribute their falls to tripping or slipping. This sample's data did not differ substantially from studies in developed countries.

Download Full-text

Research and Publication from Developing Countries

Journal of Institute of Medicine ◽

10.3126/jiom.v42i3.37478 ◽

2020 ◽

Vol 42 (3) ◽

Author(s):

Mohan R Sharma

Keyword(s):

Developing Countries ◽

Burden Of Disease ◽

Disease Burden ◽

Developed Countries ◽

Publishing Research ◽

Economic Factors ◽

Middle Income ◽

High Burden ◽

Middle Income Countries ◽

The Developed Countries

In 2002, Richard Smith wrote an editorial, “publishing research from developing countries” in the Journal “Statistics in Medicine” highlighting the importance of research and publication from the developing countries (DCs).1 In that article, he mentioned the disparity in research and publication between the developed and developing countries. Almost two decades on, the problem still largely remains the same. It is estimated that more than 80% of the world’s population lives in more than 100 developing countries.2 In terms of disease burden, the prevalence and mortality from diseases in the low and middle-income countries are disproportionately high compared to developed countries.3 Although there is a high burden of disease, we base our treatment inferring results from research and publication from the developed countries which may not be fully generalizable due to geographical cultural, racial, and economic factors. This is where the problem lies.

Download Full-text

Migraine and Stress – An Explorative Cross-Country Study of External Stress Factors

10.21203/rs.3.rs-122519/v1 ◽

2020 ◽

Author(s):

Irene van Staveren

Keyword(s):

Low Income ◽

Developed Countries ◽

Ordinary Least Squares ◽

External Stress ◽

Stress Factors ◽

Middle Income ◽

Middle Income Countries ◽

Proxy Variables ◽

Modifiable Factors ◽

Cross Country

Abstract BackgroundAccording to the Global Burden of Disease 2016 project, migraine ranks first for 15-49 years and second for all ages. The project has reported no significant relation with socio-economic status of a country. To the contrary, migraine ranks first for all ages in low- and middle-income countries suffering from civic unrest and conflict. This raises the question whether external stress factors may be correlated with migraine years lived with disability (YLD).MethodsIn the absence of cross-country studies on migraine and stress, this is a unique exploratory study. The analysis uses two country groups: developed countries (including some middle-income countries) and developing (middle- and low-income) countries. For the first group, proxy variables for stress are included that relate to flexible and highly competitive labour markets (productivity and unemployment), whereas for the second group, proxy variables are used that relate to conflict and migration. The data were analysed with multiple ordinary least squares cross-section regressions.ResultsThe results show a positive relationship between the stress variables on the one hand and migraine YLD on the other hand for both country groups. Almost all results are statistically significant at p<0.01.ConclusionsThe findings from the exploratory cross-country analysis suggest that societal stress factors may be potential candidates for modifiable factors for the prevalence and severity of migraine at the country level.

Download Full-text

The Evolution of the Digital Divide across Developing Countries

Digital Literacy ◽

10.4018/978-1-4666-1852-7.ch082 ◽

2013 ◽

pp. 1554-1570

Author(s):

Nicoletta Corrocher ◽

Anna Raineri

Keyword(s):

Developing Countries ◽

Digital Divide ◽

Low Income ◽

Competition Policy ◽

Developed Countries ◽

Policy Implications ◽

Effective Strategy ◽

Middle Income ◽

Middle Income Countries ◽

Emerging Patterns

This chapter aims at investigating the evolution of the digital divide within a set of developing countries between the years 2000 and 2005. In doing so, it moves away from the traditional analysis of the digital divide, which compares developed countries and developing countries, and examines the existing gap within a relatively homogeneous group of countries. On the basis of the theoretical and empirical contributions from scholars in different disciplines, we select a series of socioeconomic and technological indicators and provide an empirical assessment of the digitalization patterns in a set of 51 low income and lower-middle income countries. By means of cluster analysis techniques, we identify three emerging patterns of the digital divide and derive a series of policy implications, related to the implementation of an effective strategy to reduce digital backwardness. The characteristics of each pattern of digitalization can be also usefully employed to understand whether past interventions, especially in the area of competition policy, have been successful in addressing country-specific issues.

Download Full-text

Exploring Perceived Well-Being from Urban Parks: Insights from a Megacity in Latin America

Sustainability ◽

10.3390/su12187586 ◽

2020 ◽

Vol 12 (18) ◽

pp. 7586

Author(s):

Andrea Parra-Saldívar ◽

Sebastián Abades ◽

Juan L. Celis-Diez ◽

Stefan Gelcich

Keyword(s):

Native Species ◽

Negative Impact ◽

Urban Parks ◽

Well Being ◽

Developed Countries ◽

Global Scale ◽

Ecological Knowledge ◽

Middle Income ◽

Middle Income Countries ◽

The Relationship

Urbanization has impacted biodiversity and ecosystems at a global scale. At the same time, it has been recognized as a driver of the physical and emotional gap between humans and nature. The lack of direct contact with nature can have a negative impact on several aspects of human well-being and change knowledge and attitudes of people towards the environment. However, this phenomenon is still poorly understood in megacities outside developed countries. Here, we explore the relationship between ecological knowledge and self-reported well-being in an important urban park in Santiago, Chile. We conducted semi-structured surveys of park users to explore their beliefs, preferences, ecological knowledge of plants and birds, and self-reported well-being. Citizens associated urban parks mainly with “nature,” and particularly with the presence of trees and plants. Trees were recognized as the most relevant elements of urban parks; in turn, birds were ranked as the less relevant. Regarding formal ecological knowledge, respondents correctly identified an average of 2.01 plants and 2.44 birds out of a total of 10 for each taxon, and exotic species were more likely to be recognized. Park users also reported high scores for self-reported well-being. Interestingly, variance of self-reported well-being scores tended to increase at low levels of ecological knowledge of trees, but no significant relationship was detected with knowledge of birds, nor native species. Ecological knowledge of trees was positively related to self-reported well-being. Results suggest that parks can positively contribute to bring people closer to nature in middle-income countries. Improving ecological knowledge can be critical to restore the relationship between humans and nature in megacities.

Download Full-text

Cost-effectiveness of interventions to reduce the risk of healthcare-acquired infections in middle-income countries: A systematic review

Journal of Infection Prevention ◽

10.1177/1757177419852662 ◽

2019 ◽

Vol 20 (6) ◽

pp. 266-273

Author(s):

Pushpa Udayangani Gamalathge ◽

Sanjeewa Kularatna ◽

Hannah E Carter ◽

Sameera Senanayake ◽

Nicholous Graves

Keyword(s):

Systematic Review ◽

Cost Effectiveness ◽

Developed Countries ◽

Healthcare Systems ◽

Quality Of Reporting ◽

Middle Income ◽

Middle Income Countries ◽

Use Of Resources ◽

The Cost

Background: Hospital-acquired infections (HAI) contribute to prolonged hospital stays and account for a substantial economic burden to healthcare systems. Middle-income countries (MICs) experience a greater burden of HAI than developed countries. Evidence on the cost-effectiveness of interventions to reduce HAI is required to inform decision-making in these settings. Aim: To synthesise the evidence on cost-effectiveness as related to HAI interventions in MICs and to assess the quality of this evidence. Methods: A systematic review of published literature on the cost-effectiveness of interventions to reduce the incidence of HAI in MICs between 2000 and 2018 was conducted. Results: Six studies met the pre-determined inclusion criteria. The studies were from three countries: Thailand; India; and Vietnam. The evidence suggests that interventions to reduce HAI are cost-effective and, in most cases, cost-saving to healthcare systems. The quality of the reporting varied across studies. Conclusions: The implementation of HAI prevention interventions appears to be a high value use of resources in MICs. There is a need for further cost-effectiveness analyses in a wider range of MICs in order to confirm these findings. Improved standardisation and quality of reporting is required.

Download Full-text

Opportunities and Challenges for Implementing Neurotrauma Prevention Program: A Practical Perspective for Developing Countries

Indian Journal of Neurotrauma ◽

10.1055/s-0039-3400438 ◽

2019 ◽

Vol 16 (02/03) ◽

pp. 077-081

Author(s):

Amrita Ghosh ◽

Ranabir Pal ◽

Luis Rafael Moscote-Salazar ◽

Huber Said Padilla-Zambrano ◽

Harsh Deora ◽

...

Keyword(s):

Public Health ◽

Traumatic Brain Injury ◽

Developed Countries ◽

Public Health Issue ◽

Evidence Based ◽

Middle Income ◽

Literature Research ◽

Middle Income Countries ◽

Literature Searches ◽

Low And Middle Income

AbstractNeurotrauma is an underestimated and less understood public health issue in low- and middle-income countries for which we need system-based approach to prevention plans. This study was initiated to find rationale of effective plan with projectile vision of neurotrauma prevention. In search of innovative ideas of neurotrauma prevention evidence was explored from the published literature research on traumatic brain injury. Evidence-based global guidelines on recommended content and scheduling on prevention of neurotrauma literature searches data were also synthesized and summarized from research in developed countries. Our study noted that a considerable number of victims of neurotrauma with death and disabilities put mammoth costs to the already compromised health systems of the low- and middle-income countries. We need systems-based four-pronged approach incorporating neurotrauma registry, neurotrauma surveillance, translational research programs, and current approved process for development of clinical guidelines for prevention.

Download Full-text