Introduction: The WHO recommends mass administration of azithromycin 30 mg/kg to eradicate yaws and 20 mg/kg to eliminate trachoma. We evaluated the effectiveness of azithromycin at 20 and 30 mg/Kg, and the number of ...Introduction: The WHO recommends mass administration of azithromycin 30 mg/kg to eradicate yaws and 20 mg/kg to eliminate trachoma. We evaluated the effectiveness of azithromycin at 20 and 30 mg/Kg, and the number of cycles of mass administration on the treatment and interruption of yaws transmission in the Mbaïki health district in the Central African Republic. Methods: Following a yaws prevalence survey, azithromycin was administered as a mass treatment in four yaws endemic communities in the Mbaïki health district. Azithromycin 30 mg/kg was administered in one cycle in Kenengué and three cycles spaced three months apart in Bambou. In Kapou and Bangui-Bouchia, azithromycin was administered at a dose of 20 mg/kg in one cycle and three cycles, respectively, spaced three months apart. Before the mass treatment round, confirmed yaw cases were selected and followed for seven months. The primary endpoint was serological cure seven months after the first treatment cycle. Secondary endpoints were clinical cure at four weeks after the first treatment cycle and serological cure at four months after the first treatment cycle. A non-inferiority margin (∆) of 10% was used. Results: A total of 92 participants aged 1 to 90 years, including 52 men, were included in the study. The frequently encountered skin lesions were ulcers (65.22%) and were localized to the lower limbs (59.78%). Clinical cure was not obtained in Bangui-Bouchia and Kapou (∆ = 17.1% and 30.8%). Serological cure at four and seven months was not obtained in Kapou (∆ equal to 17.9% and 13.8% respectively). Conclusion: This study confirms the effectiveness of azithromycin 30 mg/kg in a single dose for the treatment of yaws. However, the study suggests that for yaws eradication programs, two to three cycles of mass administration of azithromycin at 20 or 30 mg/kg spaced three months apart, with therapeutic coverage greater than 90% are essential.展开更多
With the mission of absorption of the capital through urban renovation, AKP （the Justice and Welfare Party） took over the metropolitan municipality administrations in big cities in 1995, and the Government of the Re...With the mission of absorption of the capital through urban renovation, AKP （the Justice and Welfare Party） took over the metropolitan municipality administrations in big cities in 1995, and the Government of the Republic of Turkey in 2002. Together with the 2003 Mass Housing Act, 14 legal regulations were enacted between 2002 and 2008 to expand the field of activity and increase the funds of TOKI （Governmental Mass Housing Administration） which was already established during ANAP （the Motherland Party） Government in 1980s. As a result of those regulations, TOKI, as the ＂latest goddess of the construction myth＂, became the only authorized organization in the field of housing and land production in AKP＇s cities. It acquired new duties from generating profit-oriented projects to protecting historical texture, and it was authorized to make and approve zoning plans for the lands and plots handed over to TOKI of the last government （the Justice and Welfare Party） created as an investor-entrepreneur-contractor-performer group. This paper＇s aim is to indicate the transformation of TOKI foundation during the last twenty years, and also to prove that TOKI, as a governmental profit-oriented design tool, has demolished the unique DNA/morphological textures of the contemporary Turkish big cities by producing low profiled similar architecture and urbanity in the recent past.展开更多
Background Studies on Mass drug administration(MDA)in Ghana targeting various diseases,have mostly focused on factors that affect coverage and compliance to MDA with limited focus on evidence regarding awareness and c...Background Studies on Mass drug administration(MDA)in Ghana targeting various diseases,have mostly focused on factors that affect coverage and compliance to MDA with limited focus on evidence regarding awareness and community perception of the program.Therefore,this study sought to provide empirical evidence on the knowledge of onchocerciasis,and awareness of and participation in the MDA among community members.Methods A community-based cross-sectional survey was conducted from August to October 2019 in communities within the Atwima Nwabiagya North District,Ghana.Data was collected from 2,008 respondents.Bivariate and multivariate logistic regression analyses were performed to measure the associations between socio-demographics,having heard of onchocerciasis and its prevention,and levels of awareness of the MDA program.Results A total of 1268 respondents(63.2%)were aware of the MDA program.The majority ofMost respondents(74.4%)were of the view that the information given about the program was not enough and 45.4%of the respondents had no idea about the relevance of the MDA program.Respondents who had ever heard about onchocerciasis prevention and persons who had previously participated in the MDA program were more likely to be aware of the MDA program during implementation(AOR=2.32;95%CI 1.79-3.01 and AOR=9.31;95%CI 7.06-12.26,respectively).Conclusions We observed a significant association between being aware of MDA campaigns and knowledge of onchocerciasis and its preventive methods,and participation in previous MDA campaigns.We recommend intensification and improvement of prevention campaigns regarding the onchocerciasis MDA program as key to ensuring increased MDA program participation.展开更多
Background:Recent evidence suggests that soil-transmitted helminth(STH)transmission interruption may be feasible through community-wide mass drug administration(cMDA)that deworms community members of all ages.A change...Background:Recent evidence suggests that soil-transmitted helminth(STH)transmission interruption may be feasible through community-wide mass drug administration(cMDA)that deworms community members of all ages.A change from school-based deworming to cMDA will require reconfiguring of STH programs in endemic countries.We conducted formative qualitative research in Benin,India,and Malawi to identify barriers and facilitators to successfully launching a cMDA program from the policy-stakeholder perspective.Methods:We conducted 40 key informant interviews with policy stakeholders identified as critical change agents at national,state/district,and sub-district levels.Participants included World Health Organization country office staff,implementing partners,and national and sub-national government officials.We used the Consolidated Framework for Implementation Research to guide data collection,coding,and analysis.Heat maps were used to organize coded data and differentiate perceived facilitators and barriers to launching cMDA by stakeholder.Results:Key facilitators to launching a cMDA program included availability of high-quality,tailored sensitization materials,and human and material resources that could be leveraged from previous MDA campaigns.Key barriers included the potential to overburden existing health workers,uncertainty of external funding to sustain a cMDA program,and concerns about weak intragovernmental coordination to implement cMDA.Cross-cutting themes included the need for rigorous trial evidence on STH transmission interruption to gain confidence in cMDA,and implemen-tation evidence to effectively operationalize cMDA.Importantly,if policy stakeholders anticipate a cMDA program cannot be sustained due to cost and human resource barriers in the long term they may be less likely to support the launch of a program in the short term.Conclusions:Overall,policy stakeholders were optimistic about implementing cMDA primarily because they believe that the tools necessary to successfully implement cMDA are already available.Policy stakeholders in this study were cautiously optimistic about launching cMDA to achieve STH transmission interruption and believe that it is feasible to implement.However,launching cMDA as an alternative policy to school-based deworming will require addressing key resource and evidence barriers.展开更多
Introduction: Lymphatic filariasis (LF) is one of the neglected tropical diseases targeted for elimination as a public health issue in the world by 2020. To achieve this goal, one of the strategies is interruption of ...Introduction: Lymphatic filariasis (LF) is one of the neglected tropical diseases targeted for elimination as a public health issue in the world by 2020. To achieve this goal, one of the strategies is interruption of transmission using chemotherapy (mass drug administration). Burkina Faso in west Africa, an endemic country, has endorsed this resolution. In 2000, all Sanitary Districts (SD) in the country were endemic, and then a national elimination program has made it possible to stop mass treatment in 45 out of 70 SD over 12 years. Sixteen years later, 13 other SD were reeligible for Transmission Assessment Surveys (TAS). This study aimed to determine the current level of the Mass drugs Administration (MDA) impact indicators in these 13 targeted SD in order to decide whether we need to continue MDA. Method: It was a descriptive study that took place from June to September 2017 in 13 SD regrouped into 7 Evaluation Units (EU). The population of the study was 6 to 7 years old children. The community-based cluster survey method was used. The diagnostic test used to detect Wuchereria bancrofti’s circulating antigen (W. bancrofti) is the Filariasis Test Strip (FTS). The critical threshold of positivity was set at 18 positive subjects per EU. Results: We sampled a total of 12,060 children, 48.9% were female and 51.1% male. In the 7 EU, 13 children were positive to W. bancrofti test. The average antigenic prevalence was 0.11% (13/12,060). In all EU, the number of positive subjects was below the critical threshold. Conclusion: At the end of this evaluation of the transmission of lymphatic filariasis in 13 SD of Burkina Faso, we can tell the MDA could be stopped in these areas without risk of resurgence of the disease, according to the current recommendations of WHO. This can be possible by setting up post-TMM surveillance, considering migratory flows, and including villages where positive cases were found to search possible residual transmission zones.展开更多
Zoonotic hookworm infections remain a significant public health problem,causing nearly 500 milion cases globally and approximately four million disability-adjusted life years lost annually.More than one-fth of these c...Zoonotic hookworm infections remain a significant public health problem,causing nearly 500 milion cases globally and approximately four million disability-adjusted life years lost annually.More than one-fth of these cases are attrib-uted to Ancylostoma ceylanicum,an emerging zoonotic health issue in the Asia-Pacific region.This review presents key research gaps regarding the epidemiology,diagnosis,control,prevention and elimination of A.ceylanicum and other canine zoonotic hookworms as neglected health threats.A.ceylanicum is the second most prevalent human hook-worm in the region;it is the most common hookworm among dogs and cats-reservoirs of zoonotic infections.Previous population genetic and phylogenetic analyses revealed that A.ceylanicum has three possible transmis-sion dynamics:zoonotic,animal-only,and human-only pathways.The actual burden of zoonotic ancylostomiasis in most endemic countries remains unknown due to the use of parasitological techniques(e.g.,Kato-Katz thick smear and floatation techniques)that have reduced diagnostic performance and do not allow accurate species identifica-tion in helminth surveys.The emergence of benzimidazole resistance in soil-transmitted helminths(STHs),includ-ing hookworms,is a concern due to the protracted implementation of mass drug administration(MDA).Resistance is conferred by single nucleotide polymorphisms(SNPs)that occur in theβ-tubulin isotype 1 gene.These mutations have been reported in drug-resistant A.caninum but have not been found in A.ceylanicum in the field.A.ceylanicum remains understudied in the Asia-Pacific region.The zoonotic nature of the parasite warrants investigation of its occur-rence in human and animal reservoir hosts to understand the dynamics of zoonotic transmission in different endemic foci.The detection of benzimidazole resistance-associated SNPs in zoonotic hookworms from Asia-Pacific countries has yet to be thoroughly explored.Considering the high level of hookworm endemicity in the region,the circulation of resistant isolates between humans and animals potentially presents a significant One Health threat that can under-mine current MDA and proposed animal deworming-based control efforts.展开更多
Background Current soil-transmitted helminth(STH)control guidelines endorse the use of albendazole or meben-dazole for school-based targeted preventive chemotherapy(PC),yet their reduced efficacy against Strongyloides...Background Current soil-transmitted helminth(STH)control guidelines endorse the use of albendazole or meben-dazole for school-based targeted preventive chemotherapy(PC),yet their reduced efficacy against Strongyloides sterc-oralis and Trichuris trichiura presents significant limitations.Emerging evidence indicates that community-wide PC[or mass drug administration(MDA)]using ivermectin,commonly used in other neglected tropical disease(NTD)control programs,may play an important role in controlling these parasites.We conducted a systematic review and meta-analysis to evaluate the effectiveness of ivermectin PC in reducing STH prevalence in endemic populations.Methods We searched Pubmed,EMBASE,and Web of Science on February 14,2023,for studies that investigated the effectiveness of ivermectin PC,either alone or in combination with other anthelmintic drugs,on STH infec-tions,and provided a measure of STH prevalence before and after PC.We calculated pooled prevalence reductions for each STH using random-effects meta-analyses.Our protocol is available on PROSPERO(registration number CRD42023401219).Results A total of 21 were eligible for the systematic review,of which 15 were eligible for meta-analysis.All studies delivered ivermectin through MDA.The pooled prevalence reduction of S.stercoralis following MDA with ivermec-tin alone was 84.49%(95%CI:54.96-94.66)across five studies and 81.37%(95% CI:61.62-90.96)across seven studies with or without albendazole.The prevalence reduction of T.trichiura was 49.93%(95%CI:18.23-69.34)across five studies with ivermectin alone,and 89.40%(95%CI:73.66-95.73)across three studies with the addition of albendazole.There was high heterogeneity for all syntheses(I^(2)>65%).Conclusions This study underscores the key role of ivermectin-based MDA in addressing limitations in current global STH guidelines in terms of limited efficacy against S.stercoralis and T.trichiura.Based on these findings,revising inter-national STH guidelines to include ivermectin is a promising option to progress the control and eventual elimination ofSTHsandotherNTDs.展开更多
Background Soil-transmitted helminths(STH)affect approximately 1.5 billion people globally.The current STH control strategy is annual or twice-annual preventive chemotherapy,typically school-based deworming targeting ...Background Soil-transmitted helminths(STH)affect approximately 1.5 billion people globally.The current STH control strategy is annual or twice-annual preventive chemotherapy,typically school-based deworming targeting children and women of reproductive age.Mathematical modeling suggests that it may be possible to interrupt STH transmission through high-coverage community-wide mass drug administration(cMDA).DeWorm3 is a cluster randomized trial testing cMDA for prevalence reduction and transmission interruption.The purpose of this study is to describe coverage of cMDA in study clusters over time and correlates of coverage at individual and cluster levels.Methods From 2018-2020,DeWorm3 delivered six rounds of cMDA with 400 mg albendazole at sites in Benin,India,and Malawi.We report coverage,treatment uptake,and directly observed therapy across all rounds.Factors associated with coverage at the cluster level were identified using binomial generalized estimating equations,while factors associated with non-treatment at the individual level were identified using binomial mixed-effects models.Results Coverage was high across all clusters and rounds,exceeding the WHO target of 75%in all sites and across all rounds(78%to 95%);cluster-level coverage tended to increase over time.Younger,unmarried,and migratory adults were more likely to be untreated at all sites;adult males were more likely to be untreated in Benin and Malawi.Among children,girls were more likely to be untreated,as were non-school-attending and migratory children.Higher adult education was associated with greater odds of non-treatment among adults,but lower odds among children in the household.Belonging to a less wealthy or minority language-speaking household was associated with non-treatment among both adults and children.Conclusions It is possible to deliver community-wide MDA with high coverage.Unique individual and community-level factors influence treatment across settings,and these may be addressed through targeted programming.Trial Registration:Field Studies on the Feasibility of Interrupting the Transmission of Soil-transmitted Helminths(STH),NCT03014167.展开更多
Background: Antibiotics are a key part of modern healthcare,but their use has downsides,including selecting for antibiotic resistance,both in the individuals treated with antibiotics and in the community at large.When...Background: Antibiotics are a key part of modern healthcare,but their use has downsides,including selecting for antibiotic resistance,both in the individuals treated with antibiotics and in the community at large.When evaluating the benefits and costs of mass administration of azithromycin to reduce childhood mortality,effects of antibiotic use on antibiotic resistance are important but difficult to measure,especially when evaluating resistance that“spills over”from antibiotic-treated individuals to other members of their community.The aim of this scoping review was to identify how the existing literature on antibiotic resistance modeling could be better leveraged to understand the effect of mass drug administration(MDA)on antibiotic resistance.Main text: Mathematical models of antibiotic use and resistance may be useful for estimating the expected effects of different MDA implementations on different populations,as well as aiding interpretation of existing data and guiding future experimental design.Here,strengths and limitations of models of antibiotic resistance are reviewed,and possible applications of those models in the context of mass drug administration with azithromycin are discussed.Conclusions: Statistical models of antibiotic use and resistance may provide robust and relevant estimates of the possible effects of MDA on resistance.Mechanistic models of resistance,while able to more precisely estimate the effects of different implementations of MDA on resistance,may require more data from MDA trials to be accurately parameterized.展开更多
Background:Onchocerciasis is endemic in 12 of the 14 health districts of Sierra Leone.Good treatment coverage of community-directed treatment with ivermectin was achieved between 2005 and 2009 after the 11-year civil ...Background:Onchocerciasis is endemic in 12 of the 14 health districts of Sierra Leone.Good treatment coverage of community-directed treatment with ivermectin was achieved between 2005 and 2009 after the 11-year civil conflict.Sentinel site surveys were conducted in 2010 to evaluate the impact of five annual rounds of ivermectin distribution.Methods:In total,39 sentinel villages from hyper-and meso-endemic areas across the 12 endemic districts were surveyed using skin snips in 2010.Results were analyzed and compared with the baseline data from the same 39 villages.Results:The average microfilaridermia(MF)prevalence across 39 sentinel villages was 53.10%at baseline.The MF prevalence was higher in older age groups,with the lowest in the age group of 1-9 years(11.00%)and the highest in the age group of 40-49 years(82.31%).Overall mean MF density among the positives was 28.87 microfilariae(mf)/snip,increasing with age with the lowest in the age group of 1-9 years and the highest in the age group of 40-49 years.Males had higher MF prevalence and density than females.In 2010 after five rounds of mass drug administration,the overall MF prevalence decreased by 60.26%from 53.10%to 21.10%;the overall mean MF density among the positives decreased by 71.29%from 28.87 mf/snip to 8.29 mf/snip;and the overall mean MF density among all persons examined decreased by 88.58%from 15.33 mf/snip to 1.75 mf/snip.Ten of 12 endemic districts had>50%reduction in MF prevalence.Eleven of 12 districts had≥50%reduction in mean MF density among the positives.Conclusions:A significant reduction of onchocerciasis MF prevalence and mean density was recorded in all 12 districts of Sierra Leone after five annual MDAs with effective treatment coverage.The results suggested that the onchocerciasis elimination programme in Sierra Leone was on course to reach the objective of eliminating onchocerciasis in the country by the year 2025.Annual MDA with ivermectin should continue in all 12 districts and further evaluations are needed across the country to assist the NTDP with programme decision making.展开更多
Backgrounds:Azithromycin mass drug administration(MDA)is a key part of the strategy for controlling trachoma.This systematic review aimed to comprehensively summarize the present studies of azithromycin MDA on trachom...Backgrounds:Azithromycin mass drug administration(MDA)is a key part of the strategy for controlling trachoma.This systematic review aimed to comprehensively summarize the present studies of azithromycin MDA on trachoma;provide an overview of the impact of azithromycin MDA on trachoma in different districts;and explore the possible methods to enhance the effectiveness of azithromycin MDA in hyperendemic districts.Methods:PubMed,Embase,the Cochrane Central Register of Controlled Trials,Web of Science,and ClinicalTrials.gov were searched up to February 2021 with no language restriction.Studies reporting the effect of azithromycin MDA on trachoma were included.Mathematical modeling studies,animal studies,case reports,and reviews were excluded.The trachomatous inflammation-follicular(TF)<5.0%was used to judge the effect of azithromycin MDA on eliminating trachoma as a public health problem.Two researchers independently conducted the selection process and risk of bias assessment.Results:A total of 1543 studies were screened,of which 67 studies including 13 cluster-randomized controlled trials and 54 non-randomized studies were included.The effect of azithromycin MDA on trachoma was closely related to the baseline prevalence in districts.For the districts with baseline prevalence between 5.0%and 9.9%,a single round of MDA achieved a TF<5.0%.For the districts with baseline between 10.0%and 29.9%,annual MDA for 3 to 5 years reduced TF<5.0%.However,for the districts with high level of baseline prevalence(TF>30.0%),especially with baseline TF>50.0%,annual MDA was unable to achieve the TF<5.0%even after 5 to 7 years of treatment.Quarterly MDA is more effective in controlling trachoma in these hyperendemic districts.Conclusions:Azithromycin MDA for controlling trachoma depends on the baseline prevalence.The recommendation by the World Health Organization that annual MDA for 3 to 5 years in the districts with TF baseline>10.0%is not appropriate for all eligible districts.展开更多
Background:Lymphatic filariasis is targeted for elimination in India through mass drug administration(MDA)with diethylcarbamazine(DEC)combined with albendazole(ABZ).For the strategy to be effective,>65%of those liv...Background:Lymphatic filariasis is targeted for elimination in India through mass drug administration(MDA)with diethylcarbamazine(DEC)combined with albendazole(ABZ).For the strategy to be effective,>65%of those living in endemic areas must be covered by and compliant to MDA.Post the MDA 2011 campaign in the endemic district of Odisha,we conducted a survey to assess:(i)the filariasis knowledge in the community,(ii)the coverage and compliance of MDA from the community perspective,and(iii)factors affecting compliance,as well as the operational issues involved in carrying out MDA activities from the drug distributor’s perspective.Methods:A sample of 691 participants-both male and female,aged two years or above-were selected through multistage stratified sampling and interviewed using a semi-structured questionnaire.Additionally,drug distributors and the medical officers in charge of the MDA were also interviewed to understand some of the operational issues encountered during MDA.Results:Ninety-nine percent of the study participants received DEC and ABZ tablets during MDA,of which only just above a quarter actually consumed the drugs.The cause of non-compliance was mostly due to fear of side effects,lack of awareness of the benefits of MDA,and non-attendance of health staff in the villages.Lack of adequate training of drug distributors and poor health communication activities before the MDA campaign commenced and the absence of follow-up by health workers following MDA were a few of the operational difficulties encountered during the MDA campaign.Conclusion:Currently MDA is restricted to the distribution of drugs only and the key issues of implementation in compliance,health education,managing side effects,and logistics are not given enough attention.It is therefore essential to address the issues linked to low compliance to make the program more efficient and achieve the goal of filariasis elimination.展开更多
Background:Lymphatic filariasis(LF)elimination program in Tanzania started in 2000 in response to the Global program for the elimination of LF by 2020.Evidence shows a persistent LF transmission despite more than a de...Background:Lymphatic filariasis(LF)elimination program in Tanzania started in 2000 in response to the Global program for the elimination of LF by 2020.Evidence shows a persistent LF transmission despite more than a decade of mass drug administration(MDA).It is advocated that,regular monitoring should be conducted in endemic areas to evaluate the progress towards elimination and detect resurgence of the disease timely.This study was therefore designed to assess the status of Wuchererio bancrofti infection in Culex quinqefasciatus and Anopheles species after six rounds of MDA in Masasi District,South Eastern Tanzania.展开更多
Background:Lymphatic filariasis(LF)#a neglected tropical disease(NTD)and leading cause of global disability,is endemic in 32 countries in Africa with almost 350 million people requiring regular drug administration,and...Background:Lymphatic filariasis(LF)#a neglected tropical disease(NTD)and leading cause of global disability,is endemic in 32 countries in Africa with almost 350 million people requiring regular drug administration,and only 16 countries achieving target coverage.Community Drug Distributors(CDDs)are critical for the success of NTD programs,and the distribution of medicines during mass drug administration(MDA)in Africa;however they could also be a weak link.The primary aim of this study is to explore and describe perceptions of CDDs during MDA for LF in Mvita sub-county in Mombasa county and Kaloleni sub-county in Kilifi county,Kenya;and provide recommendations for the effective engagement of communities and CDDs in low-resource settings.Methods:In September 2018,we conducted six focus group discussions with community members in each sub-county,three with men aged 18-30,31-50,and 51 years and above and three with women stratified into the same age groups.In each sub-county,we also conducted semi-struaured interviews with nine community health extension workers(CHEWs),the national LF focal point,the county NTD focal points,and seven community leaders.Content analysis of the data was conducted,involving a process of reading,coding,and displaying data in order to develop a codebook.Results:We found that several barriers and facilitators impact the engagement between CDDs and community members during MDA.These barriers include poor communication and trust between CDDs and communities;community distrust of the federal government;low community knowledge and perceived risk of LF,poor timing of MDA,fragmented supervision of CDDs during MDA;and CDD bias when distributing medicines.We also found that CDD motivation was a critical factor in their ability to successfully meet MDA targets.It was acknowledged that directly observed treatment and adequate health education were often not executed by CDDs.The involvement of community leaders as informal supervisors of CDDs and community members improves MDA.Conclusions:In order to achieve global targets around the elimination of LF,CDDs and communities must be effectively engaged by improving planning and implementation of MDA.展开更多
BackgroundIn onchocerciasis-endemic areas with high ongoing Onchocerca volvulus transmission,a high prevalence of epilepsy has been reported.This study aimed to determine the prevalence and clinical characteristics of...BackgroundIn onchocerciasis-endemic areas with high ongoing Onchocerca volvulus transmission,a high prevalence of epilepsy has been reported.This study aimed to determine the prevalence and clinical characteristics of epilepsy in the Bono Region of Ghana following 27 years of implementation of ivermectin mass drug administration(MDA).MethodsBetween October 2020 and August 2021,cross-sectional surveys were conducted in nine communities in the Tain District and Wenchi Municipality of the Bono Region of Ghana.In the first stage,a random door-to-door approach was used to screen the population for epilepsy using a pre-tested questionnaire.Persons suspected of having epilepsy were invited for a second-stage neurological examination for case verification.Community O.volvulus microfilarial infection status and Ov16 seropositivity were also determined.Ninety-five confidence intervals(95%CI)for prevalence values were calculated using the Wilson Score Interval.ResultsOf the 971 participants,500(51.5%)were females,and the median age(interquartile range)was 26(15‒43)years.Fourteen participants(1.4%,95%CI:1.0‒2.0)were diagnosed as having epilepsy with generalized seizures being the most frequent seizure type(85.7%,12/14).The overall microfilarial prevalence of O.volvulus was 10.3%(November 2020)and 9.9%(August 2021);the Ov16 seroprevalence was 22.2%(June 2021).Only 63.2%took ivermectin in the last round of MDA distribution in March 2021.ConclusionsThe 1.4%prevalence of epilepsy in the Bono region is similar to the median epilepsy prevalence in sub-Saharan Africa.However,the persistent microfilarial prevalence and low ivermectin study coverage call for the Ghana Onchocerciasis Elimination Programme to step up its efforts to ensure that the gains achieved are consolidated and improved to achieve the elimination of onchocerciasis by 2030.展开更多
Background:To secure the gains of lymphatic filariasis(LF)elimination programs,attention is needed to the Yesidual microfilaremia phase;in which high-risk populations may be crucial.The present study documents the imp...Background:To secure the gains of lymphatic filariasis(LF)elimination programs,attention is needed to the Yesidual microfilaremia phase;in which high-risk populations may be crucial.The present study documents the impact of mass drug administration(MDA)in the urban Indian setting of Surat City,with high rates of in-migration.展开更多
Background:Mass drug administration(MDA)of medications to entire at-risk communities or populations has shown promise in the control and elimination of global infectious diseases.MDA of the broad-spectrum antibiotic a...Background:Mass drug administration(MDA)of medications to entire at-risk communities or populations has shown promise in the control and elimination of global infectious diseases.MDA of the broad-spectrum antibiotic azithromycin has demonstrated the potential to reduce childhood mortality in children at risk of premature death in some global settings.However,MDA of antibiotics raises complex ethical challenges,including weighing near-term benefts against longer-term risks—particularly the development of antimicrobial resistance that could diminish antibiotic efectiveness for current or future generations.The aim of this study was to understand how key actors involved in MDA perceive the ethical challenges of MDA.Methods:We conducted 35 semi-structured interviews from December 2020–February 2022 with investigators,funders,bioethicists,research ethics committee members,industry representatives,and others from both highincome countries(HICs)and low-and middle-income countries(LMICs).Interview participants were identifed via one of seven MDA studies purposively chosen to represent diversity in terms of use of the antibiotic azithromycin;use of a primary mortality endpoint;and whether the study occurred in a high child mortality country.Data were analyzed using constructivist grounded theory methodology.Results:The most frequently discussed ethical challenges related to meaningful community engagement,how to weigh risks and benefts,and the need to target MDA We developed a concept map of how participants considered ethical issues in MDA for child mortality;it emphasizes MDA’s place alongside other public health interventions,empowerment,and equity.Concerns over an ethical double standard in weighing risks and benefts emerged as a unifying theme,albeit one that participants interpreted in radically diferent ways.Some thought MDA for reducing child mortality was ethically obligatory;others suggested it was impermissible.Conclusions:Ethical challenges raised by MDA of antibiotics for childhood mortality-which span socio-cultural issues,the environment,and efects on future generations-require consideration beyond traditional clinical trial review.The appropriate role of MDA also requires attention to concerns over ethical double standards and power dynamics in global health that afect how we view antibiotic use in HICs versus LMICs.Our fndings suggest the need to develop additional,comprehensive guidance on managing ethical challenges in MDA.展开更多
Background: Mass drug administration(MDA)is a strategy to improve health at the population level through widespread delivery of medicine in a community.We surveyed the literature to summarize the benefits and potentia...Background: Mass drug administration(MDA)is a strategy to improve health at the population level through widespread delivery of medicine in a community.We surveyed the literature to summarize the benefits and potential risks associated with MDA of antibacterials,focusing predominantly on azithromycin as it has the greatest evidence base.Main body: High-quality evidence from randomized controlled trials(RCTs)indicate that MDA-azithromycin is effective in reducing the prevalence of infection due to yaws and trachoma.In addition,RCTs suggest that MDA-azithromycin reduces under-five mortality in certain low-resource settings that have high childhood mortality rates at baseline.This reduction in mortality appears to be sustained over time with twice-yearly MDA-azithromycin,with the greatest effect observed in children<1 year of age.In addition,observational data suggest that infections such as skin and soft tissue infections,rheumatic heart disease,acute respiratory illness,diarrheal illness,and malaria may all be treated by azithromycin and thus incidentally impacted by MDA-azithromycin.However,the mechanism by which MDA-azithromycin reduces childhood mortality remains unclear.Verbal autopsies performed in MDA-azithromycin childhood mortality studies have produced conflicting data and are underpowered to answer this question.In addition to benefits,there are several important risks associated with MDA-azithromycin.Direct adverse effects potentially resulting from MDA-azithromycin include gastrointestinal side effects,idiopathic hypertrophic pyloric stenosis,cardiovascular side effects,and increase in chronic diseases such as asthma and obesity.Antibacterial resistance is also a risk associated with MDA-azithromycin and has been reported for both gram-positive and enteric organisms.Further,there is the risk for cross-resistance with other antibacterial agents,especially clindamycin.Conclusions: Evidence shows that MDA-azithromycin programs may be beneficial for reducing trachoma,yaws,and mortality in children<5 years of age in certain under-resourced settings.However,there are significant potential risks that need to be considered when deciding how,when,and where to implement these programs.Robust systems to monitor benefits as well as adverse effects and antibacterial resistance are warranted in communities where MDA-azithromycin programs are implemented.展开更多
Background:World Health Organization guidelines recommend preventive chemotherapy with praziquantel to control morbidity due to schistosomiasis.The primary aim of this cross-sectional study was to determine if 4 years...Background:World Health Organization guidelines recommend preventive chemotherapy with praziquantel to control morbidity due to schistosomiasis.The primary aim of this cross-sectional study was to determine if 4 years of annual mass drug administration(MDA)in primary and secondary schools lowered potential markers of morbidity in infected children 1 year after the final MDA compared to infected children prior to initial MDA intervention.Methods:Between 2012 and 2016 all students in two primary and three secondary schools within three kilometers of Lake Victoria in western Kenya received annual mass praziquantel administration.To evaluate potential changes in morbidity we measured height,weight,mid-upper arm circumference,hemoglobin levels,abdominal ultrasound,and quality of life in children in these schools.This study compared two cross-sectional samples of Schistosoma mansoni egg-positive children:one at baseline and one at year five,1 year after the fourth annual MDA.Data were analyzed for all ages(6–18 years old)and stratified by primary(6–12 years old)and secondary(12–18 years old)school groups.Results:The prevalence of multiple potential morbidity markers did not differ significantly between the egg-positive participants at baseline and those at 5 years by Mann Whitney nonparametric analysis and Fisher’s exact test for continuous and categorical data,respectively.There was a small but significantly higher score in school-related quality of life assessment by year five compared to baseline by Mann Whitney analysis(P=0.048)in 13–18 year olds where malaria-negative.However,anemia was not positively impacted by four annual rounds of MDA,but registered a significant negative outcome.Conclusions:We did not detect differences in morbidity markers measured in a population of those infected or re-infected after multiple MDA.This could have been due to their relative insensitivity or a failure of MDA to prevent morbidity among those who remain infected.High malaria transmission in this area and/or a lack of suitable methods to measure the more subtle functional morbidities caused by schistosomiasis could be a factor.Further research is needed to identify and develop well-defined,easily quantifiable S.mansoni morbidity markers for this age group.展开更多
文摘Introduction: The WHO recommends mass administration of azithromycin 30 mg/kg to eradicate yaws and 20 mg/kg to eliminate trachoma. We evaluated the effectiveness of azithromycin at 20 and 30 mg/Kg, and the number of cycles of mass administration on the treatment and interruption of yaws transmission in the Mbaïki health district in the Central African Republic. Methods: Following a yaws prevalence survey, azithromycin was administered as a mass treatment in four yaws endemic communities in the Mbaïki health district. Azithromycin 30 mg/kg was administered in one cycle in Kenengué and three cycles spaced three months apart in Bambou. In Kapou and Bangui-Bouchia, azithromycin was administered at a dose of 20 mg/kg in one cycle and three cycles, respectively, spaced three months apart. Before the mass treatment round, confirmed yaw cases were selected and followed for seven months. The primary endpoint was serological cure seven months after the first treatment cycle. Secondary endpoints were clinical cure at four weeks after the first treatment cycle and serological cure at four months after the first treatment cycle. A non-inferiority margin (∆) of 10% was used. Results: A total of 92 participants aged 1 to 90 years, including 52 men, were included in the study. The frequently encountered skin lesions were ulcers (65.22%) and were localized to the lower limbs (59.78%). Clinical cure was not obtained in Bangui-Bouchia and Kapou (∆ = 17.1% and 30.8%). Serological cure at four and seven months was not obtained in Kapou (∆ equal to 17.9% and 13.8% respectively). Conclusion: This study confirms the effectiveness of azithromycin 30 mg/kg in a single dose for the treatment of yaws. However, the study suggests that for yaws eradication programs, two to three cycles of mass administration of azithromycin at 20 or 30 mg/kg spaced three months apart, with therapeutic coverage greater than 90% are essential.
文摘With the mission of absorption of the capital through urban renovation, AKP （the Justice and Welfare Party） took over the metropolitan municipality administrations in big cities in 1995, and the Government of the Republic of Turkey in 2002. Together with the 2003 Mass Housing Act, 14 legal regulations were enacted between 2002 and 2008 to expand the field of activity and increase the funds of TOKI （Governmental Mass Housing Administration） which was already established during ANAP （the Motherland Party） Government in 1980s. As a result of those regulations, TOKI, as the ＂latest goddess of the construction myth＂, became the only authorized organization in the field of housing and land production in AKP＇s cities. It acquired new duties from generating profit-oriented projects to protecting historical texture, and it was authorized to make and approve zoning plans for the lands and plots handed over to TOKI of the last government （the Justice and Welfare Party） created as an investor-entrepreneur-contractor-performer group. This paper＇s aim is to indicate the transformation of TOKI foundation during the last twenty years, and also to prove that TOKI, as a governmental profit-oriented design tool, has demolished the unique DNA/morphological textures of the contemporary Turkish big cities by producing low profiled similar architecture and urbanity in the recent past.
基金funded by DANIDA under the Building Stronger Universities(Grant Number:BSU 3-KNUST)initiative—Work Package III(Health Delivery System)issued by the KNUST Office of Grants and Research。
文摘Background Studies on Mass drug administration(MDA)in Ghana targeting various diseases,have mostly focused on factors that affect coverage and compliance to MDA with limited focus on evidence regarding awareness and community perception of the program.Therefore,this study sought to provide empirical evidence on the knowledge of onchocerciasis,and awareness of and participation in the MDA among community members.Methods A community-based cross-sectional survey was conducted from August to October 2019 in communities within the Atwima Nwabiagya North District,Ghana.Data was collected from 2,008 respondents.Bivariate and multivariate logistic regression analyses were performed to measure the associations between socio-demographics,having heard of onchocerciasis and its prevention,and levels of awareness of the MDA program.Results A total of 1268 respondents(63.2%)were aware of the MDA program.The majority ofMost respondents(74.4%)were of the view that the information given about the program was not enough and 45.4%of the respondents had no idea about the relevance of the MDA program.Respondents who had ever heard about onchocerciasis prevention and persons who had previously participated in the MDA program were more likely to be aware of the MDA program during implementation(AOR=2.32;95%CI 1.79-3.01 and AOR=9.31;95%CI 7.06-12.26,respectively).Conclusions We observed a significant association between being aware of MDA campaigns and knowledge of onchocerciasis and its preventive methods,and participation in previous MDA campaigns.We recommend intensification and improvement of prevention campaigns regarding the onchocerciasis MDA program as key to ensuring increased MDA program participation.
基金Project is funded by a grant from the Bill&Melinda Gates Foundation(OPP1129535).
文摘Background:Recent evidence suggests that soil-transmitted helminth(STH)transmission interruption may be feasible through community-wide mass drug administration(cMDA)that deworms community members of all ages.A change from school-based deworming to cMDA will require reconfiguring of STH programs in endemic countries.We conducted formative qualitative research in Benin,India,and Malawi to identify barriers and facilitators to successfully launching a cMDA program from the policy-stakeholder perspective.Methods:We conducted 40 key informant interviews with policy stakeholders identified as critical change agents at national,state/district,and sub-district levels.Participants included World Health Organization country office staff,implementing partners,and national and sub-national government officials.We used the Consolidated Framework for Implementation Research to guide data collection,coding,and analysis.Heat maps were used to organize coded data and differentiate perceived facilitators and barriers to launching cMDA by stakeholder.Results:Key facilitators to launching a cMDA program included availability of high-quality,tailored sensitization materials,and human and material resources that could be leveraged from previous MDA campaigns.Key barriers included the potential to overburden existing health workers,uncertainty of external funding to sustain a cMDA program,and concerns about weak intragovernmental coordination to implement cMDA.Cross-cutting themes included the need for rigorous trial evidence on STH transmission interruption to gain confidence in cMDA,and implemen-tation evidence to effectively operationalize cMDA.Importantly,if policy stakeholders anticipate a cMDA program cannot be sustained due to cost and human resource barriers in the long term they may be less likely to support the launch of a program in the short term.Conclusions:Overall,policy stakeholders were optimistic about implementing cMDA primarily because they believe that the tools necessary to successfully implement cMDA are already available.Policy stakeholders in this study were cautiously optimistic about launching cMDA to achieve STH transmission interruption and believe that it is feasible to implement.However,launching cMDA as an alternative policy to school-based deworming will require addressing key resource and evidence barriers.
文摘Introduction: Lymphatic filariasis (LF) is one of the neglected tropical diseases targeted for elimination as a public health issue in the world by 2020. To achieve this goal, one of the strategies is interruption of transmission using chemotherapy (mass drug administration). Burkina Faso in west Africa, an endemic country, has endorsed this resolution. In 2000, all Sanitary Districts (SD) in the country were endemic, and then a national elimination program has made it possible to stop mass treatment in 45 out of 70 SD over 12 years. Sixteen years later, 13 other SD were reeligible for Transmission Assessment Surveys (TAS). This study aimed to determine the current level of the Mass drugs Administration (MDA) impact indicators in these 13 targeted SD in order to decide whether we need to continue MDA. Method: It was a descriptive study that took place from June to September 2017 in 13 SD regrouped into 7 Evaluation Units (EU). The population of the study was 6 to 7 years old children. The community-based cluster survey method was used. The diagnostic test used to detect Wuchereria bancrofti’s circulating antigen (W. bancrofti) is the Filariasis Test Strip (FTS). The critical threshold of positivity was set at 18 positive subjects per EU. Results: We sampled a total of 12,060 children, 48.9% were female and 51.1% male. In the 7 EU, 13 children were positive to W. bancrofti test. The average antigenic prevalence was 0.11% (13/12,060). In all EU, the number of positive subjects was below the critical threshold. Conclusion: At the end of this evaluation of the transmission of lymphatic filariasis in 13 SD of Burkina Faso, we can tell the MDA could be stopped in these areas without risk of resurgence of the disease, according to the current recommendations of WHO. This can be possible by setting up post-TMM surveillance, considering migratory flows, and including villages where positive cases were found to search possible residual transmission zones.
文摘Zoonotic hookworm infections remain a significant public health problem,causing nearly 500 milion cases globally and approximately four million disability-adjusted life years lost annually.More than one-fth of these cases are attrib-uted to Ancylostoma ceylanicum,an emerging zoonotic health issue in the Asia-Pacific region.This review presents key research gaps regarding the epidemiology,diagnosis,control,prevention and elimination of A.ceylanicum and other canine zoonotic hookworms as neglected health threats.A.ceylanicum is the second most prevalent human hook-worm in the region;it is the most common hookworm among dogs and cats-reservoirs of zoonotic infections.Previous population genetic and phylogenetic analyses revealed that A.ceylanicum has three possible transmis-sion dynamics:zoonotic,animal-only,and human-only pathways.The actual burden of zoonotic ancylostomiasis in most endemic countries remains unknown due to the use of parasitological techniques(e.g.,Kato-Katz thick smear and floatation techniques)that have reduced diagnostic performance and do not allow accurate species identifica-tion in helminth surveys.The emergence of benzimidazole resistance in soil-transmitted helminths(STHs),includ-ing hookworms,is a concern due to the protracted implementation of mass drug administration(MDA).Resistance is conferred by single nucleotide polymorphisms(SNPs)that occur in theβ-tubulin isotype 1 gene.These mutations have been reported in drug-resistant A.caninum but have not been found in A.ceylanicum in the field.A.ceylanicum remains understudied in the Asia-Pacific region.The zoonotic nature of the parasite warrants investigation of its occur-rence in human and animal reservoir hosts to understand the dynamics of zoonotic transmission in different endemic foci.The detection of benzimidazole resistance-associated SNPs in zoonotic hookworms from Asia-Pacific countries has yet to be thoroughly explored.Considering the high level of hookworm endemicity in the region,the circulation of resistant isolates between humans and animals potentially presents a significant One Health threat that can under-mine current MDA and proposed animal deworming-based control efforts.
文摘Background Current soil-transmitted helminth(STH)control guidelines endorse the use of albendazole or meben-dazole for school-based targeted preventive chemotherapy(PC),yet their reduced efficacy against Strongyloides sterc-oralis and Trichuris trichiura presents significant limitations.Emerging evidence indicates that community-wide PC[or mass drug administration(MDA)]using ivermectin,commonly used in other neglected tropical disease(NTD)control programs,may play an important role in controlling these parasites.We conducted a systematic review and meta-analysis to evaluate the effectiveness of ivermectin PC in reducing STH prevalence in endemic populations.Methods We searched Pubmed,EMBASE,and Web of Science on February 14,2023,for studies that investigated the effectiveness of ivermectin PC,either alone or in combination with other anthelmintic drugs,on STH infec-tions,and provided a measure of STH prevalence before and after PC.We calculated pooled prevalence reductions for each STH using random-effects meta-analyses.Our protocol is available on PROSPERO(registration number CRD42023401219).Results A total of 21 were eligible for the systematic review,of which 15 were eligible for meta-analysis.All studies delivered ivermectin through MDA.The pooled prevalence reduction of S.stercoralis following MDA with ivermec-tin alone was 84.49%(95%CI:54.96-94.66)across five studies and 81.37%(95% CI:61.62-90.96)across seven studies with or without albendazole.The prevalence reduction of T.trichiura was 49.93%(95%CI:18.23-69.34)across five studies with ivermectin alone,and 89.40%(95%CI:73.66-95.73)across three studies with the addition of albendazole.There was high heterogeneity for all syntheses(I^(2)>65%).Conclusions This study underscores the key role of ivermectin-based MDA in addressing limitations in current global STH guidelines in terms of limited efficacy against S.stercoralis and T.trichiura.Based on these findings,revising inter-national STH guidelines to include ivermectin is a promising option to progress the control and eventual elimination ofSTHsandotherNTDs.
基金Funding is provided by The Bill&Melinda Gates Foundation(OPP1129535)。
文摘Background Soil-transmitted helminths(STH)affect approximately 1.5 billion people globally.The current STH control strategy is annual or twice-annual preventive chemotherapy,typically school-based deworming targeting children and women of reproductive age.Mathematical modeling suggests that it may be possible to interrupt STH transmission through high-coverage community-wide mass drug administration(cMDA).DeWorm3 is a cluster randomized trial testing cMDA for prevalence reduction and transmission interruption.The purpose of this study is to describe coverage of cMDA in study clusters over time and correlates of coverage at individual and cluster levels.Methods From 2018-2020,DeWorm3 delivered six rounds of cMDA with 400 mg albendazole at sites in Benin,India,and Malawi.We report coverage,treatment uptake,and directly observed therapy across all rounds.Factors associated with coverage at the cluster level were identified using binomial generalized estimating equations,while factors associated with non-treatment at the individual level were identified using binomial mixed-effects models.Results Coverage was high across all clusters and rounds,exceeding the WHO target of 75%in all sites and across all rounds(78%to 95%);cluster-level coverage tended to increase over time.Younger,unmarried,and migratory adults were more likely to be untreated at all sites;adult males were more likely to be untreated in Benin and Malawi.Among children,girls were more likely to be untreated,as were non-school-attending and migratory children.Higher adult education was associated with greater odds of non-treatment among adults,but lower odds among children in the household.Belonging to a less wealthy or minority language-speaking household was associated with non-treatment among both adults and children.Conclusions It is possible to deliver community-wide MDA with high coverage.Unique individual and community-level factors influence treatment across settings,and these may be addressed through targeted programming.Trial Registration:Field Studies on the Feasibility of Interrupting the Transmission of Soil-transmitted Helminths(STH),NCT03014167.
文摘Background: Antibiotics are a key part of modern healthcare,but their use has downsides,including selecting for antibiotic resistance,both in the individuals treated with antibiotics and in the community at large.When evaluating the benefits and costs of mass administration of azithromycin to reduce childhood mortality,effects of antibiotic use on antibiotic resistance are important but difficult to measure,especially when evaluating resistance that“spills over”from antibiotic-treated individuals to other members of their community.The aim of this scoping review was to identify how the existing literature on antibiotic resistance modeling could be better leveraged to understand the effect of mass drug administration(MDA)on antibiotic resistance.Main text: Mathematical models of antibiotic use and resistance may be useful for estimating the expected effects of different MDA implementations on different populations,as well as aiding interpretation of existing data and guiding future experimental design.Here,strengths and limitations of models of antibiotic resistance are reviewed,and possible applications of those models in the context of mass drug administration with azithromycin are discussed.Conclusions: Statistical models of antibiotic use and resistance may provide robust and relevant estimates of the possible effects of MDA on resistance.Mechanistic models of resistance,while able to more precisely estimate the effects of different implementations of MDA on resistance,may require more data from MDA trials to be accurately parameterized.
基金All the studies reported in this paper were funded by WHO through OCP or APOC,who also provided technical support in the design,implementation(quality control)interpretation of the baseline data.
文摘Background:Onchocerciasis is endemic in 12 of the 14 health districts of Sierra Leone.Good treatment coverage of community-directed treatment with ivermectin was achieved between 2005 and 2009 after the 11-year civil conflict.Sentinel site surveys were conducted in 2010 to evaluate the impact of five annual rounds of ivermectin distribution.Methods:In total,39 sentinel villages from hyper-and meso-endemic areas across the 12 endemic districts were surveyed using skin snips in 2010.Results were analyzed and compared with the baseline data from the same 39 villages.Results:The average microfilaridermia(MF)prevalence across 39 sentinel villages was 53.10%at baseline.The MF prevalence was higher in older age groups,with the lowest in the age group of 1-9 years(11.00%)and the highest in the age group of 40-49 years(82.31%).Overall mean MF density among the positives was 28.87 microfilariae(mf)/snip,increasing with age with the lowest in the age group of 1-9 years and the highest in the age group of 40-49 years.Males had higher MF prevalence and density than females.In 2010 after five rounds of mass drug administration,the overall MF prevalence decreased by 60.26%from 53.10%to 21.10%;the overall mean MF density among the positives decreased by 71.29%from 28.87 mf/snip to 8.29 mf/snip;and the overall mean MF density among all persons examined decreased by 88.58%from 15.33 mf/snip to 1.75 mf/snip.Ten of 12 endemic districts had>50%reduction in MF prevalence.Eleven of 12 districts had≥50%reduction in mean MF density among the positives.Conclusions:A significant reduction of onchocerciasis MF prevalence and mean density was recorded in all 12 districts of Sierra Leone after five annual MDAs with effective treatment coverage.The results suggested that the onchocerciasis elimination programme in Sierra Leone was on course to reach the objective of eliminating onchocerciasis in the country by the year 2025.Annual MDA with ivermectin should continue in all 12 districts and further evaluations are needed across the country to assist the NTDP with programme decision making.
基金supported by grants from the National Science Foundation of China(Nos.81630038,81971433,81971428,81771634,and 81701499)WHO(WHO Registration 2018/859223-0)+3 种基金Deep Underground Space Medical(No.DUGM201809)Science and Technology Bureau of Sichuan Province(No.2016TD0002)the National Key R&D Program of China(No.2017YFA0104200)the Grant of clinical discipline program(Neonatology)from the Ministry of Health of China(No.1311200003303)。
文摘Backgrounds:Azithromycin mass drug administration(MDA)is a key part of the strategy for controlling trachoma.This systematic review aimed to comprehensively summarize the present studies of azithromycin MDA on trachoma;provide an overview of the impact of azithromycin MDA on trachoma in different districts;and explore the possible methods to enhance the effectiveness of azithromycin MDA in hyperendemic districts.Methods:PubMed,Embase,the Cochrane Central Register of Controlled Trials,Web of Science,and ClinicalTrials.gov were searched up to February 2021 with no language restriction.Studies reporting the effect of azithromycin MDA on trachoma were included.Mathematical modeling studies,animal studies,case reports,and reviews were excluded.The trachomatous inflammation-follicular(TF)<5.0%was used to judge the effect of azithromycin MDA on eliminating trachoma as a public health problem.Two researchers independently conducted the selection process and risk of bias assessment.Results:A total of 1543 studies were screened,of which 67 studies including 13 cluster-randomized controlled trials and 54 non-randomized studies were included.The effect of azithromycin MDA on trachoma was closely related to the baseline prevalence in districts.For the districts with baseline prevalence between 5.0%and 9.9%,a single round of MDA achieved a TF<5.0%.For the districts with baseline between 10.0%and 29.9%,annual MDA for 3 to 5 years reduced TF<5.0%.However,for the districts with high level of baseline prevalence(TF>30.0%),especially with baseline TF>50.0%,annual MDA was unable to achieve the TF<5.0%even after 5 to 7 years of treatment.Quarterly MDA is more effective in controlling trachoma in these hyperendemic districts.Conclusions:Azithromycin MDA for controlling trachoma depends on the baseline prevalence.The recommendation by the World Health Organization that annual MDA for 3 to 5 years in the districts with TF baseline>10.0%is not appropriate for all eligible districts.
基金We sincerely thank the Odisha Government for providing financial support to AKS to successfully complete his Postgraduate Diploma in Public Health Management.
文摘Background:Lymphatic filariasis is targeted for elimination in India through mass drug administration(MDA)with diethylcarbamazine(DEC)combined with albendazole(ABZ).For the strategy to be effective,>65%of those living in endemic areas must be covered by and compliant to MDA.Post the MDA 2011 campaign in the endemic district of Odisha,we conducted a survey to assess:(i)the filariasis knowledge in the community,(ii)the coverage and compliance of MDA from the community perspective,and(iii)factors affecting compliance,as well as the operational issues involved in carrying out MDA activities from the drug distributor’s perspective.Methods:A sample of 691 participants-both male and female,aged two years or above-were selected through multistage stratified sampling and interviewed using a semi-structured questionnaire.Additionally,drug distributors and the medical officers in charge of the MDA were also interviewed to understand some of the operational issues encountered during MDA.Results:Ninety-nine percent of the study participants received DEC and ABZ tablets during MDA,of which only just above a quarter actually consumed the drugs.The cause of non-compliance was mostly due to fear of side effects,lack of awareness of the benefits of MDA,and non-attendance of health staff in the villages.Lack of adequate training of drug distributors and poor health communication activities before the MDA campaign commenced and the absence of follow-up by health workers following MDA were a few of the operational difficulties encountered during the MDA campaign.Conclusion:Currently MDA is restricted to the distribution of drugs only and the key issues of implementation in compliance,health education,managing side effects,and logistics are not given enough attention.It is therefore essential to address the issues linked to low compliance to make the program more efficient and achieve the goal of filariasis elimination.
文摘Background:Lymphatic filariasis(LF)elimination program in Tanzania started in 2000 in response to the Global program for the elimination of LF by 2020.Evidence shows a persistent LF transmission despite more than a decade of mass drug administration(MDA).It is advocated that,regular monitoring should be conducted in endemic areas to evaluate the progress towards elimination and detect resurgence of the disease timely.This study was therefore designed to assess the status of Wuchererio bancrofti infection in Culex quinqefasciatus and Anopheles species after six rounds of MDA in Masasi District,South Eastern Tanzania.
文摘Background:Lymphatic filariasis(LF)#a neglected tropical disease(NTD)and leading cause of global disability,is endemic in 32 countries in Africa with almost 350 million people requiring regular drug administration,and only 16 countries achieving target coverage.Community Drug Distributors(CDDs)are critical for the success of NTD programs,and the distribution of medicines during mass drug administration(MDA)in Africa;however they could also be a weak link.The primary aim of this study is to explore and describe perceptions of CDDs during MDA for LF in Mvita sub-county in Mombasa county and Kaloleni sub-county in Kilifi county,Kenya;and provide recommendations for the effective engagement of communities and CDDs in low-resource settings.Methods:In September 2018,we conducted six focus group discussions with community members in each sub-county,three with men aged 18-30,31-50,and 51 years and above and three with women stratified into the same age groups.In each sub-county,we also conducted semi-struaured interviews with nine community health extension workers(CHEWs),the national LF focal point,the county NTD focal points,and seven community leaders.Content analysis of the data was conducted,involving a process of reading,coding,and displaying data in order to develop a codebook.Results:We found that several barriers and facilitators impact the engagement between CDDs and community members during MDA.These barriers include poor communication and trust between CDDs and communities;community distrust of the federal government;low community knowledge and perceived risk of LF,poor timing of MDA,fragmented supervision of CDDs during MDA;and CDD bias when distributing medicines.We also found that CDD motivation was a critical factor in their ability to successfully meet MDA targets.It was acknowledged that directly observed treatment and adequate health education were often not executed by CDDs.The involvement of community leaders as informal supervisors of CDDs and community members improves MDA.Conclusions:In order to achieve global targets around the elimination of LF,CDDs and communities must be effectively engaged by improving planning and implementation of MDA.
文摘BackgroundIn onchocerciasis-endemic areas with high ongoing Onchocerca volvulus transmission,a high prevalence of epilepsy has been reported.This study aimed to determine the prevalence and clinical characteristics of epilepsy in the Bono Region of Ghana following 27 years of implementation of ivermectin mass drug administration(MDA).MethodsBetween October 2020 and August 2021,cross-sectional surveys were conducted in nine communities in the Tain District and Wenchi Municipality of the Bono Region of Ghana.In the first stage,a random door-to-door approach was used to screen the population for epilepsy using a pre-tested questionnaire.Persons suspected of having epilepsy were invited for a second-stage neurological examination for case verification.Community O.volvulus microfilarial infection status and Ov16 seropositivity were also determined.Ninety-five confidence intervals(95%CI)for prevalence values were calculated using the Wilson Score Interval.ResultsOf the 971 participants,500(51.5%)were females,and the median age(interquartile range)was 26(15‒43)years.Fourteen participants(1.4%,95%CI:1.0‒2.0)were diagnosed as having epilepsy with generalized seizures being the most frequent seizure type(85.7%,12/14).The overall microfilarial prevalence of O.volvulus was 10.3%(November 2020)and 9.9%(August 2021);the Ov16 seroprevalence was 22.2%(June 2021).Only 63.2%took ivermectin in the last round of MDA distribution in March 2021.ConclusionsThe 1.4%prevalence of epilepsy in the Bono region is similar to the median epilepsy prevalence in sub-Saharan Africa.However,the persistent microfilarial prevalence and low ivermectin study coverage call for the Ghana Onchocerciasis Elimination Programme to step up its efforts to ensure that the gains achieved are consolidated and improved to achieve the elimination of onchocerciasis by 2030.
文摘Background:To secure the gains of lymphatic filariasis(LF)elimination programs,attention is needed to the Yesidual microfilaremia phase;in which high-risk populations may be crucial.The present study documents the impact of mass drug administration(MDA)in the urban Indian setting of Surat City,with high rates of in-migration.
文摘Background:Mass drug administration(MDA)of medications to entire at-risk communities or populations has shown promise in the control and elimination of global infectious diseases.MDA of the broad-spectrum antibiotic azithromycin has demonstrated the potential to reduce childhood mortality in children at risk of premature death in some global settings.However,MDA of antibiotics raises complex ethical challenges,including weighing near-term benefts against longer-term risks—particularly the development of antimicrobial resistance that could diminish antibiotic efectiveness for current or future generations.The aim of this study was to understand how key actors involved in MDA perceive the ethical challenges of MDA.Methods:We conducted 35 semi-structured interviews from December 2020–February 2022 with investigators,funders,bioethicists,research ethics committee members,industry representatives,and others from both highincome countries(HICs)and low-and middle-income countries(LMICs).Interview participants were identifed via one of seven MDA studies purposively chosen to represent diversity in terms of use of the antibiotic azithromycin;use of a primary mortality endpoint;and whether the study occurred in a high child mortality country.Data were analyzed using constructivist grounded theory methodology.Results:The most frequently discussed ethical challenges related to meaningful community engagement,how to weigh risks and benefts,and the need to target MDA We developed a concept map of how participants considered ethical issues in MDA for child mortality;it emphasizes MDA’s place alongside other public health interventions,empowerment,and equity.Concerns over an ethical double standard in weighing risks and benefts emerged as a unifying theme,albeit one that participants interpreted in radically diferent ways.Some thought MDA for reducing child mortality was ethically obligatory;others suggested it was impermissible.Conclusions:Ethical challenges raised by MDA of antibiotics for childhood mortality-which span socio-cultural issues,the environment,and efects on future generations-require consideration beyond traditional clinical trial review.The appropriate role of MDA also requires attention to concerns over ethical double standards and power dynamics in global health that afect how we view antibiotic use in HICs versus LMICs.Our fndings suggest the need to develop additional,comprehensive guidance on managing ethical challenges in MDA.
文摘Background: Mass drug administration(MDA)is a strategy to improve health at the population level through widespread delivery of medicine in a community.We surveyed the literature to summarize the benefits and potential risks associated with MDA of antibacterials,focusing predominantly on azithromycin as it has the greatest evidence base.Main body: High-quality evidence from randomized controlled trials(RCTs)indicate that MDA-azithromycin is effective in reducing the prevalence of infection due to yaws and trachoma.In addition,RCTs suggest that MDA-azithromycin reduces under-five mortality in certain low-resource settings that have high childhood mortality rates at baseline.This reduction in mortality appears to be sustained over time with twice-yearly MDA-azithromycin,with the greatest effect observed in children<1 year of age.In addition,observational data suggest that infections such as skin and soft tissue infections,rheumatic heart disease,acute respiratory illness,diarrheal illness,and malaria may all be treated by azithromycin and thus incidentally impacted by MDA-azithromycin.However,the mechanism by which MDA-azithromycin reduces childhood mortality remains unclear.Verbal autopsies performed in MDA-azithromycin childhood mortality studies have produced conflicting data and are underpowered to answer this question.In addition to benefits,there are several important risks associated with MDA-azithromycin.Direct adverse effects potentially resulting from MDA-azithromycin include gastrointestinal side effects,idiopathic hypertrophic pyloric stenosis,cardiovascular side effects,and increase in chronic diseases such as asthma and obesity.Antibacterial resistance is also a risk associated with MDA-azithromycin and has been reported for both gram-positive and enteric organisms.Further,there is the risk for cross-resistance with other antibacterial agents,especially clindamycin.Conclusions: Evidence shows that MDA-azithromycin programs may be beneficial for reducing trachoma,yaws,and mortality in children<5 years of age in certain under-resourced settings.However,there are significant potential risks that need to be considered when deciding how,when,and where to implement these programs.Robust systems to monitor benefits as well as adverse effects and antibacterial resistance are warranted in communities where MDA-azithromycin programs are implemented.
基金This study received financial support from a grant(R01 AI053695)from the National Institutes of Allergy and Infectious Diseases,National Institute of Health.
文摘Background:World Health Organization guidelines recommend preventive chemotherapy with praziquantel to control morbidity due to schistosomiasis.The primary aim of this cross-sectional study was to determine if 4 years of annual mass drug administration(MDA)in primary and secondary schools lowered potential markers of morbidity in infected children 1 year after the final MDA compared to infected children prior to initial MDA intervention.Methods:Between 2012 and 2016 all students in two primary and three secondary schools within three kilometers of Lake Victoria in western Kenya received annual mass praziquantel administration.To evaluate potential changes in morbidity we measured height,weight,mid-upper arm circumference,hemoglobin levels,abdominal ultrasound,and quality of life in children in these schools.This study compared two cross-sectional samples of Schistosoma mansoni egg-positive children:one at baseline and one at year five,1 year after the fourth annual MDA.Data were analyzed for all ages(6–18 years old)and stratified by primary(6–12 years old)and secondary(12–18 years old)school groups.Results:The prevalence of multiple potential morbidity markers did not differ significantly between the egg-positive participants at baseline and those at 5 years by Mann Whitney nonparametric analysis and Fisher’s exact test for continuous and categorical data,respectively.There was a small but significantly higher score in school-related quality of life assessment by year five compared to baseline by Mann Whitney analysis(P=0.048)in 13–18 year olds where malaria-negative.However,anemia was not positively impacted by four annual rounds of MDA,but registered a significant negative outcome.Conclusions:We did not detect differences in morbidity markers measured in a population of those infected or re-infected after multiple MDA.This could have been due to their relative insensitivity or a failure of MDA to prevent morbidity among those who remain infected.High malaria transmission in this area and/or a lack of suitable methods to measure the more subtle functional morbidities caused by schistosomiasis could be a factor.Further research is needed to identify and develop well-defined,easily quantifiable S.mansoni morbidity markers for this age group.
