Association between footwear use and neglected tropical diseases: a systematic review and meta-analysis

BACKGROUND The control of neglected tropical diseases (NTDs) has primarily focused on preventive chemotherapy and case management. Less attention has been placed on the role of ensuring access to adequate water, sanitation, and hygiene and personal preventive measures in reducing exposure to infection. Our aim was to assess whether footwear use was associated with a lower risk of selected NTDs. METHODOLOGY We conducted a systematic review and meta-analysis to assess the association between footwear use and infection or disease for those NTDs for which the route of transmission or occurrence may be through the feet. We included Buruli ulcer, cutaneous larva migrans (CLM), leptospirosis, mycetoma, myiasis, podoconiosis, snakebite, tungiasis, and soil-transmitted helminth (STH) infections, particularly hookworm infection and strongyloidiasis. We searched Medline, Embase, Cochrane, Web of Science, CINAHL Plus, and Popline databases, contacted experts, and hand-searched reference lists for eligible studies. The search was conducted in English without language, publication status, or date restrictions up to January 2014. Studies were eligible for inclusion if they reported a measure of the association between footwear use and the risk of each NTD. Publication bias was assessed using funnel plots. Descriptive study characteristics and methodological quality of the included studies were summarized. For each study outcome, both outcome and exposure data were abstracted and crude and adjusted effect estimates presented. Individual and summary odds ratio (OR) estimates and corresponding 95% confidence intervals (CIs) were calculated as a measure of intervention effect, using random effects meta-analyses. PRINCIPAL FINDINGS Among the 427 studies screened, 53 met our inclusion criteria. Footwear use was significantly associated with a lower odds of infection of Buruli ulcer (OR=0.15; 95% CI: 0.08-0.29), CLM (OR=0.24; 95% CI: 0.06-0.96), tungiasis (OR=0.42; 95% CI: 0.26-0.70), hookworm infection (OR=0.48; 95% CI: 0.37-0.61), any STH infection (OR=0.57; 95% CI: 0.39-0.84), strongyloidiasis (OR=0.56; 95% CI: 0.38-0.83), and leptospirosis (OR=0.59; 95% CI: 0.37-0.94). No significant association between footwear use and podoconiosis (OR=0.63; 95% CI: 0.38-1.05) was found and no data were available for mycetoma, myiasis, and snakebite. The main limitations were evidence of heterogeneity and poor study quality inherent to the observational studies included. CONCLUSIONS/SIGNIFICANCE Our results show that footwear use was associated with a lower odds of several different NTDs. Access to footwear should be prioritized alongside existing NTD interventions to ensure a lasting reduction of multiple NTDs and to accelerate their control and elimination. PROTOCOL REGISTRATION PROSPERO International prospective register of systematic reviews CRD42012003338

COMPARATIVE EFFECTIVENESS AND OPTIONAL PERIOD OF THE FLOTATION METHOD USING NaCl, ZnSO4 AND MgSO4 FOR THE DIAGNOSTIC OF SOIL-TRANSMITTED HELMINTHS

Background. Factors that affect the effectiveness of flotation method in Soil-transmitted helminths diagnostic are flotation solution and optional period. Further research is required to determine the optional period that gives the best effectiveness from three flotation solutions, which are NaCl, MgSO4, and ZnSO4. Aim. To compare the effectiveness of NaCl, MgSO4 and ZnSO4 as flotation solution in flotation method and the best optional period of each floating solution determined by counting number of eggs. Methods. This research was quasi-experimental analytic with two independent variable. Independent variables 1 were flotation solutions (saturated NaCl, MgSO4 and ZnSO4) . Independent variables 2 were optional period (15,30,45,60 and 70 minutes). Each combination of treatments performed on 8 samples. Results. There were significant differences between different of optional periods in one solution .The same optional period for each solution ( saturated NaCl, saturated MgSO4 and saturated ZnSO4) were not gives siginificant differences. The difference considered significant when the p value < 0.05. The most number of eggs found in NaCl was at 60 minutes, ZnSO4 at 45 minutes, and MgSO4 at 45 minutes). Conclusion. The optimum of optional period for each solution were: saturated NaCl (60 minutes), ZnSO4 (45 minutes), and MgSO4 (45 minutes). Flotation method using ZnSO4 as solution with 45 minutes as optional period considered as the most effective method based on number eggs found and time. In other hand, the effectiveness of the flotation method obtained either with NaCl, MgSO4 and ZnSO4 in all level of optional period were same. Keywords: flotation method, soil transmitted helminths, parasite diagnosti

Medical Ecology

Author Institution: Department of Zoology, Miami Universit

Health, Hygiene and Sanitation in Latin America, c.1870 to c.1950

This Research Paper sets out to examine transitions within health care in Latin America between c. 1870 and c. 1950 and offers a preliminary synthesis. Whereas a powerful historiography has evolved over the past thirty years that strives to synthesise diffuse materials on the insertion of Latin America into the world economy and subsequent 'de-linkage', there are few attempts to summarise the historiography of social policy. Given the embryonic nature of the subject, the author is trying to avoid premature generalisation and excessive claims, and is fully conscious that more questions are raised than are resolved by this paper. A broad chronological canvas is adopted, which is useful in clarifying diversity within the continent, but can also obscure issues of periodisation. The first section enquires into the relationship between the genesis of a modern public health policy and the experience of tackling epidemic and endemic diseases, and reviews the motives behind ameliorative health measures undertaken by the state and business, especially foreign enterprise, and their significance. The second section investigates the interaction between external forces and domestic changes: both the role of an international voluntary agency in tackling prostitution and, by implication, venereal diseases; and the significance of missions from developed countries that aimed to raise an alertness to modern methodology and investigation in 'tropical medicine', to institutionalise public health laboratories, and to undertake 'campaigns' against targeted diseases. This section concludes with an analysis of a specific example of externally inspired innovation in hygiene and sanitation: the Panama Canal. There follows a section that uses the special case of Rio de Janeiro to elucidate problems of evolving a public health policy for cities; and from that vantage point looks at the beginnings of public health policy in the Brazilian countryside. The penultimate section looks at the diffusion of scientific knowledge, the limits to its impact and the resilience of Luso-Hispanic, Amerindian and Afro-Latin American traditions of healing and curing. The final section consists of notes on the nature of the relationship between levels of health and of nutrition and housing

A national study of gastrointestinal parasites infecting dogs and cats in Australia

Despite the popularity of companion animal ownership in Australia, recent and comprehensive information with regard to the prevalence, epidemiology and public health significance associated with gastrointestinal parasites of pet dogs and cats in Australia is largely lacking. The primary aims of this study were to close this knowledge gap and to evaluate the veterinarian’s perception, awareness and knowledge of GI parasites in their locality, from a veterinary and public health stand-point. This included sourcing information with regard to commonly recommended deworming protocols. The awareness of pet owners regarding parasitic zoonoses and the degree of education provided to them by veterinarians was also determined. A total of 1400 canine and 1063 feline faecal samples were collected from veterinary clinics and refuges from across Australia. The overall prevalence of gastrointestinal parasites in dogs and cats was 23.9% (CI 21.7-26.1) and 18.4% (CI 16.1-20.7), respectively. Overall Giardia duodenalis was the most prevalent parasite in dogs (9.3%, CI 7.8-10.8) followed by hookworm (6.7%, CI 5.4-8.0). Isospora felis was the most prevalent parasite in cats (5.6%, CI 4.2-7.0), followed by Toxocara cati (3.2%, CI 2.1-4.3). A highly sensitive and species-specific PCR-RFLP technique was utilized to differentiate the various hookworm species which can infect dogs and cats directly from eggs in faeces. Ancylostoma ceylanicum was detected for the first time in Australia in 10.9% of the dogs found positive for hookworm. This was a significant finding in terms of the zoonotic risk associated with this parasite. The zoonotic potential of Giardia and Cryptosporidium was investigated by genetically characterising isolates recovered from dogs and cats. All but one of the Giardia isolates successfully genotyped were host specific, indicating a low zoonotic risk. It was hypothesized that the lack of zoonotic Giardia Assemblages was a consequence of there being a low prevalence of Giardia in the human population. The Cryptosporidium recovered from dogs and cats was determined to be Cryptosporidium canis and Cryptosporidium felis respectively, a finding which supports growing evidence that Cryptosporidium in companion animals is of limited public health significance to healthy people. Very few of the veterinarians surveyed in the study routinely discussed the zoonotic potential of pet parasites with clients. Most of the veterinarians recommended the regular prophylactic administration of anthelmintics throughout a pet’s life. The low national prevalence of GI parasites reported is most likely a consequence of the widespread use of anthelmintics by pet owners. There is an over-reliance on anthelmintics by veterinarians to prevent and control parasites and their zoonotic risk. This has resulted in veterinarians becoming complacent about educating pet owners about parasites. A combination of routinely screening faecal samples for parasites, strategic anthelmintic regimes and improved pet owner education is recommended for the control of GI parasites in pet dogs and cats in Australia

The role of nutrition in integrated programs to control neglected tropical diseases

There are strong and direct relationships between undernutrition and the disease caused by infectious organisms, including the diverse pathogens labeled as neglected tropical diseases (NTDs). Undernutrition increases the risk of infection, the severity of disease and the risk that children will die, while the physical damage, loss of appetite, and host responses during chronic infection can contribute substantially to undernutrition. These relationships are often synergistic. This opinion article examines the role of nutrition in controlling NTDs and makes the point that mass drug treatment - the major strategy currently proposed to control several diseases - is crucial to controlling disease and transmission, but is only the start of the process of physical recovery. Without adequate energy and nutrients to repair damaged tissues or recover lost growth and development, the benefits of treatment may not be evident quickly; the effects of control programs may be not appreciated by beneficiaries; while vulnerability to reinfection and disease may not be reduced. There is substantial potential for nutritional interventions to be added to large-scale programs to deliver drug treatments and thereby contribute, within a broad strategy of public health interventions and behavior change activities, to controlling and preventing NTDs in populations, and to restoring their health

Interactions between health and farm-labor productivity:

In the 21st century, agriculture remains fundamental to economic growth, poverty alleviation, improvement in rural livelihood, and environmental sustainability (World Bank 2007). Three-quarters of the world's poor live in rural areas, particularly in Asia and Africa (Ravallion, Chen, and Sangraula 2007), and depend on agriculture as their primary source of livelihood. This report provides an overview of current knowledge of the impact of health issues on farm-level productivity and decisionmaking, and the impact of agriculture on health. Findings are based on a review of the relevant studies of agricultural regions throughout the developing world. Two conceptual frameworks are used to frame this research: (1) Examining the two-way linkages between agriculture and health (2) Tracking the pathway from a disease condition to its effects, including impacts on household decisionmaking and ultimate impacts on livelihood. Agriculture underpins the health of rural households. It provides income that makes households resilient to health shocks; it provides food to meet their nutrient and energy needs; and it provides medicinal plants for treating ailments. But agricultural systems can also have negative effects on health. Agricultural development may lead to environmental change with adverse health impacts: for example, irrigation dams that create suitable conditions for mosquitoes may lead to increased incidence of malaria locally. The use of agricultural inputs such as pesticides by untrained farm personnel often causes illness. Improper food harvesting and storage practices allow mycotoxins to flourish. Lack of diet diversity can lead to malnutrition. Certain animal diseases also can infect humans. Labor migration (including agricultural labor migration) can contribute to high incidence of HIV infection. The effects of ill health on farm households include three broad impacts: absenteeism from work due to morbidity (and eventual death); family time diverted to caring for the sick; and loss of savings and assets in dealing with disease and its consequences. The long-term impacts of ill health include loss of farming knowledge, reduction of land under cultivation, planting of less labor-intensive crops, reduction of variety of crops planted, and reduction of livestock. The ultimate impact of ill health is a decline in household income and possible food insecurity—that is, a severe deterioration in household livelihood. The research found that the household's ability to cope with a shock reflected both its asset portfolio—including human, physical, and financial assets—and its intangible social resources. Good health must be seen as both an investment and consumption asset, like agricultural production, in that it has compounding returns. Health problems, conversely, may trigger a cycle of lowered agricultural productivity and poor health. At the household level, the investment in health can improve resilience and enhance the ability to cope with emergencies, including ill health. But an investment in health in turn requires an adequate livelihood. Access to appropriate inputs (knowledge, land, tools, fertilizer, and seeds) and remunerative markets is necessary to improve the productivity, health, and resilience of farm households.health, Labor, productivity,

General health conditions in the dog population of Lilongwe

In many cases, disease in the animal population is regarded as only an animal health issue, but may often also constitute a risk to public health. This applies especially in developing countries where people often are living under conditions of extreme poverty and then often in close proximity to their animals. It is often cheaper to prevent diseases within the animal population than it is to treat disease in the human population. However, to prevent diseases in a population it is important to know which infectious diseases are circulating. The aim of this study was to determine the prevalence of selected infectious diseases in the dog population in Lilongwe, Malawi, by testing a sample population of 100 dogs. Samples were collected from 40 free roaming dogs and 40 dogs kept chained outdoors, all participating in vaccination and spaying campaigns. In addition, samples were collected from 20 dogs visiting the Lilongwe Society for Protection and Care of Animals veterinary clinic as clients. In total 100 blood samples and 40 faecal samples were analysed and 100 dogs went through a general physical exam including getting their coats checked for ectoparasites. The blood samples were analysed using commercial snap tests and the faecal samples by faecal floatation in saturated NaCl. The sampled population had a prevalence of 12% for Anaplasma spp, 22% for Ehrlichia canis, 4% for Dirofilaria immitis and 1% for Leishmania spp. No dogs were positive for antibodies against Borrelia burgdorferi. Eggs from Ancylostoma spp were found in 80% of the collected faecal samples. Trichuris vulpis, Toxocara canis and Toxoscaris leonine were not as common with a prevalence of 2.5%, 7.5% and 12.5% respectively. There was a high prevalence of ectoparasites, especially fleas which were present on 97.5% of the sampled community dogs and also lice that were present on 25.0%. Ticks were not as common with a prevalence of 11.3%. Ectoparasites were not as common on the client dogs, assumingly because of regular treatment with different spot-on medication and lesser contact with other dogs and infected environment.I många fall anses sjukdomar i djurpopulationen vara enbart ett djurvälfärdsproblem men de kan även utgöra en risk för humanhälsan. Detta gäller framför allt i utvecklingsländer där människor lever i utbredd fattigdom och djuren ofta hålls i närmiljön. Det är ofta billigare att förebygga sjukdom i djurpopulationen än vad det är att behandla sjukdom i den humana populationen. För att förebygga sjukdom i en population är det dock viktigt att veta vilka infektiösa sjukdomar som cirkulerar. Målet med denna studie var att bestämma prevalensen av utvalda infektiösa sjukdomar hos hundpopulationen i Lilongwe, Malawi. Detta gjordes genom att en grupp på 100 hundar provtogs. Prover samlades in från 80 hundar som deltog i vaccinations eller kastrationskampanjen samt 20 hundar som besökte Lilongwe Society for Protection and Care of Animals-kliniken som patienter. Av kampanjhundarna hölls 40 frigående och 40 fastkedjade utomhus. Totalt samlades 100 blodprover och 40 avföringsprov in och analyserades. Samtliga 100 hundar genomgick först en generell hälsokontroll som inkluderade att deras päls undersöktes för närvaro av ektoparasiter. Blodproverna analyserades med hjälp av kommersiella snap-tester och avföringsproverna genom faecal flotation i mättad NaCl. I den provtagna populationen var prevalensen 12% för Anaplasma spp, 22% för Ehrlichia canis, 4% för Dirofilaria immitis och 1% för Leishmania spp. Inga hundar var positiva för antikroppar mot Borrelia burgdorferi. Ägg från Ancylostoma spp påvisades i 80% av de insamlade avföringsproverna. Trichuris vulpis, Toxocara canis och Toxoscaris leonine var inte lika vanliga med prevalenser på 2,5%, 7,5% och 12,5%. Prevalensen för ektoparasiter var hög, speciellt för loppor vilka 97,5% av kampanjhundarna hade. Löss var närvarande hos 25% av kampanjhundarna men fästingar var inte lika vanliga med en prevalens på enbart 11,3%. Ektoparasiter var inte lika vanligt förekommande hos hundarna som kom till kliniken, troligen tack vare regelbunden lusbehandling med spot on preparat och mindre kontakt med andra hundar och infekterad miljö

Parasitic nematodes in humans : exploring the host-parasite dynamic through historical, biological, and public health evaluations of infection.

This thesis investigated infection dynamics of parasitic nematodes at both the population and individual levels by exploring evolutionary and historical aspects of infection as well as how host-parasite interactions influence virulence. In particular, this thesis sought to answer questions of how host populations have influenced the spread of infection and how transmission determines infection virulence, with a final goal of understanding how eradication programs for parasites can be developed or improved with this knowledge. The host-parasite dynamic was explored throughout history, with particular focus on the ways host populations have shaped infection distribution in present, historic, and prehistoric times. Then, data for each nematode was systemically collected and presented for a comprehensive analysis of virulence and transmission mode. It was discovered that microparasitic principles of virulence can be applied limitedly to predict virulence of macroparasitic nematodes, and the relative virulence of each nematode can be explained partially by transmission mode