Yaws.

Yaws is an infectious disease caused by Treponema pallidum pertenue-a bacterium that closely resembles the causative agent of syphilis-and is spread by skin-to-skin contact in humid tropical regions. Yaws causes disfiguring, and sometimes painful lesions of the skin and bones. As with syphilis, clinical manifestations can be divided into three stages; however, unlike syphilis, mother-to-child transmission does not occur. A major campaign to eradicate yaws in the 1950s and 1960s, by mass treatment of affected communities with longacting, injectable penicillin, reduced the number of cases by 95% worldwide, but yaws has reappeared in recent years in Africa, Asia, and the western Pacific. In 2012, one oral dose of azithromycin was shown to be as effective as intramuscular penicillin in the treatment of the disease, and WHO launched a new initiative to eradicate yaws by 2020

Podoconiosis, skin-NTDs and global health.

Skin diseases affect more than 900 million persons globally each year and, as a result, are amongst the commonest conditions seen by healthcare workers. In most countries with tropical climates, many patients coming to a primary health centre have a skin problem and, although the prevalence of many endemic skin diseases such as scabies is variable and changes over time, it may reach unsustainable rates, greater than 15% in some communities. Equally, many of the important disabling infections that are public health priorities in the poorest tropical regions, such as onchocerciasis, leprosy, yaws, Buruli ulcer, mycetoma, lymphatic filariasis and leishmaniasis in addition to scabies, known collectively as Neglected Tropical Diseases or NTDs, present with skin signs and symptoms (skin NTDs)

Yaws.

INTRODUCTION: Yaws, caused by Treponema pallidum ssp. pertenue, is endemic in parts of West Africa, Southeast Asia and the Pacific. The WHO has launched a campaign based on mass treatment with azithromycin, to eradicate yaws by 2020. SOURCES OF DATA: We reviewed published data, surveillance data and data presented at yaws eradication meetings. AREAS OF AGREEMENT: Azithromycin is now the preferred agent for treating yaws. Point-of-care tests have demonstrated their value in yaws. AREAS OF CONTROVERSY: There is limited data from 76 countries, which previously reported yaws. Different doses of azithromycin are used in community mass treatment for yaws and trachoma. GROWING POINTS: Yaws eradication appears an achievable goal. The programme will require considerable support from partners across health and development sectors. AREAS TIMELY FOR DEVELOPING RESEARCH: Studies to complete baseline mapping, integrate diagnostic tests into surveillance and assess the impact of community mass treatment with azithromycin are ongoing

Yaws

Introduction Yaws, caused by Treponema pallidum ssp. pertenue, is endemic in parts of West Africa, Southeast Asia and the Pacific. The WHO has launched a campaign based on mass treatment with azithromycin, to eradicate yaws by 2020. Sources of data We reviewed published data, surveillance data and data presented at yaws eradication meetings. Areas of agreement Azithromycin is now the preferred agent for treating yaws. Point-of-care tests have demonstrated their value in yaws. Areas of controversy There is limited data from 76 countries, which previously reported yaws. Different doses of azithromycin are used in community mass treatment for yaws and trachoma. Growing points Yaws eradication appears an achievable goal. The programme will require considerable support from partners across health and development sectors. Areas timely for developing research Studies to complete baseline mapping, integrate diagnostic tests into surveillance and assess the impact of community mass treatment with azithromycin are ongoin

Nutrition and Lifestyle Modifications in the Prevention and Treatment of Non-Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is a burgeoning health problem worldwide. NAFLD is an umbrella term for a range of liver conditions affecting people who drink little to no alcohol Different methods are employed in the diagnosis of NAFLD. Certain drugs, genetics, lifestyle factors have been implicated in the development of NAFLD. NAFLD symptoms are asymptomatic but indicated when there is unexplained persistent elevation of liver enzyme levels. Nutrition and lifestyle modifications are widely prescribed as helpful in the prevention and treatment of Non-Alcoholic Fatty Liver disease (NAFLD). Dietary and lifestyle modifications are apparent measures considering the disease association with obesity, diabetes, and cardiovascular disease which many reviews have linked to the condition. Reduction in body weight, involvement in both aerobic and anaerobic exercises, conscious intake in the types of fat and carbohydrates are helpful in the management of NAFLD. This chapter highlights the various theories and principles underlying nutrition and lifestyle modifications in the prevention and treatment of NAFLDs

Buruli Ulcer in Ghana: Results of a National Case Search

A national search for cases of Buruli ulcer in Ghana identified 5,619 patients, with 6,332 clinical lesions at various stages. The overall crude national prevalence rate of active lesions was 20.7 per 100,000, but the rate was 150.8 per 100,000 in the most disease-endemic district. The case search demonstrated widespread disease and gross underreporting compared with the routine reporting system. The epidemiologic information gathered will contribute to the design of control programs for Buruli ulcer

Prioritizing surveillance activities for certification of yaws eradication based on a review and model of historical case reporting

BACKGROUNDt: The World Health Organization (WHO) has targeted yaws for global eradication. Eradication requires certification that all countries are yaws-free. While only 14 Member States currently report cases to WHO, many more are known to have a history of yaws and some of them may have ongoing transmission. We reviewed the literature and developed a model of case reports to identify countries in which passive surveillance is likely to find and report cases if transmission is still occurring, with the goal of reducing the number of countries in which more costly active surveillance will be required. METHODSt: We reviewed published and unpublished documents to extract data on the number of yaws cases reported to WHO or appearing in other literature in any year between 1945 and 2015. We classified countries as: a) having interrupted transmission; b) being currently endemic; c) being previously endemic (current status unknown); or d) having no history of yaws. We constructed a panel dataset for the years 1945-2015 and ran a regression model to identify factors associated with some countries not reporting cases during periods when there was ongoing (and documented) transmission. For previously endemic countries whose current status is unknown, we then estimated the probability that countries would have reported cases if there had in fact been transmission in the last three years (2013-2015)." - Label: RESULTS content: Yaws has been reported in 103 of the 237 countries and areas considered. 14 Member States and 1 territory (Wallis and Futuna Islands) are currently endemic. 2 countries are believed to have interrupted transmission. 86 countries and areas are previously endemic (current status unknown). Reported cases peaked in the 1950s, with 55 countries reporting at least one case in 1950 and a total of 2.35 million cases reported in 1954. Our regression model suggests that case reporting during periods of ongoing transmission is positively associated with socioeconomic development and, in the short-term, negatively associated with independence. We estimated that for 66 out of the 86 previously endemic countries whose current status is unknown, the probability of reporting cases in the absence of active surveillance is less than 50%. DISCUSSION: Countries with a history of yaws need to be prioritized so that international resources for global yaws eradication may be deployed efficiently. Heretofore, the focus has been on mass treatment in countries currently reporting cases. It is also important to undertake surveillance in the 86 previously endemic countries for which the current status is unknown. Within this large and diverse group, we have identified a group of 20 countries with more than a 50% probability of reporting cases in the absence of active surveillance. For the other 66 countries, international support for active surveillance will likely be required

The cost and cost-effectiveness of rapid testing strategies for yaws diagnosis and surveillance.

BACKGROUND: Yaws is a non-venereal treponemal infection caused by Treponema pallidum subspecies pertenue. The disease is targeted by WHO for eradication by 2020. Rapid diagnostic tests (RDTs) are envisaged for confirmation of clinical cases during treatment campaigns and for certification of the interruption of transmission. Yaws testing requires both treponemal (trep) and non-treponemal (non-trep) assays for diagnosis of current infection. We evaluate a sequential testing strategy (using a treponemal RDT before a trep/non-trep RDT) in terms of cost and cost-effectiveness, relative to a single-assay combined testing strategy (using the trep/non-trep RDT alone), for two use cases: individual diagnosis and community surveillance. METHODS: We use cohort decision analysis to examine the diagnostic and cost outcomes. We estimate cost and cost-effectiveness of the alternative testing strategies at different levels of prevalence of past/current infection and current infection under each use case. We take the perspective of the global yaws eradication programme. We calculate the total number of correct diagnoses for each strategy over a range of plausible prevalences. We employ probabilistic sensitivity analysis (PSA) to account for uncertainty and report 95% intervals. RESULTS: At current prices of the treponemal and trep/non-trep RDTs, the sequential strategy is cost-saving for individual diagnosis at prevalence of past/current infection less than 85% (81-90); it is cost-saving for surveillance at less than 100%. The threshold price of the trep/non-trep RDT (below which the sequential strategy would no longer be cost-saving) is US$1.08 (1.02-1.14) for individual diagnosis at high prevalence of past/current infection (51$ 0.54 (0.52-0.56) for community surveillance at low prevalence (15%). DISCUSSION: We find that the sequential strategy is cost-saving for both diagnosis and surveillance in most relevant settings. In the absence of evidence assessing relative performance (sensitivity and specificity), cost-effectiveness is uncertain. However, the conditions under which the combined test only strategy might be more cost-effective than the sequential strategy are limited. A cheaper trep/non-trep RDT is needed, costing no more than US$ 0.50-1.00, depending on the use case. Our results will help enhance the cost-effectiveness of yaws programmes in the 13 countries known to be currently endemic. It will also inform efforts in the much larger group of 71 countries with a history of yaws, many of which will have to undertake surveillance to confirm the interruption of transmission

Mothers/Caregivers Age and Family Structure Predicted Knowledge on Recommended Nutrition Practices for Children under 5 Years

Introduction: There are recommendations regarding infant and young child feeding and when followed children’s growth are optimum. These feeding practices are age definitive, starting from exclusive breastfeeding, to the transition of the child to complementary foods. Objective: The objective of this study was to assess factors that determine nutritional knowledge among mothers/caretaker regarding children under five years. Methods: A cross sectional study design employing quantitative methods was chosen for this study. The study population comprised 285 caregivers and their children aged of 6 and 59 months. Respondents were chosen randomly from four hard-to-reach communities and two peri-urban communities within three sub-municipalities, who lived in and accessed child welfare services during the study period. Face-to-face interviews were used to collect background and nutritional knowledge data from the respondents. Maternal/caretaker knowledge on recommended nutritional practice was split into two with scores were greater than 7 out of the 13 knowledge items was considered as good. STATA version 14 was used to analyze data and statistical significance determine at 95% confidence interval.Results: The average age of the children under 5 years and their mothers/caretakers were 32 months and 29 years respectively. About 73% had nuclear family structure. Results of Chi square and Fisher’s exact tests for association indicated that, mother’s/caretaker’s age (p<0.001), family structure (p=0.010) and access to media information (p<0.001) were significantly associated with mother’s good nutritional knowledge on recommended practices. Mothers/caretakers age (OR=0.17; 95%CI: (0.70-0.43); family structure (OR=0.30; 95% CI (0.11-0.78) and access to media (AOR=5.12; 95% (2.46-10.69) predicted mothers nutritional knowledge. Conclusions: Maternal/caretaker factors predicted nutritional knowledge when feeding a child in both peri-urban and rural areas. These factors should be considered when promoting child nutrition