Dual burden of diseases in resource poor countries : diabetes mellitus and neglected tropical diseases

Background: The prevalence of diabetes mellitus and neglected tropical diseases are nowadays escalating, especially in endemic resource poor countries and their impact on social and economic development are negatively huge. Recent studies indicate that diabetes mellitus problem is now truly global epidemic and a number of risk factors are contributed to diabetes. Dengue viral infections have been one of the most reemerging diseases worldwide in recent years and case fatalities are usually high among dengue infected individuals having any underlying co-morbid disease condition. Helminth or parasite infections mainly contribute to global burden of diseases and cause adverse events on health. Therefore, it is very important to understand the interaction between diabetes mellitus and neglected tropical diseases in clinical management for curative, as well as disease epidemiology for preventive purposes. Methods: Firstly, we conducted a systematic review and meta-analysis to summarize and update the current knowledge of diabetes mellitus and dengue viral infections as well as helminth or parasite infections. To follow up the findings between diabetes and parasite infections and to explore their association in epidemiological settings, we conducted two field studies. A cross-sectional community based study was carried out among adults in 4 provinces of Lao People’s Democratic Republic. We also investigated a longitudinal study among schoolchildren in poor neighborhoods of South Africa to figure out the comorbid association and effect of helminth infections on blood sugar concentration determined by HbA1c measurements after deworming. Results: In this PhD work, we found a positive relationship between diabetes mellitus and neglected tropical diseases we studied. Firstly, our systematic review and meta-analysis summarized that diabetic patients are more likely to have a severe form of dengue if they were infected with a dengue viral infection. In the context of relationship between diabetes mellitus and another neglected tropical disease, our findings showed that the prevalence and species of helminth infections were different in different country settings. In Laos PDR, food born trematodes were more prevalent and the prevalence of diabetes was also higher than estimated figures. We observed a positive relationship between diabetes mellitus and teania infection in Lao PDR setting. In South Africa, we found soil transmitted helminth infections and H. pylori infections were quite common among schoolchildren and the high numbers of prediabetic prevalence. A positive relationship between diabetes mellitus and H. pylori infections has been revealed in the study. No association has been found between diabetes and other infections. We also disclosed that HbA1c levels are more likely to increase after deworming. Conclusion: Our research work provides valuable insights of co-morbid association. It can be concluded that diabetes mellitus and dengue or taenia or H. Pylori infections have influenced each other not in a good way, either dengue infection or teania or H. Pylori infections exacerbate diabetes mellitus or vise visa. The patho-physiological mechanism behind these associations should be further explored. As diabetes is a multi-faceted disease, many other factors could also top up these interactions. Diabetes, dengue, parasitic infections remain of major public health concerns in both Laos PDR and South Africa. Hence, our findings call for action to establish a proper public health policy with an integrated approach addressing both diseases condition to reduce mortality and/or morbidity and to ameliorate clinical outcomes and preventive measures among affected population. Additional studies in other endemic countries are also greatly recommended to reflect our current findings to be able to apply for the implementation as a global perspective

Association between gastrointestinal tract infections and glycated hemoglobin in school children of poor neighborhoods in Port Elizabeth, South Africa

BACKGROUND: Low- and middle-income countries are facing a dual disease burden with infectious diseases (e.g., gastrointestinal tract infections) and non-communicable diseases (e.g., diabetes) being common. For instance, chronic parasite infections lead to altered immune regulatory networks, anemia, malnutrition, and diarrhea with an associated shift in the gut microbiome. These can all be pathways of potential relevance for insulin resistance and diabetes. The aim of this study was to investigate the association between common gastrointestinal tract infections and glycemia in children from non-fee paying schools in South Africa. METHODOLOGY: We conducted a cross-sectional survey among 9- to 14-year-old school children in Port Elizabeth. Stool and urine samples were collected to assess infection status with parasitic worms (e.g., Ascaris lumbricoides, Enterobius vermicularis, and Trichuris trichiura), intestinal protozoa (e.g., Cryptosporidium parvum and Giardia intestinalis), and the bacterium Helicobacter pylori. Glycated hemoglobin (HbA1c) was measured in finger prick derived capillary blood. All children at schools with a high prevalence of helminth infections and only infected children at the schools with low infection rates were treated with albendazole. The association of anthelmintic treatment with changes in HbA1c 6 months after the drug intervention was also investigated. FINDINGS: A high prevalence of 71.8% of prediabetes was measured in this group of children, with only 27.8% having HbA1c in the normal range. H. pylori was the predominant infectious agent and showed an independent positive association with HbA1c in a multivariable regression analysis (β = 0.040, 95% confidence interval (CI) 0.006-0.073, p<0.05). No association of HbA1c with either any other infectious agent or albendazole administration was found. CONCLUSION: The role of H. pylori in diabetes needs confirmation in the context of longitudinal treatment interventions. The specific effect of other gastrointestinal tract infections on glycemia remains unclear. Future studies should integrate the measurement of biomarkers, including immunological parameters, to shed light on the potential mediating mechanisms between parasite infections and diabetes

Defining the hidden burden of disease in rural communities in Bangladesh, Cambodia and Thailand: a cross-sectional household health survey protocol

Introduction In low-income and middle-income countries in Southeast Asia, the burden of diseases among rural population remains poorly understood, posing a challenge for effective healthcare prioritisation and resource allocation. Addressing this knowledge gap, the South and Southeast Asia Community-based Trials Network (SEACTN) will undertake a survey that aims to determine the prevalence of a wide range of non-communicable and communicable diseases, as one of the key initiatives of its first project-the Rural Febrile Illness project (RFI). This survey, alongside other RFI studies that explore fever aetiology, leading causes of mortality, and establishing village and health facility maps and profiles, will provide an updated epidemiological background of the rural areas where the network is operational. Methods and analysis During 2022-2023, a cross-sectional household survey will be conducted across three SEACTN sites in Bangladesh, Cambodia and Thailand. Using a two-stage cluster-sampling approach, we will employ a probability-proportional-to-size sample method for village, and a simple random sample for household, selection, enrolling all members from the selected households. Approximately 1500 participants will be enrolled per country. Participants will undergo questionnaire interview, physical examination and haemoglobin point-of-care testing. Blood samples will be collected and sent to central laboratories to test for chronic and acute infections, and biomarkers associated with cardiovascular disease, and diabetes. Prevalences will be presented as an overall estimate by country, and stratified and compared across sites and participants' sociodemographic characteristics. Associations between disease status, risk factors and other characteristics will be explored. Ethics and dissemination This study protocol has been approved by the Oxford Tropical Research Ethics Committee, National Research Ethics Committee of Bangladesh Medical Research Council, the Cambodian National Ethics Committee for Health Research, the Chiang Rai Provincial Public Health Research Ethical Committee. The results will be disseminated via the local health authorities and partners, peer-reviewed journals and conference presentations. Trial registration number NCT05389540

Defining the burden of febrile illness in rural South and Southeast Asia: an open letter to announce the launch of the Rural Febrile Illness project.

In rural areas of South and Southeast Asia malaria is declining but febrile illnesses still account for substantial morbidity and mortality. Village health workers (VHWs) are often the first point of contact with the formal health system, and for patients with febrile illnesses they can provide early diagnosis and treatment of malaria. However, for the majority of febrile patients, VHWs lack the training, support and resources to provide further care. Consequently, treatable bacterial illnesses are missed, antibiotics are overused and poorly targeted, and patient attendance wanes along with declining malaria. This announces the start of a new initiative, the Rural Febrile Illness (RFI) project, the first in a series of projects to be implemented as part of the South and Southeast Asian Community-based Trials Network (SEACTN) research programme. This multi-country, multi-site project will begin in Bangladesh, Cambodia, Lao PDR, and Myanmar and will define the epidemiological baseline of febrile illness in five remote and underserved areas of Asia where malaria endemicity is declining and access to health services is limited. The RFI project aims to determine the incidence, causes and outcomes of febrile illness; understand the opportunities, barriers and appetite for adjustment of the role of VHWs to include management of non-malarial febrile illnesses; and establish a network of community healthcare providers and facilities capable of implementing interventions designed to triage, diagnose and treat patients presenting with febrile illnesses within these communities in the future. [Abstract copyright: Copyright: © 2021 Chandna A et al.

Meta-analysis of case-control studies on the association between diabetes mellitus and a severe clinical presentation of dengue.

<p>Meta-analysis of case-control studies on the association between diabetes mellitus and a severe clinical presentation of dengue.</p

Summary of case-control studies and case series.

<p>Summary of case-control studies and case series.</p

PRISMA flow diagram of diabetes and dengue.

<p>PRISMA flow diagram of diabetes and dengue.</p

Adjusted associations of infection with HbA1c at baseline.

<p>Adjusted associations of infection with HbA1c at baseline.</p

Children retained in the study sample for complete case analysis.

<p>Children retained in the study sample for complete case analysis.</p

Baseline prevalence (%) of gastrointestinal tract infections, stratified by schools.

<p>Baseline prevalence (%) of gastrointestinal tract infections, stratified by schools.</p