Strengthening cutaneous leishmaniasis control in Guatemala: policy recommendations

The country incidence rate of cutaneous leishmaniasis (CL) in Guatemala has increased from 3.14 per 100,000 inhabitants in 2011 to 6.24 per 100,000 inhabitants in 2019, (Fig.1) (1), probably due to a combination of improved active surveillance (2), climate changes (3,4), and occupational activities involving continued forest contact (5) among others. A national control program has been in place since 2003, but continued efforts are generating uneven results for the different endemic communities. Nationwide actions for CL control include active and passive surveillance, diagnosis and treatment offered free of cost by the Ministry of Health (MoH) and awareness-raising activities. We explored barriers and facilitators of CL control in Guatemala as experienced and perceived by service users and providers in order to inform evidence-based strategies to strengthen CL control in the country

Global epidemiology of podoconiosis: a systematic review

Background Podoconiosis is one of the few diseases that could potentially be eliminated within one generation. Nonetheless, the global distribution of the disease remains largely unknown. The global atlas of podoconiosis was conceived to define the epidemiology and distribution of podoconiosis through dedicated surveys and assembling the available epidemiological data. Methods We have synthesized the published literature on the epidemiology of podoconiosis. Through systematic searches in SCOPUS and MEDLINE from inception to February 14, 2018, we identified observational and population-based studies reporting podoconiosis. To establish existence of podoconiosis, we used case reports and presence data. For a study to be included in the prevalence synthesis, it needed to be a population-based survey that involved all residents within a specific area. Studies that did not report original data were excluded. We undertook descriptive analyses of the extracted data. This study is registered with PROSPERO, number CRD42018084959. Results We identified 3,260 records, of which 27 studies met the inclusion criteria. Podoconiosis was described to exist or be endemic in 32 countries, 18 from the African Region, 3 from Asia and 11 from Latin America. Overall, podoconiosis prevalence ranged from 0·10% to 8.08%, was highest in the African region, and was substantially higher in adults than in children and adolescents. The highest reported prevalence values were in Africa (8.08% in Cameroon, 7.45% in Ethiopia, 4.52% in Uganda, 3.87% in Kenya and 2.51% in Tanzania). In India, a single prevalence of 0.21% was recorded from Manipur, Mizoram and Rajasthan states. None of the Latin American countries reported prevalence data. Conclusion Our data suggest that podoconiosis is more widespread in the African Region than in the rest of the regions, although this could be related to the fact that most podoconiosis epidemiological research has been focused in the African continent. The assembled dataset confirms that comprehensive podoconiosis control strategies such as promotion of footwear and personal hygiene are urgently needed in endemic parts of Africa. Mapping, active surveillance and a systematic approach to the monitoring of disease burden must accompany the implementation of podoconiosis control activities

The global dimensions of health

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Risk negotiations in the mines of Potosí: implications for rethinking current Health and Safety approaches

It is generally agreed that knowledge of the causes and consequences of a particular risk influences how people prepare for and respond to it. Ethnographic research in Potosí (Bolivia) shows however a more complex scenario, in which miners simultaneously face a number of physical and socio-economic risks and uncertainties that must be carefully weighed against each other. Miners often have little or no control over most of these risks that affect them, and health and safety risks are only a small group of concerns. Prone to take health risks at work as a strategy to manage other risks that simultaneously affect them, the Potosí’s miners are well aware of the potential losses of taking these risks, but also of the potential gains of their decisions

‘My appetite and mind would go’: Inuit perceptions of (im)mobility and wellbeing loss under climate change across Inuit Nunangat in the Canadian Arctic

Abstract The academic literature on personal experiences of climate-induced wellbeing erosion (often conceptualised as ‘non-economic losses and damages’) is still limited. This represents a serious climate policy gap that hinders support for marginalised people across the world including Indigenous People. Lately, we have seen a rapid growth in empirical studies exploring linkages between climate change and mental health among Indigenous Inuit in Canada. However, its association with human (im)mobility remains unexplored. This review article brings together the empirical evidence of Inuit experiences and perceptions of climate-related wellbeing loss and (im)mobility while providing climate policy with guidance for appropriate action. The systematic review investigates how Inuit in Arctic Canada felt that climatic changes impacted their (im)mobility and mental health while putting these feelings into a wider context of colonial violence, forced child removal, the residential schools, and other systematic human rights abuses. Twelve electronic databases (four specific to Arctic research) were searched for English and French, peer reviewed, qualitative studies published between 2000 and 2021. Fifteen selected articles were analysed using NVivo and thematic narrative analysis from a climate-violence-health nexus systems approach. Three overarching climate-related wellbeing loss themes, all strongly intertwined with feelings of immobility, emerged from the literature namely ‘identity and cultural loss’, ‘land connection as a source of healing’, and ‘changing environment triggering emotional distress’. The narratives circled around Inuit land connection and how climate-induced temporary (im)mobility interrupted this relationship. Climatic changes isolated Inuit away from the land and cut off their ability to partake in land activities. This strongly eroded Inuit wellbeing, expressed through distress, anxiety, depression, social tension, suicide ideation and deep feelings of cultural loss. The findings showed how Inuit mental health strongly depend on a sustained connection to the land. Further empirical research among other Indigenous People or nomadic groups on wellbeing loss and climate-induced involuntary immobility is urgently needed. Future research should particularly explore how such mental health impacts tie into past and present (post)colonial traumas and current suicide occurrences. This will help climate policy, research, and adaptation planning better prepare and propose more contextually and culturally appropriate health actions in the future

Cutaneous leishmaniasis control in Alta Verapaz (northern Guatemala): evaluating current efforts through stakeholders’ experiences

Background Cutaneous leishmaniasis (CL), endemic in Guatemala, mostly affects poor people living in the northern region. A national control program that includes surveillance, diagnose, and treatment offered free of cost by the Ministry of Health (MoH) has been in place since 2003. However, the incidence is increasing and treatment rates are not optimal, suggesting that current efforts are not being effective. This study aimed to understand barriers and facilitators of CL control in Guatemala as experienced and perceived by key stakeholders in order to comprehend what works well and does not and suggest evidence-informed interventions. Methods The study was conducted in the Cobán municipality, the most endemic of Guatemala, situated in the Department of Alta Verapaz. Data were collected during May and June 2019 via focus groups and semi-structured interviews with key stakeholders, including local and national health personnel and residents of four communities of the endemic region. Thematic and content analysis of the collected data was conducted using NVIVO. Results Three overarching issues hamper the effectiveness of current CL efforts: resource scarcity, treatment challenges, and knowledge-action gaps. Scarce economic resources from the MoH and community residents negatively impact incidence, detection of cases and treatment rates in that preventive action is insufficient and healthcare access is low. In addition, local health workers often lack specialized CL training and access to the national CL control guidelines. With regards to the population living in the study area, misunderstanding of disease causation, shame associated with CL lesions, treatment pain fear, and long (often uncertain) waiting times for diagnose and treatment negatively affect people’s willingness to seek help, treatment adherence, and their trust on the healthcare provided. Conclusions Culturally sensitive CL preventive action must be developed. Given the scarce economic resources available for CL control in the country, the involvement of trained community health workers and the inclusion of thermotherapy as a treatment option is also advised. Other cost-effective actions include: ensuring all health workers receive CL training and have access to national CL control guidelines, improving national procurement system to avoid treatment shortages, and provision of motorized vehicles to increase active surveillance and treatment rates

Countries reporting existence of podoconiosis.

<p>Countries reporting existence of podoconiosis.</p

Podoconiosis prevalence by age group in selected studies Ethiopia 1 [4], Ethiopia 2 [29], Cameroon 1 [49] and Cameroon 2 [50].

<p>Podoconiosis prevalence by age group in selected studies Ethiopia 1 [<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0006324#pntd.0006324.ref004" target="_blank">4</a>], Ethiopia 2 [<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0006324#pntd.0006324.ref029" target="_blank">29</a>], Cameroon 1 [<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0006324#pntd.0006324.ref049" target="_blank">49</a>] and Cameroon 2 [<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0006324#pntd.0006324.ref050" target="_blank">50</a>].</p

Podoconiosis prevalence studies included in the review.

<p>Podoconiosis prevalence studies included in the review.</p

Geographical distribution of A) Surveys included B) Prevalence of podoconiosis. Dots represent various island nations.

<p>Geographical distribution of A) Surveys included B) Prevalence of podoconiosis. Dots represent various island nations.</p