Toxoplasma gondii Infection in Relation to Pregnancy Characteristics and Bad Obstetric History among Pregnant Women Seeking Healthcare in Sana’a City, Yemen

Objective: To determine the seroprevalence and risk factors associated with Toxoplasma gondii among pregnant women seeking healthcare in Sana’a city in relation to pregnancy characteristics and bad obstetric history (BOH). Methods: This hospital-based, cross-sectional study was conducted among 379 pregnant women seeking healthcare in Sana’a city. Data on socioeconomic and pregnancy characteristics, BOH and possible risk factors associated with T. gondii infection were collected using a structured, pre-designed questionnaire. Anti-Toxoplasma IgG and IgM antibodies were detected using OnSiteTM Combo tests. Data were analyzed using the IBM SPSS Statistics using appropriate statistical tests, and a bivariate logistic regression model was used to determine the risk factors possibly associated with T. gondii infection among pregnant women. Differences or associations between categorical variables were considered statistically significant at P values <0.05. Results: T. gondii infection was seroprevalent among 18.7% of pregnant women seeking healthcare in Sana’a. Educational status and household size were the sociodemographic factors significantly associated with anti-Toxoplasma IgG seropositivity. Illiterate women were at fourfold higher risk of infection compared to those with higher education (OR = 4.0, 95% CI: 1.69–9.25; P = 0.002). Although those with school education were twice more likely to be infected with T. gondii compared to those with higher education, the association was on the borderline (OR = 2.0, 95% CI: 0.98–4.06; P = 0.055). On the other hand, pregnant women living in households of ≥5 members were 1.7 times more likely to be infected (OR = 1.7, 95% CI: 1.03–2.95; P = 0.026). Regarding the BOH among pregnant women, past exposure to infection was significantly associated with premature delivery (P = 0.004) and history of fetal deaths (P = 0.004). Drinking unboiled water (OR = 2.1, 95% CI = 0.55–8.07; P = 0.192) and frequent blood transfusion (OR = 1.8, 95% CI = 0.50–6.1; P  =  0.288) increased the odds of exposure of pregnant women to infection, but the associations were not statistically significant. On the other hand, other studied factors were not significantly associated with past exposure to infection. Conclusions: The majority (>80.0%) of pregnant women seeking healthcare in Sana’a city are non-immune to primary infection with T. gondii during pregnancy as evidenced by their seronegative status, where only 18.7% of them were seropositive for anti-Toxoplasma IgG. Higher infection rates were significantly associated with being illiterate and living within households of ≥5 members. With respect to self-reported BOH, T. gondii infection was significantly associated with premature delivery and history of fetal deaths. Drinking unboiled water and frequent blood transfusions increased the odds of exposure of pregnant women to infection, though not reaching statistical significance. Further large-scale community-based studies are recommended to determine the risk factors associated with pregnancy characteristics and BOH among pregnant women in the country

Towards rapid genotyping of resistant malaria parasites: could loop-mediated isothermal amplification be the solution?

Loop-mediated isothermal amplification (LAMP) is an innovative molecular technique that has been validated for point-of-care testing to diagnose malaria. Molecular detection and tracking of anti-malarial drug resistance is mainly based on highly sophisticated, costly and time-consuming techniques. With the validation of resistance-associated gene mutations in malaria parasites, there is a need to develop rapid, easy-to-use molecular tests for anti-malarial drug resistance genotyping. LAMP could be further developed as a point-of-care test to rapidly detect anti-malarial drug resistance-associated molecular markers, thereby help detecting and monitoring drug resistance in surveillance studies

Malaria Research Priorities in Yemen: Paving the Way for Malaria Elimination

Malaria represents a major health problem in Yemen, and it appears that the efforts devoted to its control and elimination only tackle the tip of malaria iceberg. There is an evident gap between research activities and control efforts reflected by the fact that efforts and funding allocation are mainly directed to control activities. Research on basic, clinical and epidemiological aspects of the disease, which could serve elimination efforts, is rather ignored. This can simply be observed by searching online scientific databases, where the majority of published articles are of researchers and post-graduate students. Therefore, organized and collaborative research activities intended to serve the efforts to eliminate the disease are urgently needed, with a fair allocation of funds between research and control activities. The present editorial highlights research priorities needed to pave the way for malaria elimination and the need for bridging the existing gap between research and control strategie

Combat against Neglected Parasitic Diseases in Yemen: The Need for Mapping as a Prerequisite for Elimination

Besides poverty, war and social unrest, Yemen is afflicted with the majority of neglected tropical diseases (NTDs) listed by the World health organization, particularly parasitic ones. Despite the efforts made by some control and elimination programmes, there is a lack of reliable mapping services that could help to identify the top-priority endemic areas and at-risk populations and to monitor the effectiveness of past and ongoing efforts to eliminate parasitic NTDs. Therefore, most of the NTD burden iceberg in Yemen is still submerged and needs to be assessed, mapped and stratified for the implementation of cost-effective elimination interventions. Availability of accessible data on the burden of parasitic diseases as well as mass drug administration in endemic areas is a prerequisite for any successful cost-effective elimination efforts. The establishment of an open-access national NTDs mapping center in Yemen should be considered as a databank for researchers, policy makers and funding bodies

Strategic use of antimalarial drugs that block falciparum malaria parasite transmission to mosquitoes to achieve local malaria elimination

The ultimate aim of malaria chemotherapy is not only to treat symptomatic infection but also to reduce transmission potential. With the absence of clinically proven vaccines, drug-mediated blocking of malaria transmission gains growing interest in the research agenda for malaria control and elimination. In addition to the limited arsenal of antimalarials available, the situation is further complicated by the fact that most commonly used antimalarials are being extensively resisted by the parasite and do not assist in blocking its transmission to vectors. Most antimalarials do not exhibit gametocytocidal and/ or sporontocidal activity against the sexual stages of Plasmodium falciparum but may even enhance gametocytogenesis and gametocyte transmissibility. Artemisinin derivatives and 8-aminoquinolines are useful transmission-blocking antimalarials whose optimal actions are on different stages of gametocytes. Transmission control interventions that include gametocytocides covering the spectrum of gametocyte development should be used to reduce and, if possible, stop transmission and infectivity of gametocytes to mosquitoes. Potent gametocytocidal drugs could also help deter the spread of antimalarial drug resistance. Novel proof-of-concept compounds with gametocytocidal activity, such as trioxaquines, synthetic endoperoxides, and spiroindolone, should be further tested for possible clinical utility before investigating the possibility of integrating them in transmission-reducing interventions. Strategic use of potent gametocytocides at appropriate timing with artemisinin-based combination therapies should be given attention, at least, in the short run. This review highlights the role that antimalarials could play in blocking gametocyte transmission and infectivity to mosquitoes and, hence, in reducing the potential of falciparum malaria transmissibility and drug resistance spread

Levels and predictors of nurses’ knowledge about diabetes care and management: disparity between perceived and actual knowledge

Abstract Background Nurses have a crucial role in managing, educating, and caring for diabetic patients. However, their knowledge should be regularly assessed to avoid preventable complications and reduce costs. Therefore, the present study assessed the perceived and actual knowledge about diabetes among nurses in Hail province of Saudi Arabia and investigated predictors of such knowledge. Methods A cross-sectional study was conducted among 325 conveniently sampled nurses from all public hospitals and primary healthcare centres in Hail province from September to December 2022. A pre-designed questionnaire was used to collect demographic and practice-related characteristics of the nurses. In addition, data on nurses’ perceived and actual knowledge about diabetes were collected using the Diabetes Self-Report Tool (DSRT) and Diabetes Basic Knowledge Tool (DBKT) self-report questionnaires, respectively. The mean knowledge scores for demographic and practice-related variables were compared using the independent-samples t-test and one-way analysis of variance. Multiple linear regression was used to identify significant predictors of perceived and actual knowledge. The correlation between perceived and actual knowledge was investigated using Pearson’s correlation coefficient. A P-value ˂0.05 was considered statistically significant. Results Based on a highest maximum score of 60 using the DSRT, the mean score of perceived knowledge was 38.4 ± 12.0, corresponding to a percentage mean score of 64%. On the other hand, based on a highest maximum score of 49 using the DBKT, the mean score of actual knowledge was 23.2 ± 9.6, corresponding to a percentage mean score of 47.3% of correct responses. Being Indian, having a diploma or a bachelor’s degree, and having a poor or fair self-perception of competence in diabetes care were predictors of lower perceived knowledge scores, whereas having no access to diabetes guidelines was a predictor of higher scores. However, being non-Saudi and having experience of at least 16 years were predictors of higher actual knowledge scores. The correlation between actual and perceived knowledge about diabetes was negligible and statistically non-significant (r = 0.011, P = 0.055). Conclusion Nurses affiliated with public health facilities in Hail province lack adequate knowledge about diabetes, with no correlation between what is perceived to be known and what is actually known. Indian citizenship, having a diploma or bachelor’s degree, not having access to diabetes guidelines, not attending courses/workshops, and having a poor or fair self-perception of competence in diabetes care can significantly predict nurses’ perceived knowledge. However, being non-Saudi (Filipino or Indian) and having at least 16 years of experience can significantly predict their actual knowledge of diabetes

Chemotherapeutic efficacy of a natural combination in the treatment of mansonic schistosomiasis: an experimental study

Rashad Abdul-Ghani1, Naguiba Loutfy2, Manal Sheta3, Azza Hassan21Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen; 2Tropical Health Department, High Institute of Public Health, 3Department of Pathology, Medical Research Institute, Alexandria University, Alexandria, EgyptPurpose: Combination chemotherapy of Schistosoma mansoni has been studied previously, with praziquantel being the basis of combination. Artemether and myrrh are compounds of a natural origin that have been investigated experimentally and clinically against schistosomiasis. Artemether is used as an antimalarial drug, and has been used as a chemoprophylactic drug against Schistosoma japonica in China whereas myrrh extract is manufactured and prescribed as an antischistosomal drug in Egypt. The present study investigated the experimental efficacy of combining artemether and myrrh using three different protocols in mice infected with the Egyptian strain of S. mansoni.Methods: Experiments were performed on 40 eight-week-old female Swiss albino mice divided into three experimental groups and one control group. Assessment of efficacy was based on a suite of parasitologic and histopathologic parameters. Parasitologic parameters included reductions in total and female worm burdens, reductions in hepatic and intestinal wall tissue egg loads, and alterations in oogram patterns in the experimental groups compared to the infected untreated control. Histopathologic parameters comprised microscopic examination of liver sections stained with hematoxylin and eosin to study the reductions in the mean counts and diameters of hepatic granulomas as well as their healing ratios compared to the control.Results: Reductions of 43.9%–58.2% in total worm burdens and 42.4%–63.7% in female worm burdens were induced. Meanwhile, significant reductions of 63.1%–77.8% in eggs per gram of small intestinal tissue and of 56.5%–66.3% in eggs per gram of liver tissue were also observed. The combination also caused alterations in the oogram pattern as well as amelioration of hepatic lesions as evidenced by increased ratios of healed granulomas in the treated groups compared to the control.Conclusion: The experimental efficacy of the artemether–myrrh combination against the Egyptian strain of S. mansoni was evident, but not to an extent that would warrant clinical trials in humans.Keywords: Schistosoma mansoni, combination chemotherapy, artemether, myrrh, natural drug

Onchocerciasis in Yemen: Time to take action against a neglected tropical parasitic disease

[Display omitted] •Onchocerciasis mainly affects poor, rural communities in western Yemeni governorates.•The disease is of the localized, hyperreactive form, referred to as sowda.•Diagnosis by skin snip examination is challenging due to the low microfilarial load.•Vector situation needs evaluation because there is no vector control.•Simulium species have not been investigated in Yemen since the 1980s. Onchocerciasis is a neglected parasitic disease affecting the poorest underserved people in Yemen. A national control programme with goals to eliminate onchocerciasis has yet to be launched due to the current upheaval and social unrest in the country. The disease, locally termed as sowda, is unique in its clinicopathologic pattern, being of the localized, non-blinding, hyperreactive onchocercal skin disease. Although early reports identified endemic foci along seasonal watercourses, there is a need to redefine its epidemiologic patterns as well as health and socioeconomic impacts. Laboratory diagnosis of sowda among Yemeni patients is difficult due to the low load of microfilariae in skin snips and the presence of asymptomatic itching-free microfilaria carriers. Adoption of ivermectin use at three-month intervals as a control strategy has not been evaluated because the drug is mostly used in clinics and distributed to only a few affected communities. This paper addresses key aspects of onchocerciasis in Yemen and highlights the need for screening at-risk populations using highly sensitive techniques and mapping the distributions of the parasite in human and vector populations of blackflies. The new research should be integrated with the launch of a national onchocerciasis control programme to achieve onchocerciasis elimination