The prevalence of common skin infections in four districts in Timor-Leste: a cross sectional survey

Background\ud Skin infections are a common public health problem in developing countries; however, they are rarely managed using a population based approach. Recent data on the burden of skin infections in Timor-Leste are limited. Our survey appears to be the only widespread survey conducted in more than 30 years and was designed to determine the baseline prevalence of some common skin infections in Timor-Leste.\ud \ud Methods\ud We conducted a cross sectional survey in 14 sites including community health clinics, schools and hospitals within four different geographical regions. Participants were examined for five conditions (scabies, pyoderma, fungal infections, leprosy and yaws) by a multidisciplinary team. Analyses were conducted using EpiInfo version 6.04d.\ud \ud Results\ud We examined the skin of 1535 participants aged between four months and 97 years. The majority of participants were male, aged between 11 and 20 years and had at least one condition of interest (56.0%, 56.0%, and 63.1%, respectively). Fungal infections were the most common presentation (39.0%) and males were more commonly affected than females (42.3% vs 34.0%, respectively, pvalue < 0.0001).\ud \ud Among those people with more than one condition the two most common co-infections were scabies with either pyoderma or a fungal infection (38.0% and 32.0%, respectively). The survey identified 29 previously undiagnosed cases of leprosy and six cases of yaws.\ud \ud Conclusions\ud Our findings indicate the need for a comprehensive programme to address these conditions. There are successful disease control programmes in place within the country and it is hoped a healthy skin programme could be integrated into an established disease control programme in order to maximise health benefits and resources

Prevalence of soil transmitted nematodes on Nukufetau, a remote Pacific island in Tuvalu

BACKGROUND: The population of Nukufetau, a remote coral atoll island in Tuvalu in the Western Pacific, received annual mass drug administration (MDA) of diethylcarbamazine and albendazole under the Pacific Elimination of Lymphatic Filariasis program in 2001, 2002 and 2003, with the last MDA occurring six months before a cross-sectional survey of the whole population for soil transmitted helminths (STH). METHODS: A cross-sectional survey in May 2004 recruited 206 residents (35.2% of the population) who provided a single faecal sample that was preserved, concentrated and examined microscopically. RESULTS: Overall prevalence of STH was 69.9%; only hookworm and Trichuris trichiura were diagnosed. Trichuris was present in 68.4% with intensity of infection being light in 56.3%, medium in 11.7% and heavy in 0.5%. Hookworm occurred in 11.7% with intensity of infection 11.2% being light and medium in 0.5%. Twenty individuals (9.7%) had dual infections. The prevalence of Trichuris was constant across all ages while the prevalence of hookworm was significantly lower in residents below 30 years of age. In the age group 5–12 years comparison of results with a 2001 survey [1] suggested that the prevalence of STH has declined minimally, due to sustained high prevalence of Trichuris, while hookworm has declined dramatically from 34.4% to 1.6%. CONCLUSION: The results of this survey suggest that although the MDA appears to have reduced hookworm prevalence in residents below 30 years of age, there has been minimal effect on Trichuris prevalence. An integrated program to control STH is required

The prevalence and impact of the co-morbidity of scabies and other neglected tropical diseases in two countries in the Asia-Pacific region

Many people living in tropical settings in the developing world are burdened with neglected infectious diseases which remain unaddressed by the health sector. This study conducted baseline and follow-up surveys on a cohort of 900 children of Tuvalu to determine the prevalence and scope of skin infections and intestinal parasites; as well as cross-sectional survey of multiple sites in Timor-Leste. \ud \ud Results indicated a high prevalence of infectious disease, especially skin infections in both countries with many participants presenting with multiple infections. Scabies and scabies co-infection with secondary bacterial or fungal diseases were the most common presentations in both populations. Intestinal parasites were present in 67% of the children surveyed in Tuvalu where one third of this cohort also had anaemia and abnormal urine results. \ud \ud Overall these communities show a high burden of co-morbidity, the impact of which is unknown. However, the high proportion of multiple infectious diseases along with the clinical evidence suggests a negative health impact on these populations, which could benefit from multiple interventions in an integrated community-bases disease control programme

Was infectious syphilis being misclassified in remote Australian outbreaks? Evidence that informed modification of the national case definition

Objective: To assess the ability of the national case definition to identify infectious syphilis during an outbreak affecting predominantly Aboriginal and Torres Strait Islander people in a remote Australian region. Methods: A retrospective case series study of all non-congenital syphilis cases in the region notified between 1 January 2009 and 31 December 2012 was performed. The national infectious syphilis case definition was compared with an expanded case definition derived from experienced clinician assessment and the definition proposed in the Interim Guidelines for the Public Health Management of Syphilis Outbreaks in Remote Populations in Australia from the Communicable Diseases Network Australia (CDNA). Results: Two hundred and forty syphilis cases were notified, of which 44 (18.3%) were symptomatic. The national case definition classified 106 (44.2%) cases as infectious, compared with 182 (75.8%) using the clinician-derived expanded case definition and 165 (68.8%) by the interim guidelines case definition. Seven confirmed and 6 probable cases were diagnosed as a result of contact tracing of probable infectious cases identified using the expanded case definition. Conclusions and implications: The national case definition for infectious syphilis applied in this remote Australian outbreak underestimated infectious cases when compared with experienced clinicians' evaluation by up to 76 cases (42%) and was inadequate to monitor the magnitude of a syphilis outbreak in such a setting. This may compromise surveillance and resource allocation decisions, and could reduce the capacity to interrupt transmission and contain an outbreak. A revised national case definition, informed by this analysis, was released by CDNA in July 2015

Was infectious syphilis being misclassified in remote Australian outbreaks? Evidence that informed modification of the national case definition

Objective: To assess the ability of the national case definition to identify infectious syphilis during an outbreak affecting predominantly Aboriginal and Torres Strait Islander people in a remote Australian region. Methods: A retrospective case series study of all non-congenital syphilis cases in the region notified between 1 January 2009 and 31 December 2012 was performed. The national infectious syphilis case definition was compared with an expanded case definition derived from experienced clinician assessment and the definition proposed in the Interim Guidelines for the Public Health Management of Syphilis Outbreaks in Remote Populations in Australia from the Communicable Diseases Network Australia (CDNA). Results: Two hundred and forty syphilis cases were notified, of which 44 (18.3%) were symptomatic. The national case definition classified 106 (44.2%) cases as infectious, compared with 182 (75.8%) using the clinician-derived expanded case definition and 165 (68.8%) by the interim guidelines case definition. Seven confirmed and 6 probable cases were diagnosed as a result of contact tracing of probable infectious cases identified using the expanded case definition. Conclusions and implications: The national case definition for infectious syphilis applied in this remote Australian outbreak underestimated infectious cases when compared with experienced clinicians' evaluation by up to 76 cases (42%) and was inadequate to monitor the magnitude of a syphilis outbreak in such a setting. This may compromise surveillance and resource allocation decisions, and could reduce the capacity to interrupt transmission and contain an outbreak. A revised national case definition, informed by this analysis, was released by CDNA in July 2015

An exploration of the perceptions of male partners involved in the birthing experience at a regional Australian hospital

Introduction: The benefits to women of having their male partners present during labor and birth have been well documented, but the effects on men of sharing the birth experience have been less well explored. Several studies have suggested that male partners' positive experiences at this time may benefit partner and family relationships subsequently, whereas negative experiences may translate into later difficulties in these relationships. This study explored the perceptions of male partners involved in the birthing experience in the Integrated Women's Health Unit of Cairns Base Hospital, Cairns, Australia, over a 6-month period in 2010. The aims of the study were to document male partners' self-reported perceptions of their antenatal, labor, and birth experiences and birth expectations and birth involvement and to determine whether these perceptions influenced their feelings that their presence during birth was beneficial to the birthing woman.\ud \ud Methods: Participants were men experiencing for the first time their partner giving birth. A self-administered 14-item questionnaire was used to collect data; 163 of 200 eligible participants returned completed questionnaires. Continuous variables were converted to categorical variables and chi-square testing was used to determine significant differences between groups. The relationship between beneficial presence and antenatal, labor, and birthing experiences was assessed using correlation analysis and hierarchical regression analysis.\ud \ud Results: There was a significant relationship demonstrated between perceived benefit of the partners' presence and positive perception of both antenatal experience and birth involvement. There also was a positive relationship between realized birth expectations and both antenatal experience and birth involvement.\ud \ud Discussion: This study suggests that male partners' perceptions of beneficial presence during the birth experience can be enhanced by their feeling well informed and supported during the antenatal period and feeling involved and supported by staff during birth. These findings have implications for the provision of information and support to male partners by midwives and childbirth educators and provide the basis for further research in this area

Prevalence of soil transmitted nematodes on Nukufetau, a remote Pacific island in Tuvalu

Abstract Background The population of Nukufetau, a remote coral atoll island in Tuvalu in the Western Pacific, received annual mass drug administration (MDA) of diethylcarbamazine and albendazole under the Pacific Elimination of Lymphatic Filariasis program in 2001, 2002 and 2003, with the last MDA occurring six months before a cross-sectional survey of the whole population for soil transmitted helminths (STH). Methods A cross-sectional survey in May 2004 recruited 206 residents (35.2% of the population) who provided a single faecal sample that was preserved, concentrated and examined microscopically. Results Overall prevalence of STH was 69.9%; only hookworm and Trichuris trichiura were diagnosed. Trichuris was present in 68.4% with intensity of infection being light in 56.3%, medium in 11.7% and heavy in 0.5%. Hookworm occurred in 11.7% with intensity of infection 11.2% being light and medium in 0.5%. Twenty individuals (9.7%) had dual infections. The prevalence of Trichuris was constant across all ages while the prevalence of hookworm was significantly lower in residents below 30 years of age. In the age group 5–12 years comparison of results with a 2001 survey 1 suggested that the prevalence of STH has declined minimally, due to sustained high prevalence of Trichuris, while hookworm has declined dramatically from 34.4% to 1.6%. Conclusion The results of this survey suggest that although the MDA appears to have reduced hookworm prevalence in residents below 30 years of age, there has been minimal effect on Trichuris prevalence. An integrated program to control STH is required.</p