Background The risk factors for scrub typhus in Vietnam remain unknown.Scrub typhus caused by Orientia tsutsugamushi often presents as an undifferentiated febrile illness and remains under appreciated due to the limit...Background The risk factors for scrub typhus in Vietnam remain unknown.Scrub typhus caused by Orientia tsutsugamushi often presents as an undifferentiated febrile illness and remains under appreciated due to the limited availability of diagnostic tests.This tropical rickettsial illness is increasingly recognized as an important cause of non-malaria acute undifferentiated fever in Asia.This study aimed to investigate behavioural and ecological related risk factors of scrub typhus to prevent this potentially life-threatening disease in Vietnam.Methods We conducted a clinical hospital-based active surveillance study,and a retrospective residence-enrolment date-age-matched case–control study in Khanh Hoa province,Vietnam,from August 2018 to March 2020.Clinical examinations,polymerase chain reaction and enzyme-linked immunosorbent assay IgM tests were applied to define cases and controls.All enrolled participants filled out a questionnaire including demographic socio-economic status,personal behaviors/protective equipment,habitat connections,land use,and possible exposure to the vector.Multivariable conditional logistic regression was used to define the scrub typhus associated risk factors.Results We identified 44 confirmed cases and matched them with 152 controls.Among cases and controls,the largest age group was the 41–50 years old and males accounted for 61.4%and 42.8%,respectively.There were similarities in demographic characteristics between the two groups,with the exception of occupation.Several factors were significantly associated with acquisition of scrub typhus,including sitting/laying directly on household floor[adjusted OR(aOR)=4.9,95%CI:1.6–15.1,P=0.006],household with poor sanitation/conditions(aOR=7.9,95%CI:1.9–32.9,P=0.005),workplace environment with risk(aOR=3.0,95%CI:1.2–7.6,P=0.020),always observing mice around home(aOR=3.7,95%CI:1.4–9.9,P=0.008),and use of personal protective equipment in the field(aOR=0.4,95%CI:0.1–1.1,P=0.076).Conclusions Ecological and household hygiene-related factors were more associated with scrub typhus infection,than individual-level exposure activities in the hyper-endemic area.These findings support local education and allow people to protect themselves from scrub typhus,especially in areas with limitations in diagnostic capacity.展开更多
Background:Directly observed treatment,short-course(DOTS)is the current mainstay to control tuberculosis(TB)worldwide.Context-specific adaptations of DOTS have impending implications in the fight against TB.In Ethiopi...Background:Directly observed treatment,short-course(DOTS)is the current mainstay to control tuberculosis(TB)worldwide.Context-specific adaptations of DOTS have impending implications in the fight against TB.In Ethiopia,there is a national TB control programme with the goal to eliminate TB,but uneven distribution across lifestyle gradients remains a challenge.Notably,the mobile pastoralist communities in the country are disproportionately left uncovered.The aim of this study was to summarize the evidence base from published literature to guide TB control strategy for mobile pastoralist communities in Ethiopia.Main text:We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines and systematically reviewed articles in seven electronic databases:Excerptra Medical Database,African Journal Online,PubMed,Google Scholar,Centre for Agriculture and Bioscience International Direct,Cochrane Library and Web of Science.The databases were searched from inception to December 31,2018,with no language restriction.We screened 692 items of which 19 met our inclusion criteria.Using a meta-ethnographic method,we identified six themes:(i)pastoralism in Ethiopia;(ii)pastoralists’livelihood profile;(iii)pastoralists’service utilisation;(iv)pastoralists’knowledge and awareness on TB control services;(v)challenges of TB control in pastoral settings;and(vi)equity disparities affecting pastoralists.Our interpretation triangulates the results across all included studies and shows that TB control activities observed in pastoralist regions of Ethiopia are far fewer than elsewhere in the country.Conclusions:This systematic review and meta-synthesis shows that TB control in Ethiopia does not align well with the pastoralist lifestyle.Inaccessibility and lack of acceptability of TB care are the key bottlenecks to pastoralist TB service provision.Targeting these two parameters holds promise to enhance effectiveness of an intervention.展开更多
文摘Background The risk factors for scrub typhus in Vietnam remain unknown.Scrub typhus caused by Orientia tsutsugamushi often presents as an undifferentiated febrile illness and remains under appreciated due to the limited availability of diagnostic tests.This tropical rickettsial illness is increasingly recognized as an important cause of non-malaria acute undifferentiated fever in Asia.This study aimed to investigate behavioural and ecological related risk factors of scrub typhus to prevent this potentially life-threatening disease in Vietnam.Methods We conducted a clinical hospital-based active surveillance study,and a retrospective residence-enrolment date-age-matched case–control study in Khanh Hoa province,Vietnam,from August 2018 to March 2020.Clinical examinations,polymerase chain reaction and enzyme-linked immunosorbent assay IgM tests were applied to define cases and controls.All enrolled participants filled out a questionnaire including demographic socio-economic status,personal behaviors/protective equipment,habitat connections,land use,and possible exposure to the vector.Multivariable conditional logistic regression was used to define the scrub typhus associated risk factors.Results We identified 44 confirmed cases and matched them with 152 controls.Among cases and controls,the largest age group was the 41–50 years old and males accounted for 61.4%and 42.8%,respectively.There were similarities in demographic characteristics between the two groups,with the exception of occupation.Several factors were significantly associated with acquisition of scrub typhus,including sitting/laying directly on household floor[adjusted OR(aOR)=4.9,95%CI:1.6–15.1,P=0.006],household with poor sanitation/conditions(aOR=7.9,95%CI:1.9–32.9,P=0.005),workplace environment with risk(aOR=3.0,95%CI:1.2–7.6,P=0.020),always observing mice around home(aOR=3.7,95%CI:1.4–9.9,P=0.008),and use of personal protective equipment in the field(aOR=0.4,95%CI:0.1–1.1,P=0.076).Conclusions Ecological and household hygiene-related factors were more associated with scrub typhus infection,than individual-level exposure activities in the hyper-endemic area.These findings support local education and allow people to protect themselves from scrub typhus,especially in areas with limitations in diagnostic capacity.
文摘Background:Directly observed treatment,short-course(DOTS)is the current mainstay to control tuberculosis(TB)worldwide.Context-specific adaptations of DOTS have impending implications in the fight against TB.In Ethiopia,there is a national TB control programme with the goal to eliminate TB,but uneven distribution across lifestyle gradients remains a challenge.Notably,the mobile pastoralist communities in the country are disproportionately left uncovered.The aim of this study was to summarize the evidence base from published literature to guide TB control strategy for mobile pastoralist communities in Ethiopia.Main text:We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines and systematically reviewed articles in seven electronic databases:Excerptra Medical Database,African Journal Online,PubMed,Google Scholar,Centre for Agriculture and Bioscience International Direct,Cochrane Library and Web of Science.The databases were searched from inception to December 31,2018,with no language restriction.We screened 692 items of which 19 met our inclusion criteria.Using a meta-ethnographic method,we identified six themes:(i)pastoralism in Ethiopia;(ii)pastoralists’livelihood profile;(iii)pastoralists’service utilisation;(iv)pastoralists’knowledge and awareness on TB control services;(v)challenges of TB control in pastoral settings;and(vi)equity disparities affecting pastoralists.Our interpretation triangulates the results across all included studies and shows that TB control activities observed in pastoralist regions of Ethiopia are far fewer than elsewhere in the country.Conclusions:This systematic review and meta-synthesis shows that TB control in Ethiopia does not align well with the pastoralist lifestyle.Inaccessibility and lack of acceptability of TB care are the key bottlenecks to pastoralist TB service provision.Targeting these two parameters holds promise to enhance effectiveness of an intervention.
