The latest medical research on Travel Medicine

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Socioeconomic determinants of use and choice of modern contraceptive methods in Ghana.

Tropical Medicine and International Health

The slow pace of fertility decline in Africa relative to other parts of the world has important implications for the region's economic development. Modern contraceptive use is seen as important population control and family planning strategy by governments worldwide. This paper examines the socioeconomic determinants of modern contraceptive use and choice among Ghanaian men and women.

We use the most recent and nationally representative Ghana Demographic and Health Survey conducted in 2014. The analysis is observational, with no causal implications. Bivariate and multivariate methods are used to analyse the data. We first use logistic regression to explore the correlates of modern contraceptive use among Ghanaian men and women. Second, we explore the socioeconomic factors influencing the choice of modern contraceptive methods among contraceptive users using multinomial logistic regression. We classify the modern methods of contraception into three groups: long-acting reversible contraceptives (LARC), short-acting contraceptives (SAC), and permanent contraceptives.

Marital status proves to be the most significant predictor for both men and women, with women in monogamous unions having a greater propensity to use modern methods of contraception (OR = 1.4, p < 0.00). We also find that different factors affect the use and choice of modern methods of contraception among men and women in Ghana. Muslim men had a higher likelihood than Catholics to choose the permanent (sterilisation) method (OR = 11.9, p < 0.05), while their female counterparts were 0.25 times less likely to choose sterilisation over SAC (p < 0.05). Moreover, women who ever tested for HIV had higher use of LAC than the SAC ((RRR = 1.6, p < 0.01). The modern contraceptive users (women) with at most basic education were more likely than those with tertiary education to choose LAC over SAC. Finally, rural women with health insurance were 0.75 times (p < 0.01) less likely to use modern methods of contraception.

The paper reiterates the need to intensify and sustain public health education on the health benefits of using modern methods of contraception among the adult population. The paper suggests that including family planning services on Ghana's national health insurance benefits package is commendable. It can promote modern contraceptive use and curtail unwarranted population growth.

Seroprevalence of anti-Toxocara canis antibodies and associated risk factors among dog owners in the rural community of Nakhon Si Thammarat province, southern Thailand.

Tropical Medicine and International Health

Human toxocariasis is a zoonotic parasitic disease caused by the Toxocara canis and T. cati nematodes larvae. Dog owners are at a higher risk of acquiring T. canis infection, and there is no available evidence regarding the seroprevalence of T. canis infection among dog owners in Thailand. Therefore, this study aimed to investigate the seroprevalence of T. canis infection and associated risk factors among dog owners in rural areas of Thailand.

A total of 132 dog owners, including 25 men and 107 women, were recruited for this study. Serum anti-T. canis IgG antibodies were detected using a commercial enzyme-linked immunosorbent assay (ELISA) kit, and information on risk factors was collected using a questionnaire. In addition, hematological parameters were analyzed by the auto hematology analyzer. Risk variables associated with T. canis infection were investigated using univariate and multivariate logistic regression models.

The overall seroprevalence of T. canis was 76.5% (101/132). Men were more likely to be infected with T. canis than women. Univariate analysis revealed that dog owners who did not practice handwashing before meals (p = 0.005) or after contact with soil (p = 0.035) or dogs (p = 0.049) had a substantially higher risk of acquiring T. canis infection. After adjusting for confounders, not practicing handwashing before meals remained a significant risk factor for T. canis infection (p = 0.038). The mean number of eosinophils was significantly higher in the seropositive group than in the seronegative group.

This is the first serological report of T. canis infection among dog owners reflecting the high rate of T. canis seropositivity in rural areas of southern Thailand. This study also provides group-specific data concerning modifiable risk behaviors for more effective T. canis infection control and prevention strategies in Thailand.

Translation of liver stage activity of M5717, a Plasmodium elongation factor 2 inhibitor: from bench to bedside.

Malaria Journal

Targeting the asymptomatic liver stage of Plasmodium infection through chemoprevention could become a key intervention to reduce malaria-associated incidence and mortality.

M5717, a Plasmodium elongation factor 2 inhibitor, was assessed in vitro and in vivo with readily accessible Plasmodium berghei parasites. In an animal refinement, reduction, replacement approach, the in vitro IC99 value was used to feed a Population Pharmacokinetics modelling and simulation approach to determine meaningful effective doses for a subsequent Plasmodium sporozoite-induced volunteer infection study.

Doses of 100 and 200 mg would provide exposures exceeding IC99 in 96 and 100% of the simulated population, respectively.

This approach has the potential to accelerate the search for new anti-malarials, to reduce the number of healthy volunteers needed in a clinical study and decrease and refine the animal use in the preclinical phase.

Exo-erythrocytic development of Plasmodium matutinum (lineage pLINN1) in a naturally infected roadkill fieldfare Turdus pilaris.

Malaria Journal

Species of Plasmodium (Haemosporida, Plasmodiidae) are remarkably diverse haemoparasites. Information on genetic diversity of avian malaria pathogens has been accumulating rapidly, however exo-erythrocytic development of these organisms remains insufficiently addressed. This is unfortunate because, contrary to Plasmodium species parasitizing mammals, the avian malaria parasites undergo several cycles of exo-erythrocytic development, often resulting in damage of various organs. Insufficient knowledge on the exo-erythrocytic development in most described Plasmodium species precludes the understanding of mechanisms of virulence during avian malaria. This study extends information on the exo-erythrocytic development of bird malaria parasites.

A roadkill fieldfare (Turdus pilaris) was sampled in Switzerland and examined using pathologic, cytologic, histologic, molecular and microbiologic methods. Avian malaria was diagnosed, and erythrocytic and exo-erythrocytic stages of the parasite were identified using morphologic characteristics and barcode DNA sequences of the cytochrome b gene. The species-specific characteristics were described, illustrated, and pathologic changes were reported.

An infection with Plasmodium matutinum lineage pLINN1 was detected. Parasitaemia was relatively low (0.3%), with all erythrocytic stages (trophozoites, meronts and gametocytes) present in blood films. Most growing erythrocytic meronts were markedly vacuolated, which is a species-specific feature of this parasite's development. Phanerozoites at different stages of maturation were seen in leukocytes, macrophages, and capillary endothelial cells in most organs examined; they were particularly numerous in the brain. Like the erythrocytic meronts, growing phanerozoites were markedly vacuolated. Conspicuous exo-erythrocytic development and maturation in leucocytes suggests that this fieldfare was not adapted to the infection and the parasite was capable to escape from cellular immunity.

This is the first report of exo-erythrocytic development of the malaria parasite lineage pLINN1 during single infection and the first report of this lineage in the fieldfare. The findings of multiple phanerozoites in brain, skeletal muscle, and eye tissue in combination with signs of vascular blockage and thrombus formation strongly suggest an impaired vision and neuromuscular responsiveness as cause of the unexpected collision with a slowly moving car. Further studies on exo-erythrocytic stages of haemosporidian parasites are pivotal to understand the true level of populational damage of avian malaria in wild birds.

A cost analysis of the diagnosis and treatment of malaria at public health facilities and communities in three districts in Rwanda.

Malaria Journal

Malaria is a potentially fatal disease spread by the bites of Plasmodium-infected Anopheles mosquitoes. Despite long-term efforts to control malaria in Rwanda, malaria incidence increased from 48 to 403 cases/1000 individuals between 2012 and 2016. The diagnosis and treatment of malaria occurs at multiple levels, but the costs of these activities are not well understood. This research was conducted to estimate the direct medical costs incurred by the Ministry of Health in diagnosing and treating malaria in three districts of Rwanda in 2018.

A cross-sectional and retrospective costing analysis was conducted in three districts that represented low (5-200 cases per 1000 individuals), moderate (> 200-400 cases per 1000 individuals), and high (> 400 cases per 1000 individuals) endemicity regions. Data on malaria cases managed at three healthcare levels (community, health centre, district hospital) was obtained from national databases. The direct medical costs of cases per malaria severity ('simple malaria', 'simple malaria with minor digestive symptoms', and 'severe malaria') were calculated based on the minimum package of health services provided. Total costs for each of the three districts were also calculated.

A total of 298,381 malaria cases were recorded in Burera, Kirehe, and Southern Kayonza districts in 2018. The average unit cost per case ranged from USD 1.36 (for simple malaria at the community level) to USD 92.80 (for severe malaria with cerebral complications at district hospitals). Simple malaria cases managed at health centres and district hospitals were more than two-fold (USD 2.99-USD 3.00) and more than eight-fold (USD 12.10-USD 12.12) higher, respectively, than those managed in the community (USD 1.36). Overall, the Ministry of Health incurred USD 645,647.68 in direct medical costs related to malaria management across the three districts in 2018. Changes in disease rates from different endemicity regions and costs of anti-malarial oral medications significantly impacted the study results.

In Rwanda, severe malaria results in much higher expenses compared to other malaria types. Prompt diagnosis and appropriate treatment are crucial to prevent the progression of simple malaria to severe malaria, to reduce Ministry of Health malaria expenditures, and to reduce community transmission.

The impact of the COVID-19 pandemic on malaria in returning travellers in Canada: a retrospective population-based cohort study.

Journal of Travel Research

In high-income, low-prevalence settings, travel patterns largely govern malaria transmission; the COVID-19 pandemic has led to travel restrictions ...

Willingness to accept malaria vaccine among caregivers of under-5 children in Southwest Ethiopia: a community based cross-sectional study.

Malaria Journal

Malaria is widespread in Ethiopia and has been a major cause of illness and death in that country. Therefore, Ethiopia has been exerting enormous efforts towards eliminating malaria by 2030. In the context of comprehensive malaria control, the malaria vaccine is used for the prevention of Plasmodium falciparum malaria in children living in regions with moderate- to-high malaria transmission.

A community-based cross-sectional study was conducted among caregivers of children under the age of five throughout the months of September 2021. A structured interviewer-administered questionnaire was designed for data collection, and binary logistic regression analysis was used. The final result of the association was determined based on an adjusted odds ratio (AOR) at a 95% confidence interval (CI) level, and p < 0.05 indicated statistical significance.

A total of 406 caregivers of children under the age of 5 were interviewed. Overall, 131 (32.3%) respondents were willing to vaccinate their children. Marital status (AOR = 1.243; 95% CI 1.021-3.897), knowledge (AOR = 3.120; 95% CI 1.689-5.027), and previous experience with childhood vaccination (AOR = 2.673; 95% CI 1.759-4.101) were found to be significantly associated with willingness to accept a malaria vaccine for their children, at p < 0.05.

The willingness to accept a malaria vaccine for children among caregivers of children under the age of five was low in the study area. Thus, health education and communication are crucial for alleviating poor knowledge about malaria vaccines.

Challenges and lessons learned during the planning and early implementation of the RTS,S/AS01E malaria vaccine in three regions of Ghana: a qualitative study.

Malaria Journal

In 2019, the RTS,S/AS01E malaria vaccine was introduced on a pilot basis in six regions of Ghana by the Ministry of Health/Ghana Health Service as part of the WHO-coordinated Malaria Vaccine Implementation Programme (MVIP). This is the first time a malaria vaccination programme has been implemented in any country. This paper describes the challenges faced, and lessons learned, during the planning and early implementation of the RTS,S/AS01E vaccine in three out of the six regions that implemented the programme in Ghana.

Twenty-one in-depth interviews were conducted with regional and district health service managers and frontline health workers three months after the start of MVIP in May 2019. Data were coded using NVivo software version 12 and a coding framework was developed to support thematic analysis to identify the challenges and lessons learned during the RTS,S/AS01E implementation pilot, which were also categorized into the Consolidated Framework for Implementation Research (CFIR).

Participants reported challenges related to the characteristics of the intervention, such as issues with the vaccine schedule and eligibility criteria, and challenges related to how it was implemented as a pilot programme. Additionally, major challenges were faced due to the spread of rumours leading to vaccine refusals; thus, the outer setting of the CFIR was adapted to accommodate rumours within the community context. Health service managers and frontline health workers also experienced challenges with the process of implementing RTS,S/AS01E, including inadequate sensitization and training, as well as issues with the timeline. They also experienced challenges associated with the features of the systems within which the vaccine was being implemented, including inadequate resources for cold-chain at the health facility level and transportation at the district and health facility levels. This study identified the need for a longer, more intensive and sustained delivery of contextually-appropriate sensitization prior to implementation of a programme such as MVIP.

This study identified 12 main challenges and lessons learned by health service managers and health workers during the planning and early implementation phases of the RTS,S/AS01E pilot introduction in Ghana. These findings are highly relevant to the likely scale-up of RTS,S/AS01E within Ghana and possible implementation in other African countries, as well as to other future introductions of novel vaccines.

Loiasis from where you don't expect it: an illustrative case of misled diagnosis.

Journal of Travel Research

In the absence of pathognomonic signs, the diagnosis of filarial infections relies on geographical exposure and morphology of microfilariae, which ...

Travel-associated SARS-CoV-2 transmission documented with whole genome sequencing following a long-haul international flight.

Journal of Travel Research

Multiple instances of flight-associated SARS-CoV-2 transmission during long-haul flights have been reported during the COVID-19 pandemic. However, comprehensive investigations of passenger risk behaviours, before, during, and after the flight, are scarce.

To investigate suspected SARS-CoV-2 transmission during a flight from United Arab Emirates to Australia in July 2020, systematic, repeated PCR-testing of passengers in hotel quarantine was linked to whole genome sequencing. Epidemiological analyses of in-depth interviews covering behaviours during the flight and activities pre- and post-boarding were used to identify risk factors for infection.

Seventeen of the 95 passengers from four different travel origins had PCR-confirmed infection yielding indistinguishable genomic sequences. Two of the 17 passengers were symptomatic within two days of the flight, had travelled together, and classified as co-primary cases. Seven secondary cases were seated within 2-rows of the co-primary cases, but five economy passengers seated further away, and three business class passengers were also infected (attack rate = 16% [15/93]). In multivariable analysis, being seated within 2-rows of a primary case (OR 7.16; 95% CI 1.66-30.85) and spending more than an hour in the arrival airport (OR 4.96; 95% CI 1.04-23.60) were independent predictors of secondary infection, suggesting travel-associated SARS-CoV-2 transmission may have occurred both during and after the flight. Self-reported increased hand hygiene, wearing gloves, frequent aisle walking and using the bathroom on the plane did not independently affect the risk of SARS-CoV-2 acquisition.

This investigation identified substantial in-flight transmission among passengers seated both within and beyond two-rows of the primary cases, the standard applied to contact tracing on flights. Infection of passengers in separate cabin classes also suggests transmission occurred outside the cabin environment, likely at the arrival airport. Recognising that transmission may occur pre- and post- boarding may inform contact tracing advice and improve efforts to prevent future travel-associated outbreaks.

Post malaria acute motor axonal neuropathy.

Journal of Travel Research

We report herein the first case of acute motor axonal neuropathy syndrome after severe Plasmodium falciparum malaria in a traveller, diagnosed thro...

Ketoconazole increases atovaquone exposure following concomitant administration with Malarone® in healthy subjects.

Journal of Travel Research

With an aim to assess the pharmacokinetics of atovaquone, 10 healthy subjects were administered Malarone® alone and in combination with ketoconazol...