The future of any population is children. Resource limited settings with a high prevalence of HIV infection notably also have an excessive burden of malnutrition. The advances in prevention of mother to child HIV tran...The future of any population is children. Resource limited settings with a high prevalence of HIV infection notably also have an excessive burden of malnutrition. The advances in prevention of mother to child HIV transmission programmes have led to very effective combination antiretroviral regimens resulting in growing numbers of HIV exposed but uninfected children. The mortality of HIV exposed but uninfected children below 5 years is high in resource limited settings. It is also important to pay particular attention to their longitudinal growth and neurodevelopmental outcomes. In these settings, the contribution of feeding practices, choice of complementary foods and micronutrient deficiencies, to health outcomes of HIV exposed uninfected children are not clearly defined. This review highlights some gaps in research that need to be addressed in areas with increasing numbers of HIV exposed but uninfected children. Interventions to reduce mortality, improve growth and neurodevelopmental outcomes in HIV exposed uninfected children from resource limited areas should be prioritized.展开更多
Missed Prevention of Mother-to-Child Transmission of HIV (PMTCT) visits have contributed to the delayed achievement of elimination of mother-to-child transmission of HIV. Missed visits promote attrition from preventio...Missed Prevention of Mother-to-Child Transmission of HIV (PMTCT) visits have contributed to the delayed achievement of elimination of mother-to-child transmission of HIV. Missed visits promote attrition from prevention of mother-to-child transmission of HIV program and antiretroviral drug resistance. The purpose of the study was to determine the prevalence of missed PMTCT visits and its associated predictors. A descriptive cross sectional survey was carried out at a District Hospital in Goromonzi, Zimbabwe. Fifty-three women completed closed-ended questionnaires pertaining to PMTCT visits and exposure to PMTCT activities. A total of 24.5% missed at least one scheduled PMTCT visit. Statistically significant predictors of not missing a PMTCT visit were satisfaction with family support (β = −0.73, p = 0.029) and level of satisfaction with PMTCT services (β = −0.00076;p = 0.04). The number of days by which scheduled visits were missed were inversely correlated with visit number (β = −2.99, p = 0.04). Enhanced family support and quality improvement to improve patient satisfaction may reduce missed visits. Availing women with a more active role in PMTCT may also reduce the prevalence of missed visits.展开更多
Long chain polyunsaturated fatty acids are essential macronutrients that have several benefits which have been described for children’s health. Omega 3 LCPUFA metabolism has been reported to be altered in under-nouri...Long chain polyunsaturated fatty acids are essential macronutrients that have several benefits which have been described for children’s health. Omega 3 LCPUFA metabolism has been reported to be altered in under-nourished and in HIV infected children. Therefore, we describe Eicosapentaenoic acid, Docosapentaenoic acid and Docosahexaenoic acid levels of HIV infected, HIV exposed uninfected and HIV unexposed uninfected school aged children from a low income country with a high burden of HIV infection and under-nutrition. This cross-sectional study recruited children 7 to 10 years old. Capillary blood was collected on filter paper and whole blood fatty acid analysis done using automated gas liquid chromatography. Kruskal Wallis and Median tests were used to compare the distribution and medians of the Omega 3 LCPUFA among the children according to HIV status, gender, age and nutritional status. A total of 318 children were recruited with 21 (7%) being HIV infected and 116 (37%) being HIV exposed uninfected. Chronic malnutrition was present in 12% of the children. The omega 3 fatty acids were expressed as percent weight of total fatty acids. The medians (interquartile range) for EPA, DPA and DHA for all the children were 0.19 (0.09), 0.79 (0.19) and 2.14 (0.54) %wt/wt respectively. EPA, DPA and DHA levels were not associated with the HIV status of the children. EPA levels were much lower in the 7-year-age group compared with the 8 and 9 - 10-year-age groups. Further studies assessing LCPUFA levels that include larger sample size, children from both urban and rural areas are recommended as this may assist in clearly defining the association of LCPUFA with HIV status in children from low income countries with high burden of under-nutrition.展开更多
Infectious diseases of poverty(IDoP)disproportionately affect the poorest population in the world and contribute to a cycle of poverty as a result of decreased productivity ensuing from long-term illness,disability,an...Infectious diseases of poverty(IDoP)disproportionately affect the poorest population in the world and contribute to a cycle of poverty as a result of decreased productivity ensuing from long-term illness,disability,and social stigma.In 2010,the global deaths from HIV/AIDS have increased to 1.5 million and malaria mortality rose to 1.17 million.Mortality from neglected tropical diseases rose to 152,000,while tuberculosis killed 1.2 million people that same year.Substantial regional variations exist in the distribution of these diseases as they are primarily concentrated in rural areas of Sub-Saharan Africa,Asia,and Latin America,with geographic overlap and high levels of co-infection.Evidence-based interventions exist to prevent and control these diseases,however,the coverage still remains low with an emerging challenge of antimicrobial resistance.Therefore,community-based delivery platforms are increasingly being advocated to ensure sustainability and combat co-infections.Because of the high morbidity and mortality burden of these diseases,especially in resource-poor settings,it is imperative to conduct a systematic review to identify strategies to prevent and control these diseases.Therefore,we attempted to evaluate the effectiveness of one of these strategies,that is community-based delivery for the prevention and treatment of IDoP.In this paper,we describe the burden,epidemiology,and potential interventions for IDoP.In subsequent papers of this series,we describe the analytical framework and the methodology used to guide the systematic reviews,and report the findings and interpretations of our analyses of the impact of community-based strategies on individual IDoPs.展开更多
This paper describes the conceptual framework and the methodology used to guide the systematic reviews of community-based interventions(CBIs)for the prevention and control of infectious diseases of poverty(IDoP).We ad...This paper describes the conceptual framework and the methodology used to guide the systematic reviews of community-based interventions(CBIs)for the prevention and control of infectious diseases of poverty(IDoP).We adapted the conceptual framework from the 3ie work on the‘Community-Based Intervention Packages for Preventing Maternal Morbidity and Mortality and Improving Neonatal Outcomes’to aid in the analyzing of the existing CBIs for IDoP.The conceptual framework revolves around objectives,inputs,processes,outputs,outcomes,and impacts showing the theoretical linkages between the delivery of the interventions targeting these diseases through various community delivery platforms and the consequent health impacts.We also describe the methodology undertaken to conduct the systematic reviews and the meta-analyses.展开更多
In 2012,an estimated 35.3 million people lived with HIV,while approximately two million new HIV infections were reported.Community-based interventions(CBIs)for the prevention and control of HIV allow increased access ...In 2012,an estimated 35.3 million people lived with HIV,while approximately two million new HIV infections were reported.Community-based interventions(CBIs)for the prevention and control of HIV allow increased access and ease availability of medical care to population at risk,or already infected with,HIV.This paper evaluates the impact of CBIs on HIV knowledge,attitudes,and transmission.We included 39 studies on educational activities,counseling sessions,home visits,mentoring,women’s groups,peer leadership,and street outreach activities in community settings that aimed to increase awareness on HIV/AIDS risk factors and ensure treatment adherence.Our review findings suggest that CBIs to increase HIV awareness and risk reduction are effective in improving knowledge,attitudes,and practice outcomes as evidenced by the increased knowledge scores for HIV/AIDS(SMD:0.66,95%CI:0.25,1.07),protected sexual encounters(RR:1.19,95%CI:1.13,1.25),condom use(SMD:0.96,95%CI:0.03,1.58),and decreased frequency of sexual intercourse(RR:0.76,95%CI:0.61,0.96).Analysis shows that CBIs did not have any significant impact on scores for self-efficacy and communication.We found very limited evidence on community-based management for HIV infected population and prevention of mother-to-child transmission(MTCT)for HIV-infected pregnant women.Qualitative synthesis suggests that establishment of community support at the onset of HIV prevention programs leads to community acceptance and engagement.School-based delivery of HIV prevention education and contraceptive distribution have also been advocated as potential strategies to target high-risk youth group.Future studies should focus on evaluating the effectiveness of community delivery platforms for prevention of MTCT,and various emerging models of care to improve morbidity and mortality outcomes.展开更多
This series evaluates the effectiveness of community-based interventions(CBIs)to prevent and control infectious diseases of poverty(IDoP).Evidence from our reviews suggests that CBIs and school-based delivery platform...This series evaluates the effectiveness of community-based interventions(CBIs)to prevent and control infectious diseases of poverty(IDoP).Evidence from our reviews suggests that CBIs and school-based delivery platforms are effective in averting risk behaviors and reducing the disease burden.Co-implementation of interventions through existing community-based programs including immunization campaigns,antenatal care and maternal and child health programs have the potential to scale-up interventions for IDoP.Future research should focus on the process of developing and implementing efficient community-based programs through a comprehensive approach,and to gauge the effectiveness of various existing delivery models in order to improve morbidity and mortality outcomes.展开更多
In this paper,we aim to evaluate the effectiveness of community-based interventions(CBIs)for the prevention and management of malaria.We conducted a systematic review and identified 42 studies for inclusion.Twenty-fiv...In this paper,we aim to evaluate the effectiveness of community-based interventions(CBIs)for the prevention and management of malaria.We conducted a systematic review and identified 42 studies for inclusion.Twenty-five of the included studies evaluated the impact of the community-based distribution of insecticide-treated nets(ITNs),indoor residual spraying(IRS),or impregnated bed sheets;14 studies evaluated intermittent preventive therapy(IPT)delivered in community settings;two studies focused on community-based education for malaria prevention;and one study evaluated environmental management through drain cleaning.Our analysis suggests that,overall,the community-based delivery of interventions to prevent and control malaria resulted in a significant increase in ITNs ownership(RR:2.16,95%CI:1.86,2.52)and usage(RR:1.77,95%CI:1.48,2.11).However,usage of ITNs was limited to two-thirds of the population who owned them.Community-based strategies also led to a significant decrease in parasitemia(RR:0.56,95%CI:0.42,0.74),malaria prevalence(RR:0.46,95%CI:0.29,0.73),malaria incidence(RR:0.70,95%CI:0.54,0.90),and anemia prevalence(RR:0.79,95%CI:0.64,0.97).We found a non-significant impact on splenomegaly,birth outcomes(low birth weight,prematurity,stillbirth/miscarriage),anthropometric measures(stunting,wasting,and underweight),and mortality(all-cause and malaria-specific).The subgroup analysis suggested that community-based distribution of ITNs,impregnated bed sheets and IRS,and IPT are effective strategies.Qualitative synthesis suggests that high coverage could be achieved at a lower cost with the integration of CBIs with existing antenatal care and immunization campaigns.Community-based delivery of interventions to prevent and control malaria are effective strategies to improve coverage and access and reduce malaria burden,however,efforts should also be concerted to prevent over diagnosis and drug resistance.展开更多
In this paper,we aim to systematically analyze the effectiveness of community-based interventions(CBIs)for the prevention and control of helminthiasis including soil-transmitted helminthiasis(STH)(ascariasis,hookworms...In this paper,we aim to systematically analyze the effectiveness of community-based interventions(CBIs)for the prevention and control of helminthiasis including soil-transmitted helminthiasis(STH)(ascariasis,hookworms,and trichuriasis),lymphatic filariasis,onchocerciasis,dracunculiasis,and schistosomiasis.We systematically reviewed literature published before May 2013 and included 32 studies in this review.Findings from the meta-analysis suggest that CBIs are effective in reducing the prevalence of STH(RR:0.45,95%CI:0.38,0.54),schistosomiasis(RR:0.40,95%CI:0.33,0.50),and STH intensity(SMD:−3.16,95 CI:−4.28,−2.04).They are also effective in improving mean hemoglobin(SMD:0.34,95%CI:0.20,0.47)and reducing anemia prevalence(RR:0.90,95%CI:0.85,0.96).However,it did not have any impact on ferritin,height,weight,low birth weight(LBW),or stillbirths.School-based delivery significantly reduced STH(RR:0.49,95%CI:0.39,0.63)and schistosomiasis prevalence(RR:0.50,95%CI:0.33,0.75),STH intensity(SMD:−0.22,95%CI:−0.26,−0.17),and anemia prevalence(RR:0.87,95%CI:0.81,0.94).It also improved mean hemoglobin(SMD:0.24,95%CI:0.16,0.32).We did not find any conclusive evidence from the quantitative synthesis on the relative effectiveness of integrated and non-integrated delivery strategies due to the limited data available for each subgroup.However,the qualitative synthesis from the included studies supports community-based delivery strategies and suggests that integrated prevention and control measures are more effective in achieving greater coverage compared to the routine vertical delivery,albeit it requires an existing strong healthcare infrastructure.Current evidence suggests that effective community-based strategies exist and deliver a range of preventive,promotive,and therapeutic interventions to combat helminthic neglected tropical diseases(NTDs).However,there is a need to implement and evaluate efficient integrated programs with the existing disease control programs on a larger scale throughout resource-limited regions especially to reach the unreachable.展开更多
In 2012,an estimated 8.6 million people developed tuberculosis(TB)and 1.3 million died from the disease.With its recent resurgence with the human immunodeficiency virus(HIV);TB prevention and management has become fur...In 2012,an estimated 8.6 million people developed tuberculosis(TB)and 1.3 million died from the disease.With its recent resurgence with the human immunodeficiency virus(HIV);TB prevention and management has become further challenging.We systematically evaluated the effectiveness of community based interventions(CBI)for the prevention and treatment of TB and a total of 41 studies were identified for inclusion.Findings suggest that CBI for TB prevention and case detection showed significant increase in TB detection rates(RR:3.1,95%CI:2.92,3.28)with non-significant impact on TB incidence.CBI for treating patients with active TB showed an overall improvement in treatment success rates(RR:1.09,95%CI:1.07,1.11)and evidence from a single study suggests significant reduction in relapse rate(RR:0.26,95%CI:0.18,0.39).The results were consistent for various study design and delivery mechanism.Qualitative synthesis suggests that community based TB treatment delivery through community health workers(CHW)not only improved access and service utilization but also contributed to capacity building and improving the routine TB recording and reporting systems.CBI coupled with the DOTS strategy seem to be an effective approach,however there is a need to evaluate various community-based integrated delivery models for relative effectiveness.展开更多
The understanding of the impact of prenatal exposure to metal mixtures on birth weight is limited.We aimed to identify metal mixture components associated with birth weight and to determine additional pairwise interac...The understanding of the impact of prenatal exposure to metal mixtures on birth weight is limited.We aimed to identify metal mixture components associated with birth weight and to determine additional pairwise interactions between metals showing such associations.Concentrations of 18 metals were measured using inductively coupled plasma mass spectrometry in urine samples collected in the 3rd trimester from a prenatal cohort(discovery;n=1849)and the Healthy Baby Cohort(replication;n=7255)in Wuhan,China.In the discovery set,we used two penalized regression models,i.e.,elastic net regression for main effects and a lasso for hierarchical interactions,to identify important mixture components associated with birth weight,which were then replicated.We observed that 8 of the 18 measured metals were retained by elastic net regression,with five metals(vanadium,manganese,iron,cesium,and barium)showing negative associations with Z-scores for birth weight and three metals(cobalt,zinc,and strontium)showing positive associations.In replication set,associations remained significant for vanadium(β=-0.035;95%confidence interval[CI],-0.059 to0.010),cobalt(β=-0.073;95%CI,0.049 to 0.097),and zinc(β=-0.040;95%CI,0.016 to 0.065)after Bonferroni correction.We additionally identified and replicated a single pairwise interaction between iron and copper exposure on birth weight(P<0.001).Using a two-stage analysis,we identified and replicated individual metals and additional pairwise interactions-associated birth weight.The approach could be used in other studies estimating the effect of complex mixtures on human health.展开更多
文摘The future of any population is children. Resource limited settings with a high prevalence of HIV infection notably also have an excessive burden of malnutrition. The advances in prevention of mother to child HIV transmission programmes have led to very effective combination antiretroviral regimens resulting in growing numbers of HIV exposed but uninfected children. The mortality of HIV exposed but uninfected children below 5 years is high in resource limited settings. It is also important to pay particular attention to their longitudinal growth and neurodevelopmental outcomes. In these settings, the contribution of feeding practices, choice of complementary foods and micronutrient deficiencies, to health outcomes of HIV exposed uninfected children are not clearly defined. This review highlights some gaps in research that need to be addressed in areas with increasing numbers of HIV exposed but uninfected children. Interventions to reduce mortality, improve growth and neurodevelopmental outcomes in HIV exposed uninfected children from resource limited areas should be prioritized.
文摘Missed Prevention of Mother-to-Child Transmission of HIV (PMTCT) visits have contributed to the delayed achievement of elimination of mother-to-child transmission of HIV. Missed visits promote attrition from prevention of mother-to-child transmission of HIV program and antiretroviral drug resistance. The purpose of the study was to determine the prevalence of missed PMTCT visits and its associated predictors. A descriptive cross sectional survey was carried out at a District Hospital in Goromonzi, Zimbabwe. Fifty-three women completed closed-ended questionnaires pertaining to PMTCT visits and exposure to PMTCT activities. A total of 24.5% missed at least one scheduled PMTCT visit. Statistically significant predictors of not missing a PMTCT visit were satisfaction with family support (β = −0.73, p = 0.029) and level of satisfaction with PMTCT services (β = −0.00076;p = 0.04). The number of days by which scheduled visits were missed were inversely correlated with visit number (β = −2.99, p = 0.04). Enhanced family support and quality improvement to improve patient satisfaction may reduce missed visits. Availing women with a more active role in PMTCT may also reduce the prevalence of missed visits.
文摘Long chain polyunsaturated fatty acids are essential macronutrients that have several benefits which have been described for children’s health. Omega 3 LCPUFA metabolism has been reported to be altered in under-nourished and in HIV infected children. Therefore, we describe Eicosapentaenoic acid, Docosapentaenoic acid and Docosahexaenoic acid levels of HIV infected, HIV exposed uninfected and HIV unexposed uninfected school aged children from a low income country with a high burden of HIV infection and under-nutrition. This cross-sectional study recruited children 7 to 10 years old. Capillary blood was collected on filter paper and whole blood fatty acid analysis done using automated gas liquid chromatography. Kruskal Wallis and Median tests were used to compare the distribution and medians of the Omega 3 LCPUFA among the children according to HIV status, gender, age and nutritional status. A total of 318 children were recruited with 21 (7%) being HIV infected and 116 (37%) being HIV exposed uninfected. Chronic malnutrition was present in 12% of the children. The omega 3 fatty acids were expressed as percent weight of total fatty acids. The medians (interquartile range) for EPA, DPA and DHA for all the children were 0.19 (0.09), 0.79 (0.19) and 2.14 (0.54) %wt/wt respectively. EPA, DPA and DHA levels were not associated with the HIV status of the children. EPA levels were much lower in the 7-year-age group compared with the 8 and 9 - 10-year-age groups. Further studies assessing LCPUFA levels that include larger sample size, children from both urban and rural areas are recommended as this may assist in clearly defining the association of LCPUFA with HIV status in children from low income countries with high burden of under-nutrition.
文摘Infectious diseases of poverty(IDoP)disproportionately affect the poorest population in the world and contribute to a cycle of poverty as a result of decreased productivity ensuing from long-term illness,disability,and social stigma.In 2010,the global deaths from HIV/AIDS have increased to 1.5 million and malaria mortality rose to 1.17 million.Mortality from neglected tropical diseases rose to 152,000,while tuberculosis killed 1.2 million people that same year.Substantial regional variations exist in the distribution of these diseases as they are primarily concentrated in rural areas of Sub-Saharan Africa,Asia,and Latin America,with geographic overlap and high levels of co-infection.Evidence-based interventions exist to prevent and control these diseases,however,the coverage still remains low with an emerging challenge of antimicrobial resistance.Therefore,community-based delivery platforms are increasingly being advocated to ensure sustainability and combat co-infections.Because of the high morbidity and mortality burden of these diseases,especially in resource-poor settings,it is imperative to conduct a systematic review to identify strategies to prevent and control these diseases.Therefore,we attempted to evaluate the effectiveness of one of these strategies,that is community-based delivery for the prevention and treatment of IDoP.In this paper,we describe the burden,epidemiology,and potential interventions for IDoP.In subsequent papers of this series,we describe the analytical framework and the methodology used to guide the systematic reviews,and report the findings and interpretations of our analyses of the impact of community-based strategies on individual IDoPs.
文摘This paper describes the conceptual framework and the methodology used to guide the systematic reviews of community-based interventions(CBIs)for the prevention and control of infectious diseases of poverty(IDoP).We adapted the conceptual framework from the 3ie work on the‘Community-Based Intervention Packages for Preventing Maternal Morbidity and Mortality and Improving Neonatal Outcomes’to aid in the analyzing of the existing CBIs for IDoP.The conceptual framework revolves around objectives,inputs,processes,outputs,outcomes,and impacts showing the theoretical linkages between the delivery of the interventions targeting these diseases through various community delivery platforms and the consequent health impacts.We also describe the methodology undertaken to conduct the systematic reviews and the meta-analyses.
文摘In 2012,an estimated 35.3 million people lived with HIV,while approximately two million new HIV infections were reported.Community-based interventions(CBIs)for the prevention and control of HIV allow increased access and ease availability of medical care to population at risk,or already infected with,HIV.This paper evaluates the impact of CBIs on HIV knowledge,attitudes,and transmission.We included 39 studies on educational activities,counseling sessions,home visits,mentoring,women’s groups,peer leadership,and street outreach activities in community settings that aimed to increase awareness on HIV/AIDS risk factors and ensure treatment adherence.Our review findings suggest that CBIs to increase HIV awareness and risk reduction are effective in improving knowledge,attitudes,and practice outcomes as evidenced by the increased knowledge scores for HIV/AIDS(SMD:0.66,95%CI:0.25,1.07),protected sexual encounters(RR:1.19,95%CI:1.13,1.25),condom use(SMD:0.96,95%CI:0.03,1.58),and decreased frequency of sexual intercourse(RR:0.76,95%CI:0.61,0.96).Analysis shows that CBIs did not have any significant impact on scores for self-efficacy and communication.We found very limited evidence on community-based management for HIV infected population and prevention of mother-to-child transmission(MTCT)for HIV-infected pregnant women.Qualitative synthesis suggests that establishment of community support at the onset of HIV prevention programs leads to community acceptance and engagement.School-based delivery of HIV prevention education and contraceptive distribution have also been advocated as potential strategies to target high-risk youth group.Future studies should focus on evaluating the effectiveness of community delivery platforms for prevention of MTCT,and various emerging models of care to improve morbidity and mortality outcomes.
文摘This series evaluates the effectiveness of community-based interventions(CBIs)to prevent and control infectious diseases of poverty(IDoP).Evidence from our reviews suggests that CBIs and school-based delivery platforms are effective in averting risk behaviors and reducing the disease burden.Co-implementation of interventions through existing community-based programs including immunization campaigns,antenatal care and maternal and child health programs have the potential to scale-up interventions for IDoP.Future research should focus on the process of developing and implementing efficient community-based programs through a comprehensive approach,and to gauge the effectiveness of various existing delivery models in order to improve morbidity and mortality outcomes.
文摘In this paper,we aim to evaluate the effectiveness of community-based interventions(CBIs)for the prevention and management of malaria.We conducted a systematic review and identified 42 studies for inclusion.Twenty-five of the included studies evaluated the impact of the community-based distribution of insecticide-treated nets(ITNs),indoor residual spraying(IRS),or impregnated bed sheets;14 studies evaluated intermittent preventive therapy(IPT)delivered in community settings;two studies focused on community-based education for malaria prevention;and one study evaluated environmental management through drain cleaning.Our analysis suggests that,overall,the community-based delivery of interventions to prevent and control malaria resulted in a significant increase in ITNs ownership(RR:2.16,95%CI:1.86,2.52)and usage(RR:1.77,95%CI:1.48,2.11).However,usage of ITNs was limited to two-thirds of the population who owned them.Community-based strategies also led to a significant decrease in parasitemia(RR:0.56,95%CI:0.42,0.74),malaria prevalence(RR:0.46,95%CI:0.29,0.73),malaria incidence(RR:0.70,95%CI:0.54,0.90),and anemia prevalence(RR:0.79,95%CI:0.64,0.97).We found a non-significant impact on splenomegaly,birth outcomes(low birth weight,prematurity,stillbirth/miscarriage),anthropometric measures(stunting,wasting,and underweight),and mortality(all-cause and malaria-specific).The subgroup analysis suggested that community-based distribution of ITNs,impregnated bed sheets and IRS,and IPT are effective strategies.Qualitative synthesis suggests that high coverage could be achieved at a lower cost with the integration of CBIs with existing antenatal care and immunization campaigns.Community-based delivery of interventions to prevent and control malaria are effective strategies to improve coverage and access and reduce malaria burden,however,efforts should also be concerted to prevent over diagnosis and drug resistance.
文摘In this paper,we aim to systematically analyze the effectiveness of community-based interventions(CBIs)for the prevention and control of helminthiasis including soil-transmitted helminthiasis(STH)(ascariasis,hookworms,and trichuriasis),lymphatic filariasis,onchocerciasis,dracunculiasis,and schistosomiasis.We systematically reviewed literature published before May 2013 and included 32 studies in this review.Findings from the meta-analysis suggest that CBIs are effective in reducing the prevalence of STH(RR:0.45,95%CI:0.38,0.54),schistosomiasis(RR:0.40,95%CI:0.33,0.50),and STH intensity(SMD:−3.16,95 CI:−4.28,−2.04).They are also effective in improving mean hemoglobin(SMD:0.34,95%CI:0.20,0.47)and reducing anemia prevalence(RR:0.90,95%CI:0.85,0.96).However,it did not have any impact on ferritin,height,weight,low birth weight(LBW),or stillbirths.School-based delivery significantly reduced STH(RR:0.49,95%CI:0.39,0.63)and schistosomiasis prevalence(RR:0.50,95%CI:0.33,0.75),STH intensity(SMD:−0.22,95%CI:−0.26,−0.17),and anemia prevalence(RR:0.87,95%CI:0.81,0.94).It also improved mean hemoglobin(SMD:0.24,95%CI:0.16,0.32).We did not find any conclusive evidence from the quantitative synthesis on the relative effectiveness of integrated and non-integrated delivery strategies due to the limited data available for each subgroup.However,the qualitative synthesis from the included studies supports community-based delivery strategies and suggests that integrated prevention and control measures are more effective in achieving greater coverage compared to the routine vertical delivery,albeit it requires an existing strong healthcare infrastructure.Current evidence suggests that effective community-based strategies exist and deliver a range of preventive,promotive,and therapeutic interventions to combat helminthic neglected tropical diseases(NTDs).However,there is a need to implement and evaluate efficient integrated programs with the existing disease control programs on a larger scale throughout resource-limited regions especially to reach the unreachable.
文摘In 2012,an estimated 8.6 million people developed tuberculosis(TB)and 1.3 million died from the disease.With its recent resurgence with the human immunodeficiency virus(HIV);TB prevention and management has become further challenging.We systematically evaluated the effectiveness of community based interventions(CBI)for the prevention and treatment of TB and a total of 41 studies were identified for inclusion.Findings suggest that CBI for TB prevention and case detection showed significant increase in TB detection rates(RR:3.1,95%CI:2.92,3.28)with non-significant impact on TB incidence.CBI for treating patients with active TB showed an overall improvement in treatment success rates(RR:1.09,95%CI:1.07,1.11)and evidence from a single study suggests significant reduction in relapse rate(RR:0.26,95%CI:0.18,0.39).The results were consistent for various study design and delivery mechanism.Qualitative synthesis suggests that community based TB treatment delivery through community health workers(CHW)not only improved access and service utilization but also contributed to capacity building and improving the routine TB recording and reporting systems.CBI coupled with the DOTS strategy seem to be an effective approach,however there is a need to evaluate various community-based integrated delivery models for relative effectiveness.
基金supported by the National Natural Science Foundation of China(42077398),Program for HUST Academic Frontier Youth Team(2018QYTD12)and the National Institute of Environmental Health Sciences(R01 ES024381 and R01 ES025214).
文摘The understanding of the impact of prenatal exposure to metal mixtures on birth weight is limited.We aimed to identify metal mixture components associated with birth weight and to determine additional pairwise interactions between metals showing such associations.Concentrations of 18 metals were measured using inductively coupled plasma mass spectrometry in urine samples collected in the 3rd trimester from a prenatal cohort(discovery;n=1849)and the Healthy Baby Cohort(replication;n=7255)in Wuhan,China.In the discovery set,we used two penalized regression models,i.e.,elastic net regression for main effects and a lasso for hierarchical interactions,to identify important mixture components associated with birth weight,which were then replicated.We observed that 8 of the 18 measured metals were retained by elastic net regression,with five metals(vanadium,manganese,iron,cesium,and barium)showing negative associations with Z-scores for birth weight and three metals(cobalt,zinc,and strontium)showing positive associations.In replication set,associations remained significant for vanadium(β=-0.035;95%confidence interval[CI],-0.059 to0.010),cobalt(β=-0.073;95%CI,0.049 to 0.097),and zinc(β=-0.040;95%CI,0.016 to 0.065)after Bonferroni correction.We additionally identified and replicated a single pairwise interaction between iron and copper exposure on birth weight(P<0.001).Using a two-stage analysis,we identified and replicated individual metals and additional pairwise interactions-associated birth weight.The approach could be used in other studies estimating the effect of complex mixtures on human health.