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Background: Mycobacterium ulcerans infection, commonly known as Buruli ulcer (BU), is a debilitating neglected tropical disease. Its management remains complex and has three main components: antibiotic treatment combining rifampicin and streptomycin for 56 days, wound dressings and skin grafts for large ulcerations, and physical therapy to prevent functional limitations after care. In Benin, BU patient care is being integrated into the government health system. In this paper, we report on an innovative pilot program designed to introduce BU decentralization in Ouinhi district, one of Benin’s most endemic districts previously served by centralized hospital-based care. Methodology/Principal findings: We conducted intervention-oriented research implemented in four steps: baseline study, training of health district clinical staff, outreach education, outcome and impact assessments. Study results demonstrated that early BU lesions (71% of all detected cases) could be treated in the community following outreach education, and that most of the afflicted were willing to accept decentralized treatment. Ninety-three percent were successfully treated with antibiotics alone. The impact evaluation found that community confidence in decentralized BU care was greatly enhanced by clinic staff who came to be seen as having expertise in the care of most chronic wounds. Conclusions/Significance: This study documents a successful BU outreach and decentralized care program reaching early BU cases not previously treated by a proactive centralized BU program. The pilot program further demonstrates the added value of integrated wound management for NTD control. [ABSTRACT FROM AUTHOR]

Snakebite envenomation (SBE) is endemic to sub-Saharan Africa and generally over-represented in rural, remote, and impoverished agricultural communities. While poverty is an established risk factor, little research has been done to investigate the economic consequences of SBE. This cross-sectional, quantitative study aimed to measure out-of-pocket spending and lost income when a household member was bitten by a snake. In 2020, 732 snakebite survivors from Eastern Province (Rwanda) agreed to complete a survey administered by telephone. The survey focused on participant demographics, income, direct medical and non-medical costs, care-seeking decisions, and lost work during convalescence. Our results suggested that patients incurred the highest mean expenses when they sought care from hospitals (11 307 RWF or 12 USD) or traditional healers (5 836 RWF or 6 USD) but that the highest maximum cost was incurred from traditional healers (300 000 RWF or 313 USD). Across all victims, the total amount paid to traditional healers (3.4 million RWF or 3 537 USD) was 4.7 times higher than all other care providers combined. On average, families lost 111 814 RWF (117 USD) per snakebite in direct treatment costs and indirect productivity losses. Many victims sought care from traditional healers despite being eligible for free medical care. Altogether, this study serves as a reminder of the serious physical and financial consequences associated with SBE and provides justification for new investments into SBE prevention and care. Author summary: Snakebite is a life-threatening situation in sub-Saharan Africa, especially for rural and poor populations. Despite being preventable and treatable, it receives little attention from policymakers. The goal of this study was to estimate the financial losses experienced by snakebite victims due to treatment costs and lost work. Interviews with 732 snakebite victims from Eastern Province, Rwanda, indicated that a typical adult lost 12.0% of their annual income due to a single bite. Moreover, caregivers lost time and income when caring for a sick family member. Patients preferentially sought care from traditional healers rather than Community Health Workers, nurses or physicians, even when they qualified for free hospital care. Consequently, victims in our study group paid five times more to traditional healers (3.4 million RWF or 3 537 USD) than to all other care providers combined. Altogether, our analysis suggests that Rwandese lose 7.4 million USD each year in treatment costs and lost work due to snakebite. These results serve as evidence to policymakers that investments to prevention and treatment programs will not only reduce pain and suffering, but also contribute to national goals targeting poverty reduction. [ABSTRACT FROM AUTHOR]

Introduction: Although malaria has been the leading cause of fever for many years, with improved control regimes malaria transmission, morbidity and mortality have decreased. Recent studies have increasingly demonstrated the importance of non-malaria fevers, which have significantly improved our understanding of etiologies of febrile illnesses. A number of non-malaria febrile illnesses including Rift Valley Fever, dengue fever, Chikungunya virus infection, leptospirosis, tick-borne relapsing fever and Q-fever have been reported in Tanzania. This study aimed at assessing the awareness of communities and practices of health workers on non-malaria febrile illnesses. Methods: Twelve focus group discussions with members of communities and 14 in-depth interviews with health workers were conducted in Kilosa district, Tanzania. Transcripts were coded into different groups using MaxQDA software and analyzed through thematic content analysis. Results: The study revealed that the awareness of the study participants on non-malaria febrile illnesses was low and many community members believed that most instances of fever are due to malaria. In addition, the majority had inappropriate beliefs about the possible causes of fever. In most cases, non-malaria febrile illnesses were considered following a negative Malaria Rapid Diagnostic Test (mRDT) result or persistent fevers after completion of anti-malaria dosage. Therefore, in the absence of mRDTs, there is over diagnosis of malaria and under diagnosis of non-malaria illnesses. Shortages of diagnostic facilities for febrile illnesses including mRDTs were repeatedly reported as a major barrier to proper diagnosis and treatment of febrile patients. Conclusion: Our results emphasize the need for creating community awareness on other causes of fever apart from malaria. Based on our study, appropriate treatment of febrile patients will require inputs geared towards strengthening of diagnostic facilities, drugs availability and optimal staffing of health facilities. Author Summary: Understanding the awareness of the community on non-malaria febrile illnesses is crucial, especially during the recent decline of malaria episodes of malaria. This study conducted focus group discussions with communities to assess their awareness of non-malaria febrile illnesses. In addition, in-depth interviews with health workers were conducted to explore their views and practices related to diagnosis and management of these illnesses. We identified that the awareness of the study participants on non-malaria febrile illnesses was low and the majority believed that most instances of fever are due to malaria. Moreover, the participants could not mention the right causes of fever and many had inappropriate beliefs about possible causes of fever. Health workers from our study looked for non-malaria febrile illnesses when a febrile patient had negative mRDT result or there was persistence of fever following completion of anti-malarial dosage. Shortages of diagnostic facilities were identified as one of the impediments to proper diagnosis of febrile illnesses. These findings indicate the need for creation of public awareness on causes of fever other than malaria. We recommend appropriate measures be taken by the government and other stake holders to improve health care services delivery particularly at primary health care facilities. [ABSTRACT FROM AUTHOR]

Background: The prevalence of epilepsy added to inadequate treatment results in chronic morbidity and considerable mortality in poor populations. Neurocysticercosis (NCC), a helminthic disease of the central nervous system, is a leading cause of seizures and epilepsy in most of the world. Methods: Taking advantage of a cysticercosis elimination program, we performed two community-based cross-sectional studies between 2006 and 2007 in 58 rural communities (population 20,610) to assess the prevalence and characteristics of epilepsy and epileptic seizures in this endemic region. Serological and computed tomography (CT) data in individuals with epilepsy were compared to previous surveys in general population from the same region. Principal findings: In two surveys, 17,450 individuals were evaluated. Lifetime prevalence of epilepsy was 17.25/1000, and prevalence of active epilepsy was 10.8/1000 inhabitants. The prevalence of epilepsy increased after age 25 years and dropped after age 45. Only 24% (45/188) of patients with active epilepsy were taking antiepileptic drugs, all at sub-therapeutic doses. Antibodies to cysticercosis were found in approximately 40% of individuals with epilepsy in both studies. In one survey only individuals presenting strong antibody reactions were significantly associated with having epilepsy (OR 5.74; p<0.001). In the second, the seroprevalence as well as the proportion presenting strong antibody reactions were both significantly higher in individuals with epilepsy (OR 2.2 and 4.33, respectively). Brain CT showed NCC-compatible images in 109/282 individuals with epilepsy (39%). All individuals with viable parasites on CT were seropositive. Conclusion: The prevalence of epilepsy in this cysticercosis endemic region is high and NCC is an important contributor to it. Author Summary: Epilepsy is a chronic disease affecting more than 50 million people around the world. In many countries neurocysticercosis (NCC), a parasitic disease of the central nervous system, is a frequent cause of seizures and epilepsy. After a human ingests poorly cooked pork with cysts of the tapeworm Taenia solium, the larvae develops in the small intestine as an adult tapeworm. The tapeworm carrier becomes a source of infective eggs which are released with the stools and can infect humans or pigs with the larval stage, causing cysticercosis. There are many forms of clinical manifestations of NCC; epilepsy is one of them and the most frequent. Scarce population based-studies to identify individuals with epilepsy in rural communities exist, including only a few from Latin America. Our community-based study used a validated survey applied by trained non-medical professionals (nurse, nurse technicians, mid-wife, etc.) and found 301 individuals with epilepsy (17.25/1000), 70% of them without antiepileptic medication and 39% of them with images suggestive of NCC. The prevalence of epilepsy is high in this region and cysticercosis is a frequent finding in individuals with epilepsy. [ABSTRACT FROM AUTHOR]

We report the results of a joint human-animal health investigation in a Dene community in northern Saskatchewan, where residents harvest wildlife (including moose, bear, elk, and fish), live in close contact with free roaming dogs, and lack access to permanent veterinary services. Fecal analysis of owned and free-roaming dogs over two consecutive years (N = 92, 103) identified several parasites of public health concern, including Toxocara canis, Diphyllobothrium spp., Echinococcus/Taenia, Cryptosporidium spp. and Giardia spp. Administration of pyrantel pamoate to a subset of dogs (N = 122) in the community in the first year was followed by reduced shedding of T. canis and other roundworms in the second year, demonstrating the potential utility of canine de-worming as a public health intervention. Using direct agglutination tests with confirmatory indirect fluorescent antibody test, 21% of 47 dogs were sero-positive for exposure to Toxoplasma gondii. Using enzyme-linked immunosorbent assay (ELISA) sero-prevalence rates in 201 human volunteers were as follows: Toxoplasma gondii (14%), Echinococcus granulosus (48%), Toxocara canis (13%) and Trichinella spp. (16%). Overall 65% of participants were sero-positive for at least one parasite. A survey administered to volunteers indicated few associations between widely accepted risk factors for parasite exposure and serological status, emphasizing the importance of environmental transmission of these parasites through soil, food, and waterborne routes. Author Summary: Parasites are ubiquitous, and while some parasitize only one host, others are capable of crossing species barriers. Zoonotic parasites move between animals and people, and in some cases cause significant veterinary, medical and/or public health problems. Such parasites may be more prevalent in areas where veterinary and medical services are scarce, and especially if sanitation infrastructure is suboptimal. Additional risk factors include reliance on country foods, proximity to pets that come in contact with wildlife, and eating undercooked or raw fish and game. We visited one northern Indigenous community over two consecutive years to determine the prevalence of internal parasites in dogs, as well as to demonstrate the effect of selective deworming on reducing environmental contamination by zoonotic parasites. In addition, we collected blood samples and administered surveys to human volunteers in order to explore the relationship between exposure to four zoonotic parasites and several widely accepted risk factors for exposure (e.g. pet ownership). Our findings indicate that levels of parasite exposure in this community were higher than similar studies conducted in other Canadian Indigenous communities. Public health interventions that utilize a one health strategy by integrating medical, veterinary and environmental expertise may be the most effective approach in reducing human and animal exposure to parasites in this community. [ABSTRACT FROM AUTHOR]