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This review explores our understanding of Cryptosporidium species and Giardia duodenalis distribution in Middle East and North African (MENA) water resources. Results emphasize that Cryptosporidium species (sp.) and G. duodenalis (oo)cysts are present in distinct categories of water in ten MENA countries. Cryptosporidium sp. proportional prevalence in the MENA region was 24.5% (95% CI 16.3-33.8), while G. duodenalis prevalence was 37.7% (95% CI 21.9-55.1). Raw wastewater and surface water were the water categories most significantly impacted. Both parasites were reported in the various types of MENA drinking waters. The most frequent species/genotypes reported were C. hominis, C. parvum, and G. duodenalis assemblage A. Despite the high prevalence of (oo)cysts reported, we should consider the absence of waterborne outbreaks. This indicates significant underestimation and underreporting of both parasites in MENA. Stakeholders should apply water contamination legislation to eradicate Cryptosporidium sp. and G. duodenalis (oo)cysts from water resources/categories. [ABSTRACT FROM AUTHOR]

(1) Background: Organ transplant recipients (OTRs) are vulnerable groups at risk of parasitic infections. This systematic review and meta-analysis aimed to evaluate the overall prevalence of Cryptosporidium sp. in OTRs and shed light on this potentially serious complication of organ transplantation. (2) Methods: We systematically searched studies on Cryptosporidium sp. infections in OTRs in four databases (Academia, PubMed, Scopus, and Science Direct). Random effects models were used to calculate pooled prevalence estimates with 95% confidence intervals (CIs). Sub-group and meta-regression analyses were conducted. A quality assessment of the included studies was also performed. (3) Results: Among 876 articles retrieved, 21 were included, accounting for 2,642 OTRs. Twenty studies were cross-sectional in design, of which seven reported data on a comparison group, and one was a retrospective cohort. The pooled prevalence of Cryptosporidium sp. in OTRs was 15% (95% CI: 7.4–24.6). Subgroup analysis revealed that the prevalence of Cryptosporidium sp. infection was higher in adults, symptomatics and developing countries and in studies using only non-molecular methods. However, substantial heterogeneity was reported. Low to moderate heterogeneity was observed in subgroups reporting lower prevalence Cryptosporidium sp. including children (5.8; 95% CI: 2.8–9.6), studies conducted in developed countries (5.8; 95% CI: 3.0–9.4) and studies using both molecular and non-molecular diagnostics (11.4; 95% CI: 6.4–17.4). The majority of the listed research reported low-medium quality scores. (4) Conclusion: Cryptosporidium sp. infection is a significant complication in OTRs with underreported prevalence. Preventive strategies to reduce the burden should include Cryptosporidium sp. routine screening for OTRs, particularly post-transplantation in patients with diarrhea. Additional well-designed research studies are required to determine the extent of the Cryptosporidium sp. burden in OTRs. [ABSTRACT FROM AUTHOR]

Background: This study investigates the toxic activity of Artemisia judaica ethanolic extract (ArEx) as well as its phenolic fraction (ArPh), and terpenoid fraction (ArT) against Cryptosporidium parvum (C. parvum) oocysts. Methods: Over a 4 months period, estimation of the total phenolic (TPC), total flavonoids (TFC), and total terpenoids contents (TTC) in ArEx; investigation of the in vitro antioxidant activity of ArEx, ArPh, and ArT; evaluation of ArEx, ArPh, and ArT toxic activity against C. parvum oocysts using MTT assay; parasitological analysis on ArPh-treated C. parvum oocysts and comet assay were performed both in vitro and in vivo (infectivity). Results: The ArEx TPC, TFC, and TTC was 52.6 ± 3.1 mgGAE/g, 64.5 ± 3.1 mg QE/g, and 9.5 ± 1.1 mg Linol/g, respectively. Regarding the phytochemical in vitro antioxidant activity, the ArPh exhibited the highest antioxidant activity compared to the ArEx and ArT. The ArPh showed promising free radical scavenging activity of DPPH and ABTS•+ with IC50 values of 47.27 ± 1.86 µg/mL and 66.89 ± 1.94 µg/mL, respectively. Moreover, the FRAP of ArPh was 2.97 ± 0.65 mMol Fe+2/g while its TAC was 46.23 ± 3.15 mg GAE/g. The ArPh demonstrated toxic activity against C. parvum oocysts with a potent IC50 value of 31.6 µg/mL compared to ArT (promising) and ArEx (non-effective). ArPh parasitological analysis demonstrated MIC90 at 1000 µg/ml and effective oocysts destruction on count and morphology. ArPh fragmented oocysts nuclear DNA in comet assay. Beginning at 200 µg/mL, ArPh-treated oocysts did not infect mice. Conclusion: To combat C. parvum infection, the phenolic fraction of A. judaica L. shows promise as an adjuvant therapy or as a source of potentially useful lead structures for drug discovery. [ABSTRACT FROM AUTHOR]

Background: On 11 March 2011, the Great East Japan Earthquake, followed by a tsunami and nuclear-reactor meltdowns, produced one of the most severe disasters in the history of Japan. The adverse impact of this 'triple disaster' on the health of local populations and the health system was substantial. In this study we examine population-level health indicator changes that accompanied the disaster, and discuss options for re-designing Fukushima's health system, and by extension that of Japan, to enhance its responsiveness and resilience to current and future shocks.Methods: We used country-level (Japan-average) or prefecture-level data (2005-2014) available from the portal site of Official Statistics of Japan for Fukushima, Miyagi, and Iwate, the prefectures that were most affected by the disaster, to compare trends before (2005-2010) and after (2011-2014) the 'disaster'. We made time-trend line plots to describe changes over time in age-adjusted cause-specific mortality rates in each prefecture.Findings: All three prefectures, and in particular Fukushima, had lower socio-economic indicators, an older population, lower productivity and gross domestic product per capita, and less higher-level industry than the Japan average. All three prefectures were 'medically underserved', with fewer physicians, nurses, ambulance calls and clinics per 100 000 residents than the Japan average. Even before the disaster, age-adjusted all-cause mortality in Fukushima was in general higher than the national rates. After the triple disaster we found that the mortality rate due to myocardial infarction increased substantially in Fukushima while it decreased nationwide. Compared to Japan average, spikes in mortality due to lung disease (all three prefectures), stroke (Iwate and Miyagi), and all-cause mortality (Miyagi and Fukushima) were also observed post-disaster. The cause-specific mortality rate from cancer followed similar trends in all three prefectures to those in Japan as a whole. Although we found a sharp rise in ambulance calls in Iwate and Miyagi, we did not see such a rise in Fukushima: a finding which may indicate limited responsiveness to acute demand because of pre-existing restricted capacity in emergency ambulance services.Conclusions: We analyze changes in indicators of health and health systems infrastructure in Fukushima before and five years following the disaster, and explored health systems' strengths and vulnerabilities. Spikes in mortality rates for selected non-infectious conditions common among older individuals were observed compared to the national trends. The results suggest that poorer reserves in the health care delivery system in Fukushima limited its capacity to effectively meet sudden unexpected increases in demand generated by the disaster. [ABSTRACT FROM AUTHOR]

Background: Understanding the motivations and perspectives of providers in following guidance and evidence-based policies can contribute to the evidence on how to better implement and deliver care, particularly in resource-constrained settings. This study explored how providers' attitudes and behaviors influenced the implementation of an intervention, provider-initiated HIV testing and counseling, in primary health care settings in Botswana.Methods: Using a grounded-theory approach, we purposively selected and interviewed 45 providers in 15 facilities in 3 districts and inductively analyzed data for themes and patterns.Results: We found that nurses across facilities and districts were largely resistant to offering and delivering provider-initiated testing and counseling for HIV (PITC) for three reasons: (1) they felt they were overworked and had no time, (2) they felt it was not their job, and (3) they were afraid to counsel patients, particularly fearing a positive HIV test. These factors were largely related to health system constraints that affected the capacity of providers to do their job. An important underlying themes emerged: nurses and lay counselors were unsatisfied with pay and career prospects, which made them unmotivated to work in general. Variations were seen by urban and rural areas: nurses in urban areas felt generally overworked and PITC was seen as contributing to the workload. While nurses in rural areas did not feel overworked, they felt that PITC was not their job and they were unmotivated because of general unhappiness with their rural posts.Conclusions: The attitudes and behaviors of providers and barriers they faced played a critical role in whether and how PITC was being implemented in Botswana. Provider factors should be considered in the improvement of existing PITC programs and design of new ones. Addressing constraints faced by providers can do more to improve supply of human resources than merely recruiting more providers. [ABSTRACT FROM AUTHOR]

Background: On 11 March 2011, the Great East Japan Earthquake, followed by a tsunami and nuclear–reactor meltdowns, produced one of the most severe disasters in the history of Japan. The adverse impact of this ‘triple disaster’ on the health of local populations and the health system was substantial. In this study we examine population–level health indicator changes that accompanied the disaster, and discuss options for re–designing Fukushima’s health system, and by extension that of Japan, to enhance its responsiveness and resilience to current and future shocks. Methods: We used country–level (Japan–average) or prefecture–level data (2005–2014) available from the portal site of Official Statistics of Japan for Fukushima, Miyagi, and Iwate, the prefectures that were most affected by the disaster, to compare trends before (2005–2010) and after (2011–2014) the ‘disaster’. We made time–trend line plots to describe changes over time in age–adjusted cause–specific mortality rates in each prefecture. Findings: All three prefectures, and in particular Fukushima, had lower socio–economic indicators, an older population, lower productivity and gross domestic product per capita, and less higher–level industry than the Japan average. All three prefectures were ‘medically underserved’, with fewer physicians, nurses, ambulance calls and clinics per 100 000 residents than the Japan average. Even before the disaster, age–adjusted all–cause mortality in Fukushima was in general higher than the national rates. After the triple disaster we found that the mortality rate due to myocardial infarction increased substantially in Fukushima while it decreased nationwide. Compared to Japan average, spikes in mortality due to lung disease (all three prefectures), stroke (Iwate and Miyagi), and all–cause mortality (Miyagi and Fukushima) were also observed post–disaster. The cause–specific mortality rate from cancer followed similar trends in all three prefectures to those in Japan as a whole. Although we found a sharp rise in ambulance calls in Iwate and Miyagi, we did not see such a rise in Fukushima: a finding which may indicate limited responsiveness to acute demand because of pre–existing restricted capacity in emergency ambulance services. Conclusions: We analyze changes in indicators of health and health systems infrastructure in Fukushima before and five years following the disaster, and explored health systems’ strengths and vulnerabilities. Spikes in mortality rates for selected non–infectious conditions common among older individuals were observed compared to the national trends. The results suggest that poorer reserves in the health care delivery system in Fukushima limited its capacity to effectively meet sudden unexpected increases in demand generated by the disaster.