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BMJ (Clinical Research Ed.) Oct 2012To assess the quantity and distribution of evidence from randomised controlled trials for the treatment of the major neglected tropical diseases and to identify gaps in... (Review)
Review
OBJECTIVE
To assess the quantity and distribution of evidence from randomised controlled trials for the treatment of the major neglected tropical diseases and to identify gaps in the evidence with network analysis.
DESIGN
Systematic review and network analysis.
DATA SOURCES
Cochrane Central Register of Controlled Trials and PubMed from inception to 31 August 2011.
STUDY SELECTION
Randomised controlled trials that examined treatment of 16 neglected tropical diseases or complications thereof published in English, French, Spanish, Portuguese, German, or Dutch.
RESULTS
We identified 971 eligible randomised trials. Leishmaniasis (184 trials, 23,039 participants) and geohelminth infections; 160 trials, 46,887 participants) were the most studied, while dracunculiasis (nine trials, 798 participants) and Buruli ulcer (five trials, 337 participants) were least studied. Relative to its global burden of disease, lymphatic filariasis had the fewest trials and participants. Only 11% of trials were industry funded. Either a single trial or trials with fewer than 100 participants comprised the randomised evidence for first or second line treatments for Buruli ulcer, human African trypanosomiasis, American trypanosomiasis, cysticercosis, rabies, echinococcosis, New World cutaneous leishmaniasis, and each of the foodborne trematode infections. Among the 10 disease categories with more than 40 trials, five lacked sufficient head to head comparisons between first or second line treatments.
CONCLUSIONS
There is considerable variation in the amount of evidence from randomised controlled trials for each of the 16 major neglected tropical diseases. Even in diseases with substantial evidence, such as leishmaniasis and geohelminth infections, some recommended treatments have limited supporting data and lack head to head comparisons.
Topics: Anti-Infective Agents; Buruli Ulcer; Dengue; Dracunculiasis; Echinococcosis; Elephantiasis, Filarial; Helminthiasis; Humans; Leishmaniasis, Mucocutaneous; Leprosy; Multicenter Studies as Topic; Neglected Diseases; Rabies; Randomized Controlled Trials as Topic; Research Design; Research Support as Topic; Schistosomiasis; Strongyloidiasis; Trachoma; Trematode Infections; Tropical Medicine; Trypanosomiasis
PubMed: 23089149
DOI: 10.1136/bmj.e6512 -
Tropical Medicine & International... Dec 2020The objective of this study was to identify the existing challenges in the last mile of the global Guinea Worm Eradication Program.
OBJECTIVE
The objective of this study was to identify the existing challenges in the last mile of the global Guinea Worm Eradication Program.
METHODS
Systematic Review of articles published from 1 January 2000 until 31 December 2019. Papers listed in Cochrane Library, Google Scholar, ProQuest PubMed and Web of Science databases were searched and reviewed.
RESULTS
Twenty-five articles met inclusion criteria of the study and were selected for analysis. Hence, relevant data were extracted, grouped and descriptively analysed. Results revealed 10 main challenges complicating the last mile of global guinea worm eradication: unusual mode of transmission; rising animal guinea worm infection; suboptimal surveillance; insecurity; inaccessibility; inadequate safe water points; migration; poor case containment measures, ecological changes; and new geographic foci of the disease.
CONCLUSION
This systematic review shows that most of the current challenges in guinea worm eradication have been present since the start of the campaign. However, the recent change in epidemiological patterns and nature of dracunculiasis in the last remaining endemic countries illustrates a new twist. Considering the complex nature of the current challenges, there seems to be a need for a more coordinated and multidisciplinary approach of dracunculiasis prevention and control measures. These new strategies would help to make history by eradicating dracunculiasis as the first ever parasitic disease.
Topics: Animals; Communicable Disease Control; Disease Eradication; Dracunculiasis; Dracunculus Nematode; Humans; Water Supply
PubMed: 32946140
DOI: 10.1111/tmi.13492 -
Food and Waterborne Parasitology Sep 2020Waterborne parasitic diseases form one of common and important public health and economic problems in low- and middle-income countries, though little is known on the...
Waterborne parasitic diseases form one of common and important public health and economic problems in low- and middle-income countries, though little is known on the burden and patterns of these diseases in most regions. This systematic scoping review informs on the prevalence and pattern of waterborne parasitic infections in eastern Africa from 1st of January 1941 to 31st of December 2019. The review found limited number of published studies on waterborne parasitic diseases, though 13 of the 15 studied countries in eastern Africa provided one or more published report(s) totalling 47 reports. Focus of studies was mainly on schistosomiasis where 44.8% of the 47 retrieved studies reported it. Other frequently reported diseases were giardiasis (23.4% of reports), soil-transmitted helminths (23.4%) and amoebiasis (21.3%). Rarely reported diseases were malaria, cryptosporidiosis, isosporiasis, dracunculiasis and trichomoniasis. Based on parasitological examinations, schistosomiasis prevalence ranged from 17 to 33% in Burundi, 1.9 to 73.9% in Ethiopia, 2.1 to 18% in Kenya, 7.2 to 88.6% in Uganda, 22.9 to 86.3% in Tanzania, 27.2 to 65.8% in Somalia, 15 to >50% in Mauritius, 2.4% in Eritrea and 5.0 to 93.7% in Madagascar. Amoebiasis prevalence was 4.6-15,3% (Ethiopia), 5.9-58.3% (Kenya), 54.5% (Rwanda), 0.7-2.7% (Sudan), 19.93% (Uganda) and 4.5-5.0% (Seychelles). Giardiasis prevalence was 0.6-55.0% (Ethiopia), 16.6% (Kenya), 3.6% (Rwanda), 21.1% (Sudan), 40.7% (Uganda), 45.0% (Eritrea) and 3.3-6.0% (Seychelles). Soil-transmitted helminths prevalence was 41.7-52.4% (Ethiopia), 32.4-40.7% (Kenya), 9997 cases (Rwanda), 85.0% (Somalia), 4.7% (Madagascar) and 1.1-84% (Seychelles), , and hookworms were the most common helminths detected. Malaria prevalence was 2.9-4.31% (Ethiopia), an annual episode of 9 million people (Sudan), 13.0% (Tanzania), 146 hospital cases (Madagascar), 1.4-2.0% (Seychelles) and <5.0% in Djibouti. It is also observed that >50% of the populations in eastern Africa region lack improved drinking water sources or sanitation facilities. This may account for the observed high prevalence of the diseases. The author also suggests likely underestimation of the prevalence as most waterborne parasitic diseases are neglected and cases likely only recorded and left unpublished in health facilities. Thus for a thorough mapping of burdens of these diseases, grey literature, including hospital records must be reviewed while interventions focusing on improved water and sanitation are likely to reduce the burden considerably.
PubMed: 32995583
DOI: 10.1016/j.fawpar.2020.e00089