Tropical Medicine

热带医学
  • 文章类型: Journal Article
    背景:在世界卫生组织列出的21种被忽视的热带病(NTD)中,15影响中华人民共和国。尽管在控制NTD方面取得了重大成就,仍然缺乏基于实际病例数据和时空动态的详细信息的疾病负担综合评估。本研究旨在评估2005-2020年中国NTDs的疾病负担和时空分布,为制定符合全球卫生议程的国家卫生议程提供参考。并指导资源分配。
    方法:从中国公共卫生科学数据中心下载了2005年至2020年中国主要NTD的病例数和死亡人数(https://www.phsciencedata.cn/股/指数。中国疾病预防控制中心的jsp)和相关文献。残疾调整寿命年(DALYs)的简化公式有助于估计寿命损失年(YLL),残疾生活年(YLDs),和总DALY。使用MoranI统计量对2005年至2020年的平均NTDs负荷数据进行了空间自相关分析。
    结果:中国的总体NTDs负担显着下降,从2005年的245,444.53DALYs到2020年的18,984.34DALYs,减少了92.27%。2005年,由血吸虫病和狂犬病引起的DALY占总疾病负担的很大一部分,分别占65.37%和34.43%。2015年,湖南和四川省的NTD多样性最高,分别报道了9个和8个不同的NTD。疾病负担最高的是四川(242,683.46DALYs),西藏紫支曲(178,318.99DALYs)和广东(154,228.31DALYs)。NTD的“高-高”聚集区域主要在中国的中部和南部地区,通过空间自相关分析确定。
    结论:中国在防治NTDs方面做出了不懈努力,我国主要NTDs的疾病负担明显下降。运用OneHealth理念指导现场疾病预防控制,有效节约医疗资源,实现精准干预。
    BACKGROUND: Out of the 21 neglected tropical diseases (NTDs) listed by the World Health Organization, 15 affect the People\'s Republic of China. Despite significant achievements in controlling NTDs, comprehensive assessments of the disease burden based on actual case data and detailed information on spatial and temporal dynamics are still lacking. This study aims to assess the disease burden and spatial-temporal distribution of NTDs in China from 2005 to 2020, to provide a reference for the formulation of national health agendas in line with the global health agenda, and guide resource allocation.
    METHODS: The number of cases and deaths of major NTDs in China from 2005 to 2020 were downloaded from the China Public Health Science Data Center ( https://www.phsciencedata.cn/Share/index.jsp ) of the Chinese Center for Disease Control and Prevention and relevant literatures. Simplified formulas for disability-adjusted life years (DALYs) helped estimate the years of life lost (YLLs), years lived with disability (YLDs), and total DALYs. Spatial autocorrelation analysis of the average NTDs burden data for the years 2005 to 2020 was evaluated using Moran\'s I statistic.
    RESULTS: China\'s overall NTDs burden decreased significantly, from 245,444.53 DALYs in 2005 to 18,984.34 DALYs in 2020, marking a reduction of 92.27%. In 2005, the DALYs caused by schistosomiasis and rabies represent a substantial proportion of the total disease burden, accounting for 65.37% and 34.43% respectively. In 2015, Hunan and Sichuan provinces had the highest diversity of NTDs, with 9 and 8 number of different NTDs reported respectively. And the highest disease burden was observed in Sichuan (242,683.46 DALYs), Xizang Zizhiqu (178,318.99 DALYs) and Guangdong (154,228.31 DALYs). The \"high-high\" clustering areas of NTDs were mainly in China\'s central and southern regions, as identified by spatial autocorrelation analysis.
    CONCLUSIONS: China has made unremitting efforts in the prevention and control of NTDs, and the disease burden of major NTDs in China has decreased significantly. Using the One Health concept to guide disease prevention and control in the field to effectively save medical resources and achieve precise intervention.
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  • 文章类型: Journal Article
    背景:近年来,对被忽视的热带病(NTDs)的日益关注已被认为是一个紧迫的全球健康问题.这种担忧在中低收入国家表现得十分突出,青少年和年轻人的患病率不断上升。这些疾病的迅速发展有可能损害患者的职业能力和整体生活质量。尽管NTD的全球影响相当大,关注其对年轻人群影响的综合研究仍然很少。我们的研究旨在描述1990年至2019年30年间15至39岁人群中被忽视的热带病的全球患病率,并预测该疾病至2040年的疾病负担。
    方法:事故病例的年度数据,死亡率,NTDs的残疾调整寿命年(DALYs)来自2019年全球疾病负担研究(GBD2019)。这些数据按全球和地区分布分层,国家,社会发展指数(SDI)年龄,和性爱。我们计算了年龄标准化率(ASR)和事件病例数,死亡率,和DALY从1990年到2019年。计算ASR中估计的年度百分比变化(EAPC)以评估不断变化的趋势。
    结果:在2019年,估计全球约有5.52亿NTD病例(95%不确定性区间[UI]:5.199亿-5.863亿),自1990年以来下降了29%。南亚报告NTD患病率最高,估计有1.717亿例(95%UI:1.504亿至1.986亿例)。在五个SDI类别中,1990年和2019年,中、低SDI地区的NTDs患病率最高(约2.705亿例).在过去三十年中,撒哈拉以南非洲的NTD病例下降幅度最大。总的来说,NTDs的疾病负担与SDI呈显著负相关。
    结论:2019年,NTDs在全球造成了超过5亿例事故病例和1,080万DALYs损失,这与主要传染病和非传染性疾病形成了巨大的差距。在过去的三十年中,患病率和残疾负担令人鼓舞地下降,这凸显了通过基于证据的资源分配来加快进展的潜力。这种战略整合可以大大提高公众对风险因素和可用治疗方案的认识。
    BACKGROUND: In recent years, the escalating concern for neglected tropical diseases (NTDs) has been recognized as a pressing global health issue. This concern is acutely manifested in low- and middle-income countries, where there is an escalating prevalence among adolescents and young adults. The burgeoning of these conditions threatens to impair patients\' occupational capabilities and overall life quality. Despite the considerable global impact of NTDs, comprehensive studies focusing on their impact in younger populations remain scarce. Our study aims to describe the global prevalence of neglected tropical diseases among people aged 15 to 39 years over the 30-year period from 1990 to 2019, and to project the disease burden of the disease up to 2040.
    METHODS: Annual data on incident cases, mortality, and disability-adjusted life years (DALYs) for NTDs were procured from the Global Burden of Disease Study 2019 (GBD 2019). These data were stratified by global and regional distribution, country, social development index (SDI), age, and sex. We computed age-standardized rates (ASRs) and the numbers of incident cases, mortalities, and DALYs from 1990 to 2019. The estimated annual percentage change (EAPC) in the ASRs was calculated to evaluate evolving trends.
    RESULTS: In 2019, it was estimated that there were approximately 552 million NTD cases globally (95% Uncertainty Interval [UI]: 519.9 million to 586.3 million), a 29% decrease since 1990. South Asia reported the highest NTD prevalence, with an estimated 171.7 million cases (95% UI: 150.4 million to 198.6 million). Among the five SDI categories, the prevalence of NTDs was highest in the moderate and low SDI regions in 1990 (approximately 270.5 million cases) and 2019 (approximately 176.5 million cases). Sub-Saharan Africa recorded the most significant decline in NTD cases over the past three decades. Overall, there was a significant inverse correlation between the disease burden of NTDs and SDI.
    CONCLUSIONS: NTDs imposed over half a billion incident cases and 10.8 million DALYs lost globally in 2019-exerting an immense toll rivaling major infectious and non-communicable diseases. Encouraging declines in prevalence and disability burdens over the past three decades spotlight the potential to accelerate progress through evidence-based allocation of resources. Such strategic integration could substantially enhance public awareness about risk factors and available treatment options.
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  • 文章类型: Journal Article
    背景:这项研究调查了COVID-19大流行对患病率的影响,管理,以及对被忽视的热带病(NTDs)的控制,突出了COVID-19对研发资金的当前或未来影响,和执行,NTD方案。进行这项审查是为了确定,以及如何,NTD受到COVID-19的影响,以及这些影响是否会推迟可持续发展目标的消除目标。
    方法:使用来自相关利益相关者官方网站的政策和文档的开源数据,包括但不限于世界卫生组织(WHO)文件和政策,政府对外援助文件,和政策治愈G-Finder报告,本次范围审查探讨了在支持NTD的研发(R&D)和维持NTD控制计划方面面临的挑战;研究了大流行对NTD管理造成的限制,包括对医疗保健服务的破坏,减少资金,并探讨对穷人的潜在长期影响和后果,低收入和中等收入国家(LMICs)的被忽视人口。这是通过范围审查文献检索完成的,出版物要经过初步的实际筛选步骤,以确保选择最相关的出版物进行全面筛选,重点是确定COVID-19对NTD影响的指定主题。我们进一步评估了加剧COVID-19对NTD负担影响的社会经济因素。
    结果:多重中断和挫折,这项研究确定了可能影响NTD计划和实现其消除目标的进展。自2019年的资金高点以来,NTD、艾滋病和结核病的研发资金有所下降,自2018年的高点以来,疟疾的研发资金有所下降。大流行后,观察到NTD内部研发资金分配的重大变化,可能是因为捐助者之间的优先次序。据报道研发投入最少的疾病,在大流行之前(霉菌瘤,带菌者/囊虫病,沙眼和布鲁里溃疡)在大流行后尤其受到影响。我们确定了特定的NTDs,包括血吸虫病,麻风病,以及受COVID-19大流行影响的狂犬病,以及对正在进行的NTD控制和消除计划造成的干扰。大流行限制扰乱了基本医疗供应的制造和分配,影响了免疫计划,并阻碍了控制传染病传播的努力。NTD计划经历了许多挫折,包括大规模药物管理计划(例如血吸虫病)的延误,取消或延迟接种疫苗计划(例如狂犬病疫苗)和检测设施的关闭导致诊断减少,治疗,和消除所有NTD的疾病。封锁和诊所关闭导致基本医疗保健服务中断,限制了NTD监视和治疗计划。社区对感染COVID-19的担忧加剧了对服务提供的限制。全球疫苗分配的差距已经扩大,低中等收入国家面临获得疫苗的机会有限和免疫计划中断的问题。最后,这种流行病导致贫困和边缘化社区的贫困加剧,影响营养,所有这些都对NTD管理和控制具有长期影响。
    结论:COVID-19大流行深刻影响了全球卫生研究和全球卫生公平。注意力和资金从所有部门转移,显着影响世界卫生组织消除NTD路线图中规定的研发工作。资金的持续变化,经济危机,物流和供应链中断以及贫困加深给本已薄弱的医疗保健系统带来了压力,并加剧了LMIC医疗保健挑战。特别是,NTD管理和淘汰计划的延误和限制将产生深远的后果,突显了全球合作和重新投资的必要性,以使NTD路线图重回正轨。如果不为复苏进行大量投资,就不可能实现目标和里程碑,到位。
    BACKGROUND: This study investigates the impact of the COVID-19 pandemic on the prevalence, management, and control of the neglected tropical diseases (NTDs) highlighting the current or prospective impact of COVID-19 on research and development funding for, and execution of, NTD programmes. This review was conducted to determine if, and how, NTDs were affected by COVID-19, and whether those effects will delay the elimination goals of the Sustainable Development goals.
    METHODS: Using open-source available data from policy and documentation from official websites of the relevant stakeholders including but not limited to World Health Organization (WHO) documents and policies, government foreign aid documents, and the Policy Cures G-Finder reports, this scoping review explored ongoing challenges to supporting research and development (R&D) for the NTDs and in maintaining NTD control programs; examined the constraints posed for NTD management by the pandemic from disruptions to healthcare services, reduction of finance and explored the potential long-term implications and consequences for those poorer, neglected populations in low and middle income-countries (LMICs). This was done by a scoping review literature search, publications were subject to an initial practical screening step to ensure the most relevant publications were selected for full screening, with the focus on scoping the designated topic of the impact of COVID-19 on NTDs. We further undertook an evaluation of the socio-economic factors exacerbating the impact of COVID-19 on NTD burden.
    RESULTS: Multiple disruptions and setbacks, likely to affect NTD programmes and progress towards their elimination targets were identified in this study. R&D funding for the NTDs and AIDs and TB has declined since the funding high point of 2019, and for malaria since the high point of 2018. Significant changes in allocation of R&D funding within the NTDs are observed post pandemic, likely because of prioritization among donors. Diseases for which the least R&D investment was reported in place, prior to the pandemic (mycetoma, taeniasis/cysticercosis, trachoma and Buruli ulcer) have been particularly impacted post pandemic. We identified specific NTDs including schistosomiasis, leprosy, and rabies that have been affected by the COVID-19 pandemic and disruptions caused to on ongoing NTD control and elimination programs. Pandemic restrictions disrupted essential medical supply manufacturing and distribution impacting immunization programs and hindered efforts to control the spread of infectious diseases. NTD programmes have experienced numerous setbacks including delays in mass drug administration programs (e.g. for schistosomiasis), cancelled or delayed vaccination programs (e.g. for rabies) and closure of testing facilities has resulted in reduced diagnosis, treatment, and disease elimination for all NTDs. Lockdowns and clinic closures causing disruption to essential healthcare services restricted NTD surveillance and treatment programs. Community fears around contracting COVID-19 exacerbated the constraints to service delivery. Disparities in global vaccine distribution have widened with LMICs facing limited access to vaccines and disruption to immunization programs. Finally, the pandemic has led to increased poverty with poor and marginalized communities, impacting nutrition, healthcare access and education all of which have long term implications for NTD management and control.
    CONCLUSIONS: The COVID-19 pandemic profoundly impacted global health research and global health equity. Attention and funding were diverted from all sectors, significantly affecting research and development efforts set out in the World Health Organization\'s NTD elimination Roadmaps. Ongoing changes to funding, economic crises, logistics and supply chain disruptions as well as deepening poverty has put a strain on already weak healthcare systems and exacerbated LMIC healthcare challenges. In particular, the delays and constraints to NTD management and elimination programs will have long-reaching consequences highlighting the need for global cooperation and renewed investment to put the NTD roadmap back on track. Targets and milestones are unlikely to be met without significant investment for recovery, in place.
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  • 文章类型: Journal Article
    合作和联网是防治热带疾病的有力工具。由于热带疾病的跨界性质,全球范围内的合作至关重要。网络在促进这种合作方面发挥着关键作用。合作和联网都可以促进疾病控制计划的创新。合作研究可以导致新药和疫苗的开发,而共享的监测数据可以使疾病流行的早期发现和控制。因此,在第七届消除热带病监测反应系统研讨会上达成了合作和联网的共识,这反映在两份文件中,即,跨界热带病控制共识,世卫组织与NTD有关的合作中心网络的行动共识。这些文件将通过采取集体行动以实现联合国可持续发展目标(SDGs),改善与热带病作斗争的努力。
    Cooperation and networking are powerful tools in the combating against tropical diseases. Cooperation on a global scale is essential due to the transboundary nature of tropical diseases. Networking plays a pivotal role in facilitating such cooperation. Both cooperation and networking can foster innovation in disease control programmes. Collaborative research can lead to the development of new drugs and vaccines, while shared surveillance data can enable the early detection and control of disease epidemics. Therefore, consensus of cooperation and networking has been reached during the 7th Symposium on Surveillance-Response Systems Leading to Tropical Diseases Elimination, which reflected in the two documents, i.e., Consensus for Transboundary Tropical Diseases Control, and Action Consensus of the Network of WHO Collaborating Centres Related to NTDs. These documents will improve the efforts in the fighting against tropical diseases through collective actions to achieve the United Nations\' Sustainable Development Goals (SDGs).
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  • 文章类型: Editorial
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  • 文章类型: Journal Article
    背景:在过去的二十年中,越来越多的经济机会吸引了撒哈拉以南非洲的人们迁移到亚太地区。关于这些移民健康状况的信息有限。我们旨在通过范围审查来评估亚太地区撒哈拉以南非洲移民健康的科学证据。
    方法:审查将根据JBI证据综合指南进行,最终结果将根据系统评价和Meta分析扩展的首选报告项目进行组织和报告。以人口概念背景要素为中心制定了搜索战略,包括撒哈拉以南非洲,亚太地区,移民和健康。共搜寻八个资料库,包括PubMed,Embase,护理和相关健康文献的累积指数,ProQuest,Scopus,WebofScience,万方与CNKI文献标题和摘要筛选和全文筛选将由两名研究人员独立进行。数据将根据预先设计的表格绘制。
    背景:这项研究既不涉及人类参与者,也不涉及未发表的次要数据。因此,不需要机构审查委员会的批准。这项范围界定审查的结果将通过发表在同行评审的期刊上传播,通过学术网络和项目报告。
    Increasing economic opportunities have attracted people from sub-Saharan Africa to migrate to the Asia-Pacific region in the last two decades. The information on the health situation of these migrants is limited. We aim to assess scientific evidence on the health of sub-Saharan African migrants in the Asia-Pacific region using a scoping review.
    The review will be conducted according to the JBI guide on evidence synthesis, and the final results will be organised and reported in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews. Search strategies have been developed centred on population-concept-context elements including sub-Saharan Africa, Asia-Pacific, migration and health. A total of eight databases will be searched, including PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, ProQuest, Scopus, Web of Science, Wanfang and CNKI. Title and abstract screening and full-text screening will be conducted by two researchers independently. Data will be charted according to predesigned form.
    This study involves neither human participants nor unpublished secondary data. Institutional review board approval is therefore not required. Findings of this scoping review will be disseminated through publication in a peer-reviewed journal, through academic network and project report.
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  • 文章类型: Journal Article
    这篇论文是为了纪念马塞尔·坦纳教授,瑞士艺术与科学学院院长,瑞士热带和公共卫生研究所(瑞士TPH)前所长,在巴塞尔,瑞士。自1989年首次访华以来的30多年里,坦纳教授通过国际会议,不知疲倦地促进了瑞士和中国在健康和热带病方面的研究合作,学者交流,和年轻科学家的培训。作为对坦纳教授一生与中国科学家合作的贡献,我们在这里总结构思的想法,工作启动和主要成果。他的方法,体现在他华丽的表情:“阿尔卑斯山和喜马拉雅山永远不会相遇,但是瑞士人和中国人可以标志着2013年新华社,Ltd.,中国山东的一家制药公司,同意生产三苯二脒,一种新的治疗热带蠕虫感染的方法,这是瑞士TPH在巴塞尔的科学家长期研究的成果,上海国立寄生虫病研究所(NIPD)。这既不是第一个也不是最后一个坦纳教授的有力,然而外交影响,我们跟随他的足迹,继续瑞中在热带医学方面的合作。
    This paper is in honour of Professor Marcel Tanner, President of the Swiss Academies of Arts and Sciences, and former Director of the Swiss Tropical and Public Health Institute (Swiss TPH), in Basel, Switzerland. In the 30 plus years since his first visit to China in 1989, Professor Tanner has tirelessly promoted research collaboration between Switzerland and China on health and tropical diseases through international meetings, scholar exchange, and training of young scientists. As a contribution to Professor Tanner\'s life\'s work of collaboration with Chinese scientists, we summarize here ideas conceived, work initiated and major outcomes. His approach, embodied in his flowery expression: \"Alps and Himalayas never meet, but Swiss and Chinese can\", marked the occasion in 2013 when Xinhua Co., Ltd., a pharmaceutical company in Shandong of China, agreed to produce tribendimidine, a new remedy for tropical helminth infections, that was the fruit of long-term research by scientists at the Swiss TPH in Basel, and National Institute of Parasitic Diseases (NIPD) in Shanghai. This was neither the first nor the last of Professor Tanner\'s forceful, yet diplomatic influence, and we follow in his footprints when continuing in Swiss-Chinese cooperation in tropical medicine.
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  • 文章类型: Letter
    中国在建立和加强疟疾监测和应对系统方面积累了多种做法和经验。随着中国参与全球卫生的势头比以往任何时候都更强劲,中国与瑞士热带和公共卫生研究所和世卫组织在2012-2020年期间举办了五届“消除热带病监测反应系统国际论坛”,其中消除疟疾一直是最热门的话题之一。在这项研究中,为实现全球无疟疾目标,探讨了监测和应对系统国际网络的作用。中国消除疟疾的方法表明了全球合作采取联合预防和控制的意义,并建立一个全球机构网络。
    China has accumulated multiple practices and experiences in building and enhancing malaria surveillance and response system. As China\'s engagement into global health has gathered stronger momentum than ever, China together with the Swiss Tropical and Public Health Institute and WHO has organised five sessions of the International Forum on Surveillance-Response System Leading to Tropical Diseases Elimination during 2012-2020, in which malaria elimination has always been one of the hottest topics. In this study, the roles of international network on the surveillance and response system were explored to achieve a global malaria-free goal. China\'s approach to malaria elimination has demonstrated significance of global collaboration on taking joint prevention and control, and building a worldwide institutional-based network.
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  • 文章类型: Journal Article
    文献中缺少从全球角度对被忽视的热带病(NTD)的最新分析。我们旨在评估1990年至2019年NTD的全球负担和趋势。
    年度突发事件,NTDs的死亡率和残疾调整生命年(DALYs)数据来自2019年全球疾病负担研究(GBD2019),基于全球,区域,国家,社会发展指数(SDI)年龄和性别类别。年龄标准化率(ASR)和事件病例数,死亡率和DALY是1990年至2019年计算的。计算ASR中估计的年度百分比变化(EAPC)以量化变化趋势。
    全球,1990年至2019年间,年龄标准化发病率(ASIR)和总NTD的事件病例数增加,而年龄标准化死亡率(ASMR),死亡率,总NTDs的年龄标准化DALY率和DALYs下降。虽然热带拉丁美洲,南亚,东南亚和大洋洲在2019年的总NTDASIR最高,热带拉丁美洲是唯一经历ASIR下降趋势的地区,从2010年的1673.5/100000下降到2019年的1059.2/100000。中间的,中高SDI和高SDI地区在1990年至2019年期间经历了增加的ASIR趋势,而中低SDI地区保持稳定,低SDI区域呈现下降趋势。儿童和老年人容易感染登革热,狂犬病和利什曼病(皮肤和皮肤粘膜)。女性的ASIR较高,但ASMR和年龄标准化的DALY率低于男性。
    NTD仍然是一个严重的公共卫生问题,全球越来越多的ASIR和事件病例可能需要更有针对性的预防策略,控制和监视,特别是在特定人群和流行地区。
    An updated analysis of neglected tropical diseases (NTDs) from a global perspective is missing from the literature. We aimed to assess the global burden and trends of NTDs from 1990 to 2019.
    Yearly incident case, mortality and disability-adjusted life years (DALYs) data for NTDs were extracted from the Global Burden of Disease Study 2019 (GBD 2019) based on global, regional, country, social development index (SDI), age and sex categories. The age-standardized rate (ASR) and number of incident cases, mortality and DALYs were computed from 1990 to 2019. The estimated annual percentage change (EAPC) in the ASR was calculated to quantify the changing trend.
    Globally, the age-standardized incidence rate (ASIR) and the number of incident cases of total NTDs increased between 1990 and 2019, whereas the age-standardized mortality rate (ASMR), mortality, age-standardized DALY rate and DALYs of total NTDs decreased. Although tropical Latin America, South Asia, Southeast Asia and Oceania had the highest ASIR for total NTDs in 2019, tropical Latin America was the only region to experience a decreasing trend in ASIR from 1673.5 per 100 000 in 2010 to 1059.2 per 100 000 in 2019. The middle, high-middle and high SDI regions experienced increasing ASIR trends between 1990 and 2019, whereas the low-middle SDI region remained stable, and the low SDI region presented a decreasing trend. Children and older adults were vulnerable to dengue, rabies and leishmaniasis (cutaneous and mucocutaneous). Females had a higher ASIR but a lower ASMR and age-standardized DALY rate than males.
    NTDs still represent a serious problem for public health, and the increasing ASIR and incident cases globally may require more targeted strategies for prevention, control and surveillance, especially among specific populations and endemic areas.
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  • 文章类型: Journal Article
    OBJECTIVE: To identify barriers to seeking health care among returning travellers with malaria with the aim of developing targeted interventions that improve early health care-seeking behaviour, diagnosis and treatment.
    METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic review of published medical literature, selecting studies that investigated and reported barriers to seeking health care among returning travellers and migrants with malaria. In total, 633 articles were screened, of which four studies met the inclusion criteria after a full-text review.
    RESULTS: The four studies reported barriers to seeking healthcare among returning travellers in China, the United States, Thailand and the Dominican Republic. Three studies had an observational design. The identified barriers were summarised based on the appraisal delay, illness delay and utilisation delay stages. During appraisal delays, low awareness of malaria was the most significant factor. Once the patient assessed that he or she was ill, belonging to a specific minority ethnicity, being infected with P. vivax and receiving a low level of social support were predictors of delayed health care-seeking. Finally, the most significant factor associated with utilisation delays was the monetary cost.
    CONCLUSIONS: The health care-seeking behaviour of returning travellers with malaria should be further investigated and improved. Addressing the identified barriers and gaps in health care-seeking behaviour among returning travellers with malaria, particularly among groups at high risk of travel-associated infections, is important to prevent severe disease and deaths as well as secondary transmission and epidemics.
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