47 results on '"Janna M. Schurer"'
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2. Towards an actionable One Health approach
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Xiao-Xi Zhang, Zohar Lederman, Le-Fei Han, Janna M. Schurer, Li-Hua Xiao, Zhi-Bing Zhang, Qiu-Lan Chen, Dirk Pfeiffer, Michael P. Ward, Banchob Sripa, Sarah Gabriël, Kuldeep Dhama, Krishna Prasad Acharya, Lucy J. Robertson, Sharon L. Deem, Cécile Aenishaenslin, Filipe Dantas-Torres, Domenico Otranto, Delia Grace, Yang Wang, Peng Li, Chao Fu, Patrícia Poeta, Md. Tanvir Rahman, Kokouvi Kassegne, Yong-Zhang Zhu, Kun Yin, Jiming Liu, Zhao-Jun Wang, Xiao-Kui Guo, Wen-Feng Gong, Bernhard Schwartländer, Ming-Hui Ren, and Xiao-Nong Zhou
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One Health ,Global Health ,One Health Action Commission ,Research agenda ,Infectious and parasitic diseases ,RC109-216 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Despite the increasing focus on strengthening One Health capacity building on global level, challenges remain in devising and implementing real-world interventions particularly in the Asia-Pacific region. Recognizing these gaps, the One Health Action Commission (OHAC) was established as an academic community for One Health action with an emphasis on research agenda setting to identify actions for highest impact. Main text This viewpoint describes the agenda of, and motivation for, the recently formed OHAC. Recognizing the urgent need for evidence to support the formulation of necessary action plans, OHAC advocates the adoption of both bottom-up and top-down approaches to identify the current gaps in combating zoonoses, antimicrobial resistance, addressing food safety, and to enhance capacity building for context-sensitive One Health implementation. Conclusions By promoting broader engagement and connection of multidisciplinary stakeholders, OHAC envisions a collaborative global platform for the generation of innovative One Health knowledge, distilled practical experience and actionable policy advice, guided by strong ethical principles of One Health. Graphical Abstract
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- 2024
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3. Tackling global health security by building an academic community for One Health action
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Xiao-Xi Zhang, Xin-Chen Li, Qi-Yu Zhang, Jing-Shu Liu, Le-Fei Han, Zohar Lederman, Janna M. Schurer, Patrícia Poeta, Md. Tanvir Rahman, Shi-Zhu Li, Kokouvi Kassegne, Kun Yin, Yong-Zhang Zhu, Shang Xia, Lu He, Qin-Qin Hu, Le-Shan Xiu, Jing-Bo Xue, Han-Qing Zhao, Xi-Han Wang, Logan Wu, Xiao-Kui Guo, Zhao-Jun Wang, Bernhard Schwartländer, Ming-Hui Ren, and Xiao-Nong Zhou
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One Health ,Global health ,Academic community ,Infectious and parasitic diseases ,RC109-216 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background One Health approach is crucial to tackling complex global public health threats at the interface of humans, animals, and the environment. As outlined in the One Health Joint Plan of Action, the international One Health community includes stakeholders from different sectors. Supported by the Bill & Melinda Gates Foundation, an academic community for One Health action has been proposed with the aim of promoting the understanding and real-world implementation of One Health approach and contribution towards the Sustainable Development Goals for a healthy planet. Main text The proposed academic community would contribute to generating high-quality scientific evidence, distilling local experiences as well as fostering an interconnected One Health culture and mindset, among various stakeholders on different levels and in all sectors. The major scope of the community covers One Health governance, zoonotic diseases, food security, antimicrobial resistance, and climate change along with the research agenda to be developed. The academic community will be supported by two committees, including a strategic consultancy committee and a scientific steering committee, composed of influential scientists selected from the One Health information database. A workplan containing activities under six objectives is proposed to provide research support, strengthen local capacity, and enhance global participation. Conclusions The proposed academic community for One Health action is a crucial step towards enhancing communication, coordination, collaboration, and capacity building for the implementation of One Health. By bringing eminent global experts together, the academic community possesses the potential to generate scientific evidence and provide advice to local governments and international organizations, enabling the pursuit of common goals, collaborative policies, and solutions to misaligned interests. Graphical Abstract
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- 2023
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4. A cost analysis of the diagnosis and treatment of malaria at public health facilities and communities in three districts in Rwanda
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Ornella Masimbi, Janna M. Schurer, Ellen Rafferty, Jean D’ Amour Ndahimana, and J. Hellen Amuguni
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Malaria ,Community Health Workers ,Healthcare costs ,Home-Based Management ,Rwanda ,Arctic medicine. Tropical medicine ,RC955-962 ,Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background Malaria is a potentially fatal disease spread by the bites of Plasmodium-infected Anopheles mosquitoes. Despite long-term efforts to control malaria in Rwanda, malaria incidence increased from 48 to 403 cases/1000 individuals between 2012 and 2016. The diagnosis and treatment of malaria occurs at multiple levels, but the costs of these activities are not well understood. This research was conducted to estimate the direct medical costs incurred by the Ministry of Health in diagnosing and treating malaria in three districts of Rwanda in 2018. Methods A cross-sectional and retrospective costing analysis was conducted in three districts that represented low (5–200 cases per 1000 individuals), moderate (> 200–400 cases per 1000 individuals), and high (> 400 cases per 1000 individuals) endemicity regions. Data on malaria cases managed at three healthcare levels (community, health centre, district hospital) was obtained from national databases. The direct medical costs of cases per malaria severity (‘simple malaria’, ‘simple malaria with minor digestive symptoms’, and ‘severe malaria’) were calculated based on the minimum package of health services provided. Total costs for each of the three districts were also calculated. Results A total of 298,381 malaria cases were recorded in Burera, Kirehe, and Southern Kayonza districts in 2018. The average unit cost per case ranged from USD 1.36 (for simple malaria at the community level) to USD 92.80 (for severe malaria with cerebral complications at district hospitals). Simple malaria cases managed at health centres and district hospitals were more than two-fold (USD 2.99–USD 3.00) and more than eight-fold (USD 12.10–USD 12.12) higher, respectively, than those managed in the community (USD 1.36). Overall, the Ministry of Health incurred USD 645,647.68 in direct medical costs related to malaria management across the three districts in 2018. Changes in disease rates from different endemicity regions and costs of anti-malarial oral medications significantly impacted the study results. Conclusion In Rwanda, severe malaria results in much higher expenses compared to other malaria types. Prompt diagnosis and appropriate treatment are crucial to prevent the progression of simple malaria to severe malaria, to reduce Ministry of Health malaria expenditures, and to reduce community transmission.
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- 2022
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5. A One Health evaluation of water, sanitation, and hygiene (WASH) services in Butaro Sector, Rwanda
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Laura L. Coughlin, Janna M. Schurer, Carene Umubyeyi, Salome Sijenyi, Khurram Arif, Vivianne Umuhire Niyonkuru, Emmanuel Byiringiro, Naomi Lutz, Noel Korukire, Susan Murcott, and Hellen J. Amuguni
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drinking water ,livestock ,one health ,rwanda ,sanitation practices ,water treatment ,Environmental technology. Sanitary engineering ,TD1-1066 - Abstract
In 2018, rural residents of northern Rwanda raised water, sanitation, and hygiene (WASH) access and availability as a community concern; however, no baseline information was available to prioritize communities for intervention. This study aimed to assess WASH for people and animals in four cells in Butaro Sector and to identify the cell with the lowest WASH access. This cross-sectional, quantitative study utilized telephone surveys to collect data. Households were randomly selected, and 539 male and female heads-of-household agreed to participate. Overall, 56.8% of households reported access to safe drinking water, but this differed significantly by cell (p < 0.001). Approximately half (54.2%) of respondents walked 30 min or longer to fetch water, travelling one or more times per day. Nearly all (98.5%) households reported the presence of sanitation infrastructure, most often a pit latrine. Across cells, animals experienced poorer access to clean water and sanitation than people. One cell, Gatsibo, reported the poorest overall access to WASH services. Multi-sector collaboration among public health, water authorities, and local leaders is needed to reduce travel times for fetching water and to ensure that all residents can access sufficient safe water to meet the health and hygiene needs of people and animals. HIGHLIGHTS Human, animal, and environmental factors relating to human and animal WASH were characterized in four cells in Butaro Sector, Rwanda.; Important gaps were identified in access to safe drinking water, including long travel times to water sources and barriers to water treatment.; Gatsibo was identified to have the poorest overall access to WASH services for human and animal residents.;
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- 2022
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6. Podoconiosis instruction at nursing schools in Kenya, Rwanda, and Uganda
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Lilian Nantume Wampande, Lamek Mageto Nyabuga, Kelly Fowler, Grace Chinelo Okengwu, Ursin Bayisenge, and Janna M. Schurer
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Africa ,Lymphedema ,Nursing education ,Podoconiosis ,Neglected tropical disease ,Arctic medicine. Tropical medicine ,RC955-962 - Abstract
Abstract Background Podoconiosis is a preventable, progressive, and non-infectious form of elephantiasis that can contribute to significant disability and economic burden when not treated early. Nurses play a critical role in early detection and response in rural Africa, but it is unclear if they receive adequate training on podoconiosis. We aimed to characterize podoconiosis instruction at all government accredited, post-secondary nursing institutions in three African countries. Methods Data for this cross-sectional study was collected through a quantitative survey with several open-answer questions. Through a rigorous online search, we identified all post-secondary institutions in Kenya, Rwanda and Uganda accredited to teach human nursing. A total of 289 accredited programs, including 85 certificate, 56 degree and 148 diploma programs were invited to participate. Respondents completed surveys online or by telephone. Measures focused on podoconiosis knowledge, perceptions of quality/quantity of podoconiosis instruction, and barriers to sufficient podoconiosis education. Results We obtained information about 212 curricula across 149 nursing institutions in the three countries (participation rate: 73.4%). Podoconiosis coverage was limited across programs (certificate—24.1%; diploma—55.6%; degree—30.3%). Most respondents felt that the quality and quantity of instruction were insufficient (60.6%, 62.9%), respectively. Exclusion from government curricula, low priority and faculty lack of knowledge were commonly reported barriers to podoconiosis inclusion. Conclusions This study demonstrated clear gaps in podoconiosis training for nurses across the three countries and highlights a serious challenge in eliminating podoconiosis as a public health problem. Interventions to improve nurses’ knowledge could include the development and free distribution of podoconiosis teaching materials, designed for integration into pre-existing courses.
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- 2022
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7. Host and geographic differences in prevalence and diversity of gastrointestinal helminths of foxes (Vulpes vulpes), coyotes (Canis latrans) and wolves (Canis lupus) in Québec, Canada
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Émilie Bouchard, Janna M. Schurer, Temitope Kolapo, Brent Wagner, Ariane Massé, Sean A. Locke, Patrick Leighton, and Emily J. Jenkins
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Canids ,Wildlife ,Parasites ,Cestodes ,Nematodes ,Trematodes ,Zoology ,QL1-991 - Abstract
Wild canids are hosts to a wide range of parasites and can play a role in transmission of zoonoses. As many parasites are transmitted through food webs, and wild canids are at high trophic levels, parasite prevalence and diversity in wild canids can serve as excellent indicators of ecosystem health. Our main objectives were to update knowledge on the composition of gastrointestinal helminths in wild canids from Québec, Canada, and to describe differences in parasite prevalence and diversity among canid species and regions. Hunters and trappers provided whole carcasses of red foxes (Vulpes vulpes) (N = 176), and intestinal tracts of coyotes (Canis latrans) (N = 77) and gray wolves (Canis lupus) (N = 23) harvested for non-research purposes over the winter of 2016–2017. A modified Stoll's centrifugation sucrose flotation on feces of 250 wild canids was used, and eggs of one family and eight genera of parasitic helminths were recovered: diphyllobothriids, Taenia/Echinococcus spp., Capillaria spp., Toxascaris sp., Toxocara sp., Trichuris sp., Uncinaria sp., and Metorchis sp. Adult Taenia spp. cestodes were recovered from 61 of 276 (22%) canids. Six different species (T. hydatigena, T. twitchelli, T. crassiceps, T. polyacantha, T. krabbei, and T. pisiformis-“like”) were differentiated based on DNA sequenced from 65 individual adult cestodes using primers for the nicotinamide adenosine dinucleotide dehydrogenase subunit 1 (ND1) and cytochrome c oxidase subunit 1 (CO1) mitochondrial DNA loci. Alaria sp. trematodes infected 89 of 276 canids (32%). A subset were identified as A. americana at the CO1 locus. The marine trematode Cryptocotyle lingua was reported for the first time in foxes in the province of Québec. These results help us understand more fully the predator-prey relationships within this group of canids. This baseline data in regional parasite prevalence and intensity is critical in order to detect future changes following ecological disturbances due to climate and landscape alterations.
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- 2021
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8. Dental fluorosis among people and livestock living on Gihaya Island in Lake Kivu, Rwanda
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Theodore Habiyakare, Janna M. Schurer, Barika Poole, Susan Murcott, Basile Migabo, Birori Mardochee, J. Hellen Amuguni, and John P. Morgan
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Fluoride ,Dental fluorosis ,Rwanda ,One Health ,WASH ,Environmental sciences ,GE1-350 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Dental fluorosis is caused by prolonged exposure to excessive fluoride during the period of permanent tooth formation and is characterized by tooth discoloration, pitting, and loss of shape. Communities living near Lake Kivu in Western Rwanda exhibit a high prevalence of dental fluorosis; however, data on prevalence and risk factors are scarce. Methods This cross sectional, quantitative study used a One Health approach to investigate dental fluorosis prevalence among people and livestock and to measure fluoride content in the environment. In 2018, oral health examinations were conducted to assess the prevalence of fluorosis in children (aged 9 to 15 years), cattle and goats residing on Gihaya Island (Rwanda, East Africa). All children and cattle/goats meeting basic eligibility criteria (e.g., island residence) were invited to participate. Presence and severity of dental fluorosis was categorized according to the Dean’s Fluorosis Index. Samples of local foods, water, soil and grass were collected from communal sources and individual households and analyzed for fluoride content using standard laboratory techniques. Descriptive and binomial analyses (Fisher Exact Test) were used to assess this dataset. Results Overall, 186 children and 85 livestock owners (providing data of 125 livestock -23 cattle and 102 goats) participated. Dental fluorosis was recorded in 90.7% of children and 76% of livestock. Moderate to severe fluorosis was observed in 77% children while goats and cattle most often exhibited mild or absent/questionable severity, respectively. Water from Lake Kivu (used primarily for human cooking water and livestock drinking water) contained fluoride levels that were consistently higher than the maximum threshold (1.5 mg/L) recommended by the World Health Organization. Other sources (borehole and rainwater) were within safe limits. All food, soil and grass samples contained fluoride. The highest levels were observed in porridge (0.5 mg/g) and small fishes (1.05 mg/g). Conclusions Altogether, dental fluorosis was highly prevalent among children and goats on Gihaya Island with various food and water sources contributing a cumulative exposure to fluoride. An immediate and coordinated response across human, animal and water professionals is needed to reduce fluoride exposure within safe limits for island residents.
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- 2021
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9. 'At the hospital they do not treat venom from snakebites': A qualitative assessment of health seeking perspectives and experiences among snakebite victims in Rwanda
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Janna M. Schurer, Aleta Dam, Marie Thérèse Mutuyimana, Daniel Muhire Runanira, Richard Nduwayezu, and J. Hellen Amuguni
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East Africa ,Neglected tropical disease ,Venom ,Snake ,Human-animal conflict ,Toxicology. Poisons ,RA1190-1270 - Abstract
Snakebite envenomation (SBE) is a serious medical condition with human, animal, and environmental factors driving occurrence. In Rwanda, the number of SBE cases reported by the medical system is far lower than regional estimates for SBE incidence, suggesting that victims might be seeking care outside of formal medical structures. Our goals were to describe circumstances surrounding snakebite and to explore experiences of snakebite victims in accessing treatment. For this qualitative study, our team recruited individuals bitten by snakes between 2013 and 2018, who sought care either from traditional healers (N = 40) or hospitals (N = 65). In-depth interviews based on a semi-structured interview guide were conducted by telephone in Kinyarwanda. Inductive thematic analysis was conducted by two team members. Our respondents reported similar environmental circumstances surrounding their snake encounters; namely, farm fields, roads, and their homes, as well as inadequate lighting. Unsafe First Aid practices, including burning/sucking/cutting the skin and tourniquet, were often performed immediately after bites. Respondents reported various reasons for seeking traditional or hospital care, such as perceived cost, distance, transportation, and especially, community beliefs and treatment outcomes of other victims. Respondents described envenomation of livestock as well as the sale of livestock to pay SBE-related medical expenses. Improving trust and use of formal medical services will require enhanced hospital delivery of high quality medical services for SBE through improved stocking of appropriate anti-venom and reduced delays during intake. Communities might also benefit from education campaigns that discourage unsafe First Aid practices and address the common misperception that physicians are not trained to treat SBE.
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- 2022
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10. The Use of Drones to Deliver Rift Valley Fever Vaccines in Rwanda: Perceptions and Recommendations
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Evan F. Griffith, Janna M. Schurer, Billy Mawindo, Rita Kwibuka, Thierry Turibyarive, and Janetrix Hellen Amuguni
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rift valley fever ,drones ,Rwanda ,livestock vaccine supply chain ,zoonotic disease ,Medicine - Abstract
Given the recent emergence of Rift Valley Fever (RVF) in Rwanda and its profound impact on livelihoods and health, improving RVF prevention and control strategies is crucial. Vaccinating livestock is one of the most sustainable strategies to mitigate the impact of RVF on health and livelihoods. However, vaccine supply chain constraints severely limit the effectiveness of vaccination programs. In the human health sector, unmanned aerial vehicles, i.e., drones, are increasingly used to improve supply chains and last-mile vaccine delivery. We investigated perceptions of whether delivering RVF vaccines by drone in Rwanda might help to overcome logistical constraints in the vaccine supply chain. We conducted semi-structured interviews with stakeholders in the animal health sector and Zipline employees in Nyagatare District in the Eastern Province of Rwanda. We used content analysis to identify key themes. We found that stakeholders in the animal health sector and Zipline employees believe that drones could improve RVF vaccination in Nyagatare. The primary benefits study participants identified included decreased transportation time, improved cold chain maintenance, and cost savings.
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- 2023
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11. A novel protocol to isolate, detect and differentiate taeniid eggs in leafy greens and berries using real-time PCR with melting curve analysis
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Caroline F. Frey, Jenna R. Oakley, Vladislav A. Lobanov, Nelson Marreros, Janna M. Schurer, and Laura F. Lalonde
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Echinococcus spp. ,Taenia spp. ,Leafy greens ,Berries ,Food safety ,Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background Zoonotic taeniid cestodes are amongst the most important food-borne parasites affecting human health worldwide. Contamination of fresh produce with the eggs of Echinococcus granulosus (s.l.), Echinococcus multilocularis, and some Taenia species pose a potential food safety risk. However, very few studies have attempted to investigate the potential contamination of fresh produce with taeniid eggs and the available methods are not standardized for this purpose. Established protocols do exist for testing leafy greens and berries for contamination with protozoan parasites and are used in national surveillance programmes. This methodology could be suitable for the detection of taeniids. The objective of this project was to develop and standardize a sensitive and reliable method to detect contamination of leafy greens and berries with eggs of zoonotic taeniids and to differentiate between E. multilocularis, E. granulosus (s.l.) and Taenia spp. Methods We compared the efficacy of different wash solutions to remove Taenia spp. eggs from spiked produce, assessed two DNA extraction kits for their performance on Taenia spp. eggs, and adapted a published conventional multiplex PCR into a real-time PCR with fluorescence melting curve analysis (MCA) that was optimized for use on produce washes. Analytical specificity of this protocol was assessed using non-spiked produce washes as well as a variety of other potentially contaminating parasites. Results The protocol as established in this study had an analytical sensitivity of detecting five eggs per spiked sample for both romaine lettuce and strawberries. Unequivocal identification of E. multilocularis, E. granulosus (s.l.) and Taenia spp. was possible through MCA. Amplicon sequencing allowed identification of Taenia to the species level. The real-time PCR also amplified DNA from Dicrocoelium sp., but with a clearly discernable melting curve profile. Conclusion The new protocol for screening produce for taeniid contamination was highly sensitive. Melting curve analysis and the possibility of amplicon sequencing made this assay very specific. Once further validated, this method could be employed for surveillance of produce for contamination with taeniid parasites to assess potential risks for consumers.
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- 2019
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12. Checklist for One Health Epidemiological Reporting of Evidence (COHERE)
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Meghan F. Davis, Shelley C. Rankin, Janna M. Schurer, Stephen Cole, Lisa Conti, Peter Rabinowitz, Gregory Gray, Laura Kahn, Catharine Machalaba, Jonna Mazet, Marguerite Pappaioanou, Jan Sargeant, Andrew Thompson, Scott Weese, and Jakob Zinnstag
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One Health ,Reporting guidelines ,Observational studies ,Epidemiology ,Environmental health ,Medicine (General) ,R5-920 - Abstract
One Health is defined as the intersection and integration of knowledge regarding humans, animals, and the environment, yet as the One Health scientific literature expands, there is considerable heterogeneity of approach and quality of reporting in One Health studies. In addition, many researchers who publish such studies do not include or integrate data from all three domains of human, animal, and environmental health. This points to a critical need to unify guidelines for One Health studies. This report details the Checklist for One Health Epidemiological Reporting of Evidence (COHERE) to guide the design and publication format of future One Health studies. COHERE was developed by a core writing team and international expert review group that represents multiple disciplines, including human medicine, veterinary medicine, public health, allied professionals, clinical laboratory science, epidemiology, the social sciences, ecohealth and environmental health. The twin aims of the COHERE standards are to 1) improve the quality of reporting of observational or interventional epidemiological studies that collect and integrate data from humans, animals and/or vectors, and their environments; and 2) promote the concept that One Health studies should integrate knowledge from these three domains. The 19 standards in the COHERE checklist address descriptions of human populations, animal populations, environmental assessment, spatial and temporal relationships of data from the three domains, integration of analyses and interpretation, and inclusion of expertise in the research team from disciplines related to human health, animal health, and environmental health.
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- 2017
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13. A One Health systematic review of diagnostic tools for Echinococcus multilocularis surveillance: Towards equity in global detection
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Janna M. Schurer, Arlene Nishimwe, Dieudonne Hakizimana, Huan Li, Yu Huang, Jean Pierre Musabyimana, Eugene Tuyishime, and Lauren E. MacDonald
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Infectious and parasitic diseases ,RC109-216 - Abstract
Echinococcus multilocularis is a zoonotic cestode of canid definitive hosts that is emerging as a parasite of medical and veterinary concern in regions of North America, Europe and Asia. Infection with the metacestode stage (alveolar echinococcosis – AE) is life-threatening, especially for patients who reside in low resource countries and lack access to modern diagnostic tests and treatments. The overall objectives of this One Health review were to systematically describe the diagnostic tests currently employed in endemic countries to detect E. multilocularis in people, canids and the environment, and to report the test characteristics of new diagnostic techniques for population surveillance. In this systematic review of English and Chinese language databases, we identified 92 primary records of E. multilocularis surveillance in canids (N = 75), humans (N = 20) and/or the environment (food, soil; N = 3) and 12 grey literature records that reported E. multilocularis surveillance or health systems protocols between 2008 and 2018. Surveillance for E. multilocularis was conducted using a broad range of combined morphological, molecular, immunological and imaging techniques. Nine studies reporting diagnostic evaluations for cestode or metacestode detection were identified, including studies on copro-antigen ELISA, copro-PCR, intestinal examination, Western Blot, magnetic capture RT-PCR and immunochromatography. Our dataset includes prevalence estimates for E. multilocularis in canids, people, or environment in 27 of the 43 endemic countries and reports data gaps in surveillance, laboratory methods, and diagnostic sensitivity. International consensus on gold standard diagnostic techniques and harmonization of human, canid and environmental surveillance data across political boundaries are needed to comprehensively assess the global burden and distribution of this parasite. Keywords: Echinococcus_multilocularis, Diagnostic_evaluation, Surveillance, One_Health, Systematic_Review
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- 2019
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14. Knowledge, attitudes, and practices: a quantitative assessment of hospital physicians and medical interns treating snakebite envenomation in Rwanda
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Janna M Schurer, Elise M Hirwa, Ornella Masimbi, and Richard Nduwayezu
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Health Knowledge, Attitudes, Practice ,Infectious Diseases ,Antivenins ,Physicians ,Rwanda ,Public Health, Environmental and Occupational Health ,Humans ,Snake Bites ,Parasitology ,General Medicine ,Hospitals - Abstract
Background Snakebite envenomation (SBE) is a serious and potentially life-threatening condition that most often targets rural, subsistence-based farmers in sub-Saharan Africa. Rwanda is home to 13 venomous and medically important snake species. Those bitten are known to seek care from traditional healers and/or formal health facilities. No information is available on patient management at government health facilities. Methods This quantitative evaluation aimed to characterize knowledge, attitudes and practices related to snakebite management in Rwanda. Target respondents included physicians working at hospitals with the highest SBE caseload and medical interns. Respondents were asked to complete questionnaires on paper or online through Qualtrics. Results Overall, 105 physicians and 171 interns agreed to participate. Our findings suggest that overall knowledge scores were low for both groups (mean 49.4%, minimum–maximum 31.3–70.8%). Respondents were keen to receive SBE training but often lacked essential supplies needed to adhere to recommended guidelines for SBE management. One-third of respondents (34.8%) believed that traditional healers could manage SBE successfully and two-thirds (66.3%) felt that black stone therapy was an appropriate first aid practice. Conclusions These findings indicate a clear need for improved curricula related to SBE, enhanced supply chain management and practical mechanisms for supporting clinicians.
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- 2022
15. Snakebite Envenomation in Rwanda: Patient Demographics, Medical Care, and Antivenom Availability in the Formal Healthcare Sector
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Hilary Kinney, Janetrix Hellen Amuguni, Janna M. Schurer, and Richard Nduwayezu
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Adult ,Male ,Rural Population ,0301 basic medicine ,medicine.medical_specialty ,Adolescent ,030231 tropical medicine ,Antivenom ,Health Care Sector ,Snake Bites ,complex mixtures ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Virology ,Health care ,medicine ,Animals ,Humans ,Snake antivenom ,Medical prescription ,Hospital pharmacy ,Child ,Envenomation ,Retrospective Studies ,Animal Bites ,Antivenins ,business.industry ,Rwanda ,Snakes ,Articles ,Middle Aged ,030104 developmental biology ,Infectious Diseases ,One Health ,Family medicine ,Female ,Parasitology ,business - Abstract
Snakebite envenomation (SBE) is a neglected One Health issue that overwhelmingly affects people living in rural and impoverished regions of Africa and Asia. Information on SBE is scarce in Rwanda; thus, our objectives were to 1) describe the demographics of SBE patients seeking hospital care, 2) evaluate physician adherence to national treatment guidelines, and 3) assess availability of snake antivenom at hospitals in Rwanda. To achieve these goals, we obtained national data on animal bites/stings and visited every district and provincial hospital in Rwanda to obtain physical records of SBE patients treated in 2017 and 2018. Hospital pharmacies were assessed for antivenom availability. We identified snakes as the second leading cause of animal bites, after dogs, among patients who sought hospital care in 2017 and 2018. Of 363 SBE patients, the highest number of cases occurred among children (< 18 years; 32%) and young adults (18–30 years; 33%), females (61%), farmers (82%), and those living in Eastern Province (37%). Overall, physician adherence to treatment guidelines was 63%. Prescriptions of vitamin K and antivenom were low (4% and 13%, respectively), and only 8% of hospital pharmacies had antivenom in stock throughout the study period. The antivenom stocked was an Indian generic suited for Asian snakes. This minimum estimate of hospitalization cases does not include individuals who died in communities or sought care outside the formal sector. Our study highlights the need to map incidence, risk factors, and patient experiences to mitigate human–snake conflicts and improve patient outcomes.
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- 2021
16. ‘Far from the views of decision-makers’: podoconiosis instruction at medical schools across endemic countries in Africa
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Chany Uwase, Adilson Jose Manuel de Oliveira, Ursin Bayisenge, Kelly Fowler, Agazi Gebreselassie, Lilian Nantume Wampande, and Janna M. Schurer
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medicine.medical_specialty ,media_common.quotation_subject ,Decision Making ,030231 tropical medicine ,Neglect ,03 medical and health sciences ,0302 clinical medicine ,Epidemiology ,medicine ,Humans ,Elephantiasis ,030212 general & internal medicine ,Podoconiosis ,Curriculum ,Schools, Medical ,media_common ,Government ,Rural health ,Public Health, Environmental and Occupational Health ,Neglected Diseases ,Tropical disease ,General Medicine ,medicine.disease ,Infectious Diseases ,Family medicine ,Africa ,Parasitology ,Psychology ,Inclusion (education) - Abstract
Background Podoconiosis is a neglected tropical disease that causes significant physical, emotional and financial suffering, especially among impoverished rural farmers. Sufficient physician training is integral to optimizing patient outcomes through timely diagnosis and appropriate management. Therefore we sought to characterize podoconiosis instruction offered to medical students in endemic African countries. Methods We invited faculty from 170 medical schools in all podoconiosis-endemic African countries to provide information about podoconiosis inclusion in medical curricula. Surveys were available in French and English and captured podoconiosis knowledge, quantity/quality of instruction, ranking of importance relative to other diseases and barriers for improvement. Respondents voluntarily shared responses online or by telephone. Results Study participants provided information about curricula at 97 medical schools across 14 countries. In total, 42.6% of schools across nine countries offered podoconiosis-specific instruction; most respondents felt that the quality (60.4%) and quantity (61.5%) of instruction was insufficient. Common barriers to sufficient training included exclusion from government curricula, prioritization according to caseload and scarce epidemiological data. Conclusions Our study demonstrates widespread neglect in podoconiosis training for physicians in endemic countries. Government support is needed to ensure curricula match the needs of health workers practicing in rural, low-income regions.
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- 2020
17. Molecular Evidence for Local Acquisition of Human Alveolar Echinococcosis in Saskatchewan, Canada
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Janet E. Hill, Emily J. Jenkins, Janna M. Schurer, Temitope U. Kolapo, Karen M. Gesy, Polly Tsybina, and Stuart Skinner
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0301 basic medicine ,Mitochondrial DNA ,030231 tropical medicine ,Cestoda ,Locus (genetics) ,Echinococcus multilocularis ,Coyotes ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Echinococcosis ,law ,medicine ,Animals ,Humans ,Immunology and Allergy ,Polymerase chain reaction ,biology ,Zoonosis ,Haplotype ,030108 mycology & parasitology ,biology.organism_classification ,medicine.disease ,Virology ,Saskatchewan ,3. Good health ,Metacestode ,Infectious Diseases ,Haplotypes - Abstract
Alveolar echinococcosis (AE) is a life-threatening parasitic disease caused by the zoonotic cestode Echinococcus multilocularis. Our goals were to confirm infection, identify species, and analyze biogeographical origin of metacestode tissues from a suspected human AE case in Saskatchewan, Canada. We conducted polymerase chain reaction (PCR) targeting the nad1 mitochondrial gene for E. multilocularis and the rrnS ribosomal RNA gene for E. granulosus and conducted haplotype analysis at the nad2 locus. Our analysis confirmed AE and indicated that sequences matched infected Saskatchewan coyotes and European E3/E4 haplotypes. The patient had no travel history outside North America. This suggests autochthonous transmission of a European-type strain.
- Published
- 2020
18. Rift Valley fever knowledge, mitigation strategies and communication preferences among male and female livestock farmers in Eastern Province, Rwanda
- Author
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Anselme Shyaka, Janetrix Hellen Amuguni, Eurade Ntakiyisumba, Lindsay J. Smith, and Janna M. Schurer
- Subjects
Male ,Health Knowledge, Attitudes, Practice ,Rift Valley Fever ,Epidemiology ,animal diseases ,RC955-962 ,Viral Zoonoses ,Geographical Locations ,Arctic medicine. Tropical medicine ,Zoonoses ,Public and Occupational Health ,Rift Valley fever ,Socioeconomics ,Risk management ,Neglected tropical diseases ,Animal Management ,Aged, 80 and over ,Farmers ,Communication ,food and beverages ,Agriculture ,Middle Aged ,Livelihood ,Vaccination and Immunization ,Professions ,Geography ,Veterinary Diseases ,Infectious diseases ,Agricultural Workers ,Livestock ,Female ,Public aspects of medicine ,RA1-1270 ,Research Article ,Medical conditions ,Veterinary Medicine ,Adult ,Immunology ,Context (language use) ,Viral diseases ,Young Adult ,parasitic diseases ,medicine ,Animals ,Humans ,Aged ,Medicine and health sciences ,Government ,business.industry ,Information Dissemination ,Tropical diseases ,Public Health, Environmental and Occupational Health ,Rwanda ,Outbreak ,Biology and Life Sciences ,medicine.disease ,Rift Valley fever virus ,Cross-Sectional Studies ,Medical Risk Factors ,People and Places ,Africa ,Population Groupings ,Veterinary Science ,Livestock Care ,Perception ,Preventive Medicine ,business - Abstract
The Government of Rwanda reported an outbreak of Rift Valley fever (RVF) in the Eastern Province in 2018. To respond to the outbreak, vaccination and education campaigns about the disease were carried out. Because RVF cases continue to be detected in Rwanda and the disease impacts livelihoods and health, accurate knowledge and communication are imperative. The objectives of this study were to evaluate knowledge and risk perceptions of RVF transmission among livestock farmers in Nyagatare District, Eastern Province, Rwanda, and to compare RVF knowledge, risk perceptions, and farming practices between male and female livestock farmers. This cross-sectional, quantitative study was conducted in selected sectors of Nyagatare District in the Eastern Province of Rwanda in June 2019. A 34-question survey was used to ask about demographics, livestock ownership, risk perceptions about zoonotic diseases and livestock management, RVF knowledge, preferred communication sources and information sharing strategies, and protective strategies for RVF mitigation while working with livestock. Livestock farmers were interviewed at three milk collection centers, two village meeting points, a farm cooperative meeting, and during door-to-door visits in villages. In total, 123 livestock farmers were interviewed. The survey found that most livestock farmers lacked knowledge about epizootic and zoonotic transmission of RVF, more male livestock farmers were familiar with RVF and risk mitigation strategies, and female livestock farmers are not viewed as reliable sources of information. Additionally, most livestock farmers had not vaccinated their animals against RVF despite past vaccination campaigns. Radio was the most popular communication channel. These findings show that RVF knowledge and information sharing are inadequate among livestock farmers in Eastern Province. Therefore, vaccination and education campaigns may need to be reevaluated within the context of these trends in order to prepare for future RVF outbreaks., Author summary This study was conducted in order to evaluate RVF knowledge and awareness as well as communication and mitigation strategies among livestock farmers in Eastern Province, Rwanda. Rwanda declared an outbreak of RVF in 2018 and cases have continued to be detected. Thus, evaluating the status of knowledge, preventive strategies, and information sharing among livestock farmers is crucial in mitigating future outbreaks. Our team conducted a survey of knowledge, risk perceptions, mitigation strategies, and communication practices among livestock farmers from selected sectors within Nyagatare District and compared them between male and female livestock farmers in order to analyze gender-nuanced differences between these groups. Sectors were chosen for sampling based on their proximity to previous outbreak areas. Survey questionnaire results showed that knowledge and risk perceptions differed between male and female livestock farmers, and that they could be generally improved among all livestock farmers. Female livestock farmers and non-farming community members were viewed as unreliable sources of information which could impact information dissemination. Many farmers also reported that their livestock herds were not vaccinated for the disease despite previous vaccination campaigns. Communication strategies and information sources also differed between male and female livestock farmers, which highlights a need to consider gender in improving RVF vaccination and education campaign coverage. These findings pose implications for future community-based public health interventions as well as policy development for RVF control and mitigating future RVF outbreaks within Rwanda.
- Published
- 2021
19. Host and geographic differences in prevalence and diversity of gastrointestinal helminths of foxes (
- Author
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Sean A. Locke, Émilie Bouchard, Janna M. Schurer, Emily J. Jenkins, Brent Wagner, Temitope U. Kolapo, Patrick A. Leighton, and Ariane Massé
- Subjects
Trichuris ,Nematodes ,Vulpes ,Capillaria ,Zoology ,Wildlife ,Trematodes ,Article ,030308 mycology & parasitology ,03 medical and health sciences ,Parasite hosting ,Helminths ,Parasites ,14. Life underwater ,030304 developmental biology ,0303 health sciences ,biology ,Cestodes ,Canids ,15. Life on land ,biology.organism_classification ,3. Good health ,Infectious Diseases ,Canis ,Echinococcus ,QL1-991 ,Taenia ,Animal Science and Zoology ,Parasitology - Abstract
Wild canids are hosts to a wide range of parasites and can play a role in transmission of zoonoses. As many parasites are transmitted through food webs, and wild canids are at high trophic levels, parasite prevalence and diversity in wild canids can serve as excellent indicators of ecosystem health. Our main objectives were to update knowledge on the composition of gastrointestinal helminths in wild canids from Québec, Canada, and to describe differences in parasite prevalence and diversity among canid species and regions. Hunters and trappers provided whole carcasses of red foxes (Vulpes vulpes) (N = 176), and intestinal tracts of coyotes (Canis latrans) (N = 77) and gray wolves (Canis lupus) (N = 23) harvested for non-research purposes over the winter of 2016–2017. A modified Stoll's centrifugation sucrose flotation on feces of 250 wild canids was used, and eggs of one family and eight genera of parasitic helminths were recovered: diphyllobothriids, Taenia/Echinococcus spp., Capillaria spp., Toxascaris sp., Toxocara sp., Trichuris sp., Uncinaria sp., and Metorchis sp. Adult Taenia spp. cestodes were recovered from 61 of 276 (22%) canids. Six different species (T. hydatigena, T. twitchelli, T. crassiceps, T. polyacantha, T. krabbei, and T. pisiformis-“like”) were differentiated based on DNA sequenced from 65 individual adult cestodes using primers for the nicotinamide adenosine dinucleotide dehydrogenase subunit 1 (ND1) and cytochrome c oxidase subunit 1 (CO1) mitochondrial DNA loci. Alaria sp. trematodes infected 89 of 276 canids (32%). A subset were identified as A. americana at the CO1 locus. The marine trematode Cryptocotyle lingua was reported for the first time in foxes in the province of Québec. These results help us understand more fully the predator-prey relationships within this group of canids. This baseline data in regional parasite prevalence and intensity is critical in order to detect future changes following ecological disturbances due to climate and landscape alterations., Graphical abstract Image 1, Highlights • Combining gross examination and fecal flotation improve detection of helminths. • Cestode prevalence is underestimated when diagnosis is based only on eggs in feces. • Foxes had significantly more nematodes and fewer cestodes than wolves and coyotes. • Diets and trophic relationships influence gastrointestinal parasite communities. • Cryptocotyle lingua is reported for the first time in foxes from Québec, Canada.
- Published
- 2021
20. A cost analysis of the diagnosis and treatment of malaria at public health facilities and communities in three districts in Rwanda
- Author
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Ornella Masimbi, Janna M. Schurer, Ellen Rafferty, Jean D’ Amour Ndahimana, and J. Hellen Amuguni
- Subjects
Infectious Diseases ,Cross-Sectional Studies ,Rwanda ,Animals ,Humans ,Parasitology ,Health Facilities ,Health Expenditures ,Malaria ,Retrospective Studies - Abstract
Background Malaria is a potentially fatal disease spread by the bites of Plasmodium-infected Anopheles mosquitoes. Despite long-term efforts to control malaria in Rwanda, malaria incidence increased from 48 to 403 cases/1000 individuals between 2012 and 2016. The diagnosis and treatment of malaria occurs at multiple levels, but the costs of these activities are not well understood. This research was conducted to estimate the direct medical costs incurred by the Ministry of Health in diagnosing and treating malaria in three districts of Rwanda in 2018. Methods A cross-sectional and retrospective costing analysis was conducted in three districts that represented low (5–200 cases per 1000 individuals), moderate (> 200–400 cases per 1000 individuals), and high (> 400 cases per 1000 individuals) endemicity regions. Data on malaria cases managed at three healthcare levels (community, health centre, district hospital) was obtained from national databases. The direct medical costs of cases per malaria severity (‘simple malaria’, ‘simple malaria with minor digestive symptoms’, and ‘severe malaria’) were calculated based on the minimum package of health services provided. Total costs for each of the three districts were also calculated. Results A total of 298,381 malaria cases were recorded in Burera, Kirehe, and Southern Kayonza districts in 2018. The average unit cost per case ranged from USD 1.36 (for simple malaria at the community level) to USD 92.80 (for severe malaria with cerebral complications at district hospitals). Simple malaria cases managed at health centres and district hospitals were more than two-fold (USD 2.99–USD 3.00) and more than eight-fold (USD 12.10–USD 12.12) higher, respectively, than those managed in the community (USD 1.36). Overall, the Ministry of Health incurred USD 645,647.68 in direct medical costs related to malaria management across the three districts in 2018. Changes in disease rates from different endemicity regions and costs of anti-malarial oral medications significantly impacted the study results. Conclusion In Rwanda, severe malaria results in much higher expenses compared to other malaria types. Prompt diagnosis and appropriate treatment are crucial to prevent the progression of simple malaria to severe malaria, to reduce Ministry of Health malaria expenditures, and to reduce community transmission.
- Published
- 2021
21. Long-Tailed Macaques (Macaca fascicularis) in Urban Landscapes: Gastrointestinal Parasitism and Barriers for Healthy Coexistence in Northeast Thailand
- Author
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Sally Trufan, Stephen T. Kelley, Gemina Garland-Lewis, Pensri Kyes, Tawatchai Tanee, Vickie Ramirez, Penkhae Thamsenanupap, Natcha Patarapadungkit, Hutsacha Nueaitong, Peter M. Rabinowitz, Randall C. Kyes, Janna M. Schurer, and Erica T. Grant
- Subjects
education.field_of_study ,biology ,Trichuris ,Ascaris ,030231 tropical medicine ,Population ,Helminthiasis ,biology.organism_classification ,medicine.disease ,Macaque ,03 medical and health sciences ,0302 clinical medicine ,Infectious Diseases ,One Health ,Virology ,biology.animal ,Environmental health ,Strongyloides ,medicine ,Helminths ,Parasitology ,education - Abstract
Gastrointestinal parasites have diverse life cycles that can involve people, animals, and the environment (e.g., water and soil), demonstrating the utility of One Health frameworks in characterizing infection risk. Kosumpee Forest Park (Thailand) is home to a dense population of long-tailed macaques (Macaca fascicularis) that frequently interact with tourists and local residents. Our study investigated the presence of zoonotic parasites, and barriers to healthy coexistence by conducting stool analysis on macaques (N = 102) and people (N = 115), and by examining risk factors for infection with a household questionnaire (N = 95). Overall, 44% of macaques and 12% of people were infected with one or more gastrointestinal helminths, including Strongyloides spp., Ascaris spp., and Trichuris sp. An adults-only generalized linear mixed model identified three factors significantly associated with human infection: household size, occupational exposure, and contact with macaque feces at home. Participants identified both advantages and disadvantages to living in close contact with macaques, suggesting that interventions to improve human and animal health in Kosumpee Forest Park would be welcome.
- Published
- 2019
22. Podoconiosis in Rwanda: Knowledge, attitudes and practices among health professionals and environmental officers
- Author
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Janna M. Schurer, Rex Wong, Ursin Bayisenge, Hellen Amuguni, and Gail Davey
- Subjects
0301 basic medicine ,Male ,Health Knowledge, Attitudes, Practice ,Health Care Providers ,RC955-962 ,Social Sciences ,Nurses ,Essential medicines ,Geographical Locations ,0302 clinical medicine ,Risk groups ,Medical Conditions ,Risk Factors ,Psychological Attitudes ,Arctic medicine. Tropical medicine ,Surveys and Questionnaires ,Health care ,Medicine and Health Sciences ,Psychology ,Public and Occupational Health ,Podoconiosis ,Community Health Services ,Elephantiasis ,Medical Personnel ,Feet ,Middle Aged ,Professions ,Infectious Diseases ,Legs ,Female ,Public aspects of medicine ,RA1-1270 ,Anatomy ,Environmental Health ,Research Article ,Neglected Tropical Diseases ,Adult ,Patients ,Attitude of Health Personnel ,030231 tropical medicine ,Stigma (botany) ,03 medical and health sciences ,Young Adult ,Environmental health ,Physicians ,medicine ,Parasitic Diseases ,Humans ,Medical prescription ,Aged ,Stereotyping ,Health professionals ,business.industry ,Public Health, Environmental and Occupational Health ,Rwanda ,Tropical disease ,Biology and Life Sciences ,medicine.disease ,Tropical Diseases ,Shoes ,Health Care ,030104 developmental biology ,Cross-Sectional Studies ,Body Limbs ,People and Places ,Africa ,Population Groupings ,business - Abstract
Background Podoconiosis is a neglected tropical disease commonly found in volcanic regions, where soil is rich in silica. It usually manifests as bilateral lower limb edema. The majority of people affected by podoconiosis are farmers who do not wear shoes. The condition was recently documented in all 30 districts in Rwanda but knowledge, attitudes and practices (KAP) of Rwandan health professionals and environmental officers towards podoconiosis are unknown. Methodology/Findings The objective of this study was to assess the knowledge, attitudes and practices (KAP) of Rwandan health providers and environmental officers towards podoconiosis in order to improve patient healthcare experiences and health outcomes, and to reduce stigma against affected individuals. To achieve this goal, we administered a KAP assessment to physicians (N = 13), nurses/midwives (N = 59), community health workers (N = 226), and environmental officers (N = 38) in the third highest podoconiosis prevalence district in Rwanda (Musanze). All 336 respondents had heard of podoconiosis, but 147 (44%) respondents correctly identified soil as the only direct cause of podoconiosis. The awareness of signs and symptoms and risk groups was lower than any other category (31.5% and 47.5%, respectively). The overall attitude toward podoconiosis was positive (86.1%), with CHWs least likely to harbor negative beliefs against podoconiosis patients. One particular area where most respondents (76%) expressed negative attitude was that they saw people with podoconiosis as a threat to their own health and their family’s health. Prescription of antibiotics and use of ointments/soap to manage wounds was low (5% and 32.2%, respectively), in part due to supply shortages at health facilities. Conclusions This study identified clear gaps in health provider knowledge and practices that affect patient care for those with podoconiosis. Improved access to essential medicines at health facilities and podoconiosis-focused training sessions for practicing health providers are necessary to minimize the burden and stigma of affected individuals., Author summary Podoconiosis is a foot disease that progressively affects genetically susceptible people who do not wear shoes in volcanic soil. This disease causes disability, stigma, and impinges on people’s economic productivity. In Rwanda, it is estimated that 6429 people live with podoconiosis, but health services for these particular patients are almost nonexistent. We evaluated knowledge, attitudes and practice among 298 health professionals and 38 environmental officers and found that only 44% of all respondents knew that soil is the only direct cause of podoconiosis. Few health professionals (6%) reported having treated a podoconiosis patient and most health professionals (79%) identified shortages of critical drugs and supplies as an important barrier to providing treatment. Three quarters of environmental officers (74%) did not know that farmers are the people most vulnerable to this condition. The poor knowledge of all respondents toward podoconiosis and the lack of medical supplies suggest that podoconiosis patients likely receive substandard medical care and receive little credible information on prevention. We recommend a multi-sectoral approach to training, as well as the engagement of governments and the World Health Organization, to avail medications and treatment materials in the community.
- Published
- 2020
23. Equity for health delivery: Opportunity costs and benefits among Community Health Workers in Rwanda
- Author
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Ornella Masimbi, Jean Muhire, Ellen Rafferty, Olivia Rozanski, Hellen Amuguni, Janna M. Schurer, and Kelly Fowler
- Subjects
Male ,Economics ,Service delivery framework ,Social Sciences ,Transportation ,Global Health ,Care provision ,Geographical Locations ,0302 clinical medicine ,Health care ,Medicine and Health Sciences ,Salaries ,Global health ,Public and Occupational Health ,030212 general & internal medicine ,Health Systems Strengthening ,Community Health Workers ,Multidisciplinary ,030503 health policy & services ,Middle Aged ,Socioeconomic Aspects of Health ,Health Education and Awareness ,Workforce ,Income ,Engineering and Technology ,Medicine ,Female ,Health education ,Job satisfaction ,0305 other medical science ,Research Article ,Adult ,Science ,Job Satisfaction ,Young Adult ,03 medical and health sciences ,Nursing ,Humans ,Motivation ,Health Care Policy ,Poverty ,business.industry ,Rwanda ,Health Care ,Cross-Sectional Studies ,Labor Economics ,People and Places ,Africa ,business ,Delivery of Health Care ,Finance - Abstract
Community Health Workers (CHWs) play a vital role delivering health services to vulnerable populations in low resource settings. In Rwanda, CHWs provide village-level care focused on maternal/child health, control of infectious diseases, and health education, but do not receive salaries for these services. CHWs make up the largest single group involved in health delivery in the country; however, limited information is available regarding the socio-economic circumstances and satisfaction levels of this workforce. Such information can support governments aiming to control infectious diseases and alleviate poverty through enhanced healthcare delivery. The objectives of this study were to (1) evaluate CHW opportunity costs, (2) identify drivers for CHW motivation, job satisfaction and care provision, and (3) report CHW ideas for improving retention and service delivery. In this mixed-methods study, our team conducted in-depth interviews with 145 CHWs from three districts (Kirehe, Kayonza, Burera) to collect information on household economics and experiences in delivering healthcare. Across the three districts, CHWs contributed approximately four hours of volunteer work per day (range: 0–12 hrs/day), which translated to 127 684 RWF per year (range: 2 359–2 247 807 RWF/yr) in lost personal income. CHW out-of-pocket expenditures (e.g. patient transportation) were estimated at 36 228 RWF per year (range: 3 600–364 800 RWF/yr). Participants identified many benefits to being CHWs, including free healthcare training, improved social status, and the satisfaction of helping others. They also identified challenges, such as aging equipment, discrepancies in financial reimbursements, poverty, and lack of formal workspaces or working hours. Lastly, CHWs provided perspectives on reasonable and feasible improvements to village-level health programming that could improve conditions and equity for those providing and using the CHW system.
- Published
- 2020
24. Long-Tailed Macaques (
- Author
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Janna M, Schurer, Vickie, Ramirez, Pensri, Kyes, Tawatchai, Tanee, Natcha, Patarapadungkit, Penkhae, Thamsenanupap, Sally, Trufan, Erica T, Grant, Gemina, Garland-Lewis, Stephen, Kelley, Hutsacha, Nueaitong, Randall C, Kyes, and Peter, Rabinowitz
- Subjects
Adult ,Male ,Family Characteristics ,Adolescent ,Parks, Recreational ,Ascaris ,Monkey Diseases ,Helminthiasis ,Articles ,Middle Aged ,Thailand ,Feces ,Macaca fascicularis ,Trichuris ,Child, Preschool ,Surveys and Questionnaires ,Strongyloides ,Animals ,Humans ,Female ,Helminthiasis, Animal ,Intestinal Diseases, Parasitic ,Child - Abstract
Gastrointestinal parasites have diverse life cycles that can involve people, animals, and the environment (e.g., water and soil), demonstrating the utility of One Health frameworks in characterizing infection risk. Kosumpee Forest Park (Thailand) is home to a dense population of long-tailed macaques (Macaca fascicularis) that frequently interact with tourists and local residents. Our study investigated the presence of zoonotic parasites, and barriers to healthy coexistence by conducting stool analysis on macaques (N = 102) and people (N = 115), and by examining risk factors for infection with a household questionnaire (N = 95). Overall, 44% of macaques and 12% of people were infected with one or more gastrointestinal helminths, including Strongyloides spp., Ascaris spp., and Trichuris sp. An adults-only generalized linear mixed model identified three factors significantly associated with human infection: household size, occupational exposure, and contact with macaque feces at home. Participants identified both advantages and disadvantages to living in close contact with macaques, suggesting that interventions to improve human and animal health in Kosumpee Forest Park would be welcome.
- Published
- 2019
25. Echinococcus across the north: Current knowledge, future challenges
- Author
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Karl Skírnisson, Emily J. Jenkins, Antti Oksanen, Antti Lavikainen, Andrea L. Miller, Sergey V. Konyaev, Rebecca K. Davidson, Janna M. Schurer, Medicum, Research Programs Unit, Immunobiology Research Program, Seppo Meri / Principal Investigator, and Department of Bacteriology and Immunology
- Subjects
0301 basic medicine ,Epidemiology ,Genotypes ,030231 tropical medicine ,Alveolar echinococcosis ,413 Veterinary science ,lcsh:Infectious and parasitic diseases ,03 medical and health sciences ,Arctic ,0302 clinical medicine ,lcsh:RC109-216 ,biology ,Cystic echinococcosis ,Ecology ,Circumpolar star ,030108 mycology & parasitology ,biology.organism_classification ,3. Good health ,Geography ,Echinococcus ,Circumpolar ,Ethnology ,Alveolar echinococcosis, Arctic, Circumpolar, Cystic echinococcosis, Genotypes ,Parasitology - Abstract
Zoonotic Echinococcus spp. cestodes are present in almost all circumpolar nations, and have historically posed a risk to health of indigenous as well as other northern residents. However, surveillance data on both alveolar (AE) and cystic (CE) echinococcosis remains incomplete throughout the circumpolar region: Russia, Fennoscandia, Iceland, Greenland, Canada and Alaska (USA). Prevalence of Echinococcus spp. varies considerably in definitive canid hosts, animal intermediate hosts and accidental hosts like humans. Yet despite the high prevalence reported in canids in some geographic locations, human AE and CE are much less common than in endemic Asian and central European countries. This paper explores knowledge gaps and future challenges posed by Echinococcus spp. in eight circumpolar countries, a region where rapid environmental and social change are rewriting the boundaries, transmission, and impact of many pathogens, including zoonotic Echinococcus spp.Genotypes G6, G8 and G10 of Echinococcus canadensis are causative agents of human CE and have been identified in sylvatic (wild animal) and synanthropic (ecological association with humans) cervid-canine life cycles in the following northern regions: Alaska and northern Canada - G8 and G10; northern Russia - G6, G8, G10; and Fennoscandia - G10 in Finland - with no recent reports from Norway or Sweden. Echinococcus multilocularis, which causes AE, has been identified in a sylvatic arvicoline rodent-canine lifecycle in Alaska, Canada, Russia, Sweden and Svalbard (Norway). Asian, Mongolian, European and North American strains of E. multilocularis are found in Russia, with the North American N1 strain predominating in the north. The N1 strain is also found in Alaska, as well as Svalbard, whilst Asian strains have been identified in western Alaska. Central North American (N2) strain and European-type strains of E. multilocularis are present in Canada. Typing of the strain in Sweden is still pending. Individual human cases of AE with N2 and European-type strains are reported in North America, as well as multiple cases with Asian strains in Russia and historically on St Lawrence Island, Alaska (although genotyping of human cases was not available at the time). Echinococcus spp. have not been detected in Greenland and have been eliminated from Iceland.The predominance of E. multilocularis N1 strain and E. canadensis genotypes, in regions with high prevalence in definitive hosts yet low incidence of human AE and CE, suggests that these genotypes have lower zoonotic potential and pathogenicity than European and Asian strains of E. multilocularis and livestock genotypes of E granulosus sensu stricto. The continued monitoring of the emergence of Echinococcus genotypes within definitive and intermediate hosts, as well as people, is needed to assess the impact on public health risk, since the introduction of other genotypes could have serious repercussions. Lastly, determining risk factors and source attribution for human cases, including the possibility of food and waterborne transmission and the likelihood of autochthonous transmission, remain challenges. Keywords: Alveolar echinococcosis, Arctic, Circumpolar, Cystic echinococcosis, Genotypes
- Published
- 2016
26. Who Let the Dogs Out? Communicating First Nations Perspectives on a Canine Veterinary Intervention Through Digital Storytelling
- Author
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Janna M. Schurer, Heather Beatch, Emily J. Jenkins, Crystal Okemow, Christina McKenzie, and Arcadio Viveros-Guzmán
- Subjects
Adult ,Male ,Rural Population ,Canada ,Veterinary medicine ,medicine.medical_specialty ,Adolescent ,Health, Toxicology and Mutagenesis ,Health Promotion ,Indigenous ,Young Adult ,Dogs ,Animal welfare ,Health care ,Disease Transmission, Infectious ,medicine ,Animals ,Health Services, Indigenous ,Humans ,Bites and Stings ,Dog Diseases ,Aged ,Narration ,Ecology ,business.industry ,Rural health ,Public health ,Middle Aged ,Health promotion ,Animal ecology ,Indians, North American ,Public Health Practice ,Female ,business ,Knowledge transfer - Abstract
Dog-related human injuries affect public safety and animal welfare, and occur more frequently in rural, remote, and Indigenous communities than in urban centres in Canada. Little work has been done to identify the perspectives of those people most heavily affected by this issue or to report successful dog management programs. This project was undertaken by veterinarians and public health workers with the goal of documenting First Nations perspectives on dogs, and educating other rural health workers about introducing animal management services to Indigenous communities. We recruited 10-14 residents and healthcare workers from three First Nations to take dog-related photos in their communities and participate in group interviews during the summer of 2014. Audiovisual data were synthesised into four digital stories exploring the following aspects of participant relationships with community dogs: (1) Spay/neuter clinics; (2) Role of the dog (past and present); (3) Human-animal bond; and (4) Healthy dogs as a part of healthy communities. These videos document changes in dog husbandry behaviour, new acceptance of spay/neuter, three-way knowledge transfer between residents, researchers, and policy makers, and an overall desire to sustain the positive outcomes of the pilot dog management project. This work highlights cultural beliefs and success strategies that might guide other programs providing veterinary services in First Nations communities.
- Published
- 2015
27. Echinococcus canadensis, E. borealis, and E. intermedius. What's in a name?
- Author
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Emily J. Jenkins, Alan J. Lymbery, R.C. Andrew Thompson, and Janna M. Schurer
- Subjects
Infectious Diseases ,Taxon ,Echinococcus ,Echinococcus intermedius ,biology ,Single species ,Phylogenetic tree ,Echinococcus canadensis ,Zoology ,Parasitology ,Taxonomy (biology) ,Echinococcus granulosus ,biology.organism_classification - Abstract
The phylogenetic relationships of the G6, G7, G8, and G10 genotypes of Echinococcus granulosus are well defined, but their taxonomic status is currently unresolved. We apply an evolutionary species concept to infer that the G6 and G7 genotypes represent a single species that is different to both the G8 and G10 genotypes, and that the G8 and G10 genotypes are also on different evolutionary trajectories and, therefore, should be regarded as separate species. The names Echinococcus intermedius, Echinococcus canadensis, and Echinococcus borealis have been previously proposed for these three taxa (G6/7, G10 and G8, respectively) and we argue that it may be appropriate to resurrect these names. The correct delimitation and formal recognition of species of Echinococcus may have important veterinary and public health consequences.
- Published
- 2015
28. Global Distribution of Alveolar and Cystic Echinococcosis
- Author
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Peter Deplazes, Japhet Magambo, Giuseppe Cringoli, Majid Fasihi Harandi, S Lahmar, Emily J. Jenkins, Daniela Antolová, Thomas Romig, R.C.A. Thompson, Paul R. Torgerson, Laura Rinaldi, Janna M. Schurer, C. A. Alvarez Rojas, Deplazes, P, Rinaldi, Laura, Alvarez Rojas, C. A, Torgerson, P. R, Harandi, M. F, Romig, T, Antolova, D, Schurer, J. M, Lahmar, S, Cringoli, Giuseppe, Magambo, J, Thompson, R. C. A, Jenkins, E. J., University of Zurich, and Thompson, R C A
- Subjects
10078 Institute of Parasitology ,0301 basic medicine ,Echinococcosis, Hepatic ,Veterinary medicine ,E. canadensi ,E. intermediu ,030231 tropical medicine ,2405 Parasitology ,610 Medicine & health ,Global Health ,Echinococcus multilocularis ,03 medical and health sciences ,0302 clinical medicine ,600 Technology ,parasitic diseases ,Case fatality rate ,Prevalence ,Transmission ,Zoonose ,Helminths ,E. ortleppi ,10599 Chair in Veterinary Epidemiology ,Echinococcus granulosus ,Molecular Epidemiology ,Genetic diversity ,biology ,Molecular epidemiology ,Animal ,Transmission (medicine) ,Incidence ,Echinococcu ,030108 mycology & parasitology ,Echinococcus multiloculari ,biology.organism_classification ,Echinococcus granulosu ,Echinococcus ,Map ,570 Life sciences ,Echinococcosi ,Host assemblage ,E. equinu ,Human - Abstract
Alveolar echinococcosis (AE) and cystic echinococcosis (CE) are severe helminthic zoonoses. Echinococcus multilocularis (causative agent of AE) is widely distributed in the northern hemisphere where it is typically maintained in a wild animal cycle including canids as definitive hosts and rodents as intermediate hosts. The species Echinococcus granulosus, Echinococcus ortleppi, Echinococcus canadensis and Echinococcus intermedius are the causative agents of CE with a worldwide distribution and a highly variable human disease burden in the different endemic areas depending upon human behavioural risk factors, the diversity and ecology of animal host assemblages and the genetic diversity within Echinococcus species which differ in their zoonotic potential and pathogenicity. Both AE and CE are regarded as neglected zoonoses, with a higher overall burden of disease for CE due to its global distribution and high regional prevalence, but a higher pathogenicity and case fatality rate for AE, especially in Asia. Over the past two decades, numerous studies have addressed the epidemiology and distribution of these Echinococcus species worldwide, resulting in better-defined boundaries of the endemic areas. This chapter presents the global distribution of Echinococcus species and human AE and CE in maps and summarizes the global data on host assemblages, transmission, prevalence in animal definitive hosts, incidence in people and molecular epidemiology.
- Published
- 2017
29. Unexpected diversity of the cestode Echinococcus multilocularis in wildlife in Canada
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Ray T. Alisauskas, Stefano Liccioli, Emily J. Jenkins, Janna M. Schurer, Alessandro Massolo, Brett T. Elkin, and Karen M. Gesy
- Subjects
biology ,Vulpes ,Ecology ,NADH dehydrogenase subunit 1 ,Wildlife ,nad1 ,Echinococcus multilocularis ,biology.organism_classification ,medicine.disease ,Article ,Infectious Diseases ,Canis ,Haplotypes ,biology.animal ,parasitic diseases ,nd1 ,Alveolar hydatid disease ,medicine ,Lagopus ,Biological dispersal ,Animal Science and Zoology ,Parasitology ,Arctic fox ,Mitochondrial gene - Abstract
Highlights • First large-scale survey of Echinococcus multilocularis of western and Arctic Canada. • Identified 17 polymorphisms in the NADH dehydrogenase subunit 1 (nad1) mitochondrial gene of Echinococcus multilocularis. • Analysis of a single mitochondrial gene across adult cestodes, larvae and eggs of Canadian Echinococcus multilocularis., Echinococcus multilocularis is a zoonotic cestode with a distribution encompassing the northern hemisphere that causes alveolar hydatid disease in people and other aberrant hosts. E.multilocularis is not genetically uniform across its distribution, which may have implications for zoonotic transmission and pathogenicity. Recent findings of a European-type haplotype of E. multilocularis in wildlife in one location in western Canada motivated a broader survey of the diversity of this parasite in wildlife from northern and western Canada. We obtained intact adult cestodes of E. multilocularis from the intestines of 41 wild canids (wolf – Canis lupus, coyote – Canis latrans, and red fox – Vulpes vulpes), taeniid eggs from 28 fecal samples from Arctic fox (Vulpes lagopus), and alveolar hydatid cysts from 39 potential rodent intermediate hosts. Upon sequencing a 370-nucelotide region of the NADH dehydrogenase subunit 1 (nad1) mitochondrial locus, 17 new haplotypes were identified. This constitutes a much higher diversity than expected, as only two genotypes (European and an Asian/North American) had previously been identified using this locus. The European-type strain, recently introduced, may be widespread in wildlife within western Canada, possibly related to the large home ranges and wide dispersal range of wild canids. This study increased understanding of the biogeographic distribution, prevalence and genetic differences of a globally important pathogenic cestode in northern and western Canada.
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- 2014
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30. Echinococcus in wild canids in Québec (Canada) and Maine (USA)
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Emily J. Jenkins, Anne Lichtenwalner, Janna M. Schurer, Sarah Revell, Ann Bryant, Grace Chavis, and Émilie Bouchard
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0301 basic medicine ,Range (biology) ,Flatworms ,Foxes ,Geographical locations ,Database and Informatics Methods ,Genotype ,Parasite hosting ,Mammals ,Animal health ,lcsh:Public aspects of medicine ,Quebec ,Eukaryota ,030108 mycology & parasitology ,3. Good health ,Infectious Diseases ,Vertebrates ,Sequence Analysis ,Research Article ,Canada ,Mitochondrial DNA ,lcsh:Arctic medicine. Tropical medicine ,lcsh:RC955-962 ,Bioinformatics ,Wildlife ,Sequence Databases ,Zoology ,Biology ,Research and Analysis Methods ,Coyotes ,03 medical and health sciences ,Echinococcosis ,Helminths ,Animals ,Maine ,Canidae ,Wolves ,Cestodes ,Organisms ,Public Health, Environmental and Occupational Health ,Biology and Life Sciences ,lcsh:RA1-1270 ,biology.organism_classification ,Invertebrates ,United States ,Echinococcus ,Duplex pcr ,Biological Databases ,Amniotes ,North America ,People and places - Abstract
Zoonotic Echinococcus spp. cestodes (E. canadensis and E. multilocularis) infect domestic animals, wildlife, and people in regions of Canada and the USA. We recovered and quantified Echinococcus spp. cestodes from 22 of 307 intestinal tracts of wild canids (23 wolves, 100 coyotes, 184 red and arctic foxes) in the state of Maine and the province of Québec. We identified the species and genotypes of three Echinococcus spp. cestodes per infected animal by sequencing mitochondrial DNA at two loci. We further confirmed the absence of E. multilocularis by extracting DNA from pools of all cestodes from each animal and running a duplex PCR capable of distinguishing the two species. We detected E. canadensis (G8 and G10), but not E. multilocularis, which is emerging as an important human and animal health concern in adjacent regions. Prevalence and median intensity of E. canadensis was higher in wolves (35%, 460) than coyotes (14%, 358). This parasite has historically been absent in Atlantic regions of North America, where suitable intermediate hosts, but not wolves, are present. Our study suggests that coyotes are serving as sylvatic definitive hosts for E. canadensis in Atlantic regions, and this may facilitate eastward range expansion of E. canadensis in the USA and Canada. As well, compared to wolves, coyotes are more likely to contaminate urban green spaces and peri-urban environments with zoonotic parasites., Author summary Echinococcosis is a zoonosis caused by ingestion of tapeworm eggs in feces of wild or domestic canids (e.g. foxes, wolves, coyotes, and dogs). In North America, the number of new human echinococcosis cases reported annually is low; however, recent reports of these parasites in unusual presentations, in new locations, and in wildlife near urban areas have caused renewed interest by veterinary and human health professionals. In a cross-border collaboration, we examined the intestines of wolves (Canis lupus), coyotes (C. latrans) and foxes (Vulpes vulpes, V. lagopus) trapped in Québec (Canada) and neighboring Maine (USA), using genetic tools to identify Echinococcus tapeworms. We did not detect E. multilocularis, a serious threat to human health that has recently emerged in southern Ontario. We did identify E. canadensis in wolves and coyotes, in both Quebec and Maine. The presence of this parasite in coyotes is especially concerning because coyotes are more likely to come into close proximity with human communities. This information is relevant to veterinarians who should promote regular fecal examination and/or deworming of high risk dogs (dogs that scavenge or hunt cervids, such as moose), to physicians who might encounter this relatively rare disease, and to public health agencies who should promote surveillance and develop precautions for high risk people.
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- 2018
31. Turning poop into profit: Cost-effectiveness and soil transmitted helminth infection risk associated with human excreta reuse in Vietnam
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Rachel J. Lowe, Ngan Tran-Thi, Lauren E. MacDonald, Janna M. Schurer, Phuc Pham-Duc, and Tu Vu-Van
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Ancylostomatoidea ,Ascaris Lumbricoides ,Nematoda ,Trichuris ,Cost effectiveness ,Cost-Benefit Analysis ,010501 environmental sciences ,01 natural sciences ,Toxicology ,Feces ,Soil ,Mathematical and Statistical Techniques ,0302 clinical medicine ,Nutrient ,Medicine and Health Sciences ,Ascariasis ,Compost ,lcsh:Public aspects of medicine ,Ascaris ,Eukaryota ,Agriculture ,Plants ,Body Fluids ,Professions ,Infectious Diseases ,Vietnam ,Experimental Organism Systems ,Helminth Infections ,Physical Sciences ,Agricultural Workers ,Ascaris lumbricoides ,Agrochemicals ,Statistics (Mathematics) ,Research Article ,Neglected Tropical Diseases ,lcsh:Arctic medicine. Tropical medicine ,lcsh:RC955-962 ,030231 tropical medicine ,Biology ,engineering.material ,Research and Analysis Methods ,Hookworm Infections ,03 medical and health sciences ,Plant and Algal Models ,Helminths ,Parasitic Diseases ,Animals ,Humans ,Trichuriasis ,Grasses ,Statistical Methods ,Fertilizers ,0105 earth and related environmental sciences ,Organisms ,Public Health, Environmental and Occupational Health ,Biology and Life Sciences ,lcsh:RA1-1270 ,Tropical Diseases ,biology.organism_classification ,Invertebrates ,Soil-Transmitted Helminthiases ,Agronomy ,People and Places ,Linear Models ,engineering ,Paddy field ,Trichuris trichiura ,Population Groupings ,Rice ,Mathematics ,Meta-Analysis - Abstract
Human excreta is a low cost source of nutrients vital to plant growth, but also a source of pathogens transmissible to people and animals. We investigated the cost-savings and infection risk of soil transmitted helminths (STHs) in four scenarios where farmers used either inorganic fertilizer or fresh/composted human excreta supplemented by inorganic fertilizer to meet the nutrient requirements of rice paddies in the Red River Delta, Vietnam. Our study included two main components: 1) a risk estimate of STH infection for farmers who handle fresh excreta, determined by systematic review and meta-analysis; and 2) a cost estimate of fertilizing rice paddies, determined by nutrient assessment of excreta, a retailer survey of inorganic fertilizer costs, and a literature review to identify region-specific inputs. Our findings suggest that farmers who reuse fresh excreta are 1.24 (95% CI: 1.13–1.37, p-value, Author summary Each year, hundreds of millions of people worldwide are infected with intestinal worms spread by contaminated soil, also known as soil transmitted helminths (STHs). These worms are most common in tropical climates in areas lacking good hygiene and sanitation, and negatively impact child development, quality of life, and economic wellbeing. Reuse of human excreta for fertilizer is a common practice in many low to middle income countries because farmers require a low cost source of nutrients to grow food crops eaten by people and animals. Excreta can contain microbes, such as STHs, that cause disease in people; however, composting is a known method of killing STHs. Therefore, our goal was to determine if Vietnamese rice farmers involved in this practice are at higher risk of STH infection, and to calculate the amount of money saved by farmers composting for different lengths of time, and supplementing with various commercial fertilizers. We suggest that farmers compost excreta for six months to reduce disease exposure and optimize household savings. Optimizing practices to improve food production and protect farmer health is critical for poverty alleviation in low to middle income countries.
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- 2017
32. Toxoplasmosis and Toxocariasis: An Assessment of Human Immunodeficiency Virus Comorbidity and Health-Care Costs in Canada
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Wu Zeng, Michael Schwandt, Janna M. Schurer, Emily J. Jenkins, Marwa Farag, and Ellen Rafferty
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Adult ,Male ,Canada ,Adolescent ,Databases, Factual ,030231 tropical medicine ,HIV Infections ,Comorbidity ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Risk Factors ,Virology ,Environmental health ,Zoonoses ,Health care ,medicine ,Animals ,Humans ,030212 general & internal medicine ,Child ,Aged ,Toxocariasis ,biology ,business.industry ,Coinfection ,Incidence (epidemiology) ,Incidence ,Toxoplasma gondii ,Infant ,Health Care Costs ,Articles ,Middle Aged ,biology.organism_classification ,medicine.disease ,Toxoplasmosis ,Infectious Diseases ,One Health ,Socioeconomic Factors ,Child, Preschool ,Immunology ,Costs and Cost Analysis ,Parasitology ,Female ,business - Abstract
Toxoplasma gondii and Toxocara spp. are zoonotic parasites with potentially severe long-term consequences for those infected. We estimated incidence and investigated distribution, risk factors, and costs associated with these parasites by examining hospital discharge abstracts submitted to the Canadian Institute for Health Information (2002-2011). Annual incidence of serious toxoplasmosis and toxocariasis was 0.257 (95% confidence interval [CI]: 0.254-0.260) and 0.010 (95% CI: 0.007-0.014) cases per 100,000 persons, respectively. Median annual health-care costs per serious case of congenital, adult-acquired, and human immunodeficiency virus (HIV)-associated toxoplasmosis were $1,971, $763, and $5,744, respectively, with an overall cost of C$1,686,860 annually (2015 Canadian dollars). However, the total economic burden of toxoplasmosis is likely much higher than these direct health-care cost estimates. HIV was reported as a comorbidity in 40% of toxoplasmosis cases and accounted for over half of direct health-care costs associated with clinical toxoplasmosis. A One Health approach, integrating physician and veterinary input, is recommended for increasing public awareness and decreasing the economic burden of these preventable zoonoses.
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- 2015
33. Response to Nakao et al. - is Echinococcus intermedius a valid species?
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Emily J. Jenkins, Janna M. Schurer, Alan J. Lymbery, and R.C. Andrew Thompson
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Ecology ,Zoology ,Genetic Variation ,Biology ,biology.organism_classification ,Classification ,Echinococcus ,Infectious Diseases ,Echinococcus intermedius ,Terminology as Topic ,Animals ,Parasitology ,Echinococcus granulosus ,Nomenclature - Abstract
The aim of our Opinion article [1] was to stimulate discussion on the taxonomic status of the G6, G7, G8, and G10 genotypes of Echinococcus granulosus, and we therefore welcome the letter from Nakao et al. (2015) [2]. They make two main points, one concerning the separation of the G8 and G10 (cervid) genotypes, and one concerning the nomenclature of the G6/G7 (camel and pig) genotypes. With both these points there are aspects which we can agree upon, but others about which we must disagree. However, the areas of disagreement can be settled empirically with further data, and we hope that such data will be forthcoming soon.
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- 2015
34. Echinococcosis: An Economic Evaluation of a Veterinary Public Health Intervention in Rural Canada
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Emily J. Jenkins, Janna M. Schurer, Wu Zeng, Ellen Rafferty, and Marwa Farag
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Adult ,Male ,Canada ,Veterinary medicine ,medicine.medical_specialty ,lcsh:Arctic medicine. Tropical medicine ,Adolescent ,lcsh:RC955-962 ,Cost-Benefit Analysis ,Rural Health ,Young Adult ,Dogs ,Echinococcosis ,Epidemiology ,medicine ,Animals ,Humans ,Dog Diseases ,Child ,Aged ,2. Zero hunger ,biology ,business.industry ,Incidence ,Rural health ,Incidence (epidemiology) ,lcsh:Public aspects of medicine ,Public Health, Environmental and Occupational Health ,Infant ,lcsh:RA1-1270 ,Middle Aged ,biology.organism_classification ,medicine.disease ,Echinococcus ,3. Good health ,Quality-adjusted life year ,Infectious Diseases ,Child, Preschool ,Veterinary public health ,Female ,Rural area ,business ,Research Article ,Demography - Abstract
Echinococcosis is a rare but endemic condition in people in Canada, caused by a zoonotic cestode for which the source of human infection is ingestion of parasite eggs shed by canids. The objectives of this study were to identify risk factors associated with infection and to measure the cost-utility of introducing an echinococcosis prevention program in a rural area. We analyzed human case reports submitted to the Canadian Institutes for Health Information between 2002 and 2011. Over this 10 year period, there were 48 cases associated with E. granulosus/E. canadensis, 16 with E. multilocularis, and 251 cases of echinococcosis for which species was not identified (total 315 cases). Nationally, annual incidence of echinococcosis was 0.14 cases per 100 000 people, which is likely an underestimate due to under-diagnosis and under-reporting. Risk factors for echinococcosis included female gender, age (>65 years), and residing in one of the northern territories (Nunavut, Yukon, or Northwest Territories). The average cost of treating a case of cystic echinococcosis in Canada was $8,842 CAD. Cost-utility analysis revealed that dosing dogs with praziquantel (a cestocide) at six week intervals to control cystic echinococcosis is not currently cost-effective at a threshold of $20,000-100,000 per Quality Adjusted Life Year (QALY) gained, even in a health region with the highest incidence rate in Canada ($666,978 -755,051 per QALY gained). However, threshold analysis demonstrated that the program may become cost-saving at an echinococcosis incidence of 13-85 cases per 100,000 people and therefore, even one additional CE case in a community of 9000 people could result in the monetary benefits of the program outweighing costs., Author Summary In Canada, Echinococcus spp. tapeworms cycle primarily among wildlife hosts. People are infected with this parasite when they accidentally consume microscopic eggs spread by canids (e.g. dogs, wolves, coyotes, and foxes), and develop larval cysts, often in the liver or lungs. Echinococcosis can be a life-threatening medical condition with long-term health consequences and can be an economic burden for infected individuals and for the public health system. We analysed national health records to measure echinococcosis incidence and risk factors in Canada, and then used this information to determine if a program that facilitated dog deworming to prevent human infection might be economically feasible. Our model suggested that treating infected individuals is currently less expensive than preventing infection, even in the highest risk regions of Canada. However, deworming dogs might be feasible in small rural communities where at least one case was identified. Furthermore, the prevention program has many add-on benefits that contribute to overall community health, but are not measured by our model.
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- 2015
35. Pediatric cryptosporidiosis: An evaluation of health care and societal costs in Peru, Bangladesh and Kenya
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Eugenio L. de Hostos, Robert K. M. Choy, Ellen Rafferty, Michael B. Arndt, David A Shoultz, Marwa Farag, and Janna M. Schurer
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Sanitation ,Economics ,lcsh:Medicine ,Cryptosporidiosis ,Social Sciences ,Pathology and Laboratory Medicine ,Geographical Locations ,Indirect costs ,0302 clinical medicine ,Peru ,Health care ,Medicine and Health Sciences ,Medicine ,030212 general & internal medicine ,Economic impact analysis ,lcsh:Science ,Protozoans ,2. Zero hunger ,Bangladesh ,Multidisciplinary ,biology ,Population size ,1. No poverty ,Cryptosporidium ,3. Good health ,Livestock ,Research Article ,Diarrhea ,Asia ,Patients ,030231 tropical medicine ,Gastroenterology and Hepatology ,03 medical and health sciences ,Signs and Symptoms ,Health Economics ,Diagnostic Medicine ,Environmental health ,Parasitic Diseases ,Humans ,Inpatients ,Government ,business.industry ,lcsh:R ,Organisms ,Infant ,Biology and Life Sciences ,South America ,biology.organism_classification ,Kenya ,Parasitic Protozoans ,Health Care ,People and Places ,Africa ,lcsh:Q ,business - Abstract
Cryptosporidium is a leading cause of pediatric diarrhea in resource-limited settings; yet, few studies report the health care costs or societal impacts of this protozoan parasite. Our study examined direct and indirect costs associated with symptomatic cryptosporidiosis in infants younger than 12 months in Kenya, Peru and Bangladesh. Inputs to the economic burden model, such as disease incidence, population size, health care seeking behaviour, hospital costs, travel costs, were extracted from peer-reviewed literature, government documents, and internationally validated statistical tools for each country. Indirect losses (i.e. caregiver income loss, mortality, and growth faltering) were also estimated. Our findings suggest that direct treatment costs per symptomatic cryptosporidiosis episode were highest in Kenya ($59.01), followed by Peru ($23.32), and Bangladesh ($7.62). The total annual economic impacts for the 0-11 month cohorts were highest in Peru ($41.5M; range $0.88-$599.3M), followed by Kenya ($37.4M; range $1.6-$804.5M) and Bangladesh ($9.6M, range $0.28-$91.5M). For all scenarios, indirect societal costs far outweighed direct treatment costs. These results highlight the critical need for innovative improvements to current prevention, diagnostic and treatment strategies available in resource poor settings, as well as the need for solutions that span multiple disciplines including food and water safety, sanitation and livestock production.
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- 2017
36. Parasitic Zoonoses: One Health Surveillance in Northern Saskatchewan
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Emily J. Jenkins, Momar Ndao, Stuart Skinner, Stacey A. Elmore, James Irvine, Tasha Epp, and Janna M. Schurer
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Male ,Veterinary medicine ,Epidemiology ,Trichinella ,0302 clinical medicine ,Seroepidemiologic Studies ,Zoonoses ,Dog Diseases ,030212 general & internal medicine ,Child ,Echinococcus granulosus ,Diphyllobothrium ,Aged, 80 and over ,biology ,lcsh:Public aspects of medicine ,Trichinellosis ,Cryptosporidium ,Middle Aged ,Saskatchewan ,3. Good health ,Infectious Diseases ,Canis ,Veterinary Diseases ,Child, Preschool ,Medicine ,Female ,Public Health ,Behavioral and Social Aspects of Health ,Toxoplasmosis ,Research Article ,Adult ,lcsh:Arctic medicine. Tropical medicine ,Adolescent ,lcsh:RC955-962 ,030231 tropical medicine ,Infectious Disease Epidemiology ,Veterinary Epidemiology ,Young Adult ,03 medical and health sciences ,Dogs ,Echinococcosis ,parasitic diseases ,Parasitic Diseases ,Animals ,Humans ,Parasites ,Aged ,Toxocariasis ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,15. Life on land ,Veterinary Parasitology ,biology.organism_classification ,Echinococcus ,Veterinary Science ,GIARDIA SPP ,Toxocara canis - Abstract
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.
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- 2013
37. Bearing the burden: Podoconiosis and mental health-A three-way comparative cross-sectional study in Rwanda.
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Natnael Shimelash, Theogene Uwizeyimana, Leila Dusabe, Jeanne Uwizeyimana, Tonya Huston, and Janna M Schurer
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Arctic medicine. Tropical medicine ,RC955-962 ,Public aspects of medicine ,RA1-1270 - Abstract
Podoconiosis is a non-infectious, neglected tropical disease caused by chronic barefoot contact with irritant volcanic soils. It typically presents with lower limb swelling, disfigurement, and chronic disability. Patients and their families experience stigma from their communities. Depression, anxiety, and emotional distress contribute to the total illness burden of podoconiosis. This study used a survey-based comparative cross-sectional quantitative study design involving podoconiosis patients, their family members, and unaffected neighbors. The Depression, Anxiety, and Stress Scale (DASS 21), the WHO Quality of Life Scale (WHO-QOL Brief), and the Tekola clinical staging system were used to collect data. We surveyed 741 participants (33.1% patients, 33.3% family, 33.5% neighbors). Podoconiosis patients exhibited significantly elevated odds of severe depression (19.8x), anxiety (10.7x), and stress symptoms (13.5x) in comparison to unaffected neighbors. Family members of podoconiosis patients displayed 1.5x higher odds of experiencing severe anxiety symptoms compared to unaffected neighbors. Higher clinical stages of podoconiosis were associated with increased severity of depressive symptoms. Podoconiosis patients demonstrated lower median scores across all domains of the WHO QoL Brief in contrast to family members and unaffected neighbors. The burden of depression, anxiety, and stress on podoconiosis patients and their family members is high. Podoconiosis morbidity management programs need to encompass families of patients and integrate continuous mental health support within the broader framework of podoconiosis management.
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- 2024
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38. 'We all think boots are meant for men': A community-based participatory assessment of rural women's barriers to preventing podoconiosis in Rwanda.
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Gloria Igihozo, Leila Dusabe, Jeanne Uwizeyimana, Esperance Nyiransabimana, Tonya Huston, and Janna M Schurer
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Public aspects of medicine ,RA1-1270 - Abstract
Podoconiosis is a debilitating neglected tropical disease (NTD) that is possibly caused by prolonged exposure to irritant alkaline clay soil. It is endemic to East Africa and disproportionately affects rural female farmers. The condition can be prevented through foot hygiene and regular wearing of protective shoes. In Rwanda, there is limited information on the factors impacting rural female farmers' access to and utilization of boots while farming. Therefore, this community-based participatory study was conducted to explore the cultural, economic, and ergonomic factors affecting rural farmers' use of protective footwear. Sixteen audio-recorded focus group discussions were conducted with female and male farmers in four villages with the highest podoconiosis prevalence across four provinces of Rwanda. Transcripts were coded inductively using Dedoose (version 9.0.86) and analyzed through thematic content analysis. Participants expressed that wearing shoes protects against diseases and injuries but ability to afford a pair of protective footwear was a major barrier to accessing and wearing them. There were differences in women and men's shoe-wearing behaviors while farming, largely driven by the fact that women who wear boots face rumors and backlash. Findings highlight barriers hindering effective podoconiosis prevention among rural female farmers in Rwanda. Opportunities exist to strengthen podoconiosis and NTD prevention programs, through the integration of gender into existing community-based interventions and the inclusion of local communities into the co-designing of contextualized interventions.
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- 2024
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39. Stakeholder perspectives from 15 countries in Africa on barriers in snakebite envenoming research and the potential role of research hubs.
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Ymkje Stienstra, Leslie Mawuli Aglanu, Janna M Schurer, Rhona Mijumbi, Jean Bosco Mbonigaba, Abdulrazaq G Habib, Brent Thomas, Jonathan Steinhorst, Rachael Thomson, Sara Padidar, John H Amuasi, George O Oluoch, and David G Lalloo
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Arctic medicine. Tropical medicine ,RC955-962 ,Public aspects of medicine ,RA1-1270 - Abstract
Snakebite envenoming is a debilitating neglected tropical disease disproportionately affecting the rural poor in low and middle-income countries in the tropics and sub-tropics. Critical questions and gaps in public health and policy need to be addressed if major progress is to be made towards reducing the negative impact of snakebite, particularly in the World Health Organisation (WHO) Africa region. We engaged key stakeholders to identify barriers to evidence-based snakebite decision making and to explore how development of research and policy hubs could help to overcome these barriers. We conducted an electronic survey among 73 stakeholders from ministries of health, health facilities, academia and non-governmental organizations from 15 countries in the WHO Africa region. The primary barriers to snakebite research and subsequent policy translation were limited funds, lack of relevant data, and lack of interest from policy makers. Adequate funding commitment, strong political will, building expert networks and a demand for scientific evidence were all considered potential factors that could facilitate snakebite research. Participants rated availability of antivenoms, research skills training and disease surveillance as key research priorities. All participants indicated interest in the development of research and policy hubs and 78% indicated their organization would be willing to actively participate. In conclusion, our survey affirms that relevant stakeholders in the field of snakebite perceive research and policy hubs as a promising development, which could help overcome the barriers to pursuing the WHO goals and targets for reducing the burden of snakebite.
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- 2023
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40. 'I sold my towel and shoes to pay the traditional healer': Care-seeking costs and productivity losses among snakebite victims in Eastern Province, Rwanda.
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Janna M Schurer, Mahlet Tadesse Admasu, Mihigo Bonaventure, Dieudonne Hakizimana, Elijah Murara, Lauren E MacDonald, and Ellen Rafferty
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Arctic medicine. Tropical medicine ,RC955-962 ,Public aspects of medicine ,RA1-1270 - Abstract
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.
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- 2023
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41. Rift Valley fever knowledge, mitigation strategies and communication preferences among male and female livestock farmers in Eastern Province, Rwanda.
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Lindsay J Smith, Janna M Schurer, Eurade Ntakiyisumba, Anselme Shyaka, and Janetrix Hellen Amuguni
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Arctic medicine. Tropical medicine ,RC955-962 ,Public aspects of medicine ,RA1-1270 - Abstract
The Government of Rwanda reported an outbreak of Rift Valley fever (RVF) in the Eastern Province in 2018. To respond to the outbreak, vaccination and education campaigns about the disease were carried out. Because RVF cases continue to be detected in Rwanda and the disease impacts livelihoods and health, accurate knowledge and communication are imperative. The objectives of this study were to evaluate knowledge and risk perceptions of RVF transmission among livestock farmers in Nyagatare District, Eastern Province, Rwanda, and to compare RVF knowledge, risk perceptions, and farming practices between male and female livestock farmers. This cross-sectional, quantitative study was conducted in selected sectors of Nyagatare District in the Eastern Province of Rwanda in June 2019. A 34-question survey was used to ask about demographics, livestock ownership, risk perceptions about zoonotic diseases and livestock management, RVF knowledge, preferred communication sources and information sharing strategies, and protective strategies for RVF mitigation while working with livestock. Livestock farmers were interviewed at three milk collection centers, two village meeting points, a farm cooperative meeting, and during door-to-door visits in villages. In total, 123 livestock farmers were interviewed. The survey found that most livestock farmers lacked knowledge about epizootic and zoonotic transmission of RVF, more male livestock farmers were familiar with RVF and risk mitigation strategies, and female livestock farmers are not viewed as reliable sources of information. Additionally, most livestock farmers had not vaccinated their animals against RVF despite past vaccination campaigns. Radio was the most popular communication channel. These findings show that RVF knowledge and information sharing are inadequate among livestock farmers in Eastern Province. Therefore, vaccination and education campaigns may need to be reevaluated within the context of these trends in order to prepare for future RVF outbreaks.
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- 2021
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42. Equity for health delivery: Opportunity costs and benefits among Community Health Workers in Rwanda.
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Janna M Schurer, Kelly Fowler, Ellen Rafferty, Ornella Masimbi, Jean Muhire, Olivia Rozanski, and Hellen J Amuguni
- Subjects
Medicine ,Science - Abstract
Community Health Workers (CHWs) play a vital role delivering health services to vulnerable populations in low resource settings. In Rwanda, CHWs provide village-level care focused on maternal/child health, control of infectious diseases, and health education, but do not receive salaries for these services. CHWs make up the largest single group involved in health delivery in the country; however, limited information is available regarding the socio-economic circumstances and satisfaction levels of this workforce. Such information can support governments aiming to control infectious diseases and alleviate poverty through enhanced healthcare delivery. The objectives of this study were to (1) evaluate CHW opportunity costs, (2) identify drivers for CHW motivation, job satisfaction and care provision, and (3) report CHW ideas for improving retention and service delivery. In this mixed-methods study, our team conducted in-depth interviews with 145 CHWs from three districts (Kirehe, Kayonza, Burera) to collect information on household economics and experiences in delivering healthcare. Across the three districts, CHWs contributed approximately four hours of volunteer work per day (range: 0-12 hrs/day), which translated to 127 684 RWF per year (range: 2 359-2 247 807 RWF/yr) in lost personal income. CHW out-of-pocket expenditures (e.g. patient transportation) were estimated at 36 228 RWF per year (range: 3 600-364 800 RWF/yr). Participants identified many benefits to being CHWs, including free healthcare training, improved social status, and the satisfaction of helping others. They also identified challenges, such as aging equipment, discrepancies in financial reimbursements, poverty, and lack of formal workspaces or working hours. Lastly, CHWs provided perspectives on reasonable and feasible improvements to village-level health programming that could improve conditions and equity for those providing and using the CHW system.
- Published
- 2020
- Full Text
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43. Echinococcus in wild canids in Québec (Canada) and Maine (USA).
- Author
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Janna M Schurer, Emilie Bouchard, Ann Bryant, Sarah Revell, Grace Chavis, Anne Lichtenwalner, and Emily J Jenkins
- Subjects
Arctic medicine. Tropical medicine ,RC955-962 ,Public aspects of medicine ,RA1-1270 - Abstract
Zoonotic Echinococcus spp. cestodes (E. canadensis and E. multilocularis) infect domestic animals, wildlife, and people in regions of Canada and the USA. We recovered and quantified Echinococcus spp. cestodes from 22 of 307 intestinal tracts of wild canids (23 wolves, 100 coyotes, 184 red and arctic foxes) in the state of Maine and the province of Québec. We identified the species and genotypes of three Echinococcus spp. cestodes per infected animal by sequencing mitochondrial DNA at two loci. We further confirmed the absence of E. multilocularis by extracting DNA from pools of all cestodes from each animal and running a duplex PCR capable of distinguishing the two species. We detected E. canadensis (G8 and G10), but not E. multilocularis, which is emerging as an important human and animal health concern in adjacent regions. Prevalence and median intensity of E. canadensis was higher in wolves (35%, 460) than coyotes (14%, 358). This parasite has historically been absent in Atlantic regions of North America, where suitable intermediate hosts, but not wolves, are present. Our study suggests that coyotes are serving as sylvatic definitive hosts for E. canadensis in Atlantic regions, and this may facilitate eastward range expansion of E. canadensis in the USA and Canada. As well, compared to wolves, coyotes are more likely to contaminate urban green spaces and peri-urban environments with zoonotic parasites.
- Published
- 2018
- Full Text
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44. Turning poop into profit: Cost-effectiveness and soil transmitted helminth infection risk associated with human excreta reuse in Vietnam.
- Author
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Ngan Tran-Thi, Rachel J Lowe, Janna M Schurer, Tu Vu-Van, Lauren E MacDonald, and Phuc Pham-Duc
- Subjects
Arctic medicine. Tropical medicine ,RC955-962 ,Public aspects of medicine ,RA1-1270 - Abstract
Human excreta is a low cost source of nutrients vital to plant growth, but also a source of pathogens transmissible to people and animals. We investigated the cost-savings and infection risk of soil transmitted helminths (STHs) in four scenarios where farmers used either inorganic fertilizer or fresh/composted human excreta supplemented by inorganic fertilizer to meet the nutrient requirements of rice paddies in the Red River Delta, Vietnam. Our study included two main components: 1) a risk estimate of STH infection for farmers who handle fresh excreta, determined by systematic review and meta-analysis; and 2) a cost estimate of fertilizing rice paddies, determined by nutrient assessment of excreta, a retailer survey of inorganic fertilizer costs, and a literature review to identify region-specific inputs. Our findings suggest that farmers who reuse fresh excreta are 1.24 (95% CI: 1.13-1.37, p-value
- Published
- 2017
- Full Text
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45. Pediatric cryptosporidiosis: An evaluation of health care and societal costs in Peru, Bangladesh and Kenya.
- Author
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Ellen R Rafferty, Janna M Schurer, Michael B Arndt, Robert K M Choy, Eugenio L de Hostos, David Shoultz, and Marwa Farag
- Subjects
Medicine ,Science - Abstract
Cryptosporidium is a leading cause of pediatric diarrhea in resource-limited settings; yet, few studies report the health care costs or societal impacts of this protozoan parasite. Our study examined direct and indirect costs associated with symptomatic cryptosporidiosis in infants younger than 12 months in Kenya, Peru and Bangladesh. Inputs to the economic burden model, such as disease incidence, population size, health care seeking behaviour, hospital costs, travel costs, were extracted from peer-reviewed literature, government documents, and internationally validated statistical tools for each country. Indirect losses (i.e. caregiver income loss, mortality, and growth faltering) were also estimated. Our findings suggest that direct treatment costs per symptomatic cryptosporidiosis episode were highest in Kenya ($59.01), followed by Peru ($23.32), and Bangladesh ($7.62). The total annual economic impacts for the 0-11 month cohorts were highest in Peru ($41.5M; range $0.88-$599.3M), followed by Kenya ($37.4M; range $1.6-$804.5M) and Bangladesh ($9.6M, range $0.28-$91.5M). For all scenarios, indirect societal costs far outweighed direct treatment costs. These results highlight the critical need for innovative improvements to current prevention, diagnostic and treatment strategies available in resource poor settings, as well as the need for solutions that span multiple disciplines including food and water safety, sanitation and livestock production.
- Published
- 2017
- Full Text
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46. Echinococcosis: An Economic Evaluation of a Veterinary Public Health Intervention in Rural Canada.
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Janna M Schurer, Ellen Rafferty, Marwa Farag, Wu Zeng, and Emily J Jenkins
- Subjects
Arctic medicine. Tropical medicine ,RC955-962 ,Public aspects of medicine ,RA1-1270 - Abstract
Echinococcosis is a rare but endemic condition in people in Canada, caused by a zoonotic cestode for which the source of human infection is ingestion of parasite eggs shed by canids. The objectives of this study were to identify risk factors associated with infection and to measure the cost-utility of introducing an echinococcosis prevention program in a rural area. We analyzed human case reports submitted to the Canadian Institutes for Health Information between 2002 and 2011. Over this 10 year period, there were 48 cases associated with E. granulosus/E. canadensis, 16 with E. multilocularis, and 251 cases of echinococcosis for which species was not identified (total 315 cases). Nationally, annual incidence of echinococcosis was 0.14 cases per 100,000 people, which is likely an underestimate due to under-diagnosis and under-reporting. Risk factors for echinococcosis included female gender, age (>65 years), and residing in one of the northern territories (Nunavut, Yukon, or Northwest Territories). The average cost of treating a case of cystic echinococcosis in Canada was $8,842 CAD. Cost-utility analysis revealed that dosing dogs with praziquantel (a cestocide) at six week intervals to control cystic echinococcosis is not currently cost-effective at a threshold of $20,000-100,000 per Quality Adjusted Life Year (QALY) gained, even in a health region with the highest incidence rate in Canada ($666,978-755,051 per QALY gained). However, threshold analysis demonstrated that the program may become cost-saving at an echinococcosis incidence of 13-85 cases per 100,000 people and therefore, even one additional CE case in a community of 9000 people could result in the monetary benefits of the program outweighing costs.
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- 2015
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47. Parasitic zoonoses: one health surveillance in northern Saskatchewan.
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Janna M Schurer, Momar Ndao, Stuart Skinner, James Irvine, Stacey A Elmore, Tasha Epp, and Emily J Jenkins
- Subjects
Arctic medicine. Tropical medicine ,RC955-962 ,Public aspects of medicine ,RA1-1270 - Abstract
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.
- Published
- 2013
- Full Text
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