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The lack of a WHO-recommended strategy for onchocerciasis treatment with ivermectin in hypo-endemic areas co-endemic with loiasis is an impediment to global onchocerciasis elimination. New loiasis diagnostics (LoaScope; Loa antibody rapid test) and risk prediction tools may enable safe mass treatment decisions in co-endemic areas. In 2017–2018, an integrated mapping strategy for onchocerciasis, lymphatic filariasis (LF), and loiasis, aimed at enabling safe ivermectin treatment decisions, was piloted in Gabon. Three ivermectin-naïve departments suspected to be hypo-endemic were selected and up to 100 adults per village across 30 villages in each of the three departments underwent testing for indicators of onchocerciasis, LF, and loiasis. An additional 67 communities in five adjoining departments were tested for loiasis to extend the prevalence and intensity predictions and possibly expand the boundaries of areas deemed safe for ivermectin treatment. Integrated testing in the three departments revealed within-department heterogeneity for all the three diseases, highlighting the value of a mapping approach that relies on cluster-based sampling rather than sentinel sites. These results suggest that safe mass treatment of onchocerciasis may be possible at the subdepartment level, even in departments where loiasis is present. Beyond valuable epidemiologic data, the study generated insight into the performance of various diagnostics and the feasibility of an integrated mapping approach utilizing new diagnostic and modeling tools. Further research should explore how programs can combine these diagnostic and risk prediction tools into a feasible programmatic strategy to enable safe treatment decisions where loiasis and onchocerciasis are co-endemic.

Mapping is a prerequisite for effective implementation of interventions against neglected tropical diseases (NTDs). Before the accelerated World Health Organization (WHO)/Regional Office for Africa (AFRO) NTD Mapping Project was initiated in 2014, mapping efforts in many countries were frequently carried out in an ad hoc and nonstandardized fashion. In 2013, there were at least 2,200 different districts (of the 4,851 districts in the WHO African region) that still required mapping, and in many of these districts, more than one disease needed to be mapped. During its 3-year duration from January 2014 through the end of 2016, the project carried out mapping surveys for one or more NTDs in at least 2,500 districts in 37 African countries. At the end of 2016, most (90%) of the 4,851 districts had completed the WHO-required mapping surveys for the five targeted Preventive Chemotherapy (PC)-NTDs, and the impact of this accelerated WHO/AFRO NTD Mapping Project proved to be much greater than just the detailed mapping results themselves. Indeed, the AFRO Mapping Project dramatically energized and empowered national NTD programs, attracted donor support for expanding these programs, and developed both a robust NTD mapping database and data portal. By clarifying the prevalence and burden of NTDs, the project provided not only the metrics and technical framework for guiding and tracking program implementation and success but also the research opportunities for developing improved diagnostic and epidemiologic sampling tools for all 5 PC-NTDs—lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminthiasis, and trachoma.

Countries across West Africa began reporting COVID-19 cases in February 2020. By March, the pandemic began disrupting activities to control and eliminate neglected tropical diseases (NTDs) as health ministries ramped up COVID-19–related policies and prevention measures. This was followed by interim guidance from the WHO in April 2020 to temporarily pause mass drug administration (MDA) and community-based surveys for NTDs. While the pandemic was quickly evolving worldwide, in most of West Africa, governments and health ministries took quick action to implement mitigation measures to slow the spread. The U.S. Agency for International Development’s (USAID) Act to End NTDs | West program (Act | West) began liaising with national NTD programs in April 2020 to pave a path toward the eventual resumption of activities. This process consisted of first collecting and analyzing COVID-19 epidemiological data, policies, and standard operating procedures across the program’s 11 countries. The program then developed an NTD activity restart matrix that compiled essential considerations to restart activities. By December 2020, all 11 countries in Act | West safely restarted MDA and certain surveys to monitor NTD prevalence or intervention impact. Preliminary results show satisfactory MDA program coverage, meaning that enough people are taking the medicine to keep countries on track toward achieving their NTD disease control and elimination goals, and community perceptions have remained positive. The purpose of this article is to share the lessons and best practices that have emerged from the adoption of strategies to limit the spread of the novel coronavirus during MDA and other program activities.

Vector-borne diseases have long presented major challenges to the health of rural communities in the wet tropical regions of the world, but especially in sub-Saharan Africa. In this paper we describe the contribution that statistical modelling has made to the global elimination programme for one vector-borne disease, onchocerciasis. We explain why information on the spatial distribution of a second vector-borne disease, Loa loa, is needed before communities at high risk of onchocerciasis can be treated safely with mass distribution of ivermectin, an antifiarial medication. We show how a model-based geostatistical analysis of Loa loa prevalence survey data can be used to map the predictive probability that each location in the region of interest meets a WHO policy guideline for safe mass distribution of ivermectin and describe two applications: one is to data from Cameroon that assesses prevalence using traditional blood-smear microscopy; the other is to Africa-wide data that uses a low-cost questionnaire-based method. We describe how a recent technological development in image-based microscopy has resulted in a change of emphasis from prevalence alone to the bivariate spatial distribution of prevalence and the intensity of infection amongst infected individuals. We discuss how statistical modelling of the kind described here can contribute to health policy guidelines and decisionmaking in two ways. One is to ensure that, in a resource-limited setting, prevalence surveys are designed, and the resulting data analysed, as efficiently as possible. The other is to provide an honest quantification of the uncertainty attached to any binary decision by reporting predictive probabilities that a policy-defined condition for action is or is not met. Vector-borne diseases have long presented major challenges to the health of rural communities in the wet tropical regions of the world, but especially in sub-Saharan Africa. In this paper we describe the contribution that statistical modelling has made to the global elimination programme for one vector-borne disease, onchocerciasis. We explain why information on the spatial distribution of a second vector-borne disease, Loa loa, is needed before communities at high risk of onchocerciasis can be treated safely with mass distribuiton of ivermectin, an antiflarial medication. We show how a model-based geostatistical analysis of Loa loa prevalence survey data can be used to map the predictive probability that each location in the region of interest meets a WHO policy guideline for safe mass distribution of ivermectin and describe two applications: one to data from Cameroon that assesses prevalence using traditional blood-smear microscopy; one to Africa-wide data that uses a low-cost questionnaire-based method. We describe how a recent technological development in image-based microscopy has resulted in a change of emphasis from prevalence alone to the bivariate spatial distribution of prevalence and the intensity of infection amongst infected individuals. We discuss how statistical modelling of the kind described here can contribute to health policy guidelines and decision-making in two ways. One is to ensure that, in a resourcelimited setting, prevalece surveys are designed, and the resulting data analysed, as efficiently as possible. The other is to provide an honest quantification of the uncertainy attached to any binary decision by reporting predictive probabilities that a policy-defined condition for action is or is not met.

Background The goal of the global lymphatic filariasis (LF) program is to eliminate the disease as a public health problem by the year 2020. The WHO mapping protocol that is used to identify endemic areas in need of mass drug administration (MDA) uses convenience-based sampling. This rapid mapping has allowed the global program to dramatically scale up treatment, but as the program approaches its elimination goal, it is important to ensure that all endemic areas have been identified and have received MDA. In low transmission settings, the WHO mapping protocol for LF mapping has several limitations. To correctly identify the LF endemicity of woredas, a new confirmatory mapping tool was developed to test older school children for circulating filarial antigen (CFA) in settings where it is uncertain. Ethiopia is the first country to implement this new tool. In this paper, we present the Ethiopian experience of implementing the new confirmatory mapping tool and discuss the implications of the results for the LF program in Ethiopia and globally. Methods Confirmatory LF mapping was conducted in 1,191 schools in 45 woredas, the implementation unit in Ethiopia, in the regions of Tigray, Amhara, Oromia, SNNP, Afar and Harari, where the results of previous mapping for LF using the current WHO protocol indicated that LF endemicity was uncertain. Within each woreda schools were selected using either cluster or systematic sampling. From selected schools, a total of 18,254 children were tested for circulating filarial antigen (CFA) using the immuno-chromatographic test (ICT). Results Of the 18,254 children in 45 woredas who participated in the survey, 28 (0.16%) in 9 woredas tested CFA positive. According to the confirmatory mapping threshold, which is ≥2% CFA in children 9–14 years of age, only 3 woredas out of the total 45 had more CFA positive results than the threshold and thus were confirmed to be endemic; the remaining 42 woredas were declared non-endemic. These results drastically decreased the estimated total population living in LF-endemic woredas in Ethiopia and in need of MDA by 49.1%, from 11,580,010 to 5,893,309. Conclusion This study demonstrated that the new confirmatory mapping tool for LF can benefit national LF programs by generating information that not only can confirm where LF is endemic, but also can save time and resources by preventing MDA where there is no evidence of ongoing LF transmission., Author summary Lymphatic filariasis (LF) is a mosquito-borne parasitic disease, caused by 3 nematode parasites, Wuchereria bancrofti, Brugia malayi and Brugia timori. The aim of the Global Program to Eliminate LF (GPELF) is to interrupt LF transmission through mass drug administration (MDA) by 2020 and to alleviate the suffering of affected people. Mapping is the first programmatic step to determining areas of LF endemicity and establishing a national program. Ethiopia was believed to be endemic for LF, but until recently the distribution of LF in the country was unknown. From 2008–2013, mapping for LF was conducted using the current WHO protocol, and 112 woredas were identified as endemic or possibly endemic. In 45 of these 112 woredas, only a single CFA positive result was found (

The meaning of ‘mapping’ in relation to onchocerciasis has changed at least three times over the past 50 years as the programmatic goals and the assessment tools have changed. With the current goal being global elimination of Onchocerca volvulus (OV), all areas where OV might currently be transmitted and where mass drug administration (MDA) with ivermectin treatment has not been delivered previously must now be identified by careful, detailed ‘elimination mapping’ as either OV endemic or not, so that appropriate programmatic targets can be established. New tools and strategies for such elimination mapping have become available, though ongoing studies must still be completed to define agreed upon optimal diagnostic evaluation units, sampling strategies and serologic tools. With detailed guidance and technical support from the World Health Organization and with implementation and financial support from their global partners, the OV-endemic countries of Africa can soon complete their elimination mapping and then continue with MDA programmes to progressively achieve the same success in OV elimination as that already achieved by the growing list of formerly OV-endemic countries in the Americas.

Background Studies in Sub Saharan Africa have shown that the Circulating Cathodic Antigen point-of-care-test (POC-CCA) is more accurate in the detections of S. mansoni than the microscopic Kato-Katz technique but less is known about the accuracy of this rapid test in detecting S. haematobium infections. This study was intended to evaluate the field accuracy of POC-CCA as a rapid test kit for schistosomiasis mapping in The Gambia. Methods This prospective study was conducted in 4 regions in the country. Ten schools were randomly selected from each region, and a total of 2018 participants whose ages range from 7 to 14 years were enrolled in the study. Stool and urine samples were collected from each participant from May to June 2015, and tested for S. haematobium and S. mansoni infections in field and laboratory settings. The tests conducted included POC-CCA, double Kato-Katz slides, urine filtration and dipstick for hematuria. Results Of the 1954 participants that had complete data, the mean age of participants was 9.9 years. The prevalence of children infected with S. haematobium, using urine filtration technique was 10.1% (95% CI: 8.87–11.55). Central River Region had the highest level of urinary schistosomiasis with a prevalence of 28.0% (24.13–32.12).The lowest urinary schistosomiasis prevalence of 0.6% (0.12–1.86) was found in Lower River Region and North Bank Region had no cases of schistosomiasis detected. Only 5 participants were infected with S. mansoni. Using urine filtration as reference standard for the detection of S. haematobium, the sensitivity and specificity of POC-CCA was 47.7% and 75.8%. Whilst sensitivity and specificity of POC-CCA for detecting S. mansoni were 60.0% and 71.2% using double Kato-Katz as reference standard. Conclusion This study showed lower sensitivity of POC-CCA in detecting S. haematobium. Therefore POC-CCA is less useful for rapid diagnosis of urinary schistosomiasis.

Circadian disruption has been linked with inflammation, an established cancer risk factor. Per3 clock gene polymorphisms have also been associated with circadian disruption and with increased cancer risk. Patients completed a questionnaire and provided a blood sample prior to undergoing a colonoscopy (n = 70). Adjusted mean serum cytokine concentrations (IL-6, TNF-alpha, gamma-INF, IL-1ra, IL-1-beta, VEGF) were compared among patients with high and low scores for fatigue (Multidimensional Fatigue Inventory), depressive symptoms (Beck Depression Inventory II), or sleep disruption (Pittsburgh Sleep Quality Index), or among patients with different Per3 clock gene variants. Poor sleep was associated with elevated VEGF, and fatigue-related reduced activity was associated with elevated TNF-alpha concentrations. Participants with the 4/5 or 5/5 Per3 variable tandem repeat sequence had elevated IL-6 concentrations compared to those with the 4/4 genotype. Biological processes linking circadian disruption with cancer remain to be elucidated. Increased inflammatory cytokine secretion may play a role.

Background Shiftwork among health care workers impacts upon the safety and health of both employees and patients. Aims To characterize shiftwork-related attitudes, behaviours, symptoms and coping strategies among health care workers, two validated questionnaires (the Standard Shiftwork Index and the Pressure Management Indicator) were used to identify factors predicting shiftwork adaptation. Methods Participants (n = 376, response rate 25%) were grouped according to their work schedule (days, permanent evenings, rotating days plus evenings, permanent nights or relief and combined shifts). Indicators of lifestyle, work organization, sleep disruption, health and pressure management among workers on irregular shifts were compared with participants on day shifts, after adjustment for gender, age and marital status. Principal components analysis and ordinal logistic regression were used among irregular shiftworkers to identify factors predicting schedule adaptation. Results Night and relief/combined shiftworkers reported a greater ability to accommodate irregular schedules and disrupted sleep, but were also more likely to report work-related impacts than day workers. Permanent night workers generally reported poorer health, more absenteeism and less job satisfaction than day workers. Factors associated with optimal work performance or schedule contentment among shiftworkers included adequate sleep, evening circadian preference, increased age and organizational satisfaction. Reduced work performance or schedule discontent was associated with sleep/wake difficulties and poor health. Conclusions This study confirmed previous research and identified factors that can be targeted for the development of more effective shiftwork adaptation programmes in a health care setting (sleep timing and duration, exercise and optimal health and organizational satisfaction).

Background Exercise has been shown to decrease breast cancer risk and slow the progression of breast cancer. Physician recommendations and clinical research data most often are for gym-based exercise programs. However, the importance of exercise location on mood and stress hormones that may influence adherence to exercise has not been addressed. Methods Women first walked for an hour outdoors along a university path and then a week later, for an hour indoors on a treadmill in a typical gym environment. Pre and post outdoor and indoor exercise moods (happy, pleased, sad, frustrated, worried, angry, delighted, and joy) were assessed by a 6 point Likert questionnaire, and saliva samples were collected for analysis of cortisol, and alpha amylase (a surrogate for serum norepinephrine). Results Nineteen healthy, non-smoking, postmenopausal women (average age 58 ± 4) participated. Compared with scores after walking outdoors, walking indoors was associated with higher scores of worry (p = 0.02; mean difference 0.9; 95% CI (0.17, 1.6) and frustration (p = 0.03; mean difference 0.9; 95% CI (0.12, 1.6), and lower scores for feelings of being pleased (p = 0.03; mean difference -0.8; 95% CI: -1.7, 0.1) and delighted (p = 0.05; mean difference -0.9; 95% CI: -1.75, -0.02). Changes in salivary hormone levels did not vary significantly between the two environments. Conclusion Walking outdoors was associated with improved mood, but walking indoors was not. Improved mood may reduce breast cancer risk indirectly by promoting regular exercise. Physician recommendations for exercise should include gym and non-gym based exercise options.