Neglected tropical diseases: beyond the wars

Tuon, Felipe Francisco; Amato, Valdir Sabbaga

doi:10.1590/s0036-46652008000500013

Cited by 4 publications

(2 citation statements)

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“…Moreover, self-treatment was also associated with increased morbidity and death from TB [37]. Armed conflicts hamper TB control efforts not only by disrupting the health system but by diverting economic resources to priorities other than health needs [38]. When national priorities shift and attention is deflected, TB control efforts may suffer [39].…”

Section: Discussionmentioning

confidence: 99%

Armed conflicts have an impact on the spread of tuberculosis: the case of the Somali Regional State of Ethiopia

Gele

Bjune

2010

Confl Health

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A pessimistic view of the impact of armed conflicts on the control of infectious diseases has generated great interest in the role of conflicts on the global TB epidemic. Nowhere in the world is such interest more palpable than in the Horn of Africa Region, comprising Ethiopia, Somalia, Eritrea, Djibouti, Kenya and Sudan. An expanding literature has demonstrated that armed conflicts stall disease control programs through distraction of health system, interruption of patients' ability to seek health care, and the diversion of economic resources to military ends rather than health needs. Nonetheless, until very recently, no research has been done to address the impact of armed conflict on TB epidemics in the Somali Regional State (SRS) of Ethiopia.MethodsThis study is based on the cross-sectional data collected in 2007, utilizing structured questionnaires filled-out by a sample of 226 TB patients in the SRS of Ethiopia. Data was obtained on the delay patients experienced in receiving a diagnosis of TB, on the biomedical knowledge of TB that patients had, and the level of self-treatment by patients. The outcome variables in this study are the delay in the diagnosis of TB experienced by patients, and extent of self-treatment utilized by patients. Our main explanatory variable was place of residence, which was dichotomized as being in 'conflict zones' and in 'non-conflict zones'. Demographic data was collected for statistical control. Chi-square and Mann-Whitney tests were used on calculations of group differences. Logistic regression analysis was used to determine the association between outcome and predictor variables.ResultsTwo hundred and twenty six TB patients were interviewed. The median delay in the diagnosis of TB was 120 days and 60 days for patients from conflict zones and from non-conflict zones, respectively. Moreover, 74% of the patients residing in conflict zones undertook self-treatment prior to their diagnosis. The corresponding proportion from non-conflict zones was 45%. Fully adjusted logistic regression analysis shows that patients from conflict zones had significantly greater odds of delay (OR = 3.06; 95% CI: 1.47-6.36) and higher self treatment utilization (OR = 3.34; 95% CI: 1.56-7.12) compared to those from non-conflict zones.ConclusionPatients from conflict zones have a longer delay in receiving a diagnosis of TB and have higher levels of self treatment utilization. This suggests that access to TB care should be improved by the expansion of user friendly directly observed therapy short-course (DOTS) in the conflict zones of the region.

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Section: Discussionmentioning

confidence: 99%

Armed conflicts have an impact on the spread of tuberculosis: the case of the Somali Regional State of Ethiopia

Gele

Bjune

2010

Confl Health

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“…Despite its increasing global incidence, leishmaniasis has become a neglected disease with little interest by financial donors, public health authorities, and professionals to implement activities to research, prevent, or control the disease 17 .…”

Section: Introductionmentioning

confidence: 99%

Expression of TLR2 and TLR4 in lesions of patients with tegumentary american leishmaniasis

Tuon

Fernandes

Duarte

et al. 2012

Rev. Inst. Med. trop. S. Paulo

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SUMMARYObjectives: The aim of this study was to describe the pattern of expression of Toll-like receptor 2 (TLR2) and Toll-like receptor 4 (TLR4) in skin biopsies of patients with American tegumentary leishmaniasis (ATL) caused by Leishmania braziliensis. Methods: This prospective study evaluated 12 patients with ATL caused by Leishmania braziliensis confirmed by polymerase chain reaction. Immunohistochemistry was performed to determine the expression of TLR2 and TLR4. The number of NK cells, dendritic cells and macrophages in the tissue were calculated. The cytokine expression was determined using the anti-TNF-α, anti-IFN-γ, anti-IL-1 and anti-IL-6. Double immunostaining reactions were used to determine the cell expressing TLR2 and TLR4. Results: The numbers of cells expressing TLR2 and TLR4 were 145.48 ± 82.46 cell/mm 2 and 3.26 ± 4.11 cell/mm 2 respectively (p < 0.05). There was no correlation of TLR2 and TLR4 with the amount of cytokines and the number of NK cells, dendritic cells or macrophages. The double immunostaining revealed that TLR2 was expressed by macrophages. Conclusion: In human cutaneous leishmaniasis caused by Leishmania braziliensis, TLR2 is the most common TLR expressed during active disease, mainly by macrophages although without correlation with the amount of cytokines and number of cells.

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