Data-driven analyses of behavioral strategies to eliminate cysticercosis in sub-Saharan Africa.
Data-driven analyses of behavioral strategies to eliminate cysticercosis in sub-Saharan Africa.
复制标题
数据驱动的行为策略分析，以消除撒哈拉以南非洲的囊虫病。
DOI：
10.1371/journal.pntd.0009234
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发表时间：
2021-03
影响因子：
3.8
通讯作者：
Carabin H
中科院分区：
文献类型：
--
作者：
Skrip LA;Dermauw V;Dorny P;Ganaba R;Millogo A;Tarnagda Z;Carabin H
在全球范围内，多宿主带绦虫病/囊尾蚴病系统与显着的神经系统发病率以及经济负担相关。我们调查了在布基纳法索的 Boulkiemdé、Sanguié 和 Nayala 省，较低成本的行为干预措施是否足以在当地消除人类囊虫病。关于人类行为（即厕所使用和猪肉消费）以及人类和猪疾病的血清学流行率的各省特定数据被用来为带绦虫病/囊尾蚴病疾病系统的确定性分区模型提供信息。通过贝叶斯融合估计的参数提供了后验分布，用于比较由于未煮熟和人类暴露于环境中的猪带绦虫卵而导致人类摄入猪带绦虫囊尾蚴相关的传播率。对通过这些途径减少传播进行建模，以确定以市场为中心的烹饪行为干预措施和社区主导的环境卫生和个人卫生计划（独立或组合）所需的有效性，以消除人类囊尾蚴病这一公共卫生问题（每 1000 人<1 例）。研究发现，由于食用未煮熟的猪肉而导致的囊尾蚴传播在不同的传播环境中存在显着差异。在 Sanguié，由于未煮熟而导致的传播率比 Boulkiemdé 高 6%（95% CI：1.03, 1.09；p 值 < 0.001），比 Nayala 低 35%（95% CI：0.64，0.66；p 值 < 0.001）。我们发现，市场上消费的猪肉未煮熟的情况分别减少了 67% 和 62%，这与 Nayala 和 Sanguié 消除囊尾蚴病有关。消除 Boulkiemdé 的活动性囊尾蚴病需要减少 73%。通过环境卫生和个人卫生计划，人类对猪带绦虫卵的接触量减少了 25% 至 30%，这与各省的消除有关。尽管由于当地传播动态和行为而导致有效性存在差异，但有关正确烹饪重要性的教育，再加上社区主导的环境卫生和个人卫生工作，对降低囊尾蚴病和神经囊尾蚴病的发病率具有重要意义。在为被忽视的热带病 (NTD) 设计可扩展且可持续的干预策略时，考虑具体情况的行为和传播途径非常重要。为了降低与囊尾蚴病相关的发病率和死亡率，已建议采取一系列干预措施，但由于成本和可行性相关的限制而实施不一致。这项研究调查了在布基纳法索市场上通过烹饪干预来阻断通过未煮熟的猪肉传播的潜力。猪带绦虫寄生虫对通过改进烹饪策略可达到的温度的敏感性提供了一种低成本、以人为本的方法来防止食用受感染的猪肉食品。通过考虑三个省份的差异行为和该传播途径的相对作用，我们展示了消除囊尾蚴病（作为一个公共卫生问题）的潜力在以行为为中心的干预措施中有何不同。对人类和猪囊尾蚴病干预策略的进一步研究需要数据驱动的分析，以解释传播行为的局部差异。
The multi-host taeniosis/cysticercosis disease system is associated with significant neurological morbidity, as well as economic burden, globally. We investigated whether lower cost behavioral interventions are sufficient for local elimination of human cysticercosis in Boulkiemdé, Sanguié, and Nayala provinces of Burkina Faso. Province-specific data on human behaviors (i.e., latrine use and pork consumption) and serological prevalence of human and pig disease were used to inform a deterministic, compartmental model of the taeniosis/cysticercosis disease system. Parameters estimated via Bayesian melding provided posterior distributions for comparing transmission rates associated with human ingestion of Taenia solium cysticerci due to undercooking and human exposure to T. solium eggs in the environment. Reductions in transmission via these pathways were modeled to determine required effectiveness of a market-focused cooking behavior intervention and a community-led sanitation and hygiene program, independently and in combination, for eliminating human cysticercosis as a public health problem (<1 case per 1000 population). Transmission of cysticerci due to consumption of undercooked pork was found to vary significantly across transmission settings. In Sanguié, the rate of transmission due to undercooking was 6% higher than that in Boulkiemdé (95% CI: 1.03, 1.09; p-value < 0.001) and 35% lower than that in Nayala (95% CI: 0.64, 0.66; p-value < 0.001). We found that 67% and 62% reductions in undercooking of pork consumed in markets were associated with elimination of cysticercosis in Nayala and Sanguié, respectively. Elimination of active cysticercosis in Boulkiemdé required a 73% reduction. Less aggressive reductions of 25% to 30% in human exposure to Taenia solium eggs through sanitation and hygiene programs were associated with elimination in the provinces. Despite heterogeneity in effectiveness due to local transmission dynamics and behaviors, education on the importance of proper cooking, in combination with community-led sanitation and hygiene efforts, has implications for reducing morbidity due to cysticercosis and neurocysticercosis. It is important to consider context-specific behaviors and transmission pathways when designing scalable and sustainable intervention strategies for neglected tropical diseases (NTDs). To reduce the morbidity and mortality associated with cysticercosis, suites of interventions have been recommended but are inconsistently implemented due to cost and feasibility-related constraints. This study investigated the potential of a cooking intervention to interrupt transmission via undercooked pork in marketplaces of Burkina Faso. The sensitivity of Taenia solium parasite to temperatures attainable via improved cooking strategies provides a low-cost, human-centered approach to prevent consumption of infected pork meals. By accounting for differential behavior and the relative role of this transmission route across three provinces, we show how the potential of cysticercosis elimination (as a public health problem) varies across behavior-focused interventions. Further investigation into intervention strategies against human and pig cysticercosis warrants data-driven analyses that account for local variation in transmission behaviors.
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影响因子：
15.8
作者：
Havelaar AH;Kirk MD;Torgerson PR;Gibb HJ;Hald T;Lake RJ;Praet N;Bellinger DC;de Silva NR;Gargouri N;Speybroeck N;Cawthorne A;Mathers C;Stein C;Angulo FJ;Devleesschauwer B;World Health Organization Foodborne Disease Burden Epidemiology Reference Group
通讯作者：
World Health Organization Foodborne Disease Burden Epidemiology Reference Group
影响因子：
2.6
作者：
Dermauw, Veronique;Ganaba, Rasmane;Dorny, Pierre
通讯作者：
Dorny, Pierre
影响因子：
4.4
作者：
Bodimeade, Christopher;Marks, Michael;Mabey, David
通讯作者：
Mabey, David
影响因子：
3.8
作者：
Carabin, Helene;Millogo, Athanase;Ganaba, Rasmane
通讯作者：
Ganaba, Rasmane
影响因子：
3.3
作者：
Dermauw, Veronique;Carabin, Helene;Gabriel, Sarah
通讯作者：
Gabriel, Sarah