Integrated health care is an approach characterized by a high degree of collaboration and communication among health professionals. Integration of HIV/NCD is recommended to enhance the quality of ...healthcare services being provided. Duplication of limited resources is minimized, and a holistic care approach is promoted by shifting from acute and reactive care to care that embraces patient-centredness that includes promotive health and disease surveillance. The high burden of HIV disease in sub-Saharan Africa (SSA) combined with the increasing prevalence of chronic non-communicable diseases (NCDs) necessitates a review of how health systems has been doing to deliver quality integrated care for people living with HIV (PLWH) and comorbid chronic NCDs.
A scoping review was conducted to identify and describe all publications on integrated chronic care management models at the primary care level in the SSA context, particularly those that addressed the care of PLHIV with co-morbid chronic NCDs. The inclusion and exclusion criteria were applied, and duplicates were removed.
A total of twenty-one articles were included in the final review. Integrated healthcare systems were reported in only eight SSA countries-(South Africa, Uganda, Kenya, the United Republic of Tanzania, Zambia, Malawi, Zimbabwe and Swaziland). Integrated care systems adopted one of three health models. These included added-on NCD services to previously dedicated HIV care facilities, expansion of primary care facilities to include HIV care and establishment of integrated care services. Short-term benefits included staff capacitation, improved retention of patients and improved screening and detection of NCDs. However, the expansion of existing services resulted in an increased workload with no additional staff. A significant positive change noted by communities was that there was less or no stigmatisation of people living with HIV when attending dedicated HIV clinics.
Evidence of integrated healthcare services for PLWH and co-morbid of NCDs in SSA is scanty. Data on some short-term benefits of integrated care was available, but evidence was absent on the long-term outcomes. Randomized clinical trials with clearly defined comparator groups and standardized measures of HIV and NCD outcomes are needed to demonstrate non-inferiority of integrated against non-integrated care.
Climate change is predicted to disproportionately impact sub‐Saharan Africa, with potential devastating consequences on plant populations. Climate change may, however, impact intraspecific taxa ...differently. The aim of the study was to determine the current distribution and impact of climate change on three varieties of Vachellia sieberiana, that is, var. sieberiana, var. villosa and var. woodii. Ensemble species distribution models (SDMs) were built in “biomod2” using 66, 45, and 137 occurrence records for var. sieberiana, var. villosa, and var. woodii, respectively. The ensemble SDMs were projected to 2041–2060 and 2081–2100 under three general circulation models (GCMs) and two shared socioeconomic pathways (SSPs). The three GCMs were the Canadian Earth System Model version 5, the Institut Pierre‐Simon Laplace Climate Model version 6A Low Resolution, and the Model for Interdisciplinary Research on Climate version 6. The suitable habitat of var. sieberiana predominantly occurs in the Sudanian and Zambezian phytochoria while that of var. villosa largely occurs in the Sudanian phytochorion. The suitable habitat of var. woodii mainly occurs in the Zambezian phyotochorion. There is coexistence of var. villosa and var. sieberiana in the Sudanian phytochorion while var. sieberiana and var. woodii coexist in the Zambezian phytochorion. Under SSP2‐4.5 in 2041–2060 and averaged across the three GCMs, the suitable habitat expanded by 33.8% and 119.7% for var. sieberiana and var. villosa, respectively. In contrast, the suitable habitat of var. woodii contracted by −8.4%. Similar trends were observed in 2041–2060 under SSP5‐8.5 var. sieberiana (38.6%), var. villosa (139.0%), and var. woodii (−10.4%), in 2081–2100 under SSP2‐4.5 var. sieberiana (4.6%), var. villosa (153.4%), and var. woodii (−14.4%), and in 2081–2100 under SSP5‐8.5 var. sieberiana (49.3%), var. villosa (233.4%), and var. woodii (−30.7%). Different responses to climate change call for unique management and conservation decisions for the varieties.
Three varieties of Vachellia sieberiana respond differently to climate change. The suitable habitat of two varieties, that is, var. villosa and var. sieberiana, expands when forecasted under three general circulation models and two shared socioeconomic pathways. In contrast, the suitable habitat of var. woodii contracts.
The spatial and seasonal distribution, abundance, and infection rates of human schistosomiasis intermediate host snails and interactions with other freshwater snails, water physicochemical ...parameters, and climatic factors was determined in this study. A longitudinal malacology survey was conducted at seventy-nine sites in seven districts in KwaZulu-Natal province between September 2020 and August 2021. Snail sampling was done simultaneously by two trained personnel for fifteen minutes, once in three months. A total of 15,756 snails were collected during the study period. Eight freshwater snails were found: Bulinus globosus (n = 1396), Biomphalaria pfeifferi (n = 1130), Lymnaea natalensis (n = 1195), Bulinus tropicus (n = 1722), Bulinus forskalii (n = 195), Tarebia granifera (n = 8078), Physa acuta (n = 1579), and Bivalves (n = 461). The infection rates of B. globosus and B. pfeifferi are 3.5% and 0.9%, respectively. In our study, rainfall, pH, type of habitats, other freshwater snails and seasons influenced the distribution, abundance, and infection rates of human schistosomiasis intermediate host snails (p-value < 0.05). Our findings provide useful information which can be adopted in designing and implementing snail control strategies as part of schistosomiasis control in the study area.
The impact of climate change has led to variations in various biological processes, leading to altered transmission dynamics of infectious diseases, including snail-borne diseases (SBDs). ...Fascioliasis is one of the neglected zoonotic tropical snail-borne diseases caused by the trematode of the genus Fasciola. This review focused on laboratory experimental and model studies that evaluate the potential effect of temperature change on the ecology and biology of the intermediate host snails (IHS) of Fasciola.
A literature search was conducted on Google Scholar, EBSCOhost, and PubMed databases using predefined medical subject heading terms, Boolean operators, and truncation symbols in combination with direct keywords: Fasciolosis AND Temperature, Lymnaea OR Austropeplea OR Radix OR Galba OR Fossaria OR Pseudosuccinea AND growth, fecundity, AND survival at the global scale. Other search terms used were (Fascioliasis AND Temperature), (Lymnaea AND Temperature), (Austropeplea AND Temperature), (Fossaria AND Temperature), (Galba AND Temperature), (Pseudosuccinea AND Temperature), and (Radix AND Temperature).
The final synthesis included thirty-five published articles. The studies reviewed indicated that temperature rise may alter the distribution, and optimal conditions for breeding, growth, and survival of IHS, ultimately resulting in changing the transmission dynamics of fascioliasis. The literature also confirmed that the life history traits of IHS and their interaction with the liver fluke parasites are driven by temperature, and hence climate change may have profound outcomes on the population size of snails, parasite density, and disease epidemiology.
We concluded that understanding the impact of temperature on the growth, fecundity, and survival of IHS may broaden our knowledge of the possible effects of climate change and hence inform fascioliasis control programs.
Flood risk studies remain focused on understanding causation, impacts, perceptions and coping and adaptation measures and there remain many inappropriate measures taken to reduce household risk. ...Through a case study approach, this study assessed rural household vulnerability to flooding which helped to determine the level of risk to flood hazards in Mbire District of Zimbabwe. Three hundred and thirty-five (335) households were randomly selected to participate in the survey. The composite index approach was used to calculate vulnerability and risk indices. Results indicated that more than 70% of the households were highly vulnerable to flooding and about 50% were in the medium to very high categories of flood risk. Household vulnerability was not only a question of the natural flood event, but a result of the intersection of poor socio-economic conditions and the physical exposure to floods. The socio-economic determinants of vulnerability included high levels of unemployment resulting in low income and poverty; low levels of education; and over-dependence of the community on rain-fed smallholder farming. Physical exposure of the community mainly resulted from materials used to construct houses. Pole and dagga houses had a higher degree of exposure compared to houses with bricks and cement. Therefore, we recommend that instead of focusing on the whole ward/district the institutional services should first target the most vulnerable and at risk households in order to increase their capacity in dealing with flood hazards.
Snail-borne trematodes afflict humans, livestock, and wildlife. Recognizing their zoonotic potential and possible hybridization, a One Health approach is essential for effective control. Given the ...dearth of knowledge on African trematodes, this study aimed to map snail and trematode diversity, focusing on (i) characterizing gastropod snail species and their trematode parasites, (ii) determining infection rates of snail species as intermediate hosts for medically, veterinary, and ecologically significant trematodes, and (iii) comparing their diversity across endemic regions.
A cross-sectional study conducted in 2021 in Chiredzi and Wedza districts in Zimbabwe, known for high human schistosomiasis prevalence, involved malacological surveys at 56 sites. Trematode infections in snails were detected through shedding experiments and multiplex rapid diagnostic polymerase chain reactions (RD-PCRs). Morphological and molecular analyses were employed to identify snail and trematode species.
Among 3209 collected snail specimens, 11 species were identified, including schistosome and fasciolid competent snail species. We report for the first time the invasive exotic snail Tarebia granifera in Zimbabwe, which was highly abundant, mainly in Chiredzi, occurring at 29 out of 35 sites. Shedding experiments on 1303 snails revealed a 2.24% infection rate, with 15 trematode species identified through molecular genotyping. Five species were exclusive to Chiredzi: Bolbophorus sp., Schistosoma mansoni, Schistosoma mattheei, Calicophoron sp., and Uvulifer sp. Eight were exclusive to Wedza, including Trichobilharzia sp., Stephanoprora amurensis, Spirorchid sp., and Echinostoma sp. as well as an unidentified species of the Plagiorchioidea superfamily. One species, Tylodelphys mashonensis, was common to both regions. The RD-PCR screening of 976 non-shedding snails indicated a 35.7% trematode infection rate, including the presence of schistosomes (1.1%) Fasciola nyanzae (0.6%). In Chiredzi, Radix natalensis had the highest trematode infection prevalence (33.3%), while in Wedza, R. natalensis (55.4%) and Bulinus tropicus (53.2%) had the highest infection prevalence.
Our xenomonitoring approach unveiled 15 trematode species, including nine new records in Zimbabwe. Schistosoma mansoni persists in the study region despite six mass deworming rounds. The high snail and parasite diversity, including the presence of exotic snail species that can impact endemic species and biomedically important trematodes, underscores the need for increased monitoring.
Schsistosomiasis is endemic in sub-Saharan Africa. It is transmitted by intermediate host snails such as Bulinus and Biomphalaria. An understanding of the abundance and distribution of snail vectors ...is important in designing control strategies. This study describes the spatial and seasonal variation of B. globosus and Bio. pfeifferi and their schistosome infection rates between May 2014 and May 2015 in Ingwavuma, uMkhanyakude district, KwaZulu-Natal province, South Africa.
Snail sampling was done on 16 sites once every month by two people for 30 min at each site using the scooping and handpicking methods. Snails collected from each site were screened for schistosome mammalian cercariae by the shedding method. The negative binomial generalised linear mixed model (glmm) was used to determine the relationship between abundances of the intermediate host snails and climatic factors rainfall, land surface temperatures (LST), seasons, habitats, sampling sites and water physico-chemical parameters including pH and dissolved oxygen (DO).
In total, 1846 schistosomiasis intermediate host snails were collected during the study period. Biompharia pfeifferi was more abundant (53.36%, n = 985) compared to B. globosus (46.64%, n = 861). Bulinus globosus was recorded at 12 sites (75%) and Bio. pfeifferi was present at 7 sites (43.8%). Biompharia pfeifferi cohabited with B. globosus at all the sites it was present. High numbers of Bio. pfeifferi (n = 872, 88.5%) and B. globosus (n = 705, 81.9%) were found between winter and mid-spring. Monthly rainfall showed a statistically significant negative relationship with the abundance of B. globosus (p < 0.05). Dissolved oxygen (DO) had a statistically significant positive relationship with the abundance of Bio. pfeifferi (p < 0.05) while (LST) had a statistically significant negative relationship (p < 0.05). More B. globosus (8.9%, n = 861) were shedding schistosome mammalian cercariae compared to Bio. pfeifferi (0.1%, n = 985) confirming the already documented high prevalence of S. haematobium in Ingwavuma compared to S. mansoni.
Results of this study provide updated information on the distribution of schistosomiasis intermediate host snails in the study area and contributes towards the understanding of the transmission dynamics of schistosomiasis at the micro-geographical scale in this area.
Highly active antiretroviral therapy (HAART) has improved the life expectancy of people living with HIV (PLWH) and has increased the risk of chronic non-communicable diseases. Comorbid HIV and ...diabetes mellitus (DM) significantly increase cardiovascular disease and mortality risk. This study aimed to determine the prevalence of type 2 diabetes mellitus among HIV-positive patients receiving HAART in Zimbabwe and its associated risk factors.
This cross-sectional study was conducted at eight primary healthcare facilities in Harare, Zimbabwe, between January 2022 and March 2023. Non-probability convenience sampling was used to recruit adult HIV-positive patients undergoing HAART attending the facilities. Data were captured on clinical history and socio-demographic and behavioral characteristics, and analyzed using descriptive statistics to determine DM prevalence rates. Additionally, bivariate and multivariate logistic regression models were employed to examine factors associated with HIV and DM comorbidities.
A total of 450 participants were included in this study, of which 57.6% (n = 259) were female. The majority were married (73.8%) and older than 35 years (80.2%). Most participants had completed high school (87.6%) and 68.9% were employed either formally or self-employed. The prevalence of diabetes mellitus (DM) was 14.9%. HIV/DM comorbidity was more prevalent in patients who were female, self-employed, and smoked (p < 0.05). Multivariate logistic regression analysis revealed that the factors associated with DM-HIV comorbidity were gender, age, education, marital status, employment status, smoking, physical activities, duration of HAART, and diet. Age, level of education, marital status, and occupation were not associated with HIV-DM comorbidity. Obesity (body mass index > 30 kg/m2), smoking, and alcohol consumption were associated with an increased risk of DM. Regular physical activity is associated with a reduced risk of DM.
A substantial burden of DM was found in PLWH. The intersectoral integration approach is advocated, and active screening for DM is recommended. Gender-specific interventions are necessary to target diseases and health behaviors that differ between men and women. These interventions should be customized to the specific diseases and behaviors of each group.
Introduction:
Climate change alters environmental and climatic conditions, leading to expansion or contraction and possible shifts in the geographical distribution of vectors that transmit diseases.
...Bulinus globosus
and
Biomphalaria pfeifferi
are the intermediate host snails for human schistosomiasis in KwaZulu-Natal (KZN) province, South Africa.
Methods:
Using the Maximum entropy (MaxEnt) model, we modelled the current and future distribution of human schistosomiasis intermediate host snails in KZN using two representation concentration pathways (RCP4.5 and RCP8.5) for the year 2085. Thirteen and ten bioclimatic variables from AFRICLIM were used to model the habitat suitability for
B. globosus
and
B. pfeifferi
, respectively. The Jack-knife test was used to evaluate the importance of each bioclimatic variable.
Results:
Mean temperature warmest quarter (BIO10, 37.6%), the number of dry months (dm, 32.6%), mean diurnal range in temperature (BIO2, 10.8%), isothermality (BIO3, 6.7%) were identified as the top four bioclimatic variables with significant contribution to the model for predicting the habitat suitability for
B. globosus
. Annual moisture index (mi, 34%), mean temperature warmest quarter (BIO10, 21.5%), isothermality (BIO3, 20.5%), and number of dry months (dm, 7%) were identified as the four important variables for the habitat suitability of
B. pfeifferi
. Area under the curve for the receiving operating characteristics was used to evaluate the performance of the model. The MaxEnt model obtained high AUC values of 0.791 and 0.896 for
B. globosus
and
B. pfeifferi
, respectively. Possible changes in the habitat suitability for
B. globosus
and
B. pfeifferi
were observed in the maps developed, indicating shrinkage and shifts in the habitat suitability of
B. pfeifferi
as 65.1% and 59.7% of the current suitable habitats may become unsuitable in the future under RCP4.5 and RCP8.5 climate scenarios. Conversely, an expansion in suitable habitats for
B. globosus
was predicted to be 32.4% and 69.3% under RCP4.5 and RCP8.5 climate scenarios, with some currently unsuitable habitats becoming suitable in the future.
Discussion:
These habitat suitability predictions for human schistosomiasis intermediate host snails in KZN can be used as a reference for implementing long-term effective preventive and control strategies for schistosomiasis.
This study investigated the spatial distribution, abundance, and infection rates of human schistosome-transmitting snails and related physicochemical parameters and environmental factors in 11 ...districts in KwaZulu-Natal (KZN) province, South Africa, from December 2020–February 2021. Snail sampling was carried out in 128 sites by two people for 15 min using scooping and handpicking methods. Geographical information system (GIS) was used to map surveyed sites. In situ measurements of physicochemical parameters were recorded, while remote sensing was used to obtain measurements for climatic factors required to achieve the study's objective. Cercarial shedding and snail-crushing methods were used to detect snail infections. Kruskal-Wallis test was used to test the differences in snail abundance among snail species, districts, and habitat types. A negative binomial generalized linear mixed model was used to identify the physicochemical parameters and environmental factors influencing the abundance of snail species. A total of 734 human schistosome-transmitting snails were collected. Bu. globosus were significantly more abundant (n = 488) and widely distributed (found in 27 sites) compared to B. pfeifferi (n = 246) found in 8 sites. Bu. globosus and B. pfeifferi had infection rates of 3.89% and 2.44%, respectively. Dissolved oxygen and normalized difference vegetation index showed a statistically positive relationship, while normalized difference wetness index showed a statistically negative relationship with the abundance of Bu. globosus. However, there was no statistically significant relationship between B. pfeifferi abundance, physicochemical parameters, and climatic factors. Our study described the current distribution, abundance, and infection status of human schistosome-transmitting snails in KZN province, which will contribute to informing control measure policies for schistosomiasis.
PDF
