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Schistosomiasis control is heavily reliant on the drug praziquantel (PZQ), which is used as preventive chemotherapy as part of national helminth control strategies. Given the heavy reliance on PZQ for mass drug administration, there has been considerable research on the potential of parasites developing resistance to the drug, resulting in decreased drug efficacy. However, there have been comparatively fewer studies of other factors that can potentially alter PZQ efficacy. Here, we investigate whether host PZQ metabolism contributes towards variable cure rates. We evaluate factors that can influence the metabolism of PZQ and the resultant effect on the efficacy of PZQ treatment to determine factors that potentially influence an individual's response to the drug. The literature search was directed at published studies from three online databases: Web of Science, PubMed, and EMBASE. The search terms for the review comprised of ([praziquantel OR PZQ] AND [schistosom* OR bilharzia] AND [pharmaco*]) and included studies evaluating PZQ metabolism. Publications were categorised into pharmacokinetics, drug-drug interactions, pharmacogenetics, and metabolite analysis. Forty publications describing human and experimental studies fitted the inclusion criteria and were subjected to data extraction and analysis. The analyses showed that variable exposure to PZQ was associated with alterations in the liver's capacity to metabolise PZQ and observed drug-drug interactions. Other factors influencing the efficacy of PZQ were brand, formulation, and co-administered food. Although some work has been performed on metabolite identification, there was minimal information on PZQ's metabolic pathway, and no pharmacogenetics studies were identified. The study indicated that in both human and experimental studies alterations in the liver's capacity to metabolise PZQ as well as drug-drug interactions affected systemic levels of PZQ that could result in variable cure rates. The study confirmed previous findings of higher antischistosomal activity of (R)-PZQ enantiomer when administered alone compared to the racemate at the same dose as well as improved efficacy when the drug is administered with food. The study also highlighted the need for more comprehensive studies of the PZQ metabolic pathway and PZQ pharmacogenetic studies in humans.

Profound changes are occurring in the epidemiology of schistosomiasis, a neglected tropical disease caused by a chronic infection with parasitic helminths of the genus Schistosoma. Schistosomiasis currently affects 240 million people worldwide, mostly in sub-Saharan Africa. The advent and proliferation of mass drug administration (MDA) programmes using the drug praziquantel is resulting in substantial increases in the number of people, mainly children aged 6–14 years, being effectively treated, approaching the point where most people in endemic areas will receive one or more treatments during their lifetimes. Praziquantel treatment not only cures infection but also frees the host from the powerful immunomodulatory action of the parasites. The treatment simultaneously enhances exposure to key parasite antigens, accelerating the development of protective acquired immunity, which would take many years to develop naturally. At a population level, these changes constitute a substantial alteration to schistosome ecology in that the parasites are more likely to be exposed not only to praziquantel directly but also to hosts with altered immune phenotypes. Here, we consider the consequences of this for schistosome biology, immunoepidemiology, and public health. We anticipate that there could be substantial effects on chronic pathology, natural immunity, vaccine development strategies, immune disorders, and drug efficacy. This makes for a complex picture that will only become apparent over decades. We recommend careful monitoring and assessment to accompany the roll-out of MDA programmes to ensure that the considerable health benefits to populations are achieved and sustained.

Neglected tropical diseases (NTDs) are a group of 21 diseases affecting approximately 1.5 billion people globally. Significant progress has been made in their control: by March 2024, 50 countries had eliminated at least one NTD, with 13 of these countries eliminating at least two. Togo achieved the highest milestone, having eliminated four. The eight NTDs eliminated in at least one country are Guinea worm disease, human African trypanosomiasis, lymphatic filariasis, onchocerciasis, rabies, trachoma, visceral leishmaniasis and yaws. We reviewed elimination efforts of these 50 countries to identify factors underlying their successes and failures to generate a blueprint to inform the acceleration of NTD elimination. We conducted a review of published and grey literature and extracted and recorded data on various features of the elimination programmes, including the durations and organisers of elimination efforts, interventions, strategies including mainstreaming into other health services, partnerships involved, and details of historical failed control efforts. These data were synthesised to generate a blueprint for NTD elimination. Key features of successful NTD elimination included country ownership, dedicated elimination efforts, and use of a combination of strategies. Most elimination programmes targeted one NTD at a time, while fewer utilised integrated approaches. Elimination required at least two decades of sustained efforts and partnerships between the endemic country and international stakeholders. Failure in historical efforts was frequently a result of sociopolitical instability, insufficient resources, deprioritisation, lack of effective interventions, or lax implementation of interventions. Accelerating NTD elimination requires sustained, intense, and multisectoral approaches. In addition, mainstreaming within the health system, improved cross-cutting One Health strategies including water, sanitation and hygiene, and sustained financing are critical for elimination. While this study provides valuable insights, limitations due to documentation gaps and secondary sources highlight the need for improved data reporting and future research to strengthen elimination frameworks.

Zimbabwe currently faces several healthcare challenges, most notably HIV and associated infections including tuberculosis (TB), malaria and recently outbreaks of cholera, typhoid fever and COVID-19. Fungal infections, which are also a major public health threat, receive considerably less attention. Consequently, there is dearth of data regarding the burden of fungal diseases in the country. We estimated the burden of fungal diseases in Zimbabwe based on published literature and ‘at-risk’ populations (HIV/AIDS patients, survivors of pulmonary TB, cancer, chronic obstructive pulmonary disease, asthma and patients receiving critical care) using previously described methods. Where there was no data for Zimbabwe, regional, or international data was used. Our study revealed that approximately 14.9% of Zimbabweans suffer from fungal infections annually, with 80% having tinea capitis. The annual incidence of cryptococcal meningitis and Pneumocystis jirovecii pneumonia in HIV/AIDS were estimated at 41/100,000 and 63/100,000, respectively. The estimated prevalence of recurrent vulvovaginal candidiasis (RVVC) was 2,739/100,000. The estimated burden of fungal diseases in Zimbabwe is high in comparison to other African countries, highlighting the urgent need for increased awareness and surveillance to improve diagnosis and management.

Despite increased international efforts to control schistosomiasis using preventive chemotherapy, several challenges still exist in reaching the target populations. Until recently, preschool-aged children had been excluded from the recommended target population for mass drug administration, i.e. primary school children aged 6–15 years. Our studies and those of others provided the evidence base for the need to treat preschool-aged children that led to recommendations by the World Health Organization to include preschool-aged children in treatment programmes in 2010. The major challenge now lies in the unavailability of a child-size formulation of the appropriate anthelmintic drug, praziquantel. The currently available formulation of praziquantel presents several problems. First, it is a large tablet, making it difficult for young children and infants to swallow it and thus requires its breaking/crushing to allow for safe uptake. Second, it is bitter so it is often mixed with a sweetener to make it palatable for young children. Third, the current formulation of 600 mg does not allow for flexible dose adjustments for this age group. Thus, there is a need to formulate a child-appropriate praziquantel tablet. This paper discusses the target product profile for paediatric praziquantel, as well as knowledge gaps pertinent to the successful control of schistosome infection and disease in preschool-aged children.

The antihelminthic drug praziquantel has been used as the drug of choice for treating schistosome infection for more than 40 years. Although some epidemiological studies have reported low praziquantel efficacy in cure rate (CR) and/or egg reduction rate (ERR), there is no consistent robust evidence of the development of schistosome resistance to praziquantel (PZQ). There is need to determine factors that lead to variable treatment CR and/or ERR. Therefore, we conducted a systematic review and meta-analysis to review CR and ERR as well as identify their predictors. In this systematic review and meta-analysis, a literature review was conducted using Biosis Citation Index, Data Citation Index, MEDLINE, and Web of Science Core Collection all of which were provided through Web of Science. Alongside these, EMBASE, and CAB abstracts were searched to identify relevant articles. Random effect meta-regression models were used to identify the factors that influence CR and/or ERR by considering differences in host characteristics and drug dose. In total, 12,127 potential articles were screened and 146 eligible articles (published from 1979 to 2020) were identified and included for the meta-analysis. We found that there has been no significant reduction in CR or ERR over the study period. The results showed more variability in CR, compared with ERR which was more consistent and remained high. The results showed a positive effect of \"PZQ treatment dose\" with the current recommended dose of 40 mg/kg body weight achieving 57% to 88% CR depending on schistosome species, age of participants, and number of parasitological samples used for diagnosis, and ERR of 95%. Based on a review of over 40 years of research there is no evidence to support concerns about schistosomes developing resistance to PZQ. These results indicate that PZQ remains effective in treating schistosomiasis.

Schistosomiasis affects over 200 million people worldwide, most of whom are children. Research and control strategies directed at preschool-aged children (PSAC), i.e., ≤5 years old, have lagged behind those in older children and adults. With the recent WHO revision of the schistosomiasis treatment guidelines to include PSAC, and the recognition of gaps in our current knowledge on the disease and its treatment in this age group, there is now a concerted effort to address these shortcomings. Global and national schistosome control strategies are yet to include PSAC in treatment schedules. Maximum impact of schistosome treatment programmes will be realised through effective treatment of PSAC. In this review, we (i) discuss the current knowledge on the dynamics and consequences of paediatric schistosomiasis and (ii) identify knowledge and policy gaps relevant to these areas and to the successful control of schistosome infection and disease in this age group. Herein, we highlight risk factors, immune mechanisms, pathology, and optimal timing for screening, diagnosis, and treatment of paediatric schistosomiasis. We also discuss the tools required for treating schistosomiasis in PSAC and strategies for accessing them for treatment.

Clinicians in some SSA health systems have indicated that the priority list would include first pulse oximeters to measure oxygen levels, followed by oxygen concentrators that can be used in small healthcare settings and finally higher-tech equipment like ventilators. Table 1 Comparison of oxygen cylinders and concentrators (adapted from Graham et al)22 Oxygen cylinders Oxygen concentrators Capital cost Low (higher if including regulators and flow-meter assemblies) Moderate Running cost High: frequent refilling, transport and logistics Low: power, maintenance Power source None required Required, continuously Reliability Good, so long as supply lasts Good, on selected models Continuous supply No, limited by volume (large H-type cylinders last 2–4 days with continuous low-flow use) Yes, limited by equipment or power failure Maintenance Minimal: check regulators, leakage Essential: simple preventive and intermittent repairs Training Yes, clinical use of oxygen, care of cylinders and connections Yes, clinical use of oxygen, care of concentrators and connections, technical maintenance Some solutions from African countries for building oxygen supply The problem is not insurmountable. [...]a 42-bed hospital in the Gambia has managed to ensure uninterrupted oxygen supply for 8 years straight, using oxygen concentrators (rather than the more expensive cylinders).17 In Kenya, a county government enabled the construction of an oxygen plant by a private company, while the hospital commissioning the plant committed in advanced to buying a fixed oxygen quota.18 In Ethiopia, a garment manufacturer that produces oxygen for bleaching purposes aims to provide it to a nearby hospital, reflecting technology spillover.15 In Uganda, solar-powered oxygen delivery for rural settings has been developed to overcome issues of unreliable power supply.19 Solar-powered systems can turn ambient air into medical-grade oxygen with battery banks, enabling uninterrupted service through the night and on cloudy days. Provided they come with ‘roadmaps’ for local procurement, training and maintenance, they can be used in off-grid settings.20 To deal with the shortage of ventilators, Senegal is pioneering the use of 3-D printed ventilators costing ~US$60.21 These initiatives clearly demonstrate the successes of partnerships between governments, the private sector and hospitals to urgently increase regional oxygen availability.

There is a disease epidemiological transition occurring in Africa, with increasing incidence of noninfectious diseases, superimposed on a health system historically geared more toward the management of communicable diseases. The persistence and sometimes emergence of new pathogens allows for the occurrence of coinfections and comorbidities due to both infectious and noninfectious diseases. There is therefore a need to rethink and restructure African health systems to successfully address this transition. The historical focus of more health resources on infectious diseases requires revision. We hypothesise that the growing burden of noninfectious diseases may be linked directly and indirectly to or further exacerbated by the existence of neglected tropical diseases (NTDs) and other infectious diseases within the population. Herein, we discuss the health burden of coinfections and comorbidities and the challenges to implementing effective and sustainable healthcare in Africa. We also discuss how existing NTD and infectious disease intervention programs in Africa can be leveraged for noninfectious disease intervention. Furthermore, we explore the potential for new technologies-including artificial intelligence and multiplex approaches-for diagnosis and management of chronic diseases for improved health provision in Africa.

Urogenital schistosomiasis is contracted from the Schistosoma haematobium parasite and is treated with the drug praziquantel (PZQ). Despite MDA interventions, persistent hotspots (PHS) of S. haematobium infection have been identified in multiple schistosome endemic African countries but have yet to be characterised in Zimbabwe. This study assessed long-term infection persistence and variability in praziquantel (PZQ) efficacy among school-aged children (6–15 years) in 29 districts of Zimbabwe, using data from MDAs conducted between 2012 and 2017. Metrics included infection prevalence, mean egg count, and treatment efficacy indicators. Two hotspot definitions were applied: (i) prevalence-based persistent hotspots (PPHS), identified by limited reduction or rebound in prevalence; and (ii) efficacy-based persistent hotspots (EPHS), defined by cure rates below 70%. Statistical comparisons between hotspot and non-hotspot (“responder”) districts used regression models, Fisher’s exact test and Mann-Whitney U tests. Analyses revealed four PPHS and six EPHS. PPHS districts exhibited significantly higher baseline prevalence and infection intensity compared with responders (P = 0.043), a pattern not observed for EPHS. Greater distance from freshwater sources was associated with EPHS occurrence (P = 0.016), although this appeared to be an indirect effect of initially high infection intensities. Lower treatment frequency correlated with increased hotspot occurrence, but the relationship was not statistically significant for either hotspot category. Other investigated factors including treatment coverage, timing of drug administration and ecological suitability for intermediate host snails showed no significant association with hotspot status. The elevated initial prevalence and infection intensity in PPHS suggest these indicators could be used for early hotspot identification, enabling targeted adjustments in intervention strategies. The findings underscore the limitations of relying solely on preventive chemotherapy in high-transmission settings. Integrating complementary measures such as water, sanitation and hygiene (WASH) interventions and snail control may improve outcomes, particularly in hotspot areas. In conclusion, the persistence of S. haematobium hotspots in Zimbabwe highlights the need for adaptive, integrated control approaches aligned with the WHO’s 2030 roadmap. Monitoring baseline epidemiological indicators could facilitate earlier detection of persistent transmission foci, guiding more effective and sustainable schistosomiasis control.