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Gastrointestinal nematode (GIN) infections are a common constraint in pasture-based herds and cause a decrease in animal health, productivity and farm profitability. Current control practices to prevent production losses of GIN infections in livestock depend largely on the use of anthelmintic drugs. However, due to the continued use of these drugs over more than three decades, the industry is now increasingly confronted with nematode populations resistant to the available anthelmintics. This emerging anthelmintic resistance (AR) in cattle nematodes emphasizes the need for a change toward more sustainable control approaches that limit, prevent or reverse the development of AR. The uptake of diagnostic methods for sustainable control could enable more informed treatment decisions and reduce excessive anthelmintic use. Different diagnostic and targeted or targeted selective anthelmintic control approaches that slow down the selection pressure for anthelmintic resistance have been developed and evaluated recently. Now it is time to transform these insights into guidelines for sustainable control and communicate them across the farmer community. This article reviews the current uptake of such sustainable practices with a focus on farmer's socio-psychological factors affecting this uptake. We investigate communication as a possible tool to change current behavior and successfully implement more sustainable anthelmintic treatment strategies.

Nudging, a strategy that uses subtle stimuli to direct people's behavior, has recently been included as an effective and low-cost behavior change strategy in low- and middle- income countries (LMIC), targeting behavior-based prevention and control of neglected tropical diseases (NTDs). The present scoping review aims to provide a timely overview of how nudge interventions have been applied within this field. In addition, the review proposes a framework for the ethical consideration of nudges for NTD prevention and control, or more broadly global health promotion. A comprehensive search was performed in several databases: MEDLINE, PsycINFO, and Embase (Ovid), Web of Science Core Collection, CINAHL, ERIC and Econ.Lit (EBSCO), as well as registered trials and reviews in CENTRAL and PROSPERO to identify ongoing or unpublished studies. Additionally, studies were included through a handpicked search on websites of governmental nudge units and global health or development organizations. This scoping review identified 33 relevant studies, with only two studies targeting NTDs in particular, resulting in a total of 67 nudge strategies. Most nudges targeted handwashing behavior and were focused on general health practices rather than targeting a specific disease. The most common nudge strategies were those targeting decision assistance, such as facilitating commitment and reminder actions. The majority of nudges were of moderate to high ethical standards, with the highest standards being those that had the most immediate and significant health benefits, and those implemented by agents in a trust relationship with the target audience. Three key recommendations should inform research investigating nudge strategies in global health promotion in general. Firstly, future efforts should investigate the different opportunities that nudges present for targeting NTDs in particular, rather than relying solely on integrated health promotion approaches. Secondly, to apply robust study designs including rigorous process and impact evaluation which allow for a better understanding of 'what works' and 'how it works'. Finally, to consider the ethical implications of implementing nudge strategies, specifically in LMIC.

Manual screening of a Kato-Katz (KK) thick stool smear remains the current standard to monitor the impact of large-scale deworming programs against soil-transmitted helminths (STHs). To improve this diagnostic standard, we recently designed an artificial intelligence based digital pathology system (AI-DP) for digital image capture and analysis of KK thick smears. Preliminary results of its diagnostic performance are encouraging, and a comprehensive evaluation of this technology as a cost-efficient end-to-end diagnostic to inform STH control programs against the target product profiles (TPP) of the World Health Organisation (WHO) is the next step for validation. Here, we describe the study protocol for a comprehensive evaluation of the AI-DP based on its (i) diagnostic performance, (ii) repeatability/reproducibility, (iii) time-to-result, (iv) cost-efficiency to inform large-scale deworming programs, and (v) usability in both laboratory and field settings. For each of these five attributes, we designed separate experiments with sufficient power to verify the non-inferiority of the AI-DP (KK2.0) over the manual screening of the KK stool thick smears (KK1.0). These experiments will be conducted in two STH endemic countries with national deworming programs (Ethiopia and Uganda), focussing on school-age children only. This comprehensive study will provide the necessary data to make an evidence-based decision on whether the technology is indeed performant and a cost-efficient end-to-end diagnostic to inform large-scale deworming programs against STHs. Following the protocolized collection of high-quality data we will seek approval by WHO. Through the dissemination of our methodology and statistics, we hope to support additional developments in AI-DP technologies for other neglected tropical diseases in resource-limited settings. The trial was registered on September 29, 2023 Clinicaltrials.gov (ID: NCT06055530).

Helminth infections of cattle affect productivity in all classes of stock, and are amongst the most important production-limiting diseases of grazing ruminants. Over the last decade, there has been a shift in focus in the diagnosis of these infections from merely detecting presence/absence of infection towards detecting its impact on production. This has been facilitated by studies observing consistent negative correlations between helminth diagnostic test results and measures of productivity. Veterinarians are increasingly challenged to consider the economic aspects of their work, and the use of these tests should now be integrated in economic evaluation frameworks for improved decision making. In this paper, we review recent insights in the farm-specific economic impact of helminth infections on dairy cattle farms as well as in farmer attitudes and behaviour regarding helminth control. Combining better economic impact assessments of helminth infections together with a deeper understanding of the non-economic factors that drive a farmer’s animal health decisions should result in more effective control strategies and increased farmer satisfaction.

To mitigate emerging anthelmintic resistance (AR) in cattle, sustainable gastrointestinal nematode control strategies should be adopted. A multi-centre study was set up to understand the factors affecting European dairy cattle farmers’ adoption of diagnostics and to gauge for differences between regions. The data were collected through a multi-lingual survey by participating countries of the European Co-operation in Science and Technology (COST) action COMbatting Anthelmintic Resistance in ruminants (COMBAR). Four countries provided sufficient data to be included in the data analysis: Norway, Italy, Germany and Austria. Three models were estimated and validated through structural equation modelling. Norway, along with Germany and Austria (pooled dataset) showed similar trends that align with previous studies. AR risk perception had no influence on the adoption intention of diagnostics, a positive influence was found for attitude towards diagnostics and subjective norms (i.e., perceived opinion of others), and a negative influence of attitudes towards anthelminthics. Additionally, routine (i.e., perception of the current treatment) had an indirect effect on adoption intention through attitudes. Italy’s data deviated from these findings, presenting a positive effect of the perceived severity of AR, and perceived behavioural control (i.e., perceived ability to perform a specific behaviour) on adoption intention of diagnostics. Finally, Norway’s data set allowed for inclusion of a measurement of current behaviour in the model, identifying a direct positive effect of the perceived actual behaviour of other farmers on their own behaviour. Pour atténuer la résistance émergente aux anthelminthiques (RA) chez les bovins, des stratégies durables de contrôle des nématodes gastro-intestinaux devraient être adoptées. Une étude multicentrique a été réalisée pour comprendre les facteurs affectant l’adoption des diagnostics par les éleveurs de bovins laitiers européens, et pour évaluer les différences entre les régions. Les données ont été recueillies au moyen d’une enquête multilingue menée par les pays participants à l’action de European Co-operation in Science and Technology (COST) COMbatting Anthelmintic Resistance in ruminants (COMBAR). Quatre pays ont collecté suffisamment de données pour être inclus dans l’analyse statistique : la Norvège, l’Italie, l’Allemagne et l’Autriche. Trois modèles ont été estimés et validés par modélisation d’équations structurelles. La Norvège, et d’autre part l’Allemagne et l’Autriche (données regroupées) ont montré des tendances similaires qui correspondent aux études précédentes. La perception de la RA n’avait aucune influence sur l’intention d’adoption des diagnostics, une influence positive a été trouvée pour l’attitude envers les diagnostics et les normes subjectives (c’est-à-dire l’opinion perçue des autres), et une influence négative des attitudes envers les anthelminthiques. De plus, la routine (c’est-à-dire la perception du traitement actuel) a eu un effet indirect sur l’intention d’adoption par le biais des attitudes. Les données de l’Italie s’écartaient des résultats précédents, présentant un effet positif de la gravité perçue du risque de la RA, et du contrôle comportemental perçu (c’est-à-dire la capacité perçue à adopter un comportement spécifique) sur l’intention d’adoption de diagnostic. Enfin, l’ensemble de données de la Norvège a permis d’inclure une mesure du comportement actuel dans le modèle, identifiant un effet positif direct du comportement réel perçu des autres agriculteurs sur son propre comportement.

The World Health Organization emphasizes the importance of integrated monitoring and evaluation in neglected tropical disease (NTD) control programs. Serological assays offer a potential solution for integrated diagnosis of NTDs, particularly for those requiring mass drug administration (MDA) as primary control and elimination strategy. This scoping review aims (i) to provide an overview of assays using serum or plasma to detect infections with soil-transmitted helminths (STHs) in both humans and animals, (ii) to examine the methodologies used in this research field and (iii) to discuss advancements in serological diagnosis of STHs to guide prevention and control programs in veterinary and human medicine. We conducted a systematic search in the Ovid MEDLINE, Embase and Cochrane Library databases, supplemented by a Google search using predefined keywords to identify commercially available serological assays. Additionally, we performed a patent search through Espacenet. We identified 85 relevant literature records spanning over 50 years, with a notable increased interest in serological assay development in recent years. Most of the research efforts concentrated on diagnosing Ascaris infections in both humans and pigs, primarily using ELISA and western blot technologies. Almost all records targeted antibodies as analytes, employing proteins and peptides as analyte detection agents. Approximately 60% of sample sets described pertained to human samples. No commercially available tests for Trichuris or hookworms were identified, while for Ascaris, there are at least seven different ELISAs on the market. While a substantial number of assays are employed in epidemiological research, the current state of serological diagnosis for guiding STH prevention and control programs is limited. Only two assays designed for pigs are used to inform efficient deworming practices in pig populations. Regarding human diagnosis, none of the existing assays has undergone extensive large-scale validation or integration into routine diagnostics for MDA programs.

Background In Africa, ongoing challenges posed by zoonotic foodborne diseases highlight the need to improve control practices. This review aims to present a structured overview by summarizing documented practices in African abattoirs, factors influencing the implementation of either poor or good practices, and the recommended solutions to enhance good practices. Methods This scoping review followed the PRISMA-ScR guidelines, the Arksey and O’Malley methodological framework, and the Population-Concept-Context framework. To identify relevant articles, searches were conducted across the Scopus, PubMed, PubMed Central, ScienceDirect, and Web of Science databases, along with additional records from African Journal Online, Google, and Google Scholar. Results Out of 1,547 identified articles, 91 that met the eligibility criteria were included in the final analysis. These studies were conducted in 12 African countries, including Nigeria, Ethiopia, Ghana, Kenya, Sudan, Cameroon, Morocco, South Africa, Uganda, Tanzania, Egypt, and Sierra Leone. The review identified several poor meat-processing practices, such as a lack of inspections, unhygienic processing, inadequate cleaning, improper meat storage, and poor waste disposal. On the other hand, the current scoping review identified good practices, such as documenting and reporting inspection findings, waste treatment, waste reuse, timely meat delivery, and the reversal of these poor practices. Barriers to good practices were weak policies, lack of basic infrastructure and facilities, insufficient funds, absence of supervision, poor enforcement, poor information flow, lack of knowledge, and inadequate training. Good practices were facilitated by factors like available policy, the establishment and use of critical control points, and basic infrastructure and facilities. Results of the present scoping review also demonstrate that recommended solutions for improvement include following guidelines, developing policies, better enforcement, providing basic infrastructure and facilities, providing training, collaboration, and adopting the One Health approach. Conclusions This scoping review identified a range of poor and good practices and factors that influence the implementation of such practices and recommended improvement solutions. Overcoming barriers and leveraging facilitators are essential for improvement and require collaboration among stakeholders. Furthermore, research is needed to validate the effectiveness of the recommended solutions.

BackgroundNudging, a strategy that uses subtle stimuli to direct people's behavior, has recently been included as an effective and low-cost behavior change strategy in low- and middle- income countries (LMIC), targeting behavior-based prevention and control of neglected tropical diseases (NTDs). The present scoping review aims to provide a timely overview of how nudge interventions have been applied within this field. In addition, the review proposes a framework for the ethical consideration of nudges for NTD prevention and control, or more broadly global health promotion.MethodsA comprehensive search was performed in several databases: MEDLINE, PsycINFO, and Embase (Ovid), Web of Science Core Collection, CINAHL, ERIC and Econ.Lit (EBSCO), as well as registered trials and reviews in CENTRAL and PROSPERO to identify ongoing or unpublished studies. Additionally, studies were included through a handpicked search on websites of governmental nudge units and global health or development organizations.ResultsThis scoping review identified 33 relevant studies, with only two studies targeting NTDs in particular, resulting in a total of 67 nudge strategies. Most nudges targeted handwashing behavior and were focused on general health practices rather than targeting a specific disease. The most common nudge strategies were those targeting decision assistance, such as facilitating commitment and reminder actions. The majority of nudges were of moderate to high ethical standards, with the highest standards being those that had the most immediate and significant health benefits, and those implemented by agents in a trust relationship with the target audience.ConclusionThree key recommendations should inform research investigating nudge strategies in global health promotion in general. Firstly, future efforts should investigate the different opportunities that nudges present for targeting NTDs in particular, rather than relying solely on integrated health promotion approaches. Secondly, to apply robust study designs including rigorous process and impact evaluation which allow for a better understanding of 'what works' and 'how it works'. Finally, to consider the ethical implications of implementing nudge strategies, specifically in LMIC.

Background The World Health Organization emphasizes the importance of integrated monitoring and evaluation in neglected tropical disease (NTD) control programs. Serological assays offer a potential solution for integrated diagnosis of NTDs, particularly for those requiring mass drug administration (MDA) as primary control and elimination strategy. This scoping review aims (i) to provide an overview of assays using serum or plasma to detect infections with soil-transmitted helminths (STHs) in both humans and animals, (ii) to examine the methodologies used in this research field and (iii) to discuss advancements in serological diagnosis of STHs to guide prevention and control programs in veterinary and human medicine. Methodology We conducted a systematic search in the Ovid MEDLINE, Embase and Cochrane Library databases, supplemented by a Google search using predefined keywords to identify commercially available serological assays. Additionally, we performed a patent search through Espacenet. Principal findings We identified 85 relevant literature records spanning over 50 years, with a notable increased interest in serological assay development in recent years. Most of the research efforts concentrated on diagnosing Ascaris infections in both humans and pigs, primarily using ELISA and western blot technologies. Almost all records targeted antibodies as analytes, employing proteins and peptides as analyte detection agents. Approximately 60% of sample sets described pertained to human samples. No commercially available tests for Trichuris or hookworms were identified, while for Ascaris, there are at least seven different ELISAs on the market. Conclusions While a substantial number of assays are employed in epidemiological research, the current state of serological diagnosis for guiding STH prevention and control programs is limited. Only two assays designed for pigs are used to inform efficient deworming practices in pig populations. Regarding human diagnosis, none of the existing assays has undergone extensive large-scale validation or integration into routine diagnostics for MDA programs.

Globally, notable emphasis is currently being placed on improving access to and acceptance of sanitation in schools as part of the drive towards achieving the United Nations Sustainable Development Goal 6. However, the importance of sustaining effective cleaning of latrines in schools remains an under-emphasized and under-researched topic, with serious negative consequences for the health of school-aged children in low-income settings. In this Perspective, we summarize the limited existing literature on the impacts of unclean latrines in schools on aspects of child health, and the methods that have been trialled to achieve sustainable school latrine cleaning programmes. We highlight research needs and propose a new approach to school-led total sanitation, with the aim of moving towards a world in which no child gets sick because of the unhygienic state of the toilets in their schools.Access to sanitation is a fundamental right that is still missing, especially in many parts of low-income countries. This Perspective focuses on the impact of unclean school latrines on child health.