Neglected tropical diseases (NTD) in low- and middle-income countries are still not on target per the World Health Organization's (WHO) elimination goal of 2020. Mass drug administration (MDA) is one of the effective strategies supported by the WHO for the control and subsequent elimination of NTD. This quantitative study explored how supply chain logistic capacity may be hampering MDA coverage in countries in which the diseases are endemic. The study examined secondary data from WHO data bank for MDA coverage, to quantify the relationship between supply chain logistics capacity, as measured by the World Bank's logistics performance index (LPIs), and the control of NTD using MDA. The ecological theory of health behavior was the theoretical framework for this study. The research questions explored whether a low- and/or middle-income country's supply chain infrastructure, logistics services, customs and border procedures, and supply chain reliability, predict the coverage of MDA in controlling NTD. A multiple regression model determined the linear relations between each predictor: supply chain infrastructure (H1), logistics services (H2), custom and border procedures (H3), and supply chain reliability (H4) and the control of neglected diseases as determine by MDA. Results indicated that supply chain capacity, custom and border processes, and supply chain reliability are statistically significant in predictors of MDA coverage in the control of NTD in developing countries. This study may enhance social change by improving supply chain capacity for more effective distribution of PCT drugs, thus helping with the elimination of NTDs and improved health outcomes in low- and middle-income countries.

Made available in DSpace on 2016-08-19T17:47:06Z (GMT). No. of bitstreams: 1 DISSERTACAO_IRAMAR BORBA DE CARVALHO.pdf: 3080156 bytes, checksum: 254d7f4e8bff85de8ad661652e7c3b1a (MD5) Previous issue date: 2014-10-23 / Schistosomiasis is a parasitic disease, considered one of the greatest public health problems in Brazil. This is due to the complexity of the transmission of the disease, which depends on several factors involved as definitive and intermediate hosts, socioeconomic conditions, poor sanitation and low educational level of the population susceptible to infection. Starting in 1999 with the decentralization of the Schistosomiasis Control Program (PCE) responsibility of shares shall be the responsibility of municipalities shall be implemented by the Family Health Strategy. The city of St. Louis presents conducive to the development and spread of the disease in peripheral neighborhoods conditions. They are: unfavorable socioeconomic characteristics and the presence of B. glabrata snail in water collections. These data support the population's vulnerability to the spread of endemic disease, so it is important to conduct studies to evaluate the work of epidemiological surveillance. Considering this perspective, the present study is to evaluate the overall implementation of the surveillance and control of schistosomiasis in São Luís activities. Methodology used for the study is kind of evaluative and normative components in their structure and process. Data collection was conducted in the months from March to July 2014, using semi-structured questionnaires as a tool for health professionals who work surveillance and control of schistosomiasis. There was collected secondary data from the Information System of the Schistosomiasis Control Program (SISPCE) concerning epidemiological indicators. All data were consolidated and arrays of judgment that allowed measuring the degree of implementation of the Program. The results show that the degree of implementation is partially satisfying, as well as external organizational and political context, they present problems of operationalization. The centralization of services program, disarticulation of primary care, in addition to socioeconomic and environmental conditions of the municipality may increase the risk of spreading the disease. To achieve improvements in the functioning of the program is important to the managers and technicians understand that planning and continuous monitoring activities are fundamental for the achievement of satisfactory results. / A esquistossomose é uma doença parasitária, considerada um dos maiores problemas de saúde pública no Brasil. Isso se deve à complexidade da transmissão da enfermidade, que depende de vários fatores envolvidos como: hospedeiros definitivo e intermediário, condições socioeconômicas, falta de saneamento básico e baixo nível de escolaridade da população suscetível à infecção. A partir de 1999 com a descentralização do Programa de Controle de Esquistossomose (PCE) a responsabilidade das ações passa a ser da competência dos municípios devendo ser executadas pela Estratégia de Saúde da Família. O município de São Luís apresenta condições propícias ao desenvolvimento e expansão da doença nos bairros de periferia. São elas: características socioeconômicas desfavoráveis e a presença de caramujo B. glabrata nas coleções hídricas. Esses dados fundamentam a vulnerabilidade da população à propagação da endemia, por isso é importante a realização de estudos para avaliar o trabalho de vigilância epidemiológica. Levando em consideração esta perspectiva, o presente trabalho tem como objetivo geral avaliar as atividades de vigilância e controle da esquistossomose em São Luís. A metodologia utilizada para o estudo é do tipo avaliativa e normativa em seus componentes de estrutura e processo. Foi realizada coleta de dados nos meses de março a julho de 2014, utilizando como instrumento questionários semiestruturados aplicados aos profissionais de saúde que atuam na vigilância epidemiológica e no controle da esquistossomose. Houve coleta de dados secundários do Sistema de Informação do Programa de Controle de Esquistossomose (SISPCE) referentes aos indicadores epidemiológicos. Todos os dados foram consolidados e matrizes de julgamento permitiram aferir o grau de implantação do Programa. Os resultados mostram que o grau de implantação é parcialmente satisfatório, assim como o contexto organizacional, político e externo, por apresentarem problemas de operacionalização. A centralização dos serviços do Programa,a desarticulação da atenção básica, além das condições socioeconômicas e ambientais do município favorecem o risco de propagação da doença. Para alcance de melhorias no funcionamento do Programa é importante os gestores e técnicos entenderem que o planejamento e monitoramento contínuo são atividades fundamentais para o alcance de resultados satisfatórios.

Background: Human African Trypanosomiasis (HAT) also called sleeping sickness is an infectious disease in humans caused by an extracellular protozoan parasite. The disease, if left untreated, results in 100% mortality. Currently available drugs are full of severe drawbacks and fail to escape the fast development of trypanosoma resistance. Due to similarities in cell metabolism between cancerous tumors and trypanosoma cells, some of the current registered drugs against HAT have also been tested in cancer chemotherapy. Here we demonstrate for the first time that the simple ester, ethyl pyruvate, comprises such properties. Results: The current study covers the efficacy and corresponding target evaluation of ethyl pyruvate on T. brucei cell lines using a combination of biochemical techniques including cell proliferation assays, enzyme kinetics, phasecontrast microscopic video imaging and ex vivo toxicity tests. We have shown that ethyl pyruvate effectively kills trypanosomes most probably by net ATP depletion through inhibition of pyruvate kinase (Ki = 3.0±0.29 mM). The potential of ethyl pyruvate as a trypanocidal compound is also strengthened by its fast acting property, killing cells within three hours post exposure. This has been demonstrated using video imaging of live cells as well as concentration and time dependency experiments. Most importantly, ethyl pyruvate produces minimal side effects in human red cells and is known to easily cross the blood-brain-barrier. This makes it a promising candidate for effective treatment of the two clinical stages of sleeping sickness. Trypanosome drug-resistance tests indicate irreversible cell death and a low incidence of resistance development under experimental conditions. Conclusion: Our results present ethyl pyruvate as a safe and fast acting trypanocidal compound and show that it inhibits the enzyme pyruvate kinase. Competitive inhibition of this enzyme was found to cause ATP depletion and cell death. Due to its ability to easily cross the bloodbrain- barrier, ethyl pyruvate could be considered as new candidate agent to treat the hemolymphatic as well as neurological stages of sleeping sickness.

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Spatially-explicit information is essential for planning and implementing interventions against vector-borne diseases. This is also true for African trypanosomoses, a group of diseases of both humans and animals caused by protozoa of the Genus Trypanosoma, and transmitted by tsetse flies (Genus Glossina).<p>In this thesis the knowledge gaps and the requirements for an evidence-based decision making in the field of tsetse and trypanosomoses are identified, with a focus on georeferenced data and Geographic Information Systems (GIS). Datasets, tools and analyses are presented that aim to fill some of the identified knowledge gaps.<p>For the human form of the disease, also known as sleeping sickness, case detection and treatment are the mainstay of control, so that accurate knowledge of the geographic distribution of infections is paramount. In this study, an Atlas was developed that provides village-level information on the reported occurrence of sleeping sickness. The geodatabase underpinning the Atlas also includes the results of active screening activities, even when no cases were detected. The Atlas enables epidemiological maps to be generated at a range of scales, from local to global, thus providing evidence for strategic and technical decision making.<p>In the field of animal trypanosomosis control, also known as nagana, much emphasis has recently been placed on the vector. Accurate delineation of tsetse habitat appears as an essential component of ongoing and upcoming interventions against tsetse. The present study focused on land cover datasets and tsetse habitat. The suitability for tsetse of standardized land cover classes was explored at continental, regional and national level, using a combination of inductive and deductive approaches. The land cover classes most suitable for tsetse were identified and described, and tailored datasets were derived.<p>The suite of datasets, methodologies and tools presented in this thesis provides evidence for informed planning and implementation of interventions against African trypanosomoses at a range of spatial scales. / Doctorat en Sciences agronomiques et ingénierie biologique / info:eu-repo/semantics/nonPublished

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