Onchocerciasis and reproductive health in Ecuador

Guderian, Ronald H.; Lovato, Raquel; Anselmi, Mariela; Mancero, Támara; Cooper, Philip J.

doi:10.1016/s0035-9203(97)90089-4

Cited by 14 publications

(9 citation statements)

References 9 publications

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“…The question asked was whether the participant was born at term (pregnancy had completed nine months). A study in Ecuador suggested that onchocerciasis may be associated with an increased risk of spontaneous abortions [38]. In this study, the effects of onchocerciasis on preterm birth were not investigated, but as spontaneous abortions have been associated with preterm birth, it is possible that onchocerciasis could lead to preterm birth [39].…”

Section: Discussionmentioning

confidence: 93%

Risk Factors for Nodding Syndrome and Other Forms of Epilepsy in Northern Uganda: A Case-Control Study

et al. 2021

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Epidemiological studies suggest a link between onchocerciasis and various forms of epilepsy, including nodding syndrome (NS). The aetiopathology of onchocerciasis associated epilepsy remains unknown. This case-control study investigated potential risk factors that may lead to NS and other forms of non-nodding epilepsy (OFE) in northern Uganda. We consecutively recruited 154 persons with NS (aged between 8 and 20 years), and age-frequency matched them with 154 with OFE and 154 healthy community controls. Participants’ socio-demography, medical, family, and migration histories were recorded. We tested participants for O. volvulus serum antibodies. The 154 controls were used for both OFE and NS separately to determine associations. We recruited 462 people with a median age of 15 years (IQR 14, 17); 260 (56.4%) were males. Independent risk factors associated with the development of NS were the presence of O. volvulus antibodies [aOR 8.79, 95% CI (4.15–18.65), p-value < 0.001] and preterm birth [aOR 2.54, 95% CI (1.02–6.33), p-value = 0.046]. Risk factors for developing OFE were the presence of O. volvulus antibodies [aOR 8.83, 95% CI (4.48–17.86), p-value < 0.001] and being born in the period before migration to IDP camps [aOR 4.28, 95% CI (1.20–15.15), p-value = 0.024]. In conclusion, O. volvulus seropositivity was a risk factor to develop NS and OFE; premature birth was a potential co-factor. Living in IDP camps was not a risk factor for developing NS or OFE.

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Section: Discussionmentioning

confidence: 93%

Risk Factors for Nodding Syndrome and Other Forms of Epilepsy in Northern Uganda: A Case-Control Study

et al. 2021

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“…Marriage prospects, often an important part in life in endemic areas, are influenced by NTDs, particularly when an NTDs changes the physical appearance and, or someone's physical capabilities, which is the case for NTDs such as podoconiosis, onchocerciasis and cutaneous leishmaniasis (Chahed et al, 2016;Dunn et al, 2015;Ozano et al, 2020;Tsegay et al, 2018). To give an example, onchodermatitis, caused by onchocerciasis, is known as "the disease that prevents a girl from getting married" in certain parts of Nigeria (Dunn et al, 2015;Guderian et al, 1997). The influence of NTDs on marriage prospects are seen for both men and women (Chahed et al, 2016).…”

Section: Gender-specific Stigma and Health-seeking Behaviourmentioning

confidence: 99%

Protecting the neglected from disease: the role of gender, health equity and human rights in the fight against neglected tropical diseases

Rijk¹,

Klemperer²,

Depierreux³

et al. 2021

Preprint

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Poverty and inequality are both the starting point, and the ultimate outcome, for most neglected tropical diseases (NTDs). As a group of 20 diseases, NTDs are typified by their prevalence among the poor, excluded, and marginalised within society. In the absence of quality healthcare provision, many NTDs lead to long term disability, disfigurement, and stigma, which in turn act to reinforce the exclusion and poverty experienced by the afflicted. The path leading to illness is often determined by a widespread lack of access to formal education, timely healthcare, adequate living conditions, employment and nutrition. The reasons for such deprivation are complicated, but ultimately reduce to a persistence of inequalities in affected regions. These inequalities can manifest differently depending on the demographic being studied: gender, ethnicity, geographic location, level of formal education, can all determine the ease with which NTDs are transmitted, diagnosed or treated. Yet, regardless of contextual differences, NTDs continue to persist because individuals within endemic regions experience a healthcare system that is, either directly or indirectly, inequitable. The healthcare system referred to in this context is not confined to simply formal healthcare settings. Rather, it encompasses local healers, community healthcare professionals or volunteers, drug administration programmes, community mental health provision, the formal education system, and, in extension, even the infrastructure that exists to physically connect individuals to their healthcare provider. Failing to ensure parity across each of these components for every citizen equates to a discriminatory healthcare system which fails to recognise the individual’s basic human right to “a standard of living adequate for the health and well-being of themselves and of their family, including food, clothing, housing and medical care and necessary social services” (Article 25- Universal Declaration of Human Rights). To ensure NTDs are managed in a way that is sustainable in the long term, the underlying societal inequalities which allow them to persist must be first understood.

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“…The severity of onchocerciasis and its associated itching is an independent predictor of a shorter lactation period [22]. An O. volvulus infection in pregnant women may be associated with an increased risk of spontaneous abortions [23] and with earlier and more severe O. volvulus infections in their offspring [24].…”

Section: What Is Known About the Negative Impact Of Onchocerciasis In Pregnancymentioning

confidence: 99%

“…In the same period, the incidence rate of spontaneous abortions in the non-endemic area was 1.3/1000 myar. An MDA with ivermectin every six months started in 1990 in the hyper-endemic area and 90−95% of those eligible were treated [23]. This resulted in a dramatic decline in community mf load to negligible levels by 1996 [23].…”

Section: The Effect Of Ivermectin Treatment Of O Volvulus Infected Pregnant Women On Pregnancy Outcomesmentioning

confidence: 99%

Treatment of Pregnant Women with Ivermectin during Mass Drug Distribution: Time to Investigate Its Safety and Potential Benefits

et al. 2021

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To date, pregnant women are excluded from programmes delivering community-directed treatment of ivermectin (CDTI) for onchocerciasis and preventive chemotherapy of other helminthiases because of concerns over ivermectin safety during pregnancy. This systematic exclusion sustains an infection reservoir at the community level and deprives a vulnerable population from known benefits—there are indications that treating O. volvulus infected women may improve pregnancy outcomes and reduce the risk that their children develop onchocerciasis-associated morbidities. Furthermore, teratogenic effects are seen in non-clinical experiments at doses that far exceed those used in CDTI. Lastly, early, undetected and undeclared pregnancies are being systematically exposed to ivermectin in practice. Treatment of this population requires appropriate supporting evidence, for which we propose a three-pronged approach. First, to develop a roadmap defining the key steps needed to obtain regulatory clearance for the safe and effective use of ivermectin in all pregnant women who need it. Second, to conduct a randomised placebo-controlled double-blind clinical trial to evaluate the safety and benefits of ivermectin treatment in O. volvulus infected pregnant women. Such a trial should evaluate the possible effects of ivermectin in reducing adverse pregnancy outcomes and neonatal mortality, as well as in reducing the incidence of onchocerciasis-associated epilepsy. Third, to establish a pregnancy registry for women who inadvertently received ivermectin during pregnancy. This situation is not unique to ivermectin. Access to valuable therapies is often limited, delayed, or denied to pregnant women due to a lack of evidence. Concerns over protecting vulnerable people may result in harming them. We need to find acceptable ways to build robust evidence towards providing essential interventions during pregnancy.

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Onchocerciasis and reproductive health in Ecuador

Cited by 14 publications

References 9 publications

Risk Factors for Nodding Syndrome and Other Forms of Epilepsy in Northern Uganda: A Case-Control Study

Risk Factors for Nodding Syndrome and Other Forms of Epilepsy in Northern Uganda: A Case-Control Study

Protecting the neglected from disease: the role of gender, health equity and human rights in the fight against neglected tropical diseases

Treatment of Pregnant Women with Ivermectin during Mass Drug Distribution: Time to Investigate Its Safety and Potential Benefits

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