Stigma in Neurological Diseases in the Tropics

Tabah, Earnest Njih; Yepnjio, Faustin N.; Njamnshi, Alfred K.

doi:10.1007/978-1-4614-8100-3_3

Cited by 7 publications

(18 citation statements)

References 68 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the early stage, the trypanosomes multiply in the blood, lymphatic system and systemic organs giving rise to a variety of symptoms and signs some of which may be quite non-specific. 7 In the later more severe stage, the parasites cross the BBB and migrate to brain parenchyma to cause a wide range of neurological features the hallmark of which is the disturbance of sleep structure and sleep-wake rhythm. 7 In the human disease it is not known precisely when this traversal through the BBB is initiated or completed, and there is still a need to better characterize the timing and evolution of the late stage signs and symptoms in order to construct an objective clinical score that could be a useful adjunct to staging.…”

Section: The Problem Of Disease Staging In Hatmentioning

confidence: 99%

“…7 In the later more severe stage, the parasites cross the BBB and migrate to brain parenchyma to cause a wide range of neurological features the hallmark of which is the disturbance of sleep structure and sleep-wake rhythm. 7 In the human disease it is not known precisely when this traversal through the BBB is initiated or completed, and there is still a need to better characterize the timing and evolution of the late stage signs and symptoms in order to construct an objective clinical score that could be a useful adjunct to staging. There are unfortunately no stage-specific clinical features that can reliably distinguish the early from the late stages of HAT where in both disease forms the stages merge into each other.…”

Section: The Problem Of Disease Staging In Hatmentioning

confidence: 99%

“…4 In addition to these difficulties, the literature suggests that the spectrum of HAT stages spans possibly from the asymptomatic form through the early, early-late, intermediate and finally late stages. 7,29,30,31 A further difficult issue is that of 'relapses' which could occur in any of the stages, from early to late, if the infection is not sufficiently treated for several reasons. Can the asymptomatic cases constitute a stage of their own?…”

Section: The Problem Of Disease Staging In Hatmentioning

confidence: 99%

“…4,5 Almost always fatal if untreated or inadequately treated, HAT is an extremely important but also 'neglected disease' in Africa with neglected associated stigma. 6 It expresses itself clinically in two distinct forms in two broadly separate regions of Africa. 7 The parasite Trypanosoma brucei gambiense (T.b.…”

Section: Introductionmentioning

confidence: 99%

“…6 It expresses itself clinically in two distinct forms in two broadly separate regions of Africa. 7 The parasite Trypanosoma brucei gambiense (T.b. gambiense) is the causal agent of the chronic West African disease variant form which is endemic in 24 countries in Central and West Africa, accounting for about 97% of reported cases, while Trypanosoma brucei rhodesiense (T.b.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

The challenging problem of disease staging in human African trypanosomiasis (sleeping sickness): a new approach to a circular question

Njamnshi

Gettinby

Kennedy

2017

Transactions of the Royal Society of Tropical Medicine and Hygiene

Self Cite

View full text Add to dashboard Cite

Human African trypanosomiasis (HAT), also known as sleeping sickness, puts millions of people at risk in sub-Saharan Africa and is a neglected parasitic disease that is almost always fatal if untreated or inadequately treated. HAT manifests itself in two stages that are difficult to distinguish clinically. The problem of staging in HAT is extremely important since treatment options, some of which are highly toxic, are directly linked to the disease stage. Several suggested investigations for disease staging have been problematic because of the lack of an existing gold standard with which to compare new clinical staging markers. The somewhat arbitrary current criteria based on the cerebrospinal fluid (CSF) white blood cell (WBC) count have been widely used, but the new potential biomarkers are generally compared with these, thereby making the problem somewhat circular in nature. We propose an alternative 'reverse' approach to address this problem, conceptualised as using appropriate statistical methods to test the performance of combinations of established laboratory variables as staging biomarkers to correlate with the CSF WBC/trypanosomes and clinical features of HAT. This approach could lead to the use of established laboratory staging markers, potentially leading to a gold standard for staging and clinical follow-up of HAT.

show abstract

Section: The Problem Of Disease Staging In Hatmentioning

confidence: 99%

Section: The Problem Of Disease Staging In Hatmentioning

confidence: 99%

Section: The Problem Of Disease Staging In Hatmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The challenging problem of disease staging in human African trypanosomiasis (sleeping sickness): a new approach to a circular question

Njamnshi

Gettinby

Kennedy

2017

Transactions of the Royal Society of Tropical Medicine and Hygiene

Self Cite

View full text Add to dashboard Cite

show abstract

Onchocerciasis in the Ntui Health District of Cameroon: epidemiological, entomological and parasitological findings in relation to elimination prospects

et al. 2022

View full text Add to dashboard Cite

Background Despite decades of community-directed treatment with ivermectin (CDTI), onchocerciasis transmission persists in Cameroon and has been associated with increased risk for epilepsy in endemic communities. We investigated the onchocerciasis situation in the Ntui Health District (a known onchocerciasis focus in Cameroon where the Sanaga River constitutes the main source of black fly vectors) using parasitological, entomological and serological parameters. Methods In July 2021, community-based surveys were conducted in four villages (Essougli, Nachtigal, Ndjame and Ndowe). Onchocerciasis was diagnosed via microscopic examination of skin snips. Using rapid diagnostic tests, we screened children aged 3–6 years for Ov16 antibodies as a proxy for recent onchocerciasis transmission. Monthly black fly biting rates were obtained from the two riverside villages (Nachtigal and Essougli) for 12 consecutive months (July 2021 to June 2022) using the human landing catch technique. Some black flies were dissected each month to check for infection. Results Overall, 460 participants were recruited; mean age was 32.1 (range: 3–85) years with 248 (53.9%) being males. Among skin snipped participants (n = 425), onchocerciasis prevalence was 14.6%. Participants with epilepsy (n = 25) were more often skin snip positive (45.8% vs 12.7%; P < 0.001) and had higher microfilarial loads (9.2 ± 22.0 vs 0.7 ± 3.5 microfilariae/skin snip; P < 0.001) compared to their peers without epilepsy. Eight (6.5%) of the 123 tested children were Ov16 seropositive. The breeding sites we investigated along the Sanaga River during the current study harbored fewer vectors (annual biting rates reaching 530,322 vs 606,370 in the Mbam River) and exhibited lower black fly infection rates (annual transmission potentials reaching 1479 vs 4488 in the Mbam River) when compared to recent entomological reports in Cameroon. Conclusion Despite substantial biting rates, black fly infection rates (by microscopy) in the Ntui Health District were rather low resulting in overall low transmission potentials in study villages. Thanks to CDTI, O. volvulus infection in both humans and insects is on the decrease. However, there is evidence that O. volvulus is still endemic in these communities. Reducing the vector population will further accelerate onchocerciasis elimination prospects. Graphical Abstract

show abstract

Comprehensive management of epilepsy in onchocerciasis-endemic areas: lessons learnt from community-based surveys

et al. 2019

Self Cite

View full text Add to dashboard Cite

BackgroundOnchocerciasis-endemic regions are known to have a high epilepsy prevalence. Limited resources in these areas and poor access to healthcare by persons with epilepsy (PWE) result in a wide anti-epileptic treatment gap, poor seizure control and a high burden of seizure-related complications. Recent community-based surveys highlight the need for epilepsy management strategies suitable for remote onchocerciasis-endemic villages to ensure better health outcomes for PWE. In this paper, we propose a feasible approach to manage PWE in such settings.Main textImproved management of PWE in onchocerciasis-endemic areas may be achieved by decentralizing epilepsy care. Simplified approaches for the diagnosis and treatment of epilepsy may be used by non-physicians, under the supervision of physicians or specialists. To reduce the treatment gap, a regular supply of subsidized anti-epileptic drugs (AED) appropriate for different types of onchocerciasis-associated epilepsy should be instituted. Setting up a community-based epilepsy surveillance system will enable early diagnosis and treatment of PWE thereby preventing complications. Community awareness programs on epilepsy must be implemented to reduce stigma and facilitate the social rehabilitation of PWE. Finally, strengthening onchocerciasis elimination programs by optimizing community-directed treatment with ivermectin (CDTI) and considering alternative treatment strategies might reduce the incidence of epilepsy.ConclusionsA community-based approach with task-shifting of epilepsy care from specialists to non-physician health workers will reduce epilepsy-associated morbidity. Increased advocacy and collaboration with various stakeholders is needed to establish a sustainable, cost-effective chronic care model for epilepsy that will significantly improve the quality of life of PWE in onchocerciasis-endemic regions.Electronic supplementary materialThe online version of this article (10.1186/s40249-019-0523-y) contains supplementary material, which is available to authorized users.

show abstract

Stigma in Neurological Diseases in the Tropics

Cited by 7 publications

References 68 publications

The challenging problem of disease staging in human African trypanosomiasis (sleeping sickness): a new approach to a circular question

The challenging problem of disease staging in human African trypanosomiasis (sleeping sickness): a new approach to a circular question

Onchocerciasis in the Ntui Health District of Cameroon: epidemiological, entomological and parasitological findings in relation to elimination prospects

Comprehensive management of epilepsy in onchocerciasis-endemic areas: lessons learnt from community-based surveys

Contact Info

Product

Resources

About