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Article ; Online: Pharyngo-tonsillar involvement of Mpox in a cohort of men who have sex with men (MSM)

Carmela Pinnetti / Annalisa Mondi / Valentina Mazzotta / Serena Vita / Fabrizio Carletti / Camilla Aguglia / Alessia Beccacece / Alessandra Vergori / Roberta Gagliardini / Eliana Specchiarello / Tommaso Ascoli Bartoli / Francesco Baldini / Maria Letizia Giancola / Maria Beatrice Valli / Alessandra D'Abramo / Saba Gebremeskel Teklè / Carla Fontana / Anna Rosa Garbuglia / Enrico Girardi /

Fabrizio Maggi / Francesco Vaia / Emanuele Nicastri / Andrea Antinori

Journal of Infection and Public Health, Vol 17, Iss 1, Pp 130-

A serious risk of missing diagnosis

2024 Volume 136

Abstract: During the 2022-outbreak, peculiar clinical presentations of Mpox have been described, some of which can make the diagnosis of the disease extremely challenging. Here we report a case series of fourteen patients with Mpox pharynogotonsillar involvement ( ... ...

Abstract	During the 2022-outbreak, peculiar clinical presentations of Mpox have been described, some of which can make the diagnosis of the disease extremely challenging. Here we report a case series of fourteen patients with Mpox pharynogotonsillar involvement (PTI) seen at National Institute for Infectious Diseases, “Lazzaro Spallanzani”, in Rome, Italy from May to September 2022. All included patients were men who have sex with men (median age 38 years) reporting unprotected sex within three weeks from symptoms onset. Seven out of fourteen patients needed hospitalization due to uncontrolled pain, reduced airspace and difficulty swallowing, of whom five were effectively treated with tecovirimat or cidofovir. The remaining two patients were treated with symptomatic drugs. The typical Mpox muco-cutaneous manifestations were not observed simultaneously with PTI in three patients, two of whom developed the lesions after several days, while one never manifested them. Polymerase Chain Reaction (PCR) for Mpox virus was positive in oropharyngeal swab, saliva and serum. Although PTI occurs in only a small percentage of Mpox cases, its diagnosis is of utmost importance. In fact, this localization, if not identified, could lead to serious complications in the absence of early antiviral treatment and to missed diagnosis with an increased risk of disease transmission.
Keywords	Mpox ; MPXV ; MSM ; Emerging infectious diseases ; Pharyngo-tonsillitis ; Infectious and parasitic diseases ; RC109-216 ; Public aspects of medicine ; RA1-1270
Subject code	610
Language	English
Publishing date	2024-01-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
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Article ; Online: Pharyngo-tonsillar involvement of Mpox in a cohort of men who have sex with men (MSM): A serious risk of missing diagnosis.

Pinnetti, Carmela / Mondi, Annalisa / Mazzotta, Valentina / Vita, Serena / Carletti, Fabrizio / Aguglia, Camilla / Beccacece, Alessia / Vergori, Alessandra / Gagliardini, Roberta / Specchiarello, Eliana / Ascoli Bartoli, Tommaso / Baldini, Francesco / Giancola, Maria Letizia / Valli, Maria Beatrice / D'Abramo, Alessandra / Gebremeskel Teklè, Saba / Fontana, Carla / Garbuglia, Anna Rosa / Girardi, Enrico /

Maggi, Fabrizio / Vaia, Francesco / Nicastri, Emanuele / Antinori, Andrea

Journal of infection and public health

2023 Volume 17, Issue 1, Page(s) 130–136

Abstract	During the 2022-outbreak, peculiar clinical presentations of Mpox have been described, some of which can make the diagnosis of the disease extremely challenging. Here we report a case series of fourteen patients with Mpox pharynogotonsillar involvement (PTI) seen at National Institute for Infectious Diseases, "Lazzaro Spallanzani", in Rome, Italy from May to September 2022. All included patients were men who have sex with men (median age 38 years) reporting unprotected sex within three weeks from symptoms onset. Seven out of fourteen patients needed hospitalization due to uncontrolled pain, reduced airspace and difficulty swallowing, of whom five were effectively treated with tecovirimat or cidofovir. The remaining two patients were treated with symptomatic drugs. The typical Mpox muco-cutaneous manifestations were not observed simultaneously with PTI in three patients, two of whom developed the lesions after several days, while one never manifested them. Polymerase Chain Reaction (PCR) for Mpox virus was positive in oropharyngeal swab, saliva and serum. Although PTI occurs in only a small percentage of Mpox cases, its diagnosis is of utmost importance. In fact, this localization, if not identified, could lead to serious complications in the absence of early antiviral treatment and to missed diagnosis with an increased risk of disease transmission.
MeSH term(s)	Male ; Humans ; Adult ; Female ; Missed Diagnosis ; Homosexuality, Male ; Mpox (monkeypox) ; Sexual and Gender Minorities ; Pharynx
Language	English
Publishing date	2023-11-15
Publishing country	England
Document type	Journal Article
ZDB-ID	2467587-8
ISSN	1876-035X ; 1876-0341
ISSN (online)	1876-035X
ISSN	1876-0341
DOI	10.1016/j.jiph.2023.11.015
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Article ; Online: Severe Plasmodium ovale malaria complicated by acute respiratory distress syndrome in a young Caucasian man.

D'Abramo, Alessandra / Gebremeskel Tekle, Saba / Iannetta, Marco / Scorzolini, Laura / Oliva, Alessandra / Paglia, Maria Grazia / Corpolongo, Angela / Nicastri, Emanuele

Malaria journal

2018 Volume 17, Issue 1, Page(s) 139

Abstract: Background: Although Plasmodium ovale is considered the cause of only mild malaria, a case of severe malaria due to P. ovale with acute respiratory distress syndrome is reported.: Case presentation: A 37-year old Caucasian man returning home from ... ...

Abstract	Background: Although Plasmodium ovale is considered the cause of only mild malaria, a case of severe malaria due to P. ovale with acute respiratory distress syndrome is reported. Case presentation: A 37-year old Caucasian man returning home from Angola was admitted for ovale malaria to the National Institute for Infectious Diseases Lazzaro Spallanzani in Rome, Italy. Two days after initiation of oral chloroquine treatment, an acute respiratory distress syndrome was diagnosed through chest X-ray and chest CT scan with intravenous contrast. Intravenous artesunate and oral doxycycline were started and he made a full recovery. Conclusion: Ovale malaria is usually considered a tropical infectious disease associated with low morbidity and mortality. However, severe disease and death have occasionally been reported. In this case clinical failure of oral chloroquine treatment with clinical progression towards acute respiratory distress syndrome is described.
MeSH term(s)	Adult ; Antimalarials/adverse effects ; Antimalarials/therapeutic use ; Chloroquine/adverse effects ; Chloroquine/therapeutic use ; Humans ; Malaria/complications ; Malaria/diagnosis ; Malaria/drug therapy ; Malaria/parasitology ; Male ; Plasmodium ovale ; Radiography, Thoracic ; Respiratory Distress Syndrome, Adult/diagnostic imaging ; Respiratory Distress Syndrome, Adult/etiology ; Treatment Failure
Chemical Substances	Antimalarials ; Chloroquine (886U3H6UFF)
Language	English
Publishing date	2018-04-02
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1475-2875
ISSN (online)	1475-2875
DOI	10.1186/s12936-018-2289-2
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Article ; Online: Prolonged detection of dengue virus RNA in the semen of a man returning from Thailand to Italy, January 2018.

Lalle, Eleonora / Colavita, Francesca / Iannetta, Marco / Gebremeskel Teklè, Saba / Carletti, Fabrizio / Scorzolini, Laura / Bordi, Licia / Vincenti, Donatella / Castilletti, Concetta / Ippolito, Giuseppe / Capobianchi, Maria Rosaria / Nicastri, Emanuele

Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin

2018 Volume 23, Issue 18

Abstract: This study reports the presence of dengue virus RNA in longitudinally collected semen samples of a previously healthy Caucasian man, returning to Italy from Thailand with primary dengue fever, up to 37 days post-symptom onset, when viraemia and viruria ... ...

Abstract	This study reports the presence of dengue virus RNA in longitudinally collected semen samples of a previously healthy Caucasian man, returning to Italy from Thailand with primary dengue fever, up to 37 days post-symptom onset, when viraemia and viruria were undetectable. This finding, coupled with the evidence of dengue virus negative-strand RNA, an indirect marker of ongoing viral replication, in the cellular fraction of semen, indicates a need to further investigate possible sexual transmission.
MeSH term(s)	Dengue/diagnosis ; Dengue Virus/genetics ; Dengue Virus/isolation & purification ; Humans ; Immunoglobulin G/blood ; Immunoglobulin M/blood ; Italy ; Male ; RNA, Viral/genetics ; Real-Time Polymerase Chain Reaction ; Semen/virology ; Thailand ; Travel
Chemical Substances	Immunoglobulin G ; Immunoglobulin M ; RNA, Viral
Language	English
Publishing date	2018-05-08
Publishing country	Sweden
Document type	Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1338803-4
ISSN	1560-7917 ; 1025-496X
ISSN (online)	1560-7917
ISSN	1025-496X
DOI	10.2807/1560-7917.ES.2018.23.18.18-00197
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Article ; Online: Case Report: Delayed Diagnosis of Congenital Malaria by

Gebremeskel Tekle, Saba / Corpolongo, Angela / D'Abramo, Alessandra / Giancola, Maria Letizia / Iannetta, Marco / Scorzolini, Laura / Marcozzi, Paola / Buffone, Elsa / Liuzzi, Giuseppina / Nicastri, Emanuele

The American journal of tropical medicine and hygiene

2018 Volume 99, Issue 3, Page(s) 620–622

Abstract: Congenital malaria (CM) is uncommon in both malaria-endemic and non-endemic countries. It may be caused by ... ...

Abstract	Congenital malaria (CM) is uncommon in both malaria-endemic and non-endemic countries. It may be caused by any
MeSH term(s)	Antimalarials/therapeutic use ; Chickenpox/parasitology ; Chickenpox/therapy ; Delayed Diagnosis ; Eritrea ; Female ; Humans ; Immunization, Passive ; Infant, Newborn ; Intensive Care, Neonatal ; Malaria, Vivax/congenital ; Malaria, Vivax/diagnosis ; Malaria, Vivax/drug therapy ; Plasmodium vivax/drug effects ; Plasmodium vivax/isolation & purification ; Polymerase Chain Reaction ; Vomiting
Chemical Substances	Antimalarials
Language	English
Publishing date	2018-07-12
Publishing country	United States
Document type	Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2942-7
ISSN	1476-1645 ; 0002-9637
ISSN (online)	1476-1645
ISSN	0002-9637
DOI	10.4269/ajtmh.18-0091
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Article ; Online: Severe Plasmodium ovale malaria complicated by acute respiratory distress syndrome in a young Caucasian man

Alessandra D’Abramo / Saba Gebremeskel Tekle / Marco Iannetta / Laura Scorzolini / Alessandra Oliva / Maria Grazia Paglia / Angela Corpolongo / Emanuele Nicastri

Malaria Journal, Vol 17, Iss 1, Pp 1-

2018 Volume 5

Abstract: Abstract Background Although Plasmodium ovale is considered the cause of only mild malaria, a case of severe malaria due to P. ovale with acute respiratory distress syndrome is reported. Case presentation A 37-year old Caucasian man returning home from ... ...

Abstract	Abstract Background Although Plasmodium ovale is considered the cause of only mild malaria, a case of severe malaria due to P. ovale with acute respiratory distress syndrome is reported. Case presentation A 37-year old Caucasian man returning home from Angola was admitted for ovale malaria to the National Institute for Infectious Diseases Lazzaro Spallanzani in Rome, Italy. Two days after initiation of oral chloroquine treatment, an acute respiratory distress syndrome was diagnosed through chest X-ray and chest CT scan with intravenous contrast. Intravenous artesunate and oral doxycycline were started and he made a full recovery. Conclusion Ovale malaria is usually considered a tropical infectious disease associated with low morbidity and mortality. However, severe disease and death have occasionally been reported. In this case clinical failure of oral chloroquine treatment with clinical progression towards acute respiratory distress syndrome is described.
Keywords	Plasmodium ovale ; Malaria ; ARDS ; Chloroquine failure ; Arctic medicine. Tropical medicine ; RC955-962 ; Infectious and parasitic diseases ; RC109-216
Language	English
Publishing date	2018-04-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Imported severe malaria and risk factors for intensive care: A single-centre retrospective analysis.

D'Abramo, Alessandra / Lepore, Luciana / Iannetta, Marco / Gebremeskel Tekle, Saba / Corpolongo, Angela / Scorzolini, Laura / Bevilacqua, Nazario / Mariano, Andrea / Giancola, Maria Letizia / Vulcano, Antonella / Maritti, Micaela / Agresta, Alessandro / Antonini, Mario / D'Alessandro, Umberto / Nicastri, Emanuele

PloS one

2019 Volume 14, Issue 11, Page(s) e0225135

Abstract: Objectives: This study aims to identify the risk factors for intensive care (IC) in severe malaria patients admitted to the "Lazzaro Spallanzani" National Institute for Infectious Diseases, Rome, Italy.: Methods: All patients with confirmed severe ... ...

Abstract	Objectives: This study aims to identify the risk factors for intensive care (IC) in severe malaria patients admitted to the "Lazzaro Spallanzani" National Institute for Infectious Diseases, Rome, Italy. Methods: All patients with confirmed severe malaria and hospitalized between 2007 and 2015 were included in the analysis and stratified into two groups: those requiring IC and those who did not. Five prognostic malaria scores were estimated; clinical severity at IC unit admission was assessed using the Sequential Organ Failure Assessment and the quick-Sequential Organ Failure Assessment scores. Univariate and multivariate analysis were performed to assess factors independently associated to IC. Results: A total of 98 severe malaria patients were included; 10 of them required IC. There were no deaths or sequelae. Patients requiring IC had higher severity scores. At the multivariate analysis, only the number of World Health Organization criteria and the aspartate aminotransferase value were independently associated with the need of IC. Conclusions: An early and accurate assessment of the severity score is essential for the management of severe malaria patients.
MeSH term(s)	Adult ; Communicable Diseases, Imported/diagnosis ; Communicable Diseases, Imported/epidemiology ; Communicable Diseases, Imported/parasitology ; Comorbidity ; Critical Care ; Female ; Hospitalization ; Humans ; Intensive Care Units ; Malaria/diagnosis ; Malaria/epidemiology ; Malaria/parasitology ; Malaria/transmission ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Rome/epidemiology ; Severity of Illness Index
Language	English
Publishing date	2019-11-14
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0225135
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Article ; Online: Imported severe malaria and risk factors for intensive care

Alessandra D'Abramo / Luciana Lepore / Marco Iannetta / Saba Gebremeskel Tekle / Angela Corpolongo / Laura Scorzolini / Nazario Bevilacqua / Andrea Mariano / Maria Letizia Giancola / Antonella Vulcano / Micaela Maritti / Alessandro Agresta / Mario Antonini / Umberto D'Alessandro / Emanuele Nicastri / Spallanzani Group for Malaria Study

PLoS ONE, Vol 14, Iss 11, p e

A single-centre retrospective analysis.

2019 Volume 0225135

Abstract: OBJECTIVES:This study aims to identify the risk factors for intensive care (IC) in severe malaria patients admitted to the "Lazzaro Spallanzani" National Institute for Infectious Diseases, Rome, Italy. METHODS:All patients with confirmed severe malaria ... ...

Abstract	OBJECTIVES:This study aims to identify the risk factors for intensive care (IC) in severe malaria patients admitted to the "Lazzaro Spallanzani" National Institute for Infectious Diseases, Rome, Italy. METHODS:All patients with confirmed severe malaria and hospitalized between 2007 and 2015 were included in the analysis and stratified into two groups: those requiring IC and those who did not. Five prognostic malaria scores were estimated; clinical severity at IC unit admission was assessed using the Sequential Organ Failure Assessment and the quick-Sequential Organ Failure Assessment scores. Univariate and multivariate analysis were performed to assess factors independently associated to IC. RESULTS:A total of 98 severe malaria patients were included; 10 of them required IC. There were no deaths or sequelae. Patients requiring IC had higher severity scores. At the multivariate analysis, only the number of World Health Organization criteria and the aspartate aminotransferase value were independently associated with the need of IC. CONCLUSIONS:An early and accurate assessment of the severity score is essential for the management of severe malaria patients.
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2019-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
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Article ; Online: Risk and predictive factors of prolonged viral RNA shedding in upper respiratory specimens in a large cohort of COVID-19 patients admitted to an Italian reference hospital.

Mondi, Annalisa / Lorenzini, Patrizia / Castilletti, Concetta / Gagliardini, Roberta / Lalle, Eleonora / Corpolongo, Angela / Valli, Maria Beatrice / Taglietti, Fabrizio / Cicalini, Stefania / Loiacono, Laura / Di Gennaro, Francesco / D'Offizi, Gianpiero / Palmieri, Fabrizio / Nicastri, Emanuele / Agrati, Chiara / Petrosillo, Nicola / Ippolito, Giuseppe / Vaia, Francesco / Girardi, Enrico /

Capobianchi, Maria Rosaria / Antinori, Andrea / Zito, Sara / Abbonizio, Maria Alessandra / Abdeddaim, Amina / Agostini, Elisabetta / Albarello, Fabrizio / Amadei, Gioia / Amendola, Alessandra / Antonica, Maria Assunta / Antonini, Mario / Bartoli, Tommaso Ascoli / Baldini, Francesco / Barbaro, Raffaella / Bartolini, Barbara / Bellagamba, Rita / Benigni, Martina / Bevilacqua, Nazario / Biava, Gianluigi / Bibas, Michele / Bordi, Licia / Bordoni, Veronica / Boumis, Evangelo / Branca, Marta / Buonomo, Rosanna / Busso, Donatella / Camici, Marta / Campioni, Paolo / Canichella, Flaminia / Capone, Alessandro / Caporale, Cinzia / Caraffa, Emanuela / Caravella, Ilaria / Carletti, Fabrizio / Cataldo, Adriana / Cerilli, Stefano / Cerva, Carlotta / Chiappini, Roberta / Chinello, Pierangelo / Cianfarani, Maria Assunta / Ciaralli, Carmine / Cimaglia, Claudia / Cinicola, Nicola / Ciotti, Veronica / Colavita, Francesca / Cristofaro, Massimo / Curiale, Salvatore / D'Abramo, Alessandra / Dantimi, Cristina / De Angelis, Alessia / De Angelis, Giada / De Palo, Maria Grazia / De Zottis, Federico / Di Bari, Virginia / Di Lorenzo, Rachele / Di Stefano, Federica / Donno, Davide / Evangelista, Francesca / Faraglia, Francesca / Farina, Anna / Ferraro, Federica / Fiorentini, Lorena / Frustaci, Andrea / Fusetti, Matteo / Galati, Vincenzo / Gallì, Paola / Garotto, Gabriele / Gaviano, Ilaria / Tekle, Saba Gebremeskel / Giancola, Maria Letizia / Giansante, Filippo / Giombini, Emanuela / Granata, Guido / Greci, Maria Cristina / Grilli, Elisabetta / Grisetti, Susanna / Gualano, Gina / Iacomi, Fabio / Iaconi, Marta / Iannicelli, Giuseppina / Inversi, Carlo / Lamanna, Maria Elena / Lanini, Simone / Lapa, Daniele / Lepore, Luciana / Libertone, Raffaella / Lionetti, Raffaella / Liuzzi, Giuseppina / Lucia, Andrea / Lufrani, Franco / Macchione, Manuela / Maffongelli, Gaetano / Marani, Alessandra / Marchioni, Luisa / Mariano, Andrea / Marini, Maria Cristina / Maritti, Micaela / Mastrobattista, Annelisa / Mastrorosa, Ilaria / Matusali, Giulia / Mazzotta, Valentina / Mencarini, Paola / Meschi, Silvia / Messina, Francesco / Micarelli, Sibiana / Mogavero, Giulia / Montalbano, Marzia / Montaldo, Chiara / Mosti, Silvia / Murachelli, Silvia / Musso, Maria / Nardi, Michela / Navarra, Assunta / Nocioni, Martina / Noto, Pasquale / Noto, Roberto / Oliva, Alessandra / Onnis, Ilaria / Ottou, Sandrine / Palazzolo, Claudia / Pallini, Emanuele / Palombi, Giulio / Pareo, Carlo / Passeri, Virgilio / Pelliccioni, Federico / Penna, Giovanna / Petrecchia, Antonella / Petrone, Ada / Pianura, Elisa / Pinnetti, Carmela / Pisciotta, Maria / Piselli, Pierluca / Pittalis, Silvia / Pontarelli, Agostina / Proietti, Costanza / Puro, Vincenzo / Ramazzini, Paolo Migliorisi / Rianda, Alessia / Rinonapoli, Gabriele / Rosati, Silvia / Rubino, Dorotea / Rueca, Martina / Ruggeri, Alberto / Sacchi, Alessandra / Sampaolesi, Alessandro / Sanasi, Francesco / Santagata, Carmen / Scarabello, Alessandra / Scarcia, Silvana / Schininà, Vincenzo / Scognamiglio, Paola / Scorzolini, Laura / Stazi, Giulia / Strano, Giacomo / Taibi, Chiara / Taloni, Giorgia / Nardi, Tetaj / Tonnarini, Roberto / Topino, Simone / Tozzi, Martina / Vairo, Francesco / Vergori, Alessandra / Vincenzi, Laura / Visco-Comandini, Ubaldo / Vita, Serena / Vittozzi, Pietro / Zaccarelli, Mauro / Zanetti, Antonella

International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases

2021 Volume 105, Page(s) 532–539

Abstract: Background: Limited data are available about the predictors and outcomes associated with prolonged SARS-CoV-2 RNA shedding (VS).: Methods: A retrospective study including COVID-19 patients admitted to an Italian hospital between March 1 and July 1, ... ...

Abstract	Background: Limited data are available about the predictors and outcomes associated with prolonged SARS-CoV-2 RNA shedding (VS). Methods: A retrospective study including COVID-19 patients admitted to an Italian hospital between March 1 and July 1, 2020. Predictors of viral clearance (VC) and prolonged VS from the upper respiratory tract were assessed by Poisson regression and logistic regression analyses. The causal relation between VS and clinical outcomes was evaluated through an inverse probability weighted Cox model. Results: The study included 536 subjects. The median duration of VS from symptoms onset was 18 days. The estimated 30-day probability of VC was 70.2%. Patients with comorbidities, lymphopenia at hospital admission, or moderate/severe respiratory disease had a lower chance of VC. The development of moderate/severe respiratory failure, delayed hospital admission after symptoms onset, baseline comorbidities, or D-dimer >1000ng/mL at admission independently predicted prolonged VS. The achievement of VC doubled the chance of clinical recovery and reduced the probability of death/mechanical ventilation. Conclusions: Respiratory disease severity, comorbidities, delayed hospital admission and inflammatory markers negatively predicted VC, which resulted to be associated with better clinical outcomes. These findings highlight the importance of prompt hospitalization of symptomatic patients, especially where signs of severity or comorbidities are present.
MeSH term(s)	Adult ; Aged ; COVID-19/virology ; Cohort Studies ; Female ; Humans ; Male ; Middle Aged ; Proportional Hazards Models ; RNA, Viral/analysis ; Respiratory System/virology ; SARS-CoV-2/isolation & purification ; Severity of Illness Index ; Time Factors ; Virus Shedding
Chemical Substances	RNA, Viral
Language	English
Publishing date	2021-03-03
Publishing country	Canada
Document type	Journal Article
ZDB-ID	1331197-9
ISSN	1878-3511 ; 1201-9712
ISSN (online)	1878-3511
ISSN	1201-9712
DOI	10.1016/j.ijid.2021.02.117
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Article ; Online: Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000–17

Kirsten E Wiens / Paulina A Lindstedt / Brigette F Blacker / Kimberly B Johnson / Mathew M Baumann / Lauren E Schaeffer / Hedayat Abbastabar, Sr / Foad Abd-Allah / Ahmed Abdelalim / Ibrahim Abdollahpour / Kedir Hussein Abegaz / Ayenew Negesse Abejie / Lucas Guimarães Abreu / Michael R M Abrigo / Ahmed Abualhasan / Manfred Mario Kokou Accrombessi / Dilaram Acharya / Maryam Adabi / Abdu A Adamu /

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Athari, Sr / Seyyede Masoume Athari / Sachin R Atre / Marcel Ausloos / Nefsu Awoke / Beatriz Paulina Ayala Quintanilla / Getinet Ayano / Martin Amogre Ayanore, Sr / Yared Asmare Aynalem IV / Samad Azari / Peter S Azzopardi / Ebrahim Babaee / Tesleem Kayode Babalola / Alaa Badawi, Sr / Mohan Bairwa / Shankar M Bakkannavar / Senthilkumar Balakrishnan / Ayele Geleto Bali / Maciej Banach, Sr / Joseph Adel Mattar Banoub, Sr / Aleksandra Barac / Till Winfried Bärnighausen / Huda Basaleem / Sanjay Basu / Vo Dinh Bay / Mohsen Bayati / Estifanos Baye / Neeraj Bedi / Mahya Mahya Beheshti Beheshti / Masoud Behzadifar / Meysam Behzadifar / Bayu Begashaw Bekele / Yaschilal Muche Belayneh / Michellr L Bell, Sr / Derrick A Bennett, Sr / Dessalegn Ajema Berbada / Robert S Bernstein / Anusha Ganapati Bhat, Sr / Krittika Bhattacharyya, Sr / Suraj Bhattarai / Soumyadeep Bhaumik / Zulfiqar A Bhutta / Ali Bijani / Boris Bikbov / Binyam Minuye Birihane IV / Raaj Kishore Biswas / Somayeh Bohlouli / Hunduma 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/ Ali Yadollahpour / Seyed Hossein Yahyazadeh Jabbari / Tomohide Yamada, Sr / Hiroshi Yatsuya / Alex Yeshaneh / Christopher Sabo Yilgwan / Mekdes Tigistu Yilma / Paul Yip, Sr / Engida Yisma / Naohiro Yonemoto, Sr / Seok-Jun Yoon / Mustafa Z Younis / Mahmoud Yousefifard / Hebat-Allah Salah A Yousof / Chuanhua Yu / Hasan Yusefzadeh / Siddhesh Zadey / Zoubida Zaidi / Sojib Bin Zaman / Mohammad Zamani / Hamed Zandian / Nejimu Biza Zepro / Taddese Alemu Zerfu / Yunquan Zhang / Xiu-Ju George Zhao / Arash Ziapour / Sanjay Zodpey, Sr / Yves Miel H Zuniga / Simon I Hay / Robert C Reiner, Jr

The Lancet Global Health, Vol 8, Iss 8, Pp e1038-e

2020 Volume 1060

Abstract: Summary: Background: Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 ... ...

Abstract	Summary: Background: Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods: We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000–17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2·5th and 97·5th percentiles of those 250 draws. Findings: While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62·6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000–7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910–68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation: To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers' understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage. Funding: Bill & Melinda Gates Foundation.
Keywords	Public aspects of medicine ; RA1-1270
Subject code	310
Language	English
Publishing date	2020-08-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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