Coinfections and comorbidities in African health systems: At the interface of infectious and noninfectious diseases

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Term Occurence Count Dictionary
diphtheria 1 infectiousdiseases
infectious disease 44 infectiousdiseases
malaria 17 infectiousdiseases
tetanus 1 infectiousdiseases
onchocerciasis 1 infectiousdiseases
schistosomiasis 1 infectiousdiseases
syphilis 1 infectiousdiseases
tuberculosis 4 infectiousdiseases
AIDS 6 infectiousdiseases
filariasis 2 infectiousdiseases
hepatitis B 1 infectiousdiseases
meningitis 1 infectiousdiseases

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AIDS 11193 malaria severity, although small.2010lsa, Gwamzhi et al., 2010 [[27]]Hepatitis B and C viruses–HIV/ AIDS Impact on causing hepatotoxicity.Sangweme, Midzi et al., 2010 [[28]]Schistosomiasis–MalariaHigher peripheral
AIDS 11577 load, increasing disease progression.2012Ntusi, Badri et al., 2012 [[30]]Acinetobacter baumannii–HIV/ AIDS Increased mortality.Faurholt-Jepsen, Range et al., 2012 [[31]]Tuberculosis–DiabetesPoor treatment outcomes
AIDS 12385 [[35]]Podoconiosis–Soil-transmitted helminthsIncreased blood losses/anaemia.2014Baldassarre, Mdodo et al., 2014 [[36]]HIV/ AIDS –Cryptococcal meningitisIncreased mortality.Knight, Muloiwa et al., 2014 [[37]]HIV–Stevens Johnson
AIDS 13644 coinfection or comorbidity to a secondary health impact published in the last 10 years.Abbreviations: AIDS , acquired immune deficiency syndrome; BCG, Bacillus Calmette–Guérin; CD4+, cluster of differentiation
AIDS 19342 hospitals.Recurrent strikes by doctors, problems with financing health systems, high cost of health services, HIV/ AIDS and malaria alone consumes the greatest part of resources.[[65]]UgandaVillage health teams and community
AIDS 23255 interventions are essential for long-term patient care. The success of HIV management, including the UN AIDS HIV 90:90:90 care continuum [[62]], relies on adherence to prescribed medicines, long-term follow up
diphtheria 36275 coadministration of the childhood vaccinations against influenza type B, whooping cough, tetanus, hepatitis B, and diphtheria as a single formulation (Pentavalent) [[103]] increases compliance. There are already indications that
filariasis 15011 noninfectious diseases like diabetes become key [[46]], requiring long-term management and care.Lymphatic filariasis and onchocerciasis pose a serious public health problem in Africa, causing long-term chronic infection
filariasis 15182 Africa, causing long-term chronic infection with permanent and long-term disability [[47]]. In human filariasis infections, coinfections with other infectious diseases is common and can affect protective immune responses
hepatitis B 36258 example, coadministration of the childhood vaccinations against influenza type B, whooping cough, tetanus, hepatitis B , and diphtheria as a single formulation (Pentavalent) [[103]] increases compliance. There are already
infectious disease 135 DiseasesCoinfections and comorbidities in African health systems: At the interface of infectious and non infectious disease sDerick Nii Mensah OsakunorDavid Moinina SengehFrancisca Mutapi [1]Centre for Infection, Immunity and
infectious disease 896 9/2018AbstractThere is a disease epidemiological transition occurring in Africa, with increasing incidence of non infectious disease s, superimposed on a health system historically geared more toward the management of communicable diseases.
infectious disease 1169 pathogens allows for the occurrence of coinfections and comorbidities due to both infectious and non infectious disease s. There is therefore a need to rethink and restructure African health systems to successfully address
infectious disease 1356 health systems to successfully address this transition. The historical focus of more health resources on infectious disease s requires revision. We hypothesise that the growing burden of noninfectious diseases may be linked directly
infectious disease 1440 health resources on infectious diseases requires revision. We hypothesise that the growing burden of non infectious disease s may be linked directly and indirectly to or further exacerbated by the existence of neglected tropical
infectious disease 1589 indirectly to or further exacerbated by the existence of neglected tropical diseases (NTDs) and other infectious disease s within the population. Herein, we discuss the health burden of coinfections and comorbidities and the
infectious disease 1823 to implementing effective and sustainable healthcare in Africa. We also discuss how existing NTD and infectious disease intervention programs in Africa can be leveraged for noninfectious disease intervention. Furthermore,
infectious disease 1898 discuss how existing NTD and infectious disease intervention programs in Africa can be leveraged for non infectious disease intervention. Furthermore, we explore the potential for new technologies—including artificial intelligence
infectious disease 2299 disability-adjusted life years (DALYs) and cause of death in Africa include both infectious and non infectious disease s, with the amount of DALYs contributed by noninfectious diseases almost catching up to those of infectious
infectious disease 2363 Africa include both infectious and noninfectious diseases, with the amount of DALYs contributed by non infectious disease s almost catching up to those of infectious diseases [[1]]. What these data do not indicate is the level
infectious disease 2414 diseases, with the amount of DALYs contributed by noninfectious diseases almost catching up to those of infectious disease s [[1]]. What these data do not indicate is the level of comorbidity within the population, a reflection
infectious disease 2786 particular, when reporting causes of death, the contribution of comorbidities arising from infectious and non infectious disease s is not reported. Population studies indicate that several tropical infectious diseases show common
infectious disease 2873 infectious and noninfectious diseases is not reported. Population studies indicate that several tropical infectious disease s show common epidemiological patterns with age and share risk factors, including poor sanitation and
infectious disease 3845 with the most common NTDs being helminth parasites [[4]]. Helminths have been implicated in several non infectious disease s including endomyocardial fibrosis [[5]], hypertension [[6], [7]], iron deficiency anaemia [[8]], and
infectious disease 4118 1Adapted maps of Africa showing the overlap of neglected tropical diseases (NTDs), infectious, and non infectious disease s.The figure shows (A) pathogeographic patterns of 187 global human infectious diseases [[3]], (B) patterns
infectious disease 4204 infectious, and noninfectious diseases.The figure shows (A) pathogeographic patterns of 187 global human infectious disease s [[3]], (B) patterns of the six most common neglected tropical diseases [[4]], (C) burden of the most
infectious disease 4424 frequently diagnosed cancer among males [[10]], and (D) probability of dying from the four main non infectious disease s between the ages of 30 and 70 years [[11]]. Infectious diseases show distinct spatial patterns (A),
infectious disease 4682 neglected tropical diseases (B), commonly diagnosed cancers (C), and the mortality rates from major non infectious disease s including cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes (D).In a recent
infectious disease 5856 M.In addition to diseases arising from infectious pathogens, there is also an increase in chronic non infectious disease s, including high blood pressure, cardiovascular diseases, diabetes, and cancer. Direct and indirect
infectious disease 6014 cardiovascular diseases, diabetes, and cancer. Direct and indirect interactions between infectious and non infectious disease s have been poorly studied, particularly in African settings. For instance, there are now suggestions
infectious disease 7304 manage multiple and chronic conditions. In this review, we hypothesise that the growing burden of non infectious disease s may be linked directly/indirectly, or further compounded by the existence of NTDs and other infectious
infectious disease 7416 diseases may be linked directly/indirectly, or further compounded by the existence of NTDs and other infectious disease s. We explore the challenges/barriers to implementing effective and consistent healthcare in SSA in the
infectious disease 7614 healthcare in SSA in the face of the observed disease trends. We discuss how existing NTDs and other infectious disease intervention programmes and infrastructure can be leveraged for noninfectious disease intervention,
infectious disease 7700 NTDs and other infectious disease intervention programmes and infrastructure can be leveraged for non infectious disease intervention, diagnosis, and long-term management of diseases, for improved health provision in Africa.MethodologyA
infectious disease 13906 diseases to chronic conditionsIn addition to communicable diseases, there is an increasing burden of non infectious disease s such as hypertension, stroke, cancer, and diabetes in the SSA region. This concurrent health challenge
infectious disease 14165 progress in the control of infection and malnutrition, if at all [[42], [43]]. The insurgence of non infectious disease s is a “time bomb” for Africa, with the region expected to record the world’s largest increase
infectious disease 14290 “time bomb” for Africa, with the region expected to record the world’s largest increase in non infectious disease deaths by 2030 [[44]]. Already, countries in northern and southern Africa account for more than three
infectious disease 14460 northern and southern Africa account for more than three quarters and close to a half of all deaths to non infectious disease s, respectively [[45]].HIV is now a chronic infection; increased access to antiretroviral therapy (ART)
infectious disease 14908 50-year-old patients living with chronic HIV, and the impact of HIV and ageing on the acquisition of non infectious disease s like diabetes become key [[46]], requiring long-term management and care.Lymphatic filariasis and onchocerciasis
infectious disease 15229 permanent and long-term disability [[47]]. In human filariasis infections, coinfections with other infectious disease s is common and can affect protective immune responses for infections like malaria and tuberculosis (TB)
infectious disease 15653 diseases.While there are many risk factors associated with the growing number of cancers in Africa, infectious disease s play a significant role (Fig 3). About a third of new cancers in Africa are due to viral, bacterial,
infectious disease 15867 bacterial, or parasitic infections [[49]]. The implication of this increasing comorbidity of cancer and infectious disease s in Africa means that disease screening, diagnosis, treatment, and care need to be revised to determine
infectious disease 16194 burden [[50]]. At the same time, although previously rare, diabetes has emerged as an important non infectious disease in SSA [[51]]. Such metabolic diseases are currently affecting individuals at a much younger age than
infectious disease 16686 societal approaches such as those that have been used in public health educational/awareness campaigns for infectious disease s, notably HIV, will have to be implemented.The socioeconomic and cultural environment around this current
infectious disease 16898 this current epidemiologic situation in SSA differs from that in most Western countries. In SSA, non infectious disease s were not anticipated, were accompanied by cultural misconceptions, and have historically received less
infectious disease 22291 resources. Lack of available health data countrywide.[[69]]The coexistence of multiple infectious and non infectious disease s, characterised by multiple comorbidities, presents unique problems for healthcare delivery in SSA.
infectious disease 22485 healthcare delivery in SSA. From the simulated global economic output losses of US$47 trillion from non infectious disease s over the next few decades [[60]], low- and middle-income countries are unlikely to be equipped to bear
infectious disease 28005 comorbidities. Knowledge, attitude, and practice (KAP) studies, including those on both infectious [[79]] and non infectious disease s [[80]], indicate that poor knowledge is associated with practices that increase risk of disease or
infectious disease 33635 solutionsLeveraging existing platforms within health systems for disease controlAfrica can leverage the successes of infectious disease control programmes to address the increasing burden of noninfectious and chronic diseases. These must
infectious disease 35169 decentralised community-based hypertension care has been adapted from HIV management [[98]].Control of infectious disease s can also be integrated for greater health impact as exemplified by antihelminthic treatment. Schistosomiasis
infectious disease 40487 Africa to develop treatments for conditions including infectious (e.g., tuberculosis and malaria) and non infectious disease s (e.g., cardiovascular disease) [[115]]. Guidelines, drugs, and appropriate monitoring equipment also
infectious disease 42945 should be willing to incorporate findings from such studies and to prioritize both infectious and non infectious disease s management.Key learning pointsThere is an epidemiological transition in sub-Saharan Africa (SSA), with
infectious disease 43179 insurgence of coinfection and comorbidities from both infectious/neglected tropical diseases (NTDs) and non infectious disease s.Health systems in SSA are ill equipped to deal with this in terms of diagnosis, intervention, and long-term
infectious disease 43676 success stories or interventions in the management of infectious and NTDs in SSA can be leveraged for non infectious disease s, addressing coinfections and comorbidities.Top five papersWoolhouse ME, Thumbi SM, Jennings A, Chase-Topping
malaria 11092 tumoursIncreased mortality.Degarege, Animut et al., 2009 [[26]]Malaria–Soil-transmitted helminthsImpact on malaria severity, although small.2010lsa, Gwamzhi et al., 2010 [[27]]Hepatitis B and C viruses–HIV/AIDSImpact
malaria 11314 hepatotoxicity.Sangweme, Midzi et al., 2010 [[28]]Schistosomiasis–MalariaHigher peripheral blood malaria parasite density, promoting transmission.Modjarrad and Vermund 2010 [[29]]HIV–Tuberculosis–SyphilisTuberculosis
malaria 12634 necrolysisIncreased risk of systemic bacterial infection and mortality.Biraro, Egesa et al., 2014 [[38]]Helminths, malaria , or HIV coinfection in household contacts of Tuberculosis patientsNo evidence of increased risk to latent
malaria 15322 other infectious diseases is common and can affect protective immune responses for infections like malaria and tuberculosis (TB) [[48]]. Chronic long-term management of filarial infections thus become a very
malaria 19351 strikes by doctors, problems with financing health systems, high cost of health services, HIV/AIDS and malaria alone consumes the greatest part of resources.[[65]]UgandaVillage health teams and community medicine
malaria 24227 support clinical symptoms may be lacking. For example, in Tanzania, less than 50% of patients with severe malaria (based on WHO clinical criteria) were laboratory confirmed [[70]], and in Ghana, 40% of such patients
malaria 24385 confirmed [[70]], and in Ghana, 40% of such patients were confirmed to have bacterial sepsis and not malaria [[71]]. Conditions like anaemia, which are common in areas coendemic for different pathogens, still
malaria 24711 conditions are still not diagnosed, e.g., in 15% of Kenyan children with a clinical history of anaemia or malaria , haemoglobin levels were not measured [[72]]. Where there are diagnostic tests available, their utility
malaria 31331 inform dosage, and the impact on drug resistance and treatment efficacy. For instance, experience from malaria intervention programmes shows that treatment regimen depends on the target species [[88]], and our recent
malaria 31528 [[88]], and our recent studies indicated that repeated treatment was required in multi-Plasmodium species malaria -infected individuals when compared to individuals with single species infection (Amanfo and colleagues,
malaria 31816 clinical diagnosis against laboratory evidence, treating symptoms instead of causes. For example, in malaria endemic areas, fever may not always be malaria [[74]], and in the advent of rapid diagnostic tests (RDTs),
malaria 31863 treating symptoms instead of causes. For example, in malaria endemic areas, fever may not always be malaria [[74]], and in the advent of rapid diagnostic tests (RDTs), even in hard to reach areas, majority of
malaria 32053 areas, majority of these tests may come out negative; in 2014, about 142 million suspected cases of malaria tested negative worldwide [[89]]. With similar tests lacking for other diseases that cause fever, health
malaria 35317 greater health impact as exemplified by antihelminthic treatment. Schistosomiasis has been linked to malaria infection in children [[99]], and schistosomiasis treatment in areas where malaria is coendemic has
malaria 35400 has been linked to malaria infection in children [[99]], and schistosomiasis treatment in areas where malaria is coendemic has been shown to reduce malaria transmission [[100]]. Anthelimintic treatment, in addition
malaria 35446 [[99]], and schistosomiasis treatment in areas where malaria is coendemic has been shown to reduce malaria transmission [[100]]. Anthelimintic treatment, in addition to killing the parasites, has been shown
malaria 40471 scientists from Africa to develop treatments for conditions including infectious (e.g., tuberculosis and malaria ) and noninfectious diseases (e.g., cardiovascular disease) [[115]]. Guidelines, drugs, and appropriate
meningitis 12405 helminthsIncreased blood losses/anaemia.2014Baldassarre, Mdodo et al., 2014 [[36]]HIV/AIDS–Cryptococcal meningitis Increased mortality.Knight, Muloiwa et al., 2014 [[37]]HIV–Stevens Johnson syndrome–Toxic epidermal
onchocerciasis 15026 diseases like diabetes become key [[46]], requiring long-term management and care.Lymphatic filariasis and onchocerciasis pose a serious public health problem in Africa, causing long-term chronic infection with permanent and
schistosomiasis 35359 antihelminthic treatment. Schistosomiasis has been linked to malaria infection in children [[99]], and schistosomiasis treatment in areas where malaria is coendemic has been shown to reduce malaria transmission [[100]].
syphilis 11442 promoting transmission.Modjarrad and Vermund 2010 [[29]]HIV–Tuberculosis–SyphilisTuberculosis and syphilis may increase HIV viral load, increasing disease progression.2012Ntusi, Badri et al., 2012 [[30]]Acinetobacter
tetanus 36249 For example, coadministration of the childhood vaccinations against influenza type B, whooping cough, tetanus , hepatitis B, and diphtheria as a single formulation (Pentavalent) [[103]] increases compliance. There
tuberculosis 15334 infectious diseases is common and can affect protective immune responses for infections like malaria and tuberculosis (TB) [[48]]. Chronic long-term management of filarial infections thus become a very important component
tuberculosis 24918 utility may be compromised by the lack of a reference standard test, as occurs in childhood peritoneal tuberculosis (CPTB). In a modelling analysis of five different methods, including the sensitive mycobacterial cultures,
tuberculosis 34287 engagement and education, mass drug campaigns for NTD interventions, and maintaining compliance to HIV and tuberculosis treatment. For example, in a population with a high prevalence of HIV, Chibanda and colleagues initiated
tuberculosis 40454 training local scientists from Africa to develop treatments for conditions including infectious (e.g., tuberculosis and malaria) and noninfectious diseases (e.g., cardiovascular disease) [[115]]. Guidelines, drugs, and

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