Papers by Vincenzo Racalbuto
The American Journal of Tropical Medicine and Hygiene
The nutrition situation in Sudan is one of the worst in northeast Africa and it is characterized ... more The nutrition situation in Sudan is one of the worst in northeast Africa and it is characterized by persistently high levels of acute and chronic malnutrition that have increased over the last two decades. The underlying causes of malnutrition are multi-sectoral and are mainly due to inequalities, inadequate food practices, and limited access to healthcare services. Based on the report The Economic and Social Impacts of Child Undernutrition in Sudan, this study assesses the impact that malnutrition has on health, education, and productivity in Sudan. The country is estimated to have lost an equivalent of about 11.6 billion Sudanese pound in 2014, which represented 2.6% of the gross domestic product (GDP). Productivity-related losses contributed the largest costs at 1.5% of GDP followed by health and education sectors at 1.1% and 0.1%, respectively. In 2020, the outbreak of the COVID-19 pandemic further exposed the fragility of Sudan's health, social, and economic system. It is mandatory that all stakeholders address child nutrition as a main concern and stunting is incorporated in the center of the development agenda. In particular, the national development frameworks should be updated to ensure the reduction of the stunting prevalence and to put in place a comprehensive multi-sectoral nutrition policy, strategy, and plan of action.
Abstract: Patent pools for second and third-line Fixed Dose Combination (FDC) antiretroviral drug... more Abstract: Patent pools for second and third-line Fixed Dose Combination (FDC) antiretroviral drugs (ARVs) should not be delayed as they are instrumental to urgent public health needs in the under-served markets. Nonetheless, multinational originator companies still seem to perceive patent pooling for ARVs as a minefield that would offer the generic competitors lots of deeply exploitable opportunities, to the detriment of patent owner’s rights. This paper analyses the brand industry concerns, while looking for a strategy up to a really equitable and free world market, without any discrimination between end-users in wealthy and resource-limited countries. This strategy would urge partnerships between originator companies first to make newer FDC ARVs quickly available and allow patent pool agreements with generic counterparts to be negotiated straight afterwards. The patent pool strategy highlighted in this paper would assert the primacy of health over for-profit policies, while aligni...
Sexuality & Culture, 2021
The World Health Organisation (WHO) defines female genital mutilation or cutting (FGM/C) as a vio... more The World Health Organisation (WHO) defines female genital mutilation or cutting (FGM/C) as a violation of human rights and includes all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons. Sudan has one of the highest rates of FGM/C in the world with 86.6% girls and women aged between 15-49 years affected. Although FGM/C is still widely practiced across all of Sudan, social attitudes and norms towards the practice are changing, especially in urban areas. On 22 April 2020, the transitional Sudanese government criminalised FGM/C in Sudan when the Sovereign and Ministerial Councils endorsed the amendment to Criminal Law Article 141. Sudan is beginning a new era in terms of FGM/C. In order to achieve effective and long-lasting effects, efficient mechanisms, specifically allocated financial resources, and broader partnerships that include governmental bodies, civil society, community-based organisations, and international actors, must be put in place.
Acta Paediatrica, 2021
AimMalnutrition is a major public health issue that has been associated with high susceptibility ... more AimMalnutrition is a major public health issue that has been associated with high susceptibility for impaired brain development and mental functioning. However, to date studies on this topic have not been collated and appraised. This systematic review and meta‐analysis investigated the association between malnutrition and cognitive development.MethodsWe searched the MEDLINE, Scopus, CINAHL, Embase PsycINFO and Cochrane Library databases in English up to 8 December 2020. All studies reporting an association between nutritional status and cognitive development were included. p values of less than 0.05 were considered statistically significant and the results are reported as standardised mean differences (SMD), 95% confidence intervals (95%) and I2 statistics.ResultsWe included 12 studies comprising 7,607 participants aged 1 to 12 years. Children with malnutrition had worse scores than controls for the Wechsler Intelligence Scale (SMD −0.40; 95% CI −0.60 to −0.20; p < 0.0001; I2 77....
Italian Journal of Pediatrics, 2020
Background An epidemiological transition is interesting Sub-Saharan Africa increasing the burden ... more Background An epidemiological transition is interesting Sub-Saharan Africa increasing the burden of non-communicable diseases most of which are of surgical interest. Local resources are far from meeting needs and, considering that 50% of the population is less than 14 years of age, Pediatric surgical coverage is specially affected. Efforts are made to improve standards of care and to increase the number of Pediatric surgeons through short-term specialist surgical Missions, facilities supported by humanitarian organization, academic Partnership, training abroad of local surgeons. This study is a half term report about three-years Partnership between the University of Chieti- Pescara, Italy and the University of Gezira, Sudan to upgrade standard of care at the Gezira National Centre for Pediatric Surgery (GNCPS) of Wad Medani. Four surgical Teams per year visited GNCPS. The Program was financed by the Italian Agency for Development Cooperation. Methods The state of local infrastructur...
Frontiers in Public Health, 2020
The COVID-19 outbreak was declared by the World Health Organization (WHO) as global pandemic in M... more The COVID-19 outbreak was declared by the World Health Organization (WHO) as global pandemic in March 2020. Considering the necessity to implement rapid response to control the pandemic and the fragility and the state of need of low income countries, it will be mandatory to develop a global approach in order to reduce the spread of infection and the creation of community viral reservoirs. So far, we could hypothesize a worst case scenario in which when the COVID-19 outbreak hits a peak in Africa and in low-income countries, the majority of such countries will be unprepared, with low resources allocated for affording the viral emergency and the consequences will be catastrophic with no lesson learnt. In the best case scenario, the COVID-19 will not affect Africa or South America on a large scale and, if the prevention measures will be implemented, we could register a lower incidence of hygiene linked diseases that still represent leading causes of death.
International Journal of Environmental Research and Public Health, 2020
At the end of 2019 a novel virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), c... more At the end of 2019 a novel virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing severe acute respiratory syndrome expanded globally from Wuhan, China. In March 2020 the World Health Organization declared the SARS-Cov-2 virus a global pandemic. We performed a narrative review to describe existing literature with regard to Corona Virus Disease 2019 (COVID-19) epidemiology, pathophysiology, diagnosis, management and future perspective. MEDLINE, EMBASE and Scopus databases were searched for relevant articles. Although only when the pandemic ends it will be possible to assess the full health, social and economic impact of this global disaster, this review represents a picture of the current state of the art. In particular, we focus on public health impact, pathophysiology and clinical manifestations, diagnosis, case management, emergency response and preparedness.
The American Journal of Tropical Medicine and Hygiene, 2009
The study was aimed to evaluate the malaria over/underdiagnosis and over/underprescription of ant... more The study was aimed to evaluate the malaria over/underdiagnosis and over/underprescription of antimalarial drugs. Between February and March 2007 blood samples were collected from 336 non-severe febrile outpatients attended in two peripheral Tanzanian hospitals. Microscopy and a rapid diagnostic test (RDT) were done locally and the accuracy evaluated by qualitative polymerase chain reaction (PCR) for Plasmodium spp. The testing was performed at National Institute for Infectious Diseases Lazzaro Spallanzani (INMI), Rome, Italy. As a result of PCR, we identified 26 malaria cases out of 336 (7.7%) patients. Microscopy and RDT accuracies were 93.5% and 97.6%, respectively. Overprescription and underdiagnosis rates were 29.3% and 30.8%, respectively. On-field training, clinical management of febrile illness, and malaria microscopy in remote settings should be considered.
International Journal of Dermatology, 2010
The aim of this fourth edition is to update knowledge of health and non-health professionals and ... more The aim of this fourth edition is to update knowledge of health and non-health professionals and to generate debate on in-depth strategies for increasing the availability and affordability of health care in developing countries, where poverty diseases are often neglected. The specific objectives of the Congress will be: • To update knowledge on key global health issues, such as poverty-related diseases, HIV, STIs, and neglected tropical diseases. • To explore innovative methods to use, at best, limited human and economic resources available to address health problems. • To promote sustainable highly effective, low-cost public health services and health care training in developing countries.
The diagnosis of schistosomiasis is usually based on clinical data associated with the detection ... more The diagnosis of schistosomiasis is usually based on clinical data associated with the detection of eggs in stool, urine, and/or rectal and bladder biopsy specimens. However antibody detection can be useful to indicate Schistosoma infection in those for whom eggs cannot be demonstrated. The aim of this study was to assess the seroprevalence of schistosomiasis and to evaluate the accuracy of indirect haemagglutination (IHA) and Western blot (WB) assays for the detection of anti-Schistosoma antibodies in 2 peripheral hospitals of the United Republic of Tanzania. Between February and March 2007 blood samples were collected from 297 non-severe febrile outpatients who attended Chake Chake Hospital, Pemba Island and Tosamaganga Hospital, Iringa region in Tanzania. The samples were processed for Schistosoma antibodies by IHA and WB assays in Italy. Two hundred and sixty-two of 297 patients were schistosomiasis antibody-positive by IHA (88.2%). Of 142 patients positive by IHA, only 22 (12.4%) cases were confirmed by WB assay. The WB assay confirmed all 35 negative cases previously identified by IHA. The seroprevalence of Schistosoma at Chake Chake Hospital was lower than in Tosamaganga Hospital (9/97, 9.3% vs 13/80, 16.2%). Schistosomiasis is endemic in Tanzania, being more prevalent on the mainland than on Pemba Island. The implications of this study are of public health relevance and suggest the need for increased efforts in large-scale chemotherapy-based morbidity control programmes, integrated with those for other soil-transmitted helminthiases, in these 2 peripheral areas of the United Republic of Tanzania.
The Journal of Infection in Developing Countries, 2013
Introduction: Diagnosing tuberculosis in low-resource settings mostly relies on sputum smear micr... more Introduction: Diagnosing tuberculosis in low-resource settings mostly relies on sputum smear microscopy. Improvement through capacity building is a priority. This project aimed to strengthen tuberculosis diagnosis at an intermediate level laboratory. Methodology: The Italian National Institute for Infectious Diseases and the Italian Development Cooperation closely collaborated with regional and national institutions and reference laboratories to provide laboratory setup, equipment and reagents, personnel training, and the implementation of culture and quality assessment programs at Dodoma Regional Hospital, Dodoma, Tanzania. Results: Microscopy sensitivity was increased, personnel were trained, and culture techniques and quality assessment programs were introduced. Conclusions: Implementing tuberculosis diagnosis in resource-constrained settings is feasible and represents a basis for further strengthening.
The Open AIDS Journal, 2010
Patent pools for second and third-line Fixed Dose Combination (FDC) antiretroviral drugs (ARVs) s... more Patent pools for second and third-line Fixed Dose Combination (FDC) antiretroviral drugs (ARVs) should not be delayed as they are instrumental to urgent public health needs in the under-served markets. Nonetheless, multinational originator companies still seem to perceive patent pooling for ARVs as a minefield that would offer the generic competitors lots of deeply exploitable opportunities, to the detriment of patent owner's rights. This paper analyses the brand industry concerns, while looking for a strategy up to a really equitable and free world market, without any discrimination between end-users in wealthy and resource-limited countries. This strategy would urge partnerships between originator companies first to make newer FDC ARVs quickly available and allow patent pool agreements with generic counterparts to be negotiated straight afterwards. The patent pool strategy highlighted in this paper would assert the primacy of health over for-profit policies, while aligning with the 61 st WHO's Assembly recommendations and G7, G8 and World Trade Organisation's warnings and pledges against trade protectionism.
PLoS ONE, 2012
Low-income countries with high Tuberculosis burden have few reference laboratories able to perfor... more Low-income countries with high Tuberculosis burden have few reference laboratories able to perform TB culture. In 2006, the Zanzibar National TB Control Programme planned to decentralize TB diagnostics. The Italian Cooperation Agency with the scientific support of the ''L. Spallanzani'' National Institute for Infectious Diseases sustained the project through the implementation of a TB reference laboratory in a low-income country with a high prevalence of TB. The implementation steps were: 1) TB laboratory design according to the WHO standards; 2) laboratory equipment and reagent supplies for microscopy, cultures, and identification; 3) on-the-job training of the local staff; 4) web-and telemedicine-based supervision. From April 2007 to December 2010, 921 sputum samples were received from 40 peripheral laboratories: 120 TB cases were diagnosed. Of all the smear-positive cases, 74.2% were culture-positive. During the year 2010, the smear positive to culture positive rate increased up to 100%. In March 20, 2010 the Ministry of Health and Social Welfare of Zanzibar officially recognized the Public Health Laboratory-Ivo de Carneri as the National TB Reference Laboratory for the Zanzibar Archipelago. An advanced TB laboratory can represent a low cost solution to strengthen the TB diagnosis, to provide capacity building and mid-term sustainability.
International Journal of Infectious Diseases, 2012
Emerging Infectious Diseases, 2014
We conducted a seroprevalence survey among 500 healthy adult donors at Zanzibar National Blood Tr... more We conducted a seroprevalence survey among 500 healthy adult donors at Zanzibar National Blood Transfusion Services. Dengue virus IgG seroprevalence was 50.6% and independently associated with age and urban residence. These data will aid in building a surveillance, preparedness, and response plan for dengue virus infections in the Zanzibar Archipelago. I n eastern Africa, the available evidence indicates that dengue virus serotypes 1, 2, and 3 (DENV-1,-2,-3) are common causes of acute fever (1). A recent map of DENV transmission has shown that the virus could be transmitted in most eastern African countries, including mainland Tanzania and the Zanzibar Archipelago (2). In 2010, a PROMED report raised concerns about DENV infections in Tanzania (3). That same year, travelers from Europe and Japan were found to be infected with DENV-3 after they returned from mainland Tanzania or Zanzibar (4-6). In Tanzania, seroprevalence rates for febrile outpatients in Tosomaganga (Iringa Region) and Pemba Island (Zanzibar) in 2007 (7) and in Moshi (Arusha Region
Current HIV Research, 2007
The Lancet, 2018
Background The increasing prevalence of non-communicable diseases in the occupied Palestinan terr... more Background The increasing prevalence of non-communicable diseases in the occupied Palestinan territory accounts for a large part of general mortality. WHO recommends a 30% reduction in mean population intake of salt or sodium as a cost-effective option to decrease the burden of cardiovascular disease. Results of surveys show that salt consumption is 7 g per day in Palestine, almost 50% higher than the recommended daily amount per person. Bread is consumed in large amounts and is an important contributor to salt intake. The aim of this study was to assess the content of salt in the bread sold in the West Bank with the aim of setting a reliable salt reduction target. Methods In this cross-sectional study, ad-hoc trained inspectors from the ministry of mealth visited 135 bakeries in all West Bank's Governorates in August, 2015. Data were collected through a structured questionnaire administered to bakers with questions about the amount of salt added to flour during the preparation of 281 bread products. The sample size was calculated for a level of accuracy of 7%. Data were analysed using SPSS 17.0. Findings The average amount of salt added to flour during bread preparation was 1•33 g per 100 g of flour (SD 0•62; range 0•00-4•00), corresponding to 1•11 g salt per 100 g bread.
Eastern Mediterranean Health Journal, 2009
A case-mix hospital information system was designed and implemented in Palestine Red Crescent Soc... more A case-mix hospital information system was designed and implemented in Palestine Red Crescent Society hospitals in order to support the network of Palestinian hospitals in Lebanon and to improve the health of refugees in the country. The system is based on routine collection of essential administrative and clinical data for each episode of hospitalization, relying on internationally accepted diagnostic codes. It is a computerized, user-friendly information system that is a stepping-stone towards better hospital management and evaluation of quality of care. It is also a useful model for the development of hospital information systems in Lebanon and in the Near East.
International journal of dermatology, 2015
In Ethiopia, skin diseases are among the leading causes of outpatient attendance to primary healt... more In Ethiopia, skin diseases are among the leading causes of outpatient attendance to primary health service. Correlation of skin diseases and HIV has long been recognized and used to guide medical management in resource-limited settings. Therefore, this study aims to assess the correlation of skin diseases and HIV infection, to estimate epidemiological distribution in the study area, and to provide health workers of skin indicators for HIV early detection. The operational research was designed as a case-control study and carried out in three intervention districts of Tigray region; baseline and final data on skin diseases and HIV were compared with those of three control districts matched for population size, density, and environmental characteristics. Health workers of intervention districts were trained on skin diseases/STIs diagnosis and treatment. Data were collected from study and control districts and then analyzed at the Italian Dermatological Centre (IDC) in Mekele. In the re...
Transactions of the Royal Society of Tropical Medicine and Hygiene, 2010
Mid-way 2007 reports indicate that many low-income countries, at current rates of progress, are u... more Mid-way 2007 reports indicate that many low-income countries, at current rates of progress, are unlikely to reach the Millennium Development Goals (MDG) by 2015. In Ethiopia, a decline was observed in under-five mortality rates from 204 to 123 per 1000 live births between 1990 and 2005, showing good progress towards the achievement of MDG4. A downward trend was observed in the maternal mortality ratio; however, because of the high degree of sampling variability, it is not possible to reach any firm conclusion about the possibility of achieving MDG5. Regarding MDG6, good progress was observed in controlling HIV/AIDS and malaria, whereas MDG indicators related to tuberculosis are still below international standards. Therefore, performance was not uniform across programmes. In general, interventions that can be routinely scheduled, such as immunisation, had much higher coverage than those that rely on functional health systems and clinical services proximate to households with 24h availability, such as skilled care at birth. These mixed results highlight that, although MDGs focus on specific diseases and conditions, targets cannot be achieved without strengthening health systems. It is for this reason that the strategic health plan in Ethiopia is focusing on high-impact and cost-effective health interventions and on health systems strengthening.
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Papers by Vincenzo Racalbuto