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  • Beneficial interventions will require collaboration between

    2019-04-15

    Beneficial interventions will require collaboration between medical, veterinary, agricultural, social, environmental, and wildlife scientists. Veterinary medicine intersects with all of these disciplines and for years has promoted the concept of One Health as a technique for promotion of collaboration. The One Health Initiative, strengthened by the UN expert panel\'s recommendations, is slowly gathering momentum as the association between the health of all types of animals and poverty relief became more fully recognised. The challenges however, remain daunting.
    Maria Rodríguez and colleagues (March, p e131) posit that the term family planning is too antiquated and euphemistic to be useful and argue that it should be replaced with the more precise and scientific term contraception. We disagree that contraception is a better term and offer two simple insights to support this view. First, the anthropological and demographic literature on fertility in Africa shows that the desire for a family factors heavily in young women\'s contraceptive choices. Our own work in Kenya and Malawi provides robust evidence that sexually active young adults use contraception to plan their families. Furthermore, many young people avoid modern contraceptive methods because they fear it will compromise their future fertility. Second, Rodríguez and colleagues\' world in which all individuals make free and informed choices about contraceptive use is an imagined and profoundly western world, which ignores the social organisation of reproduction. That sex is a relational phenomenon (ie, by definition, at least one other person is included) is more than an inconvenient truth. Those lured by methodological individualism who continue to ignore men, relationships, and extended family networks do so at their own peril.
    Oriol Mitjà and colleagues provide insight into the cause of chronic angiopoietin ulcers in a yaws-endemic area of Papua New Guinea. PCR was used to detect in swabs collected from chronic skin ulcers. Conventional microbiological techniques, such as isolation of fastidious microorganisms by culture, are time-consuming and difficult. The investigators show the usefulness of the PCR technique to diagnose infection. Clinicians should consider this previously unrecognised causative agent of skin ulcer in children living in a yaws-endemic area. Sally Roberts and Susan Taylor summarise some facts on the diagnosis and treatment of skin ulcers. Accurate diagnosis and laboratory confirmation are important for clinicians to provide timely therapy. Without a point-of-care test, empirical use of antimicrobials can lead to drug resistance. Therefore, there is a need for a diagnostic technique that does not involve costly equipment and that can be used even in remote areas. The development of a multiplex loop-mediated isothermal amplification (LAMP) assay can identify many causative agents in a single reaction and within a short time, without a thermocycler and gel documentation system. Thus, LAMP could have future application as a point-of-care test for the diagnosis of chronic skin ulcers.
    We thank Sapna Pahil and Kapil Goyal for their interest in our work. Our research has identified a previously unrecognised cause of skin ulcers in the tropics, namely . Although there had been several case reports implicating this organism as a causative agent of chronic skin ulceration, we show that this is indeed a very common pathogen in the tropics and that it can be a confusing factor in the diagnosis of yaws. We share Pahil and Goyal\'s view on the importance of laboratory confirmation of the cause of ulcerative skin lesions in individual settings. Our findings show that clinical diagnosis of the causes of skin ulcer is a challenge and requires laboratory evidence. The absence of useful serological testing and fastidious culture requirements for means a test is needed that can be done in settings with scarce resources. In this context, the development of a multiplex loop-mediated isothermal amplification (LAMP) test that can simultaneously detect several causative agents of skin ulcer seen in children in the tropics, such as subsp. , , and , would be optimum. The widespread use of the LAMP test is restricted because it is expensive, at a cost of about US$4 per test, and it requires basic equipment and trained personnel. During a worldwide yaws eradication campaign, sustaining access to LAMP technology for all yaws programmes across Africa, Asia, and the south Pacific could be difficult.