bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of mouth‐to‐mask ventilation in resuscitation of asphyxic newborn babies. A pilot study
Authors: Massawe August , Kilewo Charles , Irani Simin , Verma Rahul J. , Chakrapam Anupam B. , Ribbe Tommy , Tunell Ragnar , Fischler BjÖrn
Published: August 2010

The aim of the study was to compare the effectiveness of mouth‐to‐mask ventilation (MM) in neonatal asphyxia with bag‐and‐mask ventilation (BM). A new mouth‐to‐mask infant resuscitation system was constructed. The study was performed in two university clinics with different resources. The KEM Hospital in Bombay was well equipped and neonatologists took part in all resuscitations; Muhimbili Medical Centre in Dar es Salaam was understaffed and had no physicians available at resuscitation. Therefore, different protocols had to be used. In Bombay, the study period was limited to 5 minutes. If needed, mask ventilation was then replaced by intubation. In Dar es Salaam, MM ventilation was continued for up to 10 minutes, the inspiratory pressure was adjusted to 30 cmH2O and the ventilation was slow (8–10 breaths/min). In Bombay, 30 babies were allocated to the BM and 24 to the MM groups. In Dar es Salaam 56 were in the BM and 64 in the MM groups.

The results for term babies in Bombay and both term and pre‐term babies in Dar es Salaam showed no significant differences between the two groups of treatment, as determined by Apgar score 4 at 5 and 10 minutes, number of babies with their first gasp, heart rate >130 beats/min or pulse oximeter values above 75%, all at 5 minutes. An Apgar score 4 at 5 minutes was achieved in more than 75% of all infants, irrespective of treatment. The rates of early neonatal mortality and neonatal convulsions did not differ between the two methods of resuscitation.

In Dar es Salaam, the low respiratory frequency used in both groups was associated with a slow increase in heart rate above 130 beats per min. This result indicates that further studies will be needed before such slow respiratory frequencies are used. We conclude that, if adequate training is provided and the respiratory frequency is kept within the normal range, MM ventilation is an alternative to assisted ventilation when no bag and mask is available. However, further studies are necessary, since this method has proved to be tiring and uncomfortable for the resuscitating health personnel.
Spectrum of neuropsychiatric complications in 791 cases of typhoid fever
Authors: Ali Gazanfar , Rashid Samia , Kamli M. A. , Shah Parvez A. , Allaqaband G. Q.
Published: August 2010

Summary Over a 6‐year period, we studied 791 patients with multidrug‐resistant typhoid fever, of whom 665 individuals (84%) developed neuropsychiatric manifestations. These were: acute confusional state (73%); myelitis (6%); cerebellitis (1%); parkinsonism (1%); acute psychosis (0.6%); meningo‐encephalitis (0.5%); encephalitis (0.25%); sensory motor polyneuropathy, polymyositis, acute schizophrenia and bizarre neurological syndromes (0.12% each). Severe parkinsonian rigidity and meningo‐encephalitis are associated with significant morbidity but very low mortality (0.5%).
Responses of multidrug‐resistant Plasmodium falciparum parasites to mefloquine in Nigerian children
Authors: Okoyeh J. N. , Lege‐Oguntoye L. , Ugbode R. O. , Ogunrinde G. O.
Published: August 2010

Summary Thirty‐three children aged 6 months to 7 years from an area with multidrug‐resistant Plasmodium falciparum strains were treated with 25 mg/kg body weight of mefloquine base as a single oral dose. They were followed‐up using the modified 28‐day WHO extended field test. The parasite isolates from these patients were cultured in vitro with different concentrations of mefloquine. All children were parasite‐negative by day 4, and 31 remained so throughout the period of observation. Two patients who were parasitaemic on days 16 and 28 were successfully treated with a sulphadoxine/pyrimethamine combination. Parasitological and clinical responses were well correlated. The mean parasite clearance time was 65 ± 10.2 hours. A mefloquine concentration of 64 pmol/well inhibited schizont growth and the EC50 and EC99 were 5.5 and 54 pmol/well (1.1 and 10.8 μmol/l blood) respectively. This indicates reduced parasite susceptibility to the drug in vitro.
Infectivity ofCryptosporidium parvumoocysts is retained upon intestinal passage through a migratory water‐fowl species (Canada goose,Branta canadensis)
Authors: Graczyk Thaddeus K. , Cranfield Michael R. , Fayer Ronald , Trout James , Goodale Holly J.
Published: August 2010

SummaryFiveCryptosporidium‐free Canada geese (Branta canadensis) were individually orally dosed with 3–5 × 106Cryptosporidium parvumoocysts infectious to neonatal BALB/c mice. After intestinal passage, inoculum‐derived oocysts extracted from goose faeces established severe infection in 14 neonatal BALB/c mice (inoculum dose 2.5 × 105/mouse). The inoculum‐derived oocysts were detected in goose faeces up to 9 days post‐inoculation (PI); the number of intact oocysts and oocyst shells shed during the first 3 days PI was significantly higher than for the remaining 6 days PI (P<0.01). Based on acid‐fast stained air‐dried direct wet smears, 62% of the oocysts in goose faeces were intact (oocyst shells constituted 38%) and conformed to morphological features of viable and infectious inoculum oocysts. The fluorescence scores of the inoculated oocysts, obtained by use of the MERIFLUORtest, were identical to those obtained for the faeces‐recovered oocysts (majority 3 + to 4 +). The dynamics of oocyst shedding showed that overall, the birds released a significantly higher number of intact oocysts than oocyst shells (P<0.01) Retention of the viability and infectivity ofC. parvumoocysts following intestinal passage through a migratory water‐fowl species has serious epidemiological implications. Water‐fowl can serve as mechanical vectors for the water‐borne oocysts and can contaminate surface waters withC. parvum.As the concentration ofCryptosporidiumoocysts in source waters is attributable to water‐shed management practices, water‐shed protection programme officials should consider water‐fowl as a potential factor enhancing contamination of the source water withCryptosporidium.
Olive oil aspiration pneumonia (lipoid) in children
Authors: Annobil S. H. , EL Tahir M. , Kameswaran M. , Morad N.
Published: August 2010

SummaryIn the Asir region of south‐western Saudi Arabia, nasal instillation of olive oil to infants and children in the recumbent position is practised to relieve nasal congestion. Aspiration of olive oil results in lipoid pneumonia resistant to antimicrobial treatment. A series of 5 children, aged 4–72 months, with olive oil‐induced lipoid pneumonia is presented. Clinical presentation included persistent coughing, tachypnoea, recurrent febrile illness and chest infections. The pulmonary radiological picture was mainly right middle lobar and perihilar infiltrates. Bronchial lavage and microscopic examination of the aspirate confirmed the presence of fat globules. The pneumonia resolved on treatment with steroids and physiotherapy in the form of clappings and vibrations. For infants and children in this area who present with persistent pulmonary infiltrates which are not responsive to antimicrobials, the differential diagnosis of not only animal fat (ghee, clarified butter) but also of olive oil lipoid pneumonia must be considered.
Birthweight distribution in rural North‐West Burkina Faso
Authors: Wendl‐Richter H.‐U.
Published: August 2010

Summary Two thousand and twenty‐six delivery records from 1987 to 1989 in 5 rural health units in North Western Burkina Faso were analysed. The mean birthweight was 2899 g, with an overall incidence of low birthweight of 9.3%. Increasing birth order from 1 to 3 was associated with increasing birthweight; for birth orders >3, birthweight was relatively constant. There is a marked seasonal variation in birthweight, with a decrease in the rainy season and an increase during the dry season. These findings are compared with other African populations. The anthropometric measurements of these newborns were slightly lower than standards from industrialized North America.
Maternal vitamin A supplementation and immunity to malaria in pregnancy in Ghanaian primigravids
Authors: Cox Sharon E. , Staalsoe Trine , Arthur Paul , Bulmer Judith N. , Tagbor Harry , Hviid Lars , Frost Chris , Riley Eleanor M. , Kirkwood Betty R.
Published: August 2010

Background  Vitamin A supplementation is believed to enhance immune responses to infection but few studies have assessed its effects on anti‐malarial immunity, especially during pregnancy when women are at increased risk from both vitamin A deficiency and pregnancy‐associated malaria. The pathological effects of malaria in pregnancy are believed to be due to the sequestration of parasites in the placenta mediated via binding of variant surface antigens (VSA) expressed on the surface of P. falciparum infected red blood cells to placental chondroitin sulphate A (CSA).

Methods  We conducted a randomized double‐blind controlled trial of vitamin A supplementation in 98 primigravid Ghanaian women to investigate the effects of vitamin A supplementation on levels of IgG antibodies binding to VSA of a clinical, P. falciparum placental isolate and to two isolates selected (or not) for adherence to CSA in vitro (anti‐VSACSA IgG or anti‐VSA IgG). Placental malarial infection was determined by placental blood smear and histology.

Results  Vitamin A supplementation was non‐significantly associated with a decreased risk of active or chronic‐active placental malarial infection compared to past, resolved infection at delivery, as determined by histology (OR = 0.42, P = 0.13 – adjusted for level of education). After adjustment for differences in baseline values, levels of anti‐VSACSA IgG to a placental, CSA‐adherent isolate (EJ‐24) but not to two isolates selected for CSA‐adhesion in vitro (FCR3CSA and BusuaCSA), were significantly lower in women receiving vitamin A supplementation than in women receiving placebo (P = 0.002). There was no apparent effect of vitamin A supplementation to levels of Ab to non‐CSA‐adherent parasite isolates.

Conclusions  The data suggest that the reduction in the levels of anti‐VSACSA antibodies to the known placental malaria isolate may reflect reduced intensity or duration of placental parasitaemia in women receiving vitamin A supplementation. These observations are of potential public health significance and deserve further investigation.
Review editorial: Prevention of tuberculosis in resource‐poor countries with increasing access to highly active antiretroviral treatment
Authors: Apers Ludwig , Lynen Lut , Worodria William , Colebunders Robert
Published: August 2010

The administration of isoniazid (INH) has been proposed, evaluated and implemented to prevent tuberculosis (TB) disease among patients who are infected with the human immunodeficiency virus (HIV). This strategy has been developed in communities where TB is highly endemic and at a time when antiretroviral (ARV) treatment was not, or was rarely available. Although INH prevention programmes were somewhat pushed to the background due to the worldwide advocacy for ARV drugs, prevention of TB remains of paramount importance. The dual HIV–TB infection poses problems, not only for the individual and his/her clinician but also for the programme manager. We review various aspects of TB preventive treatment in countries with a high prevalence of HIV–TB co‐infection and limited resources but with increasing access to ARV treatment.
High frequency of multidrug‐resistant Mycobacterium tuberculosis isolates in Georgetown, Guyana
Authors: Menner Nikolai , Günther Ingo , Orawa Helmut , Roth Andreas , Rambajan Indal , Wagner Jutta , Hahn Helmut , Persaud Shamdeo , Ignatius Ralf
Published: August 2010

Emergence of multidrug‐resistant (MDR) Mycobacterium tuberculosis isolates constitutes a threat to public health worldwide. This study aimed at acquiring first epidemiological data for Guyana. Thirty‐six M. tuberculosis isolates from patients of the Georgetown Chest Clinic were subjected to susceptibility testing on solid agar and in broth media. Resistance to at least one first‐line drug was observed in 8 (22.2%, 95% confidence interval 8.3–36.1%) and simultaneous resistance to rifampicin and isoniazid (MDR) in 4 (11.1%, 95% confidence interval 0.6–21.6%) of the 36 isolates. The risk of infection with resistant isolates was significantly related to earlier antituberculosis therapy (P = 0.040). These data indicate a high proportion of resistant M. tuberculosis isolates in Guyana and call for the implementation of control strategies based on an improved laboratory diagnosis of TB.
Prevalence of enzootic simian viruses among urban performance monkeys in Indonesia
Authors: Schillaci Michael A. , Jones‐Engel Lisa , Engel Gregory A. , Paramastri Yasmina , Iskandar Entang , Wilson Brenda , Allan Jonathan S. , Kyes Randall C. , Watanabe Robin , Grant Richard
Published: August 2010

Animal reservoirs are the most important sources of emerging infectious diseases that threaten human populations. Global travel and tourism bring ever‐increasing numbers of humans into contact with animals, increasing the likelihood of cross species transmission of infectious agents. Non‐human primates come into contact with humans in a variety of contexts and may harbor infectious agents with zoonotic potential. We investigated the prevalence of infection with enzootic simian viruses among 20 urban performance monkeys (Macaca fascicularis) in Jakarta, Indonesia. This report documents for the first time evidence of infection with four simian viruses in urban performance monkeys. Simian foamy virus was detected by PCR in 52.9% of the macaques. Antibodies to simian retrovirus were detected in 10.5% of the macaques. Antibodies to Cercopithecine Herpesvirus 1, were detected in 5.3% of the macaques. Similarly, antibodies to simian T‐cell lymphotropic virus were detected in 5.3% of the macaques. No evidence of infection with simian immunodeficiency virus was detected in these macaques. These results suggest that urban performance monkeys are a reservoir for enzootic simian viruses known to be capable of infecting humans.
Adoption of safer infant feeding and postpartum sexual practices and their relationship to maternal HIV status and risk of acquiring HIV in Zimbabwe
Authors: Tavengwa N. V. , Piwoz E. G. , Iliff P. J. , Moulton L. H. , Zunguza C. D. , Nathoo K. J. , Hargrove J. W. ,   the ZVITAMBO Study Group, Humphrey J. H.
Published: August 2010

Objective  To examine the relationships between maternal knowledge and concern about HIV status, adoption of preventive practices and risk of acquiring HIV in Zimbabwe.

Methods  Knowledge and behavioural data were collected via interview from 2595 mothers enrolled in ZVITAMBO, a randomized trial of postpartum vitamin A supplementation that also offered education on safer infant feeding and sexual practices. Mothers were tested for HIV at delivery; those uninfected at baseline were retested during study follow‐up. Logistic regression methods were used to identify variables associated with adoption of preventive behaviours and, for HIV‐negative mothers, their relationship to risk of acquiring HIV post‐delivery.

Results  A total of 518 mothers (20%) reported practicing safer sex and 289 mothers (11%) reported modifying their feeding behaviour because of HIV. Fear of transmitting HIV (50.4%) and protecting the baby's health (30.9%) were the most frequently cited reasons for behaviour change. Forty‐nine HIV‐negative mothers acquired HIV during the first postpartum year. After taking into account other significant covariates, mothers who were concerned about their own HIV status were 1.9 times more likely (95% CI: 1.05–3.52; P = 0.03), and those reporting safer sex practices were 58% less likely to become infected (adjusted odds ratio: 0.42; 95% CI: 0.17–1.04; P = 0.06). Married women who reported practicing abstinence to prevent HIV were 3.2 times more likely to become infected than non‐abstaining mothers (P = 0.01), while there were no new HIV infections among abstaining single mothers.

Conclusions  Greater emphasis should be given to safer sex practices among women who test negative in mother‐to‐child HIV prevention programmes.
Drug toxicity and cost as barriers to community participation in HAT control in the Democratic Republic of Congo
Authors: Robays J. , Lefèvre P. , Lutumba P. , Lubanza S. , Kande Betu Ku Mesu V. , Van der Stuyft P. , Boelaert M.
Published: August 2010

Introduction  Active case‐finding programmes by mobile teams are the cornerstone of West African Human African Trypanosomiasis (HAT) control. Low attendance rates of screening and low uptake of treatment after diagnosis are major problems. The objectives of this survey were to explore community perception of HAT, to assess acceptability of control activities and to identify barriers amenable to intervention.

Methods  In September 2004, we conducted 33 focus group discussions with beneficiaries of the HAT control programme among various ethnic groups in two ecological settings (savannah and fluvial) of the Democratic Republic of Congo.

Results  The population had a very detailed knowledge and understanding of HAT transmission, utility of screening, symptoms and treatment. Melarsoprol treatment was feared for its side effects. The sudden death of previously asymptomatic people during treatment was attributed to witchcraft, to which one becomes more vulnerable when the diagnosis is disclosed in public. Lack of confidentiality was also a problem because HAT carries a stigma as a mental disease. Lumbar punctures, especially when performed in public, were disliked but less feared. Financial barriers were a major obstacle for many patients.

Conclusion  Less toxic drugs, lowering financial barriers and improving confidentiality would have considerable impact on the participation in population screening for HAT.
Viewpoint: do we have enough data to estimate the current burden of tuberculosis? The example of Bangladesh
Authors: Begum Vikarunnessa , Van Der Werf Marieke J. , Becx‐Bleumink Marijke , Borgdorff Martien W.
Published: August 2010

Objective  National tuberculosis (TB) programmes need accurate estimates of the burden of TB in order to assess case detection, and progress towards the millennium development goals (MDGs). We reviewed nationwide epidemiological data on TB burden in Bangladesh to decide whether additional information is needed, in order to assess the current burden of TB.

Method  We collected all nationwide epidemiological information: notification data for the period 1995–2004; reports of TB prevalence surveys in 1964–1966 and 1987–1988 and a tuberculin survey in 1964–1966. Data were evaluated for usefulness to provide information about the current burden of TB.

Results  The TB prevalence surveys from 1964 to 1966 and 1987 to 1988 provide very different results, respectively, 127/100 000 and 471/100 000 smear positives. In 1964–1966, the annual risk of infection was 0.6% in the 5‐ to 9‐year age group and 1.2% in those aged between 10 and 14 years. The notification data show an increase from 18/100 000 in 1995 to 46/100 000 smear positives in 2004.

Conclusion  Interpretation and extrapolation of the existing epidemiological data of Bangladesh to estimate the current burden of TB is difficult. Many of the 22 high‐burden countries have as few or even less survey data than Bangladesh. To enable the evaluation of progress towards the MDGs and to be able to assess the global burden of TB, epidemiological surveys are needed.
Improved injection safety after targeted interventions in the Syrian Arab Republic
Authors: Mantel Carsten , Khamassi Selma , Baradei Khaled , Nasri Haifa , Mohsni Ezzedine , Duclos Philippe
Published: August 2010

Objectives  Concerns about unsafe injection practices and possible infections with blood‐borne pathogens in the Syrian Arab Republic motivated an assessment of the injection safety situation in the country in July 2001. In light of the recommendations from this assessment, the Ministry of Health of Syria, with the assistance of WHO, implemented a set of activities under the ‘Focus Project’, which aims to ensure immunization safety. The first phase of the project ran from May 2002 to February 2004, and consisted of the improved provision of injection safety equipment and supplies, the elaboration and wide distribution of national guidelines on injection safety and safe waste management, a behaviour change and communication campaign targeting the general public, and comprehensive training of healthcare workers. A follow‐up survey was carried out in February 2004, 2 years after initiation of the project.

Methods  Two representative surveys were conducted using a standardized assessment tool. A cluster sampling strategy, with probability proportionate to the population size, led to the inclusion of 80 health facilities in eight districts in 2001 and of 120 health facilities in 12 districts in 2004.

Results  Injection practices had significantly improved 2 years after the start of the project. The 2001 study had pointed to a low, but non‐negligible risk to patients (2% unsafe injections), coupled with a high risk to healthcare workers (61% reported needle‐stick injuries in the last 12 months) and to the communities owing to unsafe waste disposal (sharps waste found outside 37% of health facilities, waste disposal considered unsafe in 48% of them). The 2004 survey showed that 90% of Syrian healthcare workers had received training in injection safety. All injections observed were given safely (difference to 2001 not significant), although some problems in preparation and reconstitution prevailed. The risk to healthcare workers was significantly reduced as only 14% of the staff reported needle‐stick injuries (p < 0.001). The risk to the communities was notably decreased following improvements in sharps waste management (sharps were found in the surroundings of only 13% of health facilities, p < 0.001).

Conclusions  The example of Syria shows that rapid improvement in injection safety is possible and that the necessary tools and methods to monitor and evaluate progress are at our disposal. Challenges remain in transferring this successful programme from the well‐structured immunization programme to the more diverse curative health services.
Associations between specific antibody responses and resistance to reinfection in a Senegalese population recently exposed to Schistosoma mansoni
Authors: Vereecken Kim , Naus Cynthia W. A. , Polman Katja , Scott Janet T. , Diop Mamadou , Gryseels Bruno , Kestens Luc
Published: August 2010

We examined associations between schistosome‐specific antibody responses and reinfection in Senegalese individuals recently exposed to Schistosoma mansoni. The effects of treatment, age, intensity of infection and duration of exposure on schistosome‐specific antibody responses were also investigated by comparing immune responses in individuals exposed for less than 3 years with responses in people exposed for more than 8 years. All individuals were bled before treatment as well as 6 and 12 weeks after. We used a statistical model that included interaction terms between time, age, infection intensity and duration of exposure. The overall patterns of most specific antibody responses by age were similar to those previously published for S. mansoni, Schistosoma japonicum and Schistosoma haematobium infections in different endemic areas. In general, a boost in specific antibody responses against adult worm antigen (SWA) was observed at 6 weeks after treatment whereas the majority of isotype responses against egg antigen (SEA) were not affected by treatment. Our analysis showed that the effect of treatment on schistosome‐specific antibody responses is influenced by age, infection intensity and duration of exposure. We found no evidence that treatment matures the specific antibody response of children recently infected with S. mansoni. Our results indicate that the build‐up of potentially protective immunoglobulin E (IgE) responses was associated with duration of exposure, or, in other words, experience of infection. Interestingly, in recently exposed individuals there was a significant association between IgA responses to SWA and resistance to reinfection. Resistance to reinfection and production of IgA‐SWA was associated with adulthood independently of exposure patterns, suggesting that susceptibility to S. mansoni and the development of protective immune responses is age‐dependent.
Diagnosis and management of malaria by rural community health providers in the Lao People's Democratic Republic (Laos)
Authors: Mayxay Mayfong , Pongvongsa Tiengkham , Phompida Samlane , Phetsouvanh Rattanaxay , White Nicholas J. , Newton Paul N.
Published: August 2010

We assessed the knowledge of malaria diagnosis and management by community health providers in rural Vientiane and Savannakhet Provinces, Lao PDR. Sixty health providers (17 pharmacy owners/drug sellers and 43 village health volunteers) were interviewed. All diagnosed malaria using symptoms and signs only; 14% were aware of >2 criteria for the diagnosis of severe malaria. Although chloroquine and quinine, the then recommended Lao national policy for uncomplicated malaria treatment, were the most common antimalarials prescribed – 65% gave incorrect doses and 70% did not know the side effects. Although not recommended by the then national policy, 27% of the health providers used combinations of antimalarials as they considered monotherapy ineffective. This study strongly suggests that further training of Lao rural health providers in malaria diagnosis and management is needed to improve the quality of health services in areas remote from district hospitals.
Longitudinal analysis of community health workers’ adherence to treatment guidelines, Siaya, Kenya, 1997–2002
Authors: Rowe S. Y. , Olewe M. A. , Kleinbaum D. G. , McGowan J. E. , McFarland D. A. , Rochat R. , Deming M. S.
Published: August 2010

Objectives  To investigate community health workers’ (CHW) adherence over time to guidelines for treating ill children and to assess the effect of refresher training on adherence.

Methods  Analysis of 7151 ill‐child consultations performed by 114 CHWs in their communities from March 1997–May 2002. Adherence was assessed with a score (percentage of recommended treatments that were prescribed), calculated for each consultation. Recommended treatments were those that were indicated based on CHW assessments. We used piecewise regression models to evaluate adherence before and after training.

Results  The average adherence score was 79.4%. Multivariable analyses indicate that immediately after the first refresher training, the mean adherence level improved for patients with a severe illness, but worsened for patients without severe illness. Adherence scores declined rapidly during the 6 months after the second refresher training.

Conclusions  The first refresher was partially effective, the second refresher had an effect contrary to that intended, and patient characteristics had a strong influence on adherence patterns. Longitudinal studies are useful for monitoring the dynamics of CHW performance and evaluating effects of quality improvement interventions.
Treatment‐seeking behaviour, cost burdens and coping strategies among rural and urban households in Coastal Kenya: an equity analysis
Authors: Chuma Jane , Gilson Lucy , Molyneux Catherine
Published: August 2010

Ill‐health can inflict costs on households directly through spending on treatment and indirectly through impacting on labour productivity. The financial burden can be high and, for poor households, contributes significantly to declining welfare. We investigated socio‐economic inequities in self‐reported illnesses, treatment‐seeking behaviour, cost burdens and coping strategies in a rural and urban setting along the Kenyan coast. We conducted a survey of 294 rural and 576 urban households, 9 FGDs and 9 in‐depth interviews in each setting. Key findings were significantly higher levels of reported chronic and acute conditions in the rural setting, differences in treatment‐seeking patterns by socio‐economic status (SES) and by setting, and regressive cost burdens in both areas. These data suggest the need for greater governmental and non‐governmental efforts towards protecting the poor from catastrophic illness cost burdens. Promising health sector options are elimination of user fees, at least in targeted hardship areas, developing more flexible charging systems, and improving quality of care in all facilities. The data also strongly support the need for a multi‐sectoral approach to protecting households. Potential interventions beyond the health sector include supporting the social networks that are key to household livelihood strategies and promoting micro‐finance schemes that enable small amounts of credit to be accessed with minimal interest rates.
Rapid achievement of the child survival millennium development goal: evidence from the Navrongo experiment in Northern Ghana
Authors: Binka Fred N. , Bawah Ayaga A. , Phillips James F. , Hodgson Abraham , Adjuik Martin , MacLeod Bruce
Published: August 2010

Objective  To determine the impact of deploying nurses and volunteers to village locations on demographic and health outcomes.

Method  We implemented an experimental design that emphasizes the value of aligning community health services with traditional social institutions that organize village life. Data for this analysis come from the Navrongo demographic surveillance system, a longitudinal database that tracks fertility, mortality, and migration events over time. The experiment uses conventional demographic methods for estimating mortality rates from longitudinal demographic surveillance registers.

Results  Posting nurses to community locations reduced childhood mortality rates by over half in 3 years and accelerated attainment of the childhood‐survival millennium development goal (MDG) in the study areas relative to trends observed in comparison areas.

Conclusion  Results from the Navrongo experiment demonstrate that community health and family planning programmes can have an impact on childhood mortality. Posting nurses to communities can dramatically accelerate the pace of progress in achieving the childhood‐survival MDGs. Community‐volunteer approaches, however, have no additional impact, a finding that challenges the child survival value of international investment in volunteer‐based health programmes. The total cost of the intensive arm of the project is less than $10 per capita per year. Navrongo research thus demonstrates affordable means of attaining the child survival MDG agenda with existing technologies.
Trend of case detection and leprosy elimination in Brazil
Authors: Penna Maria L. F. , Penna Gerson O.
Published: August 2010

Only six countries did not meet the leprosy elimination target during 2005, amongst them Brazil. In 2006, the Brazilian Ministry of Health announced a reduction of the detection rate of 24% or 10 900 cases from 2004 to 2005. A negative binomial parabolic regression model was adjusted to the detection rate historical series from 1980 to 2004, in order to predict the 2005 detection rate and its 95% confidence interval. This analysis showed that the number of new leprosy cases for 2005 could not be predicted from the previous behaviour of the data what calls for an epidemiological or operational explanation hypothesis. The hypothesis that this drop in detected case number is due to operational change, as a reduction in diagnosis or a modification in the reporting routine, is more likely. Recent change in prevalence case definition turned the prevalence ratio a function of only one variable, the detection rate, as the duration of the diagnosed disease became fixed. In the early nineties, based on epidemiological data evaluation, the BMoH recognized the impossibility of reaching the elimination goal, but it committed to seek leprosy control. This position changed after some years. Leprosy Elimination is a strategy supported by the national and international public opinion. As a one for all recipe, it may cause unwanted effects for it is not flexible enough to deal with different epidemiological behaviours and public health traditions.
The role of pfmdr1 in Plasmodium falciparum tolerance to artemether‐lumefantrine in Africa
Authors: Sisowath Christin , Ferreira Pedro E. , Bustamante Leyla Y. , Dahlström Sabina , Mårtensson Andreas , Björkman Anders , Krishna Sanjeev , Gil José P.
Published: August 2010

Objective  Artemether‐lumefantrine (AL), presently the most favoured combination therapy against uncomplicated Plasmodium falciparum malaria in Africa, has recently shown to select for the pfmdr1 86N allele. The objective of this study was to search for the selection of other mutations potentially involved in artemether‐lumefantrine tolerance and/or resistance, i.e. pfmdr1 gene amplification, pfmdr1 Y184F, S1034C, N1042D, D1246Y, pfcrt S163R and PfATP6 S769N.

Methods  The above mentioned SNPs were analysed by PCR–restriction fragment length polymorphism and pfmdr1 gene amplification by real‐time PCR based protocols in parasites from 200 children treated with AL for uncomplicated P. falciparum malaria in Zanzibar.

Results  A statistically significant selection of pfmdr1 184F mostly in combination with 86N was seen in reinfections after treatment. No pfmdr1 gene amplification was found.

Conclusion  The results suggest that different pfmdr1 alleles are involved in the development of tolerance/resistance to lumefantrine.
Is the Expanded Programme on Immunisation the most appropriate delivery system for intermittent preventive treatment of malaria in West Africa?
Authors: Chandramohan Daniel , Webster Jayne , Smith Lucy , Awine Timothy , Owusu‐Agyei Seth , Carneiro Ilona
Published: August 2010

Objective  To investigate the coverage and equity of the Expanded Programme on Immunisation (EPI) and its effect on age schedule, seasonality of malaria risk, and linked intermittent preventive treatment (IPT) in West Africa.

Method  Secondary analyses of data from a trial of IPT in Ghana. The potential effectiveness and impact of EPI‐linked IPT in West Africa was calculated using the coverage of Diptheria Pertussis Tetanus vaccination obtained from national surveys and the reported protective efficacies of IPT.

Results  In West Africa, where the transmission of malaria is highly seasonal, only 10% of malaria episodes in infants would be averted with the current coverage of EPI.

Conclusion  In this setting, the EPI‐linked IPT is not necessarily the most appropriate approach and alternative IPT schedules and delivery systems are needed.
Patterns of maternal care seeking behaviours in rural Bangladesh
Authors: Moran Allisyn C. , Winch Peter J. , Sultana Nighat , Kalim Nahid , Afzal Kazi M. , Koblinsky Marge , Arifeen Shams E. , Seraji M. Habibur R. , Mannan Ishtiaq , Darmstadt Gary L. , Baqui Abdullah H. ,   The Bangladesh PROJAHNMO Maternal Morbidity Study Group
Published: August 2010

Objective  Seeking care from a basic or comprehensive facility in response to obstetric complications is a key behaviour promoted in safe motherhood programmes. This study examined definitions of care seeking for maternal health complications used by families in rural Bangladesh, and the frequency and determinants of locally‐defined care seeking practices.

Methods  We conducted 24 semi‐structured qualitative interviews with women who had recently given birth to characterize care seeking behaviours in response to perceived complications. Based on these findings, a quantitative household questionnaire was developed and administered to 1490 women, half of whom reported a ‘serious or very serious’ complication during their last pregnancy and/or delivery (n = 769; 52%), and were included in the quantitative analysis.

Results  Informants described three care seeking patterns in qualitative interviews: (i) sending a family member to purchase treatment to administer in the home; (ii) sending for a provider to treat the woman in the home and (iii) taking the woman outside the home to a facility or provider's office. The quantitative survey revealed that most women sought care for ‘serious’ complications (86%), with 42% seeking multiple sources of care. The majority of women purchased a treatment to administer at home (68%), while 20% brought a provider to the home. Thirty per cent of women were taken to a provider or facility.

Conclusions  Families generally seek care for complications, but care seeking does not correspond to definitions used by maternal health programmes. Local definitions of care seeking must be considered in intervention design so that promotion of care seeking increases for facility‐based care for life‐threatening emergencies rather than unintentionally increasing the use of home‐based treatments of little medical value for prevention of mortality.
Epidemiology and risk factors for endemic typhoid fever in Uzbekistan
Authors: Srikantiah Padmini , Vafokulov Sagdullo , Luby Stephen P. , Ishmail Tharwat , Earhart Kenneth , Khodjaev Ne'mat , Jennings Gregory , Crump John A. , Mahoney Frank J.
Published: August 2010

Background  To investigate the risk factors for infection with endemic typhoid fever in the Samarkand region of Uzbekistan.

Methods  Case–control study of culture‐confirmed bloodstream infection with Salmonella Typhi. Patients were compared to age‐matched community controls. Salmonella Typhi isolates were tested for antimicrobial susceptibility.

Results  We enrolled 97 patients and 192 controls. The median age of patients was 19 years. In a conditional regression model, consumption of unboiled surface water outside the home [adjusted odds ratio (aOR) = 3.0, 95% confidence interval (CI) = 1.1–8.2], use of antimicrobials in the 2 weeks preceding onset of symptoms (aOR = 12.2, 95% CI 4.0–37.0), and being a student (aOR = 4.0, 95% CI 1.4–11.3) were independently associated with typhoid fever. Routinely washing vegetables (aOR 0.06, 95% CI 0.02–0.2) and dining at a tea‐house (aOR 0.4, 95% CI 0.2–1.0) were associated with protection against illness. Salmonella Typhi resistant to ampicillin, chloramphenicol, and trimethoprim‐sulfamethoxazole was identified in 6 (15%) of 41 isolates tested.

Conclusions  Endemic typhoid fever in Uzbekistan is transmitted by contaminated water. Recent use of antimicrobials also increased risk of infection. Targeted efforts at improving drinking water quality, especially for students and young adults, are likely to decrease transmission of typhoid fever. Measures to decrease the unnecessary use of antimicrobials would be expected to reduce the risk of typhoid fever and decrease the spread of multiple drug‐resistant Salmonella Typhi.
Influence of body mass index on pregnancy outcomes among HIV‐infected and HIV‐uninfected Zambian women
Authors: Banda Yolan , Chapman Victoria , Goldenberg Robert L. , Chi Benjamin H. , Vermund Sten H. , Stringer Jeffrey S. A.
Published: August 2010

Objectives  To determine the influence of body mass index (BMI) on pregnancy outcomes of HIV‐infected and HIV‐uninfected Zambian women and to assess the possible role of BMI on mother‐to‐child transmission rate of HIV.

Methods  We analysed data from a clinical trial on nevirapine administration for the prevention of mother‐to‐child transmission of HIV in Lusaka, Zambia. Demographic characteristics, medical information and pregnancy outcomes were used in this secondary analysis.

Results  A total of 1211 women were included in this analysis and 36% were HIV‐infected. Among HIV‐infected women, maternal parity and prior stillbirths increased with increasing BMI in univariate analysis. Mean birth weight rose as well at 28.3 g [95% confidence interval (CI) = 14.0–42.6] of infant weight per BMI unit. Transmission of HIV from mother to child appeared inversely related to BMI when compared according to BMI quartile (P for trend = 0.07). In the HIV‐uninfected group, infant birth weight increased with increasing BMI, at 32.7 g (95% CI = 23.5–41.9) of infant weight per BMI unit.

Conclusion  Birth weight increased alongside BMI in both HIV‐infected and HIV‐uninfected women. There is a suggestion that women with lower BMI have a greater risk of perinatal HIV transmission, even after adjustments for HIV viral load and CD4 count.
Sex differences in under and over nutrition among school‐going Black teenagers in South Africa: an uneven nutrition trajectory
Authors: Jinabhai C. C. , Reddy P. , Taylor M. , Monyeki D. , Kamabaran N. , Omardien R. , Sullivan K. R.
Published: August 2010

Objectives  To investigate the nutritional status of Black South African teenagers by sex and compare it with nutritional profiles of teenagers from other countries.

Methods  The first South African Youth Risk Behaviour Survey (2002) was adapted to include anthropometric data and this paper reports on the prevalence of under and over nutrition among 5322 Black teenagers, aged 13.0–17.9 years, grades 8–11. Prevalence of over nutrition in this study was compared with other countries using a World Bank country economic classification.

Results  Significant sex differences were observed for under and over nutrition. Boys (18.4%) had a higher prevalence of underweight than girls (2.6%) (P < 0.005), who were more at risk of overweight than boys (20.9%vs. 4.2%) (P < 0.005). Boys (21.9%) were more stunted than girls (9.4%) (P < 0.05), but stunted girls were at greater risk of overweight than boys across all levels of stunting. The prevalence of overweight among boys (4.2%) was lower than in other countries while for girls (20.9%) was similar to several upper middle and high income countries.

Conclusion  Gender sensitive strategies are required to address both under and over nutrition among South African teenagers to reduce stunting and future chronic disease epidemics in adulthood. This paper suggests that Black South African teenagers are experiencing an uneven nutritional transition across sex, from under nutrition to over nutrition.
Short communication: Antituberculosis drug‐induced hepatotoxicity is unexpectedly low in HIV‐infected pulmonary tuberculosis patients in Malawi
Authors: Tostmann A. , Boeree M. J. , Harries A. D. , Sauvageot D. , Banda H. T. , Zijlstra E. E.
Published: August 2010

The proportion of patients with antituberculosis drug‐induced hepatotoxicity (ATDH) was unexpectedly low during a trial on cotrimoxazole prophylaxis in Malawian HIV‐positive pulmonary tuberculosis patients. About 2% of the patients developed grade 2 or 3 hepatotoxicity during tuberculosis (TB) treatment, according to WHO definitions. Data on ATDH in sub‐Saharan Africa are limited. Although the numbers are not very strong, our trial and other papers suggest that ATDH is uncommon in this region. These findings are encouraging in that hepatotoxicity may cause less problem than expected, especially in the light of combined HIV/TB treatment, where drug toxicity is a major cause of treatment interruption.
Spatial distribution of Burkitt’s lymphoma in Kenya and association with malaria risk
Authors: Rainey Jeanette J. , Mwanda Walter O. , Wairiumu Priscilla , Moormann Ann M. , Wilson Mark L. , Rochford Rosemary
Published: August 2010

Endemic Burkitt’s lymphoma (BL) is the most common paediatric malignancy in equatorial Africa and was originally shown to occur at high‐incidence rates in regions where malaria transmission is holoendemic. New ecological models of malaria that are based on both parasite prevalence and disease have been described. In this study, we examined district level data collected from paediatric BL cases in Kenya from 1988 through 1997 and assessed whether the distribution of district level incidence rates could be explained by new ecologic estimates of malaria risk. Chi‐square tests and log‐linear regression models were used to evaluate these associations. An association with tribe of origin as a factor also was examined. The 10‐year average annual incidence rate (IR) for Kenya was 0.61 per 100 000 children. Incidence rates varied by malaria transmission intensity as follows: low malaria risk (BL IR = 0.39), arid/seasonal (0.25), highland (0.66), endemic coast (0.68), and endemic lake (1.23) (χ2 = 11.32, P = 0.002). In a log‐linear model, BL rates were 3.5 times greater in regions with chronic and intense malaria transmission intensity than in regions with no or sporadic malaria transmission (odds ratio = 3.47, 95% confidence interval = 1.30–9.30), regardless of tribe. Although crude tribe‐specific incidence rates ranged between 0.0 and 3.26, tribe was not associated with BL after controlling for malaria. These findings support the aetiologic role of intense malaria transmission intensity in BL.
Reducing financial barriers to emergency obstetric care: experience of cost‐sharing mechanism in a district hospital in Burkina Faso
Authors: Richard F. , Ouédraogo C. , Compaoré J. , Dubourg D. , De Brouwere V.
Published: August 2010

Objective  To describe the implementation of a cost‐sharing system for emergency obstetric care in an urban health district of Ouagadougou, Burkina Faso and analyse its results after 1 year of activity.

Methods  Service availability and use, service quality, knowledge of the cost‐sharing system in the community and financial viability of the system were measured before and after the system was implemented. Different sources of data were used: community survey, anthropological study, routine data from hospital files and registers and specific data collected on major obstetric interventions (MOI) in all the hospitals utilized by the district population. Direct costs of MOI were collected for each patient through an individual form and monitored during the year 2005. Rates of MOI for absolute maternal indications (AMI) were calculated for the period 2003–2005.

Results  The direct cost of a MOI was on average 136US$, including referral cost. Through the cost‐sharing system this amount was shared between families (46US$), health centres (15US$), Ministry of Health (38US$) and local authority (37US$). The scheme was started in January 2005. The rate of cost recovery was 91.3% and the balance at the end of 2005 was slightly positive (4.7% of the total contribution). The number of emergency referrals by health centres increased from 84 in 2004 to 683 in 2005. MOI per 100 expected births increased from 1.95% in 2003 to 3.56% in 2005 and MOI for AMI increased from 0.75% to 1.42%.

Conclusions  The dramatic increase in MOI suggests that the cost‐sharing scheme decreased financial and geographical barriers to emergency obstetric care. Other positive effects on quality of care were documented but the sustainability of such a system remains uncertain in the dynamic context of Burkina Faso (decentralization).