bluuebunny/crossref_metadata_2025 huggingface dataset:
Guinea worm disease in Ayod, Upper Nile Province, southern Sudan: a cross‐sectional study
Authors: Guthmann J. P. , Mercer A. J. , Gandubert C. , Morin F.
Published: November 2003

Upper Nile Province is one of the four main endemic areas for Guinea worm disease in the Sudan. In December 1994, a survey was conducted in the village of Ayod where the disease is endemic, to investigate morbidity and local knowledge of transmission and prevention. Interviews were conducted in households selected by standard cluster sampling procedures and of the 759 people examined, 156 (20.6%) had Guinea worm lesions. Adjusted odds ratios were used to estimate the relative risk for people with different personal or household characteristics in a multivariate analysis. After controlling for the possible confounding effects of other study variables, having a filter in the household, gender, and lack of knowledge about transmission and about prevention, were not associated with lesions. Only two variables were significantly associated with Guinea worm disease: getting water from a source other than a well increased the risk by a factor of 2.3, and being aged 5 years or more increased the risk by a factor of 31.1. This study demonstrates the clear association between the source of water for drinking and Guinea worm disease found elsewhere. We suggest the provision of reliable sources of pure drinking water and health education are the most suitable long‐term preventive measures. The Sudan now represents the greatest challenge to the goal of global eradication of Guinea worm disease, following the reduction in cases in Nigeria. The continuing civil war and insecurity in southern Sudan hinder the implementation of an effective water programme and other control measures, but the potential benefits through reduced incapacity and improved agricultural productivity are considerable.
Development of a competitive enzyme‐linked immunosorbent assay for diethylcarbamazine
Authors: Mitsui Y. , Takamura N. , Fujimaki Y. , Yamaguchi T. , Kitagawa T. , Aoki Y.
Published: November 2003

A sensitive and reproducible competitive enzyme‐linked immunosorbent assay (ELISA) for the determination of the concentration of diethylcarbamazine (DEC) in biological fluids was developed. Since DEC has no functional group to conjugate with bovine serum albumin (BSA), N‐(2‐aminoethyl)‐N‐ethyl‐4‐methyl‐1‐piperazinecarboxamide (DEC‐NHJ was first synthesized. This compound was then converted to carboxyl DEC (DEC‐COOH) and conjugated to BSA and to poly‐L‐lysine for use as immunogen and solid‐phase marker, respectively. The competitive ELISA was conducted by simultaneously incubating DEC with mouse anti‐DEC antiserum over DEC‐poly‐L‐lysine solid phase. Subsequently, the binding of anti‐DEC antibody was detected by using sheep anti‐mouse IgG peroxidase conjugate as a tracer. The reliability, determined by the coefficient of variation for inter and intra‐assay, was satisfactory. The cross‐reactivities of anti‐DEC antibodies with DEC metabolites, related compounds and ivermectin were negligible.

Using this assay, DEC levels were easily determined in serum of Mongolian jirds (Meriones unguiculatus) up to 4 hours following a single dose of DEC citrate base (100 mg/kg of body weight) via intraperitoneal route.
Population growth in the 21 st century: Cause for crisis or celebration?1
Authors: Cleland John
Published: November 2003

Between now and the end of the next century, the population of the planet is projected to grow from 5.7 billion to somewhere between 9 and 16 billion. In the next 25 years, continued rapid growth is inescapable because of the youthful age structures of many countries. Beyond that point much depends on fertility trends in the coming decades. Continued population growth does not make inevitable any global catastrophe but it will exacerbate greatly problems of underemployment. The prognosis for further fertility declines is good, because the communications revolution is hastening the spread of new ideas and political attitudes are becoming favourable.
Plasmid‐mediated multidrug resistance in Salmonella typhi in Kuwait
Authors: Panigrahi D. , Al‐Aneziz Abdulaziz H. , West P. W. J.
Published: November 2003

Multidrug resistant Salmonella typhi infection is common in Kuwait. Between January 1993 and December 1994, 266 strains of S. typhi were isolated from blood of suspected typhoid fever cases attending the Infectious Disease Hospital, Kuwait. Of these, 205 strains were isolated from patients from the Indian sub‐continent, 105 (45%) of which showed resistance to one or more drugs; 91 of these resistant strains showed resistance to the oral antimicrobials ampicillin, chloramphenicol, tetracycline and co‐trimoxazole (ACTCo). All 266 isolates were sensitive to fluoroquinolones and cephalosporines. The minimum inhibitory concentrations (MIC) for ampicillin, chloramphenicol and tetracycline in resistant strains were >1000 μg/ml. All 91 strains with ACTCo resistance pattern transferred their resistance to a recipient E. coli strain, whereas none of the remaining 14 strains with different resistance patterns transferred theirs. This paper reaffirms that multidrug resistant S. typhi is quite common in Kuwait and that such resistance is encoded by auto‐transferring plasmids.
Arginine vasopressin mediates the chloroquine induced increase in renal sodium excretion
Authors: Musabayane C. T. , Windle R. J. , Forsling M. L. , Balment R. J.
Published: November 2003

We postulated that chloroquine increases plasma arginine vasopressin (AVP) concentrations thus altering renal Na+clearance. Therefore, we studied a relationship between plasma AVP concentrations and urinary Na+output in separate groups of Sprague‐Dawley (SD) rats administered chloroquine (3 μg/min) for 1h 20 min. We also monitored Na+excretion rates in Brattleboro AVP‐deficient Di rats challenged with hypotonic saline load and administered chloroquine for 1 h 20 min. To establish whether chloroquine‐induced changes in renal Na +excretion were mediated via AVP VT receptors, we studied Na+excretion rates in groups of SD rats administered chloroquine or AVP in the presence of AVP V, receptor antagonist (1‐(β‐mercapto‐(β,β‐cyclopentamethylenepropionic acid)‐2‐O‐methyltyrosine arginine vasopressin (d(CH2)5(Tyr(Me)2) AVP) at 11 pmol/min for 1 h 20 min. The Na+ excretion rate rose significantly (P<0.01) from a pretreatment level of 9.8 ± 1.0 μmol/min to a peak of 14.1 ± 0.9 μmol/min in SD rats (n= 7) administered chloroquine. The Na+excretion rate remained unaltered around 8.5 μmol/min in rats simultaneously administered chloroquine and the AVP V1 receptor antagonist. This compared with control rats (8.1 ± 0.5 μmol/min, n= 7) and animals administered AVP V1 receptor antagonist alone (8.7 ± 0.6 μmol/min, n= 7). Chloroquine did not affect urine flow, Na+or K+excretion rates in Brattleboro AVP‐deficient Di rats. Administration of AVP alone was associated with significant increases in renal Na+excretion rate. Blockade of AVP V1receptors abolished the AVP‐dependent increase in urinary Na+loss. We conclude that at least part of the chloroquine‐induced increase in Na+excretion is mediated by chloroquine stimulating an increase in plasma AVP concentration.
Cost and cost effectiveness of mass diethylcarbamazine chemotherapy for the control of bancroftian filariasis: comparison of four strategies in Tanzania
Authors: Michael E. , Meyrowitsch D. W. , Simonsen P. E.
Published: November 2003

This study examines the costs and cost effectiveness of four different mass diethylcarbamazine (DEC) chemotherapy regimens—standard dose, semi‐annual single dose, low monthly dose and DEC‐medicated salt—in reducing microfilarial (mf) prevalence at the community level. Costs were estimated for each intervention in relation to both ingredient and activity, by the derivation and use of detailed itemized cost menus. The most expensive and most effective strategy in reducing community mf prevalence over 2 years was DEC salt intervention, followed in order of costs by the standard, low monthly and semi‐annual DEC strategies. The most cost effective strategy was the low monthly DEC treatment. Cost and sensitivity analyses, however, suggest that the optimal choice of mass DEC strategy for reducing mf is very sensitive to programme design parameters. In particular, the results demonstrate that if the salt delivery structure is simplified, DEC salt has the potential to be the dominant intervention for filariasis control. The results suggest that economies of scale considerations might militate against the adoption of this intervention for large‐scale applications, unless perhaps offset by its potential for cost recovery by direct patient purchase. Further analyses require a more realistic evaluation of filariasis intervention effectiveness by addressing changes in infection intensity and by accounting for the population dynamics of parasite transmission and control.
The value of maternal height as a risk factor of dystocia: a meta‐analysis
Authors: Dujardin Bruno , Cutsem Roger Van , Lambrechts Thierry
Published: November 2003

Ten publications and studies on the relation between maternal height and the risk of dystocia due to cephalopelvic disproportion (CPD) are analysed. The rate of Caesarean sections was chosen as the CPD indicator. When maternal height is presented in percentiles, curves can be superimposed, and sensitivities and specificities of the various studies may be analysed together. One biased study was excluded; the remaining 9 were pooled and regression lines calculated for sensitivity (Se) and specificity (Sp) of the entire set of points. The resulting model, i.e. Se = 10.9+1.99 Y and Sp = 99.9 − 0.99 Y, permits easy calculation of the expected sensitivity and specificity for each percentile Y. When the frequency of Caesarean section due to CPD is known, positive and negative predictive values can also be calculated. The proposed formulas can also be used to determine confidence intervals.

The findings in terms of the sensitivity and specificity of low maternal height as a risk factor for dystocia indicate that 1 out of 5 pregnant women would have to be referred for further investigation to identify half of the cases of mechanical dystocia necessitating Caesarean section. The predictive value for a Caesarean rate of 2% (a value often seen in developing countries) for this 20th percentile would be only 5%. Practical ways of choosing a reference criterion are suggested. A two‐track strategy (antenatal check‐ups and community monitoring) is proposed.
Knowledge and beliefs about transmission, prevention and control of lymphatic filariasis in rural areas of South India
Authors: Ramaiah K. D. , Kumar K. N. Vijay , Ramu K.
Published: November 2003

To identify the gaps in people's knowledge of lymphatic filariasis, we collected descriptive and quantitative information in rural areas of Tamil Nadu, South India. People are well aware of filariasis in their communities and recognize its different clinical manifestations. Only 9% of those with and 20% of those without the disease knew that filariasis is caused through mosquito bites; the rest attributed it to many other causes. People's knowledge about transmission and prevention of filariasis is also very poor. The study identifies the rationale for people's misconceptions about the disease. Misconceptions and ignorance could adversely affect personal protection measures against mosquito bites and the use of appropriate treatment. Health education campaigns aimed at highlighting the role of mosquitoes in transmission and the importance of early diagnosis should help people in taking personal protection measures and seeking appropriate treatment.
Mefloquine tolerability during chemoprophylaxis: focus on adverse event assessments, stereochemistry and compliance
Authors: Schlagenhauf P. , Steffen R. , Lobel H. , Johnson R. , Letz R. , Tschopp A. , Vranjes N. , Bergqvist Y. , Ericsson O. , Hellgren U. , Rombo L. , Mannino S. , Handschin J. , Stürchler D.
Published: November 2003

This longitudinal study of travellers to Africa taking mefloquine (MQ) chemoprophylaxis aimed to quantify and assess non‐serious adverse events (AE) occurring during short‐term prophylaxis and relate these to concentrations of racemic MQ, its enantiomers and metabolite. A total of 420 volunteers (52% F) participated. AEs with some impact on activities were reported by 11.2% of participants including 7.9% of neurological/psychiatric symptoms. Women were more likely to report AEs (P=0.02). The standardized questionnaires used showed more pathological indicators in travellers who reported subjective AE with significantly more dizziness, distress, sleep disturbances and a high total mood disturbance (TMD) in the AE group. There was, however, no significant performance deficit in computerized psychomotor tests in those experiencing AE. Furthermore, no significant differences were observed in enantiomer ratios, metabolite concentrations, or racemic MQ levels in participants with or without AEs suggesting that these factors are not the main predictors of mefloquine intolerability.
Isometamidium concentrations in the sera of cattle maintained under a chemoprophylactic regime in a tsetse‐infested area of Zimbabwe
Authors: Eisler M. C. , Maruta J. , Nqindi J. , Connor R. J. , Ushewokunze‐Obatolu U. , Holmes P. H. , Peregrine A. S.
Published: November 2003

An experiment was carried out to determine the concentrations of the trypanocidal drug isometamidium chloride in the sera of cattle maintained under a chemoprophylactic regimen at Rekomitjie, Zimbabwe, an area of high tsetse challenge in the Zambezi valley. In February 1993, 24 cattle at this site were treated intramuscularly with isometamidium chloride at a dose of 1.0 mg/kg body weight. Thereafter all animals were monitored regularly for 6 months for the presence of trypanosomes and sera were collected to determine the concentrations of isometamidium using an ELISA. Isometamidium treated cattle appeared to be protected against trypanosome infections for at least 18 weeks following treatment. Thereafter, three trypanosome infections were detected, between 20 and 22 weeks following treatment. In contrast, in 18 untreated control cattle at the same site, 9 trypanosome infections were detected over the first 18 weeks of the experiment. Quantification of the isometamidium concentration in sera from the drug treated cattle indicated that the apparent half‐life of isometamidium in these animals was 23 days. This was similar to the half‐life observed previously in cattle treated under laboratory conditions. The isometamidium ELISA was shown to be capable of quantifying drug levels in 20 out of 23 cattle for at least 70 days after treatment. There was no evidence of drug resistant trypanosomes at this site.
On estimating the basic reproduction number forSchistosoma haematobium
Authors: Woolhouse M. E. J. , Hasibeder G. , Chandiwana S. K.
Published: November 2003

Existing estimates of the basic reproduction number,Ro, for human schistosomes are mostly in the range 1–4, implying that schistosomes should be relatively easy to eliminate from endemic areas, which is contrary to practical experience. An estimate ofRofor a site in Zimbabwe is obtained here using a mathematical model explicitly incorporating two features believed to be epidemiologically significant; age‐dependent exposure and acquired immunity. Parameter estimates are, as far as possible, obtained independently, but the coefficients representing man‐snail and snail‐man transmission, as well as parameters representing effects of acquired immunity, must be estimated indirectly by fitting the model to field data. Heterogeneity in human exposure and contamination is crudely incorporated by considering ‘wormy and non‐wormy’ fractions of the population. The results suggestRoto be in the range 4–5 or more, higher than previous estimates and despite only moderate levels of infection at this site. It is shown that this estimate is sensitive to the form of the underlying model. The application of less realistic models may lead to less reliable estimates ofRo.
The public and domestic domains in the transmission of disease
Authors: Cairncross Sandy , Blumenthal Ursula , Kolsky Peter , Moraes Luiz , Tayeh Ahmed
Published: November 2003

This paper discusses the distinction between the transmission of infectious diseases within the domestic domain (the area normally occupied by and under the control of a household) and that in the public domain, which includes public places of work, schooling, commerce and recreation as well as the streets and fields. Whereas transmission in the public domain can allow a single case to cause a large epidemic, transmission in the domestic domain is less dramatic and often ignored, although it may account for a substantial number of cases. Statistical methods are available to estimate the relative importance of the two. To control transmission in the public domain, intervention by public authorities is likely to be required. Two examples show how environmental interventions for disease control tend to address transmission in one or the other domain; interventions are needed in both domains in order to interrupt transmission.
Membrane characterization of amastigote‐like forms of Leishmania donovani
Authors: Gupta Nidhi , Goyal Neena , Kumar Raj , Agrawal Ashok K. , Seth Prahlad K. , Rastogi Anil K.
Published: November 2003

During in vitro transformation, Leishmania donovani promastigotes converted into amastigote‐like forms and underwent several changes in membrane parameters. They exhibited significantly increased microviscosity comparable to true amastigotes. Activities of several functionally important membrane bound enzymes were also altered, thereby indicating a change in their orientation. Peanut agglutinin was found to be specific for agglutination of stationary phase promastigotes whereas wheat‐germ agglutinin was specific for the amastigote‐like forms as well as for pure amastigotes, implying the presence of specific glycoconjugates on the parasite surface.
Management of psoriasis with Aloe vera extract in a hydrophilic cream: a placebo‐controlled, double‐blind study*
Authors: Syed Tanweer A. , Ahmad S. Ashfaq , Holt Albert H. , Ahmad Seyed Ali , Ahmad Seyed Hamzeh , Afzal Mohammad
Published: November 2003

The purpose of this double‐blind, placebo‐controlled study was to evaluate the clinical efficacy and tolerability of topical Aloe vera extract 0.5% in a hydrophilic cream to cure patients with psoriasis vulgaris. Sixty patients (36M/24F) aged 18–50 years (mean 25.6) with slight to moderate chronic plaque‐type psoriasis and PASI (Psoriasis Area and Severity Index) scores between 4.8 and 16.7 (mean 9.3) were enrolled and randomized to two parallel groups. The mean duration of the disease prior to enrolment was 8.5 years (range 1–21). Patients were provided with a precoded 100 g tube, placebo or active (with 0.5%Aloe vera extract), and they self‐administered trial medication topically (without occlusion) at home 3 times daily for 5 consecutive days per week (maximum 4 weeks active treatment). Patients were examined on a weekly basis and those showing a progressive reduction of lesions, desquamation followed by decreased erythema, infiltration and lowered PASI score were considered healed. The study was scheduled for 16 weeks with 12 months of follow‐up on a monthly basis. The treatment was well tolerated by all the patients, with no adverse drug‐related symptoms and no dropouts. By the end of the study, the Aloe vera extract cream had cured 25/30 patients (83.3%) compared to the placebo cure rate of 2/30 (6.6%) (P<0.001) resulting in significant clearing of the psoriatic plaques (328/396 (82.8%) vs placebo 28/366 (7.7%), P<0.001) and a decreased PASI score to a mean of 2.2. The findings of this study suggest that topically applied Aloe vera extract 0.5% in a hydrophilic cream is more effective than placebo, and has not shown toxic or any other objective side‐effects. Therefore, the regimen can be considered a safe and alternative treatment to cure patients suffering from psoriasis.
Non‐typhoidal Salmonella bacteraemia: clinical features and risk factors
Authors: Thamlikitkul Visanu , Dhiraputra Chertsak , Paisarnsinsup Thongchai , Chareandee Chokchai
Published: November 2003

A case control study was conducted to determine the risk factors of non‐typhoidal Salmonella bacteraemia. Eighty adult patients with non‐typhoidal Salmonella bacteraemia admitted to Siriraj Hospital from January to December 1993 served as the cases. The controls comprised 3 groups: group 1, 80 adult in‐patients with Escherichia coli bacteraemia; group 2, 80 adult in‐patients who did not have bacteraemia and had been admitted to the hospital during the same period as the cases; group 3, 80 in‐patients who did not have Salmonella bacteraemia and matched the cases in terms of gender, age, hospital services and admission date. AIDS and corticosteroid use were the major risk factors for acquiring non‐typhoidal Salmonella bacteraemia with an odds ratio of 7.27 to 12.31 (95% confidence interval of 3.39 to 29.40). Almost all patients with non‐typhoidal Salmonella bacteraemia presented with a fever for a median duration of 7 days. AIDS patients usually had concomitant opportunistic infections. Salmonella group D was the most common serogroup. Most patients were treated with co‐trimoxazole, quinolones, ceftriaxone and ampicillin. Localized suppurative complications were observed in 14% of the patients; the overall mortality rate was 36.3%, 12% of whom died prior to receiving appropriate antibiotics for Salmonella.
Helminth infections, morbidity indicators and schistosomiasis treatment history in three villages, Dongting Lake region, PR China
Authors: Booth Mark , Li Yuesheng , Tanner Marcel
Published: November 2003

In order to estimate the public health impact of helminth infections, and to provide baseline data for interventions, parasitological and morbidity surveys were conducted among inhabitants of three villages in Dongting Lake region, Hunan Province, China. Ascaris lumbricoides was found to be the most common helminth infection, followed by Trichuris trichiura and Schistosoma japonicum. Left liver enlargement was the most common indicator of morbidity. Observed numbers of multiple species infections closely correlated with expected figures generated from a simple probabilistic model. Heterogeneity was observed in age and sex‐standardized infection and morbidity prevalences among the villages and occupations. Males had higher levels of infection, were more likely to suffer morbidity, and were more likely to have been treated for schistosomiasis than women. The prevalence of each morbidity indicator was positively correlated with the number of times of treatment for schistosomiasis, and negatively correlated with number of years since last treatment. The results imply that treatment history for S. japonicum infection may be a good indicator of current morbidity risk.
Polymerase chain reaction for detecting Onchocerca volvulus in pools of blackflies
Authors: Oskam L. , Schoone G. J. , Kroon C. C. M. , Lujan R. , Davies J. B.
Published: November 2003

The detection of Onchocerca volvulus infected simuliids or blackflies is routinely done by dissection and microscopic examination of individual flies, but this method is tedious and time consuming. Here we describe a method of detecting single O. volvulus infected blackflies in pools of uninfected blackflies. Using a PCR with Onchocerca specific primers it is possible to reproducibly detect one heavily infected blackfly in a pool of 80 flies, or to detect one blackfly inoculated with one microfilaria in a pool of 20 flies. With the method described large numbers of blackflies can be rapidly screened for the presence of O. volvulus infected flies.
Susceptibility of Ugandan Trypanosoma brucei rhodesiense isolated from man and animal reservoirs to diminazene, isometamidium and melarsoprol
Authors: Matovu Enoch , Iten Monika , Enyaru John , Schmid Cecile , Lubega George , Brun Reto , Kaminsky Ronald
Published: November 2003

Thirty‐six Trypanosoma brucei spp. stocks isolated from man and domestic animals in south‐east Uganda were studied for susceptibility to diminazene, isometamidium and melarsoprol in vitro. All stocks were susceptible to melarsoprol. One T. b. rhodesiense stock isolated from a sleeping sickness patient showed reduced susceptibility to the veterinary drugs diminazene and isometamidium. More than 100 ng/ml diminazene or 0.78 ng/ml isometamidium were required to eliminate that stock during 10 days drug exposure. In contrast, the remaining stocks were eliminated by 0.8–6.3 ng/ml diminazene and 0.01–0.20 ng/ml isometamidium. Clones derived from the resistant T. b. rhodesiense stock showed reduced susceptibility to isometamidium and diminazene comparable to the parental population. Control of sleeping sickness by treatment of the animal reservoir could, therefore, face serious problems since drug‐resistant stocks as reported here would most likely not be eliminated by recommended doses of diminazene and isometamidium.
Ethnic diversity and disease surveillance: Guinea worm among the Fulani in a predominantly Yoruba district of Nigeria
Authors: Brieger William , Oke Ganiyu , Otusanya Sakiru , Adesope Aziz , Tijanu Jamiu , Banjoko Muyiwa
Published: November 2003

Guinea‐worm eradication has been progressing internationally and efforts at case containment have begun in most endemic countries. Case containment rests on the assumption that in previous phases of eradication most if not all endemic settlements have been identified. Experiences in the predominantly Yoruba communities of Ifeloju Local Government Area (LGA) in Oyo State, Nigeria, however, have shown that the settlements of ethnic minority groups may be overlooked during initial case searches and subsequent programmes of village‐based reporting. The migrant cattle‐herding Fulani are found throughout the savannah and sahel regions of West Africa. Nearly 3000 live in 60 settlements in Ifeloju. An intensive case search identified 57 cases in 15 settlements. The assumption that village‐based health workers (VBHWs) in neighbouring Yoruba farm hamlets would identify cases in the Fulani settlements, known as gaa, proved false. Only 5 endemic gaa were located next to a Yoruba hamlet that had a VBHW, and even then the VBHW did not identify and report the cases in the gaa. Efforts to recruit VBHWs for each endemic gaa are recommended, but only after LGA staff improve the poor relationship between themselves and the Fulani, whom they view as outsiders. The results also imply the need for Guinea worm eradication staff in neighbouring LGAs, states and countries to search actively for the disease among their minority populations.
Risk factors for optic nerve disease in communities mesoendemic for savannah onchocerciasis, Kaduna State, Nigeria
Authors: Cousens S. N. , Yahaya H. , Murdoch I. , Samaila E. , Evans J. , Babalola O. E. , Zakari M. , Abiose A. , Jones B. R.
Published: November 2003

Ophthalmic examinations on 6831 individuals aged 5 years or more, living in 34 guinea savannah communities mesoendemic for onchocerciasis, in Kaduna State, Nigeria, revealed a relatively high prevalence (9%) of optic nerve disease (OND). Further investigations were performed to determine what proportion of this burden of OND might be due to onchocercal infection. Information on history of cerebro‐spinal meningitis (CSM), past use of diethylcarbamazine (DEC) and chloroquine, consumption of cassava and locally produced alcohol was collected for all individuals by questioning. In addition, a nested case‐control study of 81 cases of OND and 136 age and sex‐matched controls was performed to investigate whether syphilis or a variety of other neurological disorders were responsible for a substantial proportion of cases of OND. Our data suggest that in this population, onchocercal infection is the single most important cause of OND and may account for 50% of all cases. Some 13% of cases were associated with signs suggestive of glaucoma. DEC use might be responsible for up to 30% of all OND. We found no evidence to suggest that any of the following are important causes of OND in the communities studied: CSM, syphilis, neurological syndromes such as polyneuropathy or other generalized neurological disease, consumption of raw cassava, consumption of locally prepared alcohol.
Asking questions about women's reproductive health: validity and reliability of survey findings from Istanbul
Authors: Filippi Véronique , Marshall Tom , Bulut Aysen , Graham Wendy , Yolsal Nuray
Published: November 2003

In countries where population‐based data on health problems are scarce, the extent of reproductive morbidity can be estimated from replies in structured interviews as a complement or as an alternative to reports from physician's examination and laboratory tests. We examined the sensitivity and specificity of detected morbidity based on these replies as compared to medical diagnoses and explored the consistency of replies when the questionnaire was administered twice, by two types of interviewers in different environments. Data were collected in a cross‐sectional survey in Istanbul. The presence or absence of five morbidities, reproductive and urinary tract infections (RTI and UTI), menstrual disorders, pelvic relaxation and anaemia was determined by algorithms based on the replies, and by the physician's diagnosis. Except with anaemia, questionnaire replies were more specific than sensitive in detecting morbidity, probably partly due to many morbid conditions being accepted as normal. Specificity exceeded 80% for home reports of menstrual disorders (93.0%), pelvic relaxation (95.7%), RTI (abnormal discharge and pain) (81.2%) and UTI (80.7%), with the corresponding figure for anaemia at 41.7%; the best sensitivity results were for anaemia (58.3%), RTI (abnormal discharge only) (49.3%) and menstrual disorders (45.4%) with figures for pelvic relaxation and UTI reaching only 17.3 and 13.0%. Reliability between the interviews (assessed by the κ coefficient), was highest at 66.1% for pelvic relaxation and lowest at 39.9% for menstrual disorders. Reliability varied between the two lay interviewers, suggesting the interviewer and the interview conditions are important. Questionnaire‐based information on this type of morbidity is most useful for ascertaining perceived ill‐health and only of limited use for the corresponding medically defined conditions.
Epidemiology of syphilis in pregnancy in rural South Africa: opportunities for control
Authors: Wilkinson David , Sach Marlene , Connolly Catherine
Published: November 2003

The paper describes the epidemiology, risk factors and impact on pregnancy outcome of syphilis in pregnant women in rural South Africa. Prevalence was determined from laboratory records. A case‐control study of 200 women (50 cases with syphilis) was done to investigate possible risk factors. To determine the impact on pregnancy outcome, and to evaluate the effect of treatment, a retrospective cohort was constructed. Overall prevalence of syphilis was 6.5%; it was highest in the urban antenatal clinic (9%). The odds ratios for syphilis in women gravidity 3–5 compared to gravidity 6 was 3.2 and 2.3 compared to women with gravidity 2 or less. For women with a previous birth, those with a previous perinatal death were 3.2 times more likely to have syphilis after adjusting for other risk factors. Pregnancy outcome was available for 187 women. The adjusted odds ratio of an adverse pregnancy outcome in women with syphilis was 11.8. All still births occurred in women with syphilis. The prevalence of syphilis is high in this rural area and screening should be applied to all women. Although screening was comprehensive, less than half of the detected cases were fully treated and a poor perinatal outcome ensued. On‐site testing for syphilis at the time of booking would allow treatment to start immediately.
Acanthocheilonema viteae: vaccination with irradiated L3 induces resistance in three species of rodents (Meriones unguiculatus, Mastomys coucha, Mesocricetus auratus)
Authors: Schrempf‐Eppstein B. , Kern A. , Textor G. , Lucius R.
Published: November 2003

Three species of rodents were immunized with 50 irradiated (35 krad) stage‐3 larvae (L3) of the filaria Acanthocheilonema viteae and challenged with an infection of normal L3. The immunization induced a significant reduction of the worm burden developing from the challenge infection in all host species, the jird (Meriones unguiculatus), the multimammate rat (Mastomys coucha) and the golden hamster (Mesocricetus auratus). The induced resistance was highest in jirds (92.5±9.7) followed by golden hamsters (59.4±26.6) and multimammate rats (55.1±40.4). The time course of antibody response against antigens of L3, adult worms and microfilariae, as studied by ELISA, showed quantitative and qualitative differences between the species. The antibody response against L3 antigens in immunoblots was similar in all species. Only one of the golden hamsters developed an antibody response against the surface of vector derived L3, while sera of jirds and multimammate rats did not react with L3 surface.
Travel advice: a study among Swiss and German general practitioners
Authors: Hatz Christoph , Krause Erik , Grundmann Hajo
Published: November 2003

Travelling to tropical and subtropical destinations is common among European citizens. Many of them consult their general practitioners (GPs) for pre‐travel advice. Little is known about the knowledge, the sources of information and the needs of physicians. One hundred and fifty Swiss and 150 German GPs giving travel advice were interviewed using pretested telephone interviews and questionnaires to assess their knowledge about travel advice to be given for 2 frequent holiday destinations (Kenya and Thailand), and to ask which information sources were available to them. Ninety‐six per cent and 89%, respectively, of GPs in 2 neighbouring areas of Switzerland and Germany gave travel advice to their clients. In telephone interviews, standard recommendations on malaria medication, as approved by the national travel advice committees, were stated by 45 and 25% of Swiss GPs, and 22 and 9% of German GPs for Kenya and Thailand. The figures for correct advice on vaccination requirements were 23 and 47% for the Swiss GPs, and 2 and 25% for the German GPs. Half of the GPs wanted to consult their documents before giving advice. The main source of information used by Swiss GPs was the monthly updated Bulletin of the Federal Office of Public Health (BFOPH). A variety of different sources was recorded among German practitioners. Regular, concise information on travel advice tops the list of requested information material in both countries. The extent of correct pre‐travel advice is unsatisfactory in both study groups. Use of standardized, regularly updated and readily available sources of information on travel advice for the GP could avoid uncertainties of both the provider and the recipient of advice.
A systematic review on the treatment of giardiasis
Authors: Zaat J. O. M. , Mank Th. G. , Assendelft W. J. J.
Published: November 2003

To assess the efficacy of treatment of parasitological excretion of cysts and trophozoites and symptoms of patients with giardiasis, a systematic review of published randomized clinicial trials was conducted through extensive searches in Medline, Embase and Current Contents from 1966 till 1996 as well as manual reviews of 28 journals. The methodological quality of all trials was assessed by guidelines of the Cochrane Collaboration. Thirty‐one trials were included, only one of which had no serious methodological flaws. The mean score of parasitological examination was 4.8 out of a possible 15. There was a considerable effect in cure rate of treatment versus placebo (odds 9.3, 95%CI 4.69–18.4), but all 3 trials in this comparison had serious flaws. Metronidazole treatment over more than 3 days seems to achieve a better parasitological cure rate than other long treatment courses (pooled odds 2.6, 95% 1.7–3.8), but trials are clinically and statistically heterogeneous. Single‐dose therapy is as effective as longer treatment courses (pooled odds 0.67, 95% 0.31–1.44). Within the single‐dose regimens tinidazole (2 g) reaches a higher parasitological cure rate than other short therapies (pooled odds 55, 95% CI 3.7–8.3) with relatively few side‐effects. Placebo‐controlled trials with parasitological and clincial outcomes are needed.
Typhoid fever in Ujung Pandang, Indonesia – high‐risk groups and high‐risk behaviours
Authors: Velema Johan P. , Van Wijnen Germaine , Bult Peter , Van Naerssen Ton , Jota Santa
Published: November 2003

We performed a hospital‐based case‐control study to identify high‐risk groups and routes of transmission of typhoid fever in the city of Ujung Pandang on the island of Sulawesi, Indonesia. The annual incidence of this disease in southern Sulawesi is estimated at 3.1/1000 and the case fatality at 5.1% Cases were 50 patients over 13 years of age admitted to Stella Maris Hospital with a diagnosis of typhoid fever between June and September 1991. Diagnosis was made on clinical grounds and in 90% of cases confirmed by a Widal test.

Controls were 42 patients admitted for non‐infectious disorders during the same period and individually matched by age and sex. Controls did not have a history of typhoid fever. Interviews took place in hospital. Analysis was by unconditional logistic regression. High‐risk groups consisted of those who were single, unemployed and those who had a university education. Median age of cases was 22 years. Consumption of food from warungs (food stalls in the street) was strongly associated with risk (OR = 45). Both cases and controls washed hands after use of the toilet and before meals, but cases used soap significantly less often (OR = 30). The results of this study can be used to take preventive measures against this severe disease of educated and single young adults by targetting them for IEC‐activities emphasizing the importance of thorough hand‐washing and the need to take care in the selection of street‐foods.
Measuring hygiene practices: a comparison of questionnaires with direct observations in rural Zaïre
Authors: Manun'Ebo M. , Cousens S. , Haggerty P. , Kalengaie M. , Ashworth A. , Kirkwood B.
Published: November 2003

To date questionnaire surveys have been the most commonly used instruments to measure hygiene behaviours related to water and sanitation. More recently, a number of studies have used structured observations to study practices related to diarrhoea. During a trial of a hygiene education intervention to reduce diarrhoea among young children in Bandundu, Zaire, both instruments were used to measure the disposal of child faeces and various hand‐washing practices. Three hundred families were observed and follow‐up interviews performed with 274 (91%) mothers. At the individual level, agreement between observed and reported behaviour was little better than might be expected by chance. There was evidence of over‐reporting of hand‐washing before food preparation (44%vs 33%; P= 0.03), hand‐washing before eating (76%vs 60%; P < 0.001) and disposal of the child’s faeces in a latrine (75%vs 40%; P < 0.001). On the other hand, hand‐washing before feeding the child was reported less often than it was observed (7%vs 64%; P < 0.001). Our data are consistent with the hypothesis that, in general, mothers over‐report ‘desirable’ behaviours. At the same time, our data indicate that open questions may lead to under‐reporting of certain behaviours. The repeatability of observations at both the individual and population levels remains to be established.
Evaluation of Amplicor‐ and IS6110‐PCR for direct detection of Mycobacterium tuberculosis complex in Singapore
Authors: Thoe S. Y. Se , Tay L. , Sng E. H.
Published: November 2003

One hundred and seventy‐eight samples from 168 individuals were tested for Mycobacterium tuberculosis complex (Mtc) using Amplicor PCR, IS6110‐PCR (in‐house), acid fast (AF)‐staining and culture. Thirty‐one samples were positive by culture, but 37 samples were later resolved to be truly positive for Mtc. Of these, Amplicor detected 32 (86.5%), IS6110‐PCR detected 31 (83.6%), and AF‐staining 21 (56.8%). None of the 141 Mtc‐negative samples was positive by these tests, thus giving 100% specificity. Although the IS6110‐PCR was more sensitive than Amplicor in detecting spiked Mtc DNA, it was not more sensitive than the latter in detecting Mtc in clinical samples. Reasons likely to account for the PCR false negativity were (i) sample inoculum size, (ii) nonuniform samples due to clumping effect of Mtc and (iii) the absence of target gene sequences for IS6110‐PCR. Culture negativity, on the other hand, was likely to be associated with nonviable Mtc. Amplicor PCR is promising for direct detection of Mtc. The IS6110‐PCR, however, may not be as suitable because of possible existence of IS6110‐deleted Mtc strain in Singapore.
Incidence estimates of late stages of trachoma among women in a hyperendemic area of central Tanzania
Authors: Munoz Beatriz , Aron Joan , Turner Virginia , West Sheila
Published: November 2003

:The purpose of this study is to estimate 5‐year incidences of conjunctival scarring and trichiasis, and 10‐year incidence of corneal opacities due to trachoma, using prevalence data from a population sample of 6038 women living in a trachoma‐hyperendemic area of central Tanzania. Previous surveys have documented the age‐specific prevalence of scarring, trichiasis, and corneal opacities in women in hyperendemic areas. Using the age‐stratified prevalences of these different clinical signs, corresponding incidence rates were estimated. Transition rates from one sign to the next were also obtained by restricting the risk group to only women with a specific trachoma sign. Thus, the 5‐year incidence of trichiasis among women with conjunctival scarring, and the 10‐year incidence of corneal opacities among women with trichiasis were estimated. Incidences of all the signs markedly increased with age. For scarring, 5‐year incidence rates increased from 3.1% in the 15–19 age category to 14.3% for women between 55 and 59 years. The 5‐year incidence of trichiasis ranged from 0.3% in the 15–19 age category to 7.5% in the age group 55–59. Corneal opacities due to trachoma were highest in the age group 45–54; the 10‐year incidence increased to 2.8%. The 5‐year incidence of trichiasis among only women with scars increased from 3.2% in the 15–19 age group to 15.1% in women in the 55–59 age group. Once trichiasis is present, almost one‐third of the women below 35 and more than 40% of the women older than 45 will develop corneal opacities in a 10‐year interval. These estimates are important in understanding the dynamics of progression of trachoma from conjunctival scarring to the potentially blinding signs of trichiasis and corneal opacities. They provide important information for planning adequate services in areas where trachoma is endemic and surgery for trichiasis is a key factor to avoid blindness from trachoma. They also provide clues to the pathogenesis that may be useful in the development of new methods of control.
Issues in the design and interpretation of studies to evaluate the impact of community‐based interventions
Authors: Kirkwood Betty R , Cousens Simon N , Victora Cesar G , De Zoysa Isabelle
Published: November 2003

Increasingly, epidemiologists are faced with the need to evaluate the impact of an intervention that is delivered at the level of a community or cluster of individuals, rather than at the individual level. This has profound implications for the design and interpretation of a study to evaluate its impact. We start by discussing the issues arising in the extension of the randomized double‐blind controlled trial methodology to the evaluation of interventions delivered to clusters of individuals, or to whole communities, where the unit of randomization is a cluster of individuals rather than an individual. We then consider alternative approaches to design, discuss their relative strengths and weaknesses and present a framework of design options. Finally we propose a pragmatic approach to evaluation design in this setting. We believe that the answer lies in the judicious selection of different design elements, combined in such a way that when the evidence from each is presented together, a clear picture of the impact of the intervention emerges. We illustrate this using an example from the recent literature.
High prevalence of mutations in the dihydrofolate reductase gene of Plasmodium falciparum in isolates from Tanzania without evidence of an association to clinical sulfadoxine/pyrimethamine resistance
Authors: Jelinek T. , Rønn A. M. , Curtis J. , Duraisingh M. T. , Lemnge M. M. , Mhina J. , Bygbjerg I. C. , Warhurst D. C.
Published: November 2003

:Recently the efficacy of sulfadoxine/pyrimethamine (S/P) in treatment of uncomplicated falciparum malaria in Tanzania has been seriously compromised by the development of resistance. The occurrence of active site mutations in the Plasmodium falciparum gene sequence coding for dihydrofolate reductase (DHFR) is known to confer resistance to pyrimethamine. This study investigates the occurrence of these mutations in infected blood samples taken from Tanzanian children before treatment with S/P and their relationship to parasite breakthrough by day 7. The results confirm the occurrence of one or more DHFR mutations in all the samples, but no relationship was found with the presence of parasites in the blood at day 7. The results suggest that alterations in the coding region for dihydropteroate synthetase (DHPS), the enzyme target for sulfadoxine, should be studied in order to predict resistance to the S/P combination. It has been proposed earlier that sulfadoxine could itself act on DHFR, because of a false dihydrofolate produced by drug metabolism through DHPS and dihydrofolate synthase. The results of this treatment study suggest that such a possibility is unlikely.
The reliability of self‐reported blood in urine and schistosomiasis as indicators of Schistosoma haematobium infection in school children: a study in Muheza District, Tanzania
Authors: Ansell Juliet , Guyatt Helen , Hall Andrew , Kihamia Charles , Kivugo Joyce , Ntimbwa Perpetua , Bundy Donald
Published: November 2003

The use of self‐reported blood in urine and schistosomiasis by school children was investigated as a tool to estimate the prevalence of infection with Schistosoma haematobium and to identify infected individuals. A general questionnaire about common health problems, including questions about blood in urine and schistosomiasis, was administered by teachers to 25443 children in 137 primary schools in Muheza District, Tanzania. The prevalence of reported schistosomiasis was calculated for each school and used to select 15 schools across a range in prevalence. All children in the 15 schools (n = 2370) were interviewed again by a nurse and gave a urine sample which was subjected to a quantitative microscopical examination for the eggs of S. haematobium by filtration. The prevalence of reported schistosomiasis by the interview in the 15 schools correlated strongly with the prevalence reported during the questionnaire survey. The prevalence of reported schistosomiasis in the interview was strongly correlated with the prevalence of infection determined by microscopy and consistently under‐estimated the latter by around 20% across a range in prevalence from 22% to 93%. The sensitivity of diagnosis by an interview increased almost linearly with the prevalence of infection, so that when the prevalence was high, more infected children reported schistosomiasis. The percentage of children who were correct in their self‐diagnosis was independent of the prevalence of infection and of the mean concentration of eggs in urine, and averaged 75%. These findings suggest that self‐reported schistosomiasis is a useful method to estimate the prevalence of infection in schools and might be used to identify infected individuals.