bluuebunny/crossref_metadata_2025 huggingface dataset:
Predicting high‐risk years for malaria in Colombia using parameters of El Niño Southern Oscillation
Authors: Bouma M.J. , Poveda G. , Rojas W. , Chavasse D. , Quiñones M. , Cox J. , Patz J.
Published: November 2003

The interannual variation in malaria cases in Colombia between 1960 and 1992 shows a close association with a periodic climatic phenomenon known as El Niño Southern Oscillation (ENSO). Compared with other years, malaria cases increased by 17.3% during a Niño year and by 35.1% in the post‐Niño year. The annual total number of malaria cases is also strongly correlated (r= 0.62, P < 0.001) with sea surface temperature (SST) anomalies in the eastern equatorial Pacific, a principal parameter of ENSO. The strong relation between malaria and ENSO in Colombia can be used to predict high and low‐risk years for malaria with sufficient time to mobilize resources to reduce the impact of epidemics. In view of the current El Niño conditions, we anticipate an increase in malaria cases in Colombia in 1998. Further studies to elucidate the mechanisms which underlie the association are required. As Colombia has a wide range of climatic conditions, regional studies relating climate and vector ecology to malaria incidence may further improve an ENSO‐based early warning system. Predicting malaria risk associated with ENSO and related climate variables may also serve as a short‐term analogue for predicting longer‐term effects posed by global climate change.
Trachoma in Jimma Zone, South Western Ethiopia.
Authors: Zerihun Negussie
Published: November 2003

A population‐based survey on trachoma was carried out in Jimma zone. The survey showed that trachoma is hyperendemic: of 7,423 people examined, 33.02% had signs of trachoma, 28.9% of males and 37.01% of females; 26.13% of the urban and 34.09% of the rural population had clinical signs of trachoma. Active trachoma (TF*TI) was seen in 24.5% of the study population (an estimated half million people). The prevalence of signs of active trachoma among children 0–10 years of age was 35.7%. Blinding trachoma (CO*TT) was seen in 3.81% of the population: 6.86% of the female population aged 15 years had trichiasis and/or entropion.

Both active and critical trachoma were significantly associated with the female gender (P < 0.0000001 for each), living in rural areas (P < 0.0001 for each type), parental illiteracy (P < 0.0000001 for each) and absence of a latrine (P < 0.01 for each). Shorter distance of the household water supply was associated with a higher prevalence of both active and cicatricial trachoma. This was significant only for cases of active trachoma living in households within 16 to 30 minutes walking distance from the water source (P < 0.03).

An estimated 17000 people in the zone are blind; 3500 of these from trachoma. About 52,000 people are in danger of blindness from trichiasis. Primary eye care activities such as promoting health education (face washing) among community members, especially women and children, mass chemotherapy for trachoma, training of health workers and establishment of community‐based surgical services are recommended. These are to be executed by the Zonal Health Department in close collaboration with the community, governmental and non‐governmental organisations.
Light and electron microscopic findings in rhinosporidiosis after dapsone therapy
Authors: Venkateswaran Sarada , Date Anand , Job Anand , Mathan Minnie
Published: November 2003

Morphological findings in serial nasal mucosal biopsies from three cases of rhinosporidiosis on dapsone therapy were compared with biopsies from 33 patients taken before dapsone or surgical treatment was initiated. All biopsies were examined by light microscopy and five by electron microscopy. Counts of histologically intact and degenerated organisms showed a decreasing proportion of intact forms with treatment.
Availability of antibiotics as over‐the‐counter drugs in pharmacies: a threat to public health in Vietnam
Authors: Duong Dat Van , Binns Colin William , Le Truyen Van
Published: November 2003

A survey on the use of antibiotics purchased through retail pharmacies was conducted in the Badinh district of Hanoi, Vietnam. The survey found that purchasers visit a pharmacy when they or those who felt they needed antibiotics had minor symptoms such as cough (34.1%), sore throat (32.5%), stomach upsets (10.0%) and diarrhoea (8.8%). The most often purchased antibiotics were ampicillin (31.1%), amoxyllin (16.7%), cotrimoxazol (11.6%), tetracycline (5.2%) and cephalexin (4.8%). The median of the purchased quantity was to tablets, the mean 11.34 tablets (95% CI 9.65–12.97). About 30% of the purchasers intended to take antibiotics for three days or less. The mean cost of a antibiotic purchase was US$1.27 (95%CI 1.06–1.39). The main reason for not taking a full course of antibiotics was not economic constraint, but the purchasers poor knowledge about antibiotics. Logistic regression analysis indicates that age of purchasers, length of symptoms and kinds of treatment used before visiting a pharmacy could be used as predictive variables for the decision to buy antibiotics in preference to alternative drugs. Antibiotics are used when illness lasts longer than one week and antibiotics have not yet been taken. Antibiotics are‐also purchased by young rather than old people. The study documents the need for better health education about the rational use of antibiotics in the general public.
Pleural empyema due to Salmonella paratyphi in a patient with AIDS
Authors: Wolday Dawit , Seyoum Berhane
Published: November 2003

Pleural empyema due to Salmonella has rarely been reported in immunocompromised patients. Here, we present a case of a 25‐year old man infected with the human immunodeficiency virus type‐1 (HIV‐1) who presented with a left‐sided pleural effusion. The cause was confirmed bacteriologically to be due to Salmonella paratyphi. The outcome was favourable after antibiotic therapy coupled with pleural drainage. It should be recognised that pleural empyema due to Salmonella may occur in HIV‐infected subjects and we suggest that patients presenting with pleural empyema due to uncommon pathogens be tested for HIV‐1 antibodies.
Geographical and seasonal association between linamarin and cyanide exposure from cassava and the upper motor neurone disease konzo in former Zaire
Authors: Banea‐Mayambu Jean‐Pierre , Tylleskär Thorkild , Gitebo Nahimana , Matadi Nunga , Gebre‐Medhin Mehari , Rosling Hans
Published: November 2003

High cyanide intake from consumption of insufficiently processed cassava has been advanced as a possible aetiology of the upper motor neurone disease konzo. However, similar neurodamage has not been associated with cyanide exposure from any other source. With an ecological study design, we compared 22 cases of konzo, 57 unaffected household members and 116 members from unaffected households, a total of 195 subjects, in konzo‐affected savanna villages with 103 subjects in adjacent non‐affected forest villages in the Paykongila area in the Bandundu Region. Zaire.

In the dry season, the mean value (± SEM) of urinary thiocyanate, the main cyanide metabolite, was higher in the three groups in konzo‐affected villages (563 ± 105, 587 ± 44 and 629 ± 47 μmol*l) than in unaffected villages (241 ± 17 μmol*l). In affected villages in the dry season when konzo incidence was high, mean urinary thiocyanate was also higher than the levels found in the wet season when incidence was low. The wet season values (mean ± SEM) were 344 ± 60, 381 ± 35 and 351 ± 27 μmol*l. Urinary levels of inorganic sulphate were low in all groups, indicating low intake of the sulphur amino‐acids which provide a substrate for cyanide detoxification. These findings support an aetiological role for cyanide in konzo. However, urinary linamarin, the cyanogenic glucoside and source of cyanide in cassava, was more closely associated with the occurrence of konzo. The mean value (± SEM) of urinary linamarin in the konzo cases was 632 ± 105 μmol*l and in their household members 657 ± 52 μmol*l, which was significantly higher than in members of control households in the same village (351 ± 28 μmol*l) and in unaffected villages (147 ± 18 μmol/l). This suggests that a specific neurotoxic effect of linamarin, rather than the associated general cyanide exposure resulting from glucoside breakdown in the gut, may be the cause of konzo.
Accidental Leishmania mexicana infection in an immunosuppressed laboratory technician
Authors: Knobloch J. , Demar M.
Published: November 2003

A 30 year‐old female laboratory technician under immunosuppressive treatment because of systemic lupus erythematosus (SLE) developed cutaneous leishmaniasis 8 months after accidental percutaneous inoculation of amastigote culture forms of Leishmania mexicana. Leishmania‐specific PCR and restriction analysis patterns were identical for both the laboratory strain and the clinical specimen. The lesion was resistant to local paromomycin and oral ketoconazole, but responded to local application of meglumine antimonate. No signs of dissemination or visceralization occurred during the 5‐month period of observation. However, a future recurrence cannot be excluded since a persistent infection even after clinical cure has always to be considered in leishmaniasis. Patients under immunosuppressive therapy are possibly at risk of clinical relapse or disseminating infection although there is no experience with regard to leishmaniasis mexicana. Serious infection may require interferon gamma as part of the treatment which may contribute to deterioration of concomitant diseases like SLE. In any case, the exposure of immunodeficient laboratory workers to Leishmania spp. should be avoided.
Immunohistological studies on macrophages in lymph nodes of onchocerciasis patients after treatment with ivermectin
Authors: Knab Julia , Darge Kassa , Büttner D.W.
Published: November 2003

The role of macrophages in the killing and elimination of microfilariae (mf) was studied immunohistologically in 14 lymph nodes from 10 patients with generalized onchocerciasis 20–68 h after treatment with a single oral dose of 150 μg/kg ivermectin. Mf with signs of damage at light microscopical level were surrounded by a cellular infiltrate comprising macrophages, eosinophils and neutrophils, whereas light microscopically intact mf mostly showed no cellular reaction. Resident mature macrophages expressing the CD 68 epitope usually neither migrated nor attached to damaged mf, especially on the first and second day after ivermectin treatment. However, many young invading macrophages labelled for the L1 protein (antibodies 27 E 10, MAC 387, S 36.48 and 8.5C2) were found within the cellular infiltrate around damaged mf and in adherence to the mf in all lymph nodes after ivermectin treatment. Free L1 protein was observed on the cuticle of the mf. The attacking macrophages contained increased amounts of the enzymes lysozyme, α‐1‐antichymotrypsin and α‐1‐antitrypsin compared to resident macrophages. Free enzymes were found on the cuticle of the mf and around them, indicating a role of these enzymes in the inflammatory reaction to the parasites. The attacking macrophages were strongly labelled for human HLA‐DR and they showed further an increased expression of the complement receptors CR1 (CD 35) for C3b and CR3 (CD 11b) for C3 bi in comparison to resident macrophages and thus were considered as activated macrophages. Rarely fragments of mf were seen within multinuclear macrophages. We conclude that young activated macrophages play a major role in the elimination of mf transported to the regional lymph nodes after ivermectin treatment. The immunohistological findings are in accordance with the assumption that these activated macrophages together with granulocytes contribute to the killing of the damaged mf. They also help to limit the damage of the host tissue by release of α‐1‐antichymotrypsin and α‐1‐antitrypsin.
Early reduction of the challenge recovery rate following immunization with irradiated infective larvae in a filaria mouse system
Authors: Goff L. Le , Maréchal P. , Petit G. , Taylor D.W. , Hoffmann W. , Bain O.
Published: November 2003

The filaria Litomosoides sigmodontis, which develops a patent infection in BALB/c mice, was used to determine the fate of a challenge inoculum following immunization of mice with irradiation attenuated infective larvae (3 subcutaneous inoculations at weekly intervals with 25 L3 irradiated at 60 krad, and challenge with 25 L3 two weeks after the final immunization). The adult worm burden of vaccinated mice was reduced to 50% of that of controls although the pattern of larval migration and microfilaraemia were not affected. Necropsies showed that the increased killing of the filariae of the challenge inoculum occurred at the L3 stage within the first 2 days of challenge. This result draws attention on the protective mechanisms operating very early and probably in the subcutaneous region.
Practices and beliefs of traditional birth attendants: lessons for obstetrics in the north?
Authors: Lefèber Yvonne , Voorhoever Henk
Published: November 2003

The majority of mothers in countries in Africa, Asia and Latin America are supported by Traditional Birth Attendants (TBAs) during pregnancy and childbirth. TBAs do more than just deliver babies. As part of the local community they are acquainted with the women and their families with whom they share the cultural ideas about how the birth has to be prepared for and performed. They know the local medicines and rituals which are used before, during and after delivery. The work of the TBAs is adapted and strictly bound to the social and cultural matrix to which they belong, their practices and beliefs being in accordance with the needs of the local community. Therefore they may not be able to assist women at childbirth outside their own socio‐cultural environment.

Comparison of the practices and beliefs of TBAs in Africa, Asia and Latin America revealed a large variation among the different cultures of the three continents. Surprisingly, in spite of the cultural differences there were clearly some common practices and beliefs which may occur in all three continents. It is assumed that these common practices are due to the expression people give to the basic events of life such as pregnancy, labour and lactation. A short review of common practices is presented as they may be of value in obstetrical practice in the northern countries.
Treatment of human Mansonella streptocerca infection with ivermectin
Authors: Fischer P. , Bamuhiiga J. , Büttner D. W.
Published: November 2003

We studied the short‐term effects of a single dose of 150 μg/kg body weight ivermectin on Mansonella streptocerca in an area endemic for streptocerciasis, but not for onchocerciasis, in western Uganda. Six and 12 days after treatment no microfilariae (mf) were found in the skin of 53 out of 96 mf carriers living in 3 villages, and the geometric means of the mf densities of remaining mf carriers were only 33–40% of pretreatment levels. This reduction of mf density was highly significant (P<0.0001). Immunohistological examination of skin biopsies showed degenerated and disintegrating mf surrounded by activated eosinophils (positive for activated cationic protein), macrophages, and neutrophils (positive for myeloperoxidase and defensin) on day 6 after treatment. Remarkable was the invasion of young, L1 protein‐positive macrophages and the release of neutrophil defensin as signs of acute inflammation. We conclude that ivermectin has a strong microfilaricidal activity against M. streptocercaCommon adverse effects were increased pruritus and acute papular dermatitis in 45% of 86 mf carriers on day 6 after treatment. No serious adverse side‐effects were noticed in about 700 treated persons.
The epidemiology of cutaneous leishmaniasis in subtropical Ecuador
Authors: Armijos Rodrigo , Weigel M. , Izurieta Ricardo , Racines Jose , Zurita Camilo , Herrera Walter , Vega Milton
Published: November 2003

An epidemiologic survey (n=466) was conducted in an area of subtropical rainforest in north‐west Ecuador with the following objectives: (1) to determine the prevalence of cutaneous leishmaniasis (CL), (2) to identify the Leishmania species causing human disease, (3) to investigate the major clinical manifestations of leishmaniasis, (4) to study cellular and humoral immune response indicators associated with disease status and (5) to identify risk factors for CL. Fourteen per cent of subjects had parasitologically confirmed CL; 33% had evidence of prior disease. However, 17.2% of subjects with a negative CL clinical history presented with a positive Montenegro skin test (MST), indicating the possibility of subclinical infection. The species isolated from subject lesions were L. guyanensis (63%), L. panamensis (33%), and L. brazilensis (4%). Mean specific anti‐Leishmania IgG and IgM OD serum levels were highest in subjects diagnosed with current CL, followed by those with prior CL, and were lowest in healthy subjects, respectively (0.56±0.27 vs 0.33±0.2 vs 0.22±0.14; F‐ratio=74; P<0.00001) and (665±270 vs 481±220 vs 301±128.5; F‐ratio=37; P<0.00001). Likewise, subjects with present CL had measurably higher MST reactions (13±6.7 mm) than those with prior CL (10.9±7.8 mm) or healthy individuals (2.4±2.5 mm; F‐ratio=106; P<0.00001). Serum concentrations of IgG were predicted by lesion number (t=2.5; P=0.018), size (t=3.7; P=0.0006), and duration (t=3.5; P=0.0013). Furthermore, the MST induration size increased as a function of lesion number (t=3.0; P=0.005) and size (t=3.4; P=0.022). Subject age and sex did not predict serum IgG or IgM concentrations or MST reactions in the 3 disease groups. Although no sex differences were found with respect to clinical characteristics, children 12 years of age were almost 3 times more likely to have CL lesions or scars located on the face and head area compared to adults (OR=2.75; 95% CI=1.4–5.6, P=0.004). The risk factors associated with disease included age under 5 years (AOR=1.5; 95% CI=0.48–2.35), male gender in adults (AOR=2.8; 95% CI=1.1–7.8), and wood and/or cane exterior house walls (AOR=1.8; 95% CI=1.4–2.5). In contrast, electric home lighting was associated with decreased risk (AOR=0.7; 95% CI=0.4–2.3). The results suggest that it may be possible to modify a portion of the risk of CL by making changes in the housing environment which may help to reduce the amount of human–vector contact.
Wuchereria bancrofti in Tanzania: microfilarial periodicity and effect of blood sampling time on microfilarial intensities
Authors: Simonsen Paul , Niemann Lea , Meyrowitsch Dan
Published: November 2003

The circadian periodicity of Wuchereria bancrofti microfilarial (mf) intensities in peripheral blood was analysed in a group of infected individuals from an endemic community in north‐eastern Tanzania. The mf density was quantified at two‐hourly intervals for 24 hours. A clear nocturnal periodic pattern was observed. Mathematical analysis of the data indicated a peak at 0152 h and a periodicity index of 117.5. A periodicity equation was developed describing the average relation between mf intensity and hour of the day for the study area. Based on the observed periodicity pattern, the effect of blood sampling before peak time is discussed, and the importance of taking sampling time into consideration when analysing data from epidemiological studies is emphasized. A simple method is devised which can be used to adjust for the influence of time on mf intensities, in studies where accurate information on mf intensities is necessary, and where it is impossible to obtain all samples at peak time.
Improving the efficiency of district hospitals: is contracting an option?
Authors: Mills Anne , Hongoro Charles , Broomberg Jonathan
Published: November 2003

A world‐wide revolution in thinking about public sector management has occurred in recent years, termed the ‘new public management’. It aims to improve the efficiency of service provision primarily through the introduction of market mechanisms into the public sector. The earliest form of marketization in developed countries has tended to be the introduction of competitive tendering and contracts for the provision of public services. In less wealthy countries, the language of contracting is heard with increasing frequency in discussions of health sector reform despite the lack of evidence of the virtues (or vices) of contracting in specific country settings. This paper examines the economic arguments for contracting district hospital care in two rather different settings in Southern Africa: in South Africa using private‐for‐profit providers, and in Zimbabwe using NGO (mission) providers. The South African study compared the performance of three ‘contractor’ hospitals with three government‐run hospitals, analysing data on costs and quality. There were no significant differences in quality between the two sets of hospitals, but contractor hospitals provided care at significantly lower unit costs. However, the cost to the government of contracting was close to that of direct provision, indicating that the efficiency gains were captured almost entirely by the contractor. A crucial lesson from the study is the importance of developing government capacity to design and negotiate contracts that ensure the government is able to derive significant efficiency gains from contractual arrangements.

In other parts of Africa, contracts for hospital care are more likely to be agreed with not‐for‐profit providers. The Zimbabwean study compared the performance of two government district hospitals with two district ‘designated’ mission hospitals. It found that the two mission hospitals delivered similar services to those of the two government hospitals but at substantially lower unit cost. The nature of the contract between government and missions was implicit rather than explicit and of long standing. On the whole the mission organizations felt the informal nature of the agreement was advantageous, though the government plans to introduce service contracts at district level with all hospitals, both government and mission. The paper concludes by identifying concerns raised by the case‐studies that are of relevance to other countries considering the introduction of explicit contractual arrangements for district hospital provision.
How African doctors make ends meet: an exploration
Authors: Roenen C. , Ferrinho P. , Van Dormael M. , Conceição M. C. , Van Lerberghe W.
Published: November 2003

This paper is an attempt to identify individual coping strategies of doctors in sub‐Saharan Africa. It also provides some indication of the ‘effectiveness’ of these strategies in terms of income generation, and analyses their potential impact on the functioning of the health care system. It is based on semi‐structured interviews of 21 doctors working in the public health sector in sub‐Saharan Africa and attending in 1995 an international Master's course in Public Health in Belgium or in Portugal.

This small sample of physicians yielded reports about 28 different types of individual strategies. Most of these potentially affect health service delivery more through reduced availability of staff than through the more blatant misappropriations. Activities related to the health field are mentioned most often. Allowances and per diems seem to be top regarding frequency and effectiveness, followed by secondary jobs, private practice or gifts from patients. None of the interviewees, however, admits using public resources for private purposes. Side activities may bring in very considerable amounts of income, out of proportion to the official salary, and can also be very time consuming. Nevertheless, all interviewees identify themselves in the first place as civil servants.

Individual coping strategies may lead to undesirable side‐effects for health care delivery, through a net transfer of resources (qualified personnel‐time and material resources) from the public to the private‐for‐profit sector. There may also be positive effects though, be it in terms of mobilization of additional resources, of stabilization of qualified personnel or of realization of professional goals. However, these emerging strategies call for innovative mechanisms, likely to shape coping strategies in such a way that they remain compatible with equity and quality of care to the population.
Anthraquinones in Rheum palmatum and Rumex dentatus(Polygonaceae), and phorbol esters in Jatropha curcas(Euphorbiaceae) with molluscicidal activity against the schistosome vector snails Oncomelania,Biomphalaria, and Bulinus
Authors: Liu S. Y. , Sporer F. , Wink M. , Jourdane J. , Henning R. , Li Y. L. , Ruppel A.
Published: November 2003

Hot water extracts of Rheum palmatum and Rheum dentatus (from China) showed molluscicidal activity against the snails Oncomelania hupensis, Biomphalaria glabrata and Bulinus globosus which are vectors of Schistosoma japonicumS. mansoni and S. haematobium respectively. Activity was correlated with anthraquinones which were identified by HPLC: rhein and chrysophanol‐anthron were most active (>50% dead snails after 2 days in a 0.03% solution). Molluscicidal activity was intermediate with Rheum‐emodin and physcion and was not detectable with cinnamic acid or Aloe‐emodin. The snail O. hupensis tended to be more sensitive for several compounds than B. glabrata Extracts of Jatropha curcas seeds (from Mali) showed molluscicidal activity against both B. glabrata and O. hupensis the latter being the more sensitive snail. The activity was associated with phorbol esters extracted from Jatropha oil. Of the pure phorbol esters tested, 4β‐phorbol‐13‐decanoate killed both snail species at a concentration of 0.001% (10 p.p.m). As Jatropha is locally grown in Mali for other purposes, it might potentially be exploited for schistosomiasis control.
In vitro blood schizonticidal activity of sera containing mefloquine‐quinine against Plasmodium falciparum
Authors: Tan‐ariya P. , Na‐Bangchang K. , Ubalee R. , Boutes S. , Riengchainam S. , Karbwang J.
Published: November 2003

Serum samples collected at intervals from healthy volunteers, after the administration of 3 drug regimens (quinine (QN) 600 mg, mefloquine (MQ) 750 mg, and MQ 750 mg plus QN 600 mg) were investigated for their blood schizonticidal activities against K1 strain Plasmodium falciparum in vitro. Superiority of activity was shown in the sera collected after the combination regimen. In the diluted sera of the QN regimen, a complete inhibitory effect was observed for only 24 hours, whereas the effect was sustained for 72 hours in the sera collected after MQ in either regimen (MQ alone or MQ/QN). The pattern of minimum inhibitory concentrations (MICs) of QNEq of the sera from QN alone was constant throughout a 24‐hour period, with significantly higher concentrations than that from the combination regimen (118–150 vs 21.25–73.5 μg/l). In sera collected after the combination regimen, however, the MIC gradually decreased from 0.5 until 2.5 and 4 h, and thereafter gradually returned to the same levels again during a period of 6–24 hours. The MICs of MQEq when given as MQ alone or in combination appeared constant, with a significantly higher value in the former regimen (24.4–26.8 vs 17–19.2 μg/l).
Characterization of Mycobacterium avium complex related mycobacteria isolated from an African environment and patients with AIDS
Authors: Fonteyne P.‐A. , Kunze Z. M. , De Beenhouwer H. , Dumonceau J. M. , Dawson D. J. , McFadden J. J. , Portaels F.
Published: November 2003

Thirteen isolates from African AIDS patients and from the environment in Zaire were identified as members of the Mycobacterium avium complex by phenotypic tests. RFLP analysis showed that the isolates belong to a genetically homogeneous cluster. The 16S rRNA sequence analysis suggests a close relationship with the P‐49 strain (ATCC 35847), a reference strain for the serotype 7 of M. avium complex. This work shows the close relationship between certain M. avium complex strains responsible for disseminated infection in AIDS patients and M. avium complex strains isolated from the environment in Zaire. Further, our findings confirm that atypical mycobacteria may disseminate in AIDS patients in Africa and suggest that infection in these patients probably originates in their environment.
The effects of protease inhibitors and sugars on the survival and development of the parasite Onchocerca ochengi in its natural intermediate host Simulium damnosum s.l.
Authors: Hagen H. E. , Kläger S. L. , Barrault D. V. , Ham P. J.
Published: November 2003

A range of protease inhibitors and carbohydrates were administered to the haemolymph of the vector Simulium damnosum s.l. to test for their effects on the success of an Onchocerca ochengi infection in vivo. We found that serine protease inhibitors led to a significant increase of parasite survival. Two sugars, d(+)‐galactose and methyl‐α‐d‐mannopyranoside, had the same effect. These effects are possibly due to the successful in vivo blocking of the two respective types of inducible immune molecules, the serine proteases and the carbohydrate binding lectins, both of which have been identified in simuliids.
The non‐randomness of the distribution of Trichuris trichiura and Ascaris lumbricoides eggs in faeces and the effect of stirring faecal specimens
Authors: Ye Xiao‐Ping , Donnelly Christl , Fu Ying‐Ling , Wu Zhong‐Xing
Published: November 2003

Experiments were performed to describe the distribution of Trichuris trichiura and Ascaris lumbricoides eggs in faeces and to test for the effect of stirring faecal specimens prior to sampling. For each of 5 volunteers infected with A. lumbricoides and 7 volunteers infected with T. trichiura, helminth eggs were counted in 150 samples from a single stool specimen using the Kato‐Katz smear technique. No significant differences between the distribution of eggs in samples from the surface and the centre of the specimens were found. Prior to stirring, eggs were found to be aggregately distributed in four of the specimens with T. trichiura and all of the specimens with A. lumbricoides. The distributions of eggs were not significantly altered by stirring the stool prior to sampling except in the case of one volunteer infected with A. lumbricoides for whom stirring reduced variability.
Pitfalls in the diagnosis of complete hydatidiform mole with coexistent live fetus
Authors: Jongen V. H. W. M. , Koetsier Koetsier D. W.
Published: November 2003

Complete hydatidiform mole with coexisting live fetus is rare, causing specific difficulties in diagnosis and management. These aspects are illustrated in 2 cases that presented with antepartum haemorrhage. Fetal heart sounds and body parts or uncertainty over the duration of amenorrhoea may delay early diagnosis in the absence of ultrasonography.
Pattern of linear growth velocities of infants from birth to 12 months in Madura, Indonesia
Authors: Kolsteren P. W. , Kusin J. A. , Kardjati S.
Published: November 2003

The paper analyses growth velocity data of infants aged 0–11 months from Madura, Indonesia, with the aim of identifying the time of onset of linear growth retardation. Velocities are calculated as average velocities for mid‐point intervals, so that they can serve as comparative information for further studies. Secondly, the relation between weight and length velocities is tested. Thirdly, growth velocities are related to birthweight, length at birth and ponderal index (PI=weight/height3×100 in g/cm3). The anthropometric information of infants is taken from two large longitudinal studies, the East Java Pregnancy Studies Phase I and Phase II (EJPS I and II). These were conducted from August 1981 to December 1985 and January 1987 to December 1989, respectively, in two villages in Madura, Indonesia. The results support the following hypotheses: linear growth in the first year in Madurese infants shows two periods of deceleration. The early phase starts in the first month and is related to intra‐uterine growth. It lasts up to about 4–6 months. Children with normal birthweight but with a low PI grow slowest in length after birth. The second period is towards the second half of the first year, when differences in linear velocity decrease with the references and velocity distribution change. Differences in weight velocity increase during this period. Factors outside the intricate fetal mother–child relationship could start to play a role.
Endemicity and clinical manifestations of onchocerciasis in the province of Bururi, Burundi
Authors: Newell E. D. , Hicuburundi B. , Ndimuruvugo N.
Published: November 2003

A sample of the population of 20 ‘collines’ (administrative units) of the province of Bururi (Burundi, Central Africa) was examined to determine the prevalence and intensity of onchocerciasis in this endemic region. In all, 34.4% of the population is infected, that is about 80 000 people for the whole area. Around Rumonge onchocerciasis is hyperendemic. This area is surrounded by a mesoendemic zone and at the periphery onchocerciasis is hypoendemic. The clinical examination of a subsample showed that pruritus and skin lesions are not very frequent (58.2 and 28.1% respectively in positive persons). Subcutaneous nodules are small and difficult to find (21.3% in positive cases). Vision is 10/10 in 92.2% of the examined eyes. A slight drop in visual acuity may be attributed to onchocerciasis in 9.4% of positive cases.
Variation in weight of stool samples prepared by the Kato–Katz method and its implications
Authors: Engels D. , Nahimana S. , De Vlas S. J. , Gryseels B.
Published: November 2003

We investigated both the extent of the variation in weight of stool samples prepared by the Kato–Katz method and its influence on egg counts and commonly used group parameters of infection derived from them. In a first study group of 795 people, the total mean weight of stool aliquots, prepared with templates designed to contain 28.3 mm3, was 23.0 mg with 95% of the individual values lying between 12.0 and 34.0 mg. Minimum and maximum values were 2.4 and 49.5 mg, respectively. Frequency distributions of the individual weights, in series of slides prepared by different laboratory assistants, showed significant differences. In a second study group of 199 people, duplicate series of slides were prepared and variations in the weight of examined stool were related to variations in egg count. The correlation between repeated individual sample weights in this series was poor, but the correlation between egg counts was good. This was translated, at aggregate level, in very similar classifications in egg count categories. This classification was also hardly influenced by the choice of the conversion factor to transform egg counts per slide into eggs per gram. At the individual level, the variability in egg counts far outweighed the variability in sample weight and was not clearly related to it. We therefore concluded that variations in weight of examined stool are considerable, but account for only a minimal part of the important egg count fluctuations generally observed.
Prevalence of diabetes in rural and urban populations in southern Sierra Leone: a preliminary survey
Authors: Ceesay M. M. , Morgan M. W. , Kamanda M. O. , Willoughby V. R. , Lisk D. R.
Published: November 2003

We conducted a preliminary community survey for diabetes in the Bo district of southern Sierra Leone. Five hundred and one subjects comprising 256 rural adults in two villages and 245 urban adults in Bo town were randomly selected and screened for diabetes using random capillary blood glucose according to WHO criteria. There were 6 diabetics, all in the urban area, giving a prevalence of 2.4% in the urban population, and 0% in the rural villages. The mean (s.d.) capillary random blood glucose (RBG) concentration was 5.7±1.7 mmol/l for the entire study population, while concentrations for the urban and rural populations were 5.8±2 and 5.5±1.4 mmol/l respectively (P>0.05). RBG increased significantly with age. The mean (s.d.) body mass index (BMI) was 22.3±4.9 kg/m2 for the total population while those for the urban and rural populations were 23.0±5.8 and 21.6±3.6 respectively (P<0.01). Only 5% of the population were obese, i.e. BMI30 kg/m2. Dietary habits were similar in both town and country. According to this survey, the prevalence of diabetes is very low in rural Sierra Leone, but urban areas may be experiencing increasing prevalence. Mechanisms for effective screening and promotion of proper diet and exercise must be incorporated into existing health services to prevent an escalation of diabetes in urban Sierra Leone.
Seroepidemiology of abdominal angiostrongyliasis: the standardization of an immunoenzymatic assay and prevalence of antibodies in two localities in Southern Brazil
Authors: Graeff‐Teixeira C. , Agostini A. A. , Camillo‐Coura L. , Ferreira‐da‐Cruz M. F.
Published: November 2003

Abdominal angiostrongyliasis is a nematode disease produced by Angiostrongylus costaricensis, a metastrongylid parasite of wild rodents. Accidental human infection occurs through ingestion of food or water contaminated with third‐stage larvae present in the mucous secretion of terrestrial molluscs. An ELISA test was standardized for detection of IgG antibodies recognizing a surface antigen prepared from female worms. Competitive absorption of sera with Ascaris suum crude antigen resulted in a test with 86% sensitivity and 83% specificity. The disease is endemic in Southern Brazil and a number of cases are diagnosed every year through anatomo‐pathological examination of biopsies or surgical specimens, since no other diagnostic method is available. According to seroepidemiological studies, prevalences in two transmission foci are 29.8 and 66%, attesting to the widespread occurrence of the infection in those endemic areas.
Enhanced gametocyte production in Fansidar‐treated Plasmodium falciparum malaria patients: implications for malaria transmission control programmes
Authors: Puta Chilunga , Manyando Christine
Published: November 2003

Gametocytes are the agents in malaria transmissible between the vertebrate host and the mosquito vector, and an increase in their incidence would be expected to have a corresponding impact on the prevalence of malaria, particularly in areas of high transmission. The purpose of this study was to determine whether there is an association between the type of antimalarial drug administered and the production of gametocytes. Two commonly used drugs, Fansidar and chloroquine, were compared in this respect. A total of 94 people (mean age±s.d. 16.94±19.03 years), from a highly endemic malaria area of Zambia, were treated with either Fansidar or chloroquine (Fansidar, n=46, chloroquine, n=48). The percentages of gametocytes generated after treatment were 23.9 for Fansidar and 6.2 for chloroquine. A 2×2 table analysis of the data shows that the P values, both by χ2 and Z analysis, were less than 0.02, suggesting a statistically significant difference in the propagation of gametocytes between the two treatment groups. There was no significant difference in the quantitative gametocyte count per 200 white blood cells (Fansidar, 7.5±8.57; chloroquine, 4.5±1.64; P>0.10), probably because of the small size of the ‘gametocyte ’ sample (n=14).
Schistosoma mansoni‐related morbidity on Ukerewe Island, Tanzania: clinical, ultrasonographical and biochemical parameters
Authors: Kardorff R. , Gabone R. M. , Mugashe C. , Obiga D. , Ramarokoto C. E. , Mahlert C. , Spannbrucker N. , Lang A. , Günzler V. , Gryseels B. , Ehrich J. H. H. , Doehring E.
Published: November 2003

One thousand six hundred and ninety‐five inhabitants of 3 rural villages on Ukerewe Island, Lake Victoria, Tanzania, were examined by clinical, parasitological, ultrasonographic and—in part—serological means to evaluate Schistosoma (S.) mansoni‐related morbidity on a community level. Villagers frequently complained of typical colitis symptoms (abdominal pain 80.1%, bloody stools 43.1%, diarrhoea 35.1%); haematemesis, on the other hand, was rare (and reports doubtful in most cases). 16.9% of the population had been given praziquantel previously. Overall S. mansoni prevalence was 86.3%, with a median egg output of 176 eggs per gram (e.p.g.) and a maximum output of 17 984 e.p.g. Children and adolescents were infected more severely than adults, men more severely than women. Pretreated individuals excreted significantly fewer ova (median 124 vs 192e.p.g., P<0.001).

Hepatomegaly (determined by ultrasonography) was present in 35%, splenomegaly in 80%. Organomegaly was significantly related to egg output. Pretreated persons had lower rates of splenomegaly and left lobe hepatomegaly. Low‐degree periportal fibrosis was common, while severe grades of fibrosis (MANAGIL score II and III) were present in about 6%. About 10% had other abnormalities on liver sonography (irregular parenchymal texture and/or shape); these persons passed significantly more S. mansoni ova than others. Clear sonographic signs of portal hypertension were seen in 2.1%. Serum procollagen‐IV‐peptide and γ‐glutamyl‐transferase levels were increased in persons with severe periportal fibrosis, irregular liver texture or portofugal collateral vessels.

Thus, S. mansoni infection in the western part of Ukerewe Island is frequent and often severe, leading to a high prevalence of gastrointestinal symptoms. Hepatosplenic involvement does occur, although symptomatic cases of portal hypertension were not identified beyond doubt. The overall level of schistosomal morbidity is thus considered intermediate. Serum procollagen‐IV‐peptide may be a promising marker of schistosomal liver disease. Our data suggest that S. mansoni infection may also be related to diffuse liver parenchyma alterations in this area.
Evaluation of neonates with risk for infection/suspected sepsis: Is routine lumbar puncture necessary in the first 72 hours of life?
Authors: Ajayi Oluade , Mokuolu Olugbenga
Published: November 2003

To determine whether lumbar puncture is necessary in the evaluation of neonates with risk for infection or suspected sepsis in the first 72 hours of life, we reviewed the laboratory and medical records of 506 infants who had lumbar punctures between January 1988 and December 1990. Neonates <72 hours of age accounted for 52% of all lumbar punctures, but no case of meningitis. This led to a policy shift from routinely performing lumbar punctures to reserving them for infants with signs of severe sepsis (i.e. lethargy, hypothermia, hypotonia, poor perfusion or apnoea), specific neurological signs or clinical deterioration. This new policy was monitored prospectively from July 1991 to December 1993. Three times fewer procedures were performed in neonates <72 hours, and there was no diagnosed or missed case of meningitis. Given that meningitis is rare within the first 72 hours of life and the yield of lumbar puncture virtually zero, we recommend that lumbar punctures be reserved for selected infants.
Gender and ethnic differences in onchocercal skin disease in Oyo State, Nigeria
Authors: Brieger William , Ososanya Oladele , Kale Oladele , Oshiname Frederick , Oke Ganiyu
Published: November 2003

During preparation for a study on the effects of ivermectin treatment on onchocercal skin disease in the Ifeloju Local Government Area of Oyo State, Nigeria, 1032 adults aged20 years and older were examined for skin lesions and palpable nodules. It was found thatfor 4 types of skin lesions, acute papular onchodermatitis (APOD), chronic papular onchodermatitis (CPOD), lichenified onchodermatitis (LOD) and depigmentation (leopard skin), as well as for subcutaneous nodules, females had a significantly higher prevalence than males. Although the area is inhabited primarily by the Yoruba people, the study also included some of the cattle‐herding Fulani ethnic group. The reactive skin lesions, APOD, CPOD and LOD, were found to be more common among the Fulani, although there were no significant differences in leopard skin and nodules between both groups. While there is need for further research on both immunological and behavioural factors that may lead to these differences in disease. The need to achieve equity in health programming by ensuring that women and ethnic minorities receive full disease control services is of more immediate concern.
Trial of the ParaSight‐F test for malaria diagnosis in the primary health care system, Zimbabwe
Authors: Mharakurwa S. , Manyame B. , Shiff C. J.
Published: November 2003

Rapid diagnosis of Plasmodium falciparum malaria remains one of the main limitations to prompt treatment. Diagnosis based on clinical symptoms is decidedly unreliable, especially in areas of seasonal transmission like Zimbabwe. In view of this, the Plasmodium falciparum histidine‐rich protein (HRP‐II) antigen detection assay (ParaSight‐F test) was tried at 10 health centres in 3 malaria endemicity zones of Zimbabwe, as a malaria diagnostic tool for primary health care. Parasitological evaluations were conducted using thick and thin film microscopy as gold standard, and ease of test operation and practicability to nurses were ascertained by questionnaire. The sensitivity of the test did not vary substantially by endemicity zone and was ≈93%. Specificities were 85, 72 and 92% in the hyperendemic, mesoendemic and hypoendemic zones, respectively. Positive predictive values varied considerably with endemicity, the lowest being in the hypoendemic zone (56%). However, negative predictive values did not change significantly, with a mean of 94%. It was found that the ParaSight‐F test reduced mistreatment for malaria, relative to clinical diagnosis, by up to 81%, especially in the hypoendemic region. Test acceptability evaluations were good.
Operational aspects of bednet impregnation for community‐based malaria control in Nicaragua, Ecuador, Peru and Colombia
Authors: Kroeger A. , Meyer R. , Mancheno M. , Gonzalez M. , Pesse K.
Published: November 2003

Community intervention projects with pyrethroid (permethrin and lambdacyhalothrin) impregnated bednets and an accompanying community education programme were carried out in 6 malaria endemic areas on the Pacific coast of Nicaragua, Ecuador, Peru and Colombia as well as in the Peruvian Amazon basin. In this paper the operational aspects are analysed: bednet coverage, results of promotional activities for increased bednet use, the sale of low‐cost bednets, techniques and difficulties with impregnation, acceptance of the programme (including washing of impregnated nets), side‐effects, residual concentrations of the chemical in the nets, costs of the impregnation programme and insecticide resistance of the malaria vectors.

We found that the local manufacture of bednets and their sale through village health workers, even in communities with low cash income, is a viable way of increasing bednet coverage; the impregnation of bednets is well accepted if villagers perceive a direct benefit; pretesting of the soaking capacity of different net materials should be done at central level; the instructions for the impregnation procedures of different net materials (cotton and synthetic) should be simple and unambiguous; very cheap thin net materials should be avoided, particularly in the case of lambdacyhalothrin impregnation; educational methods and/or promotion of dark‐colour nets should be further tested in order to decrease the washing frequency of bednets at household level; in areas with early‐biting mosquitoes further studies on the protective efficacy of bednets are necessary; careful monitoring of side‐effects, particularly those of last‐generation pyrethroids, is necessary; and the community‐based impregnation programme is a powerful tool for strengthening community involvement in health actions.