bluuebunny/crossref_metadata_2025 huggingface dataset:
Parasitaemia and gametocytaemia after treatment with chloroquine, pyrimethamine/sulfadoxine, and pyrimethamine/sulfadoxine combined with artesunate in young Gambians with uncomplicated malaria
Authors: Seidlein Lorenz von , Jawara Musa , Coleman Rosalind , Doherty Tom , Walraven Gijs , Targett Geoffrey
Published: March 2003

As part of a study to assess the infectivity of gametocytes after treatment with four antimalarial regimens, the efficacy of each treatment was also determined. From September to December 1998, 598 children with uncomplicated malaria were treated; 135 received chloroquine (CQ) alone, 276 received pyrimethamine/sulfadoxine (Fansidar©, PSD) alone, 113 received PSD with a single dose of artesunate (PSD + 1ART) and 74 received PSD combined with three doses of artesunate (PSD + 3ART). On day 28 19/63 (30.2%; 95% C.I. 19.2% to 43.1%) of children treated with CQ alone, 5/134 (3.7%; 95% C.I. 1.2% to 8.5%) treated with PSD alone, 1/71 (1.4%, 95% C.I. 0.0% to 7.9%) treated with PSD + 1ART and 0/45 (0.0%; 95% C.I. 0.0% to 7.9%) treated with PSD + 3ART were parasitaemic. The proportion of children with gametocytes on day 7 after treatment with CQ alone was 16/89 (18.0%; 95% C.I. 10.6% to 27.6%), 98/174 (56.3%; 95% C.I. 48.6% to 63.8%) after treatment with PSD alone, 8/70 (11.4%; 95% C.I. 5.1% to 21.3%) after treatment with PSD + 1ART and 4/46 (8.7%; 95% C.I., 2.4% to 20.8%) after treatment with PSD + 3ART. CQ thus has a lower efficacy than PSD or either of the PSD and artesunate combinations. Use of PSD alone as an alternative first line treatment results in a very high post‐treatment gametocyte prevalence that is likely to enhance transmission. There would be greater and more sustainable benefits from using PSD and artesunate combinations.
Evidence for a reduced effect of chloroquine against Plasmodium falciparum in alpha+‐thalassaemic children
Authors: Mockenhaupt Frank P. , May Jürgen , Bergqvist Yngve , Meyer Christian G. , Falusi Adeyinka G. , Bienzle Ulrich
Published: March 2003

Alpha‐thalassaemia is common in malaria‐endemic regions and is considered to confer protection from clinical disease due to infection with Plasmodium falciparum. In vitro, sensitivity to chloroquine (CQ) of P. falciparum infecting alpha‐thalassaemic erythrocytes is reduced. We examined, in a cross‐sectional study of 405 Nigerian children, associations between alpha‐globin genotypes, blood concentrations of CQ, and P. falciparum parasitaemia. Of the children, 44% were alpha+‐thalassaemic (36.8% heterozygous, 7.6% homozygous). CQ in blood and P. falciparum‐infection were observed in 52 and 80%, respectively. CQ was more frequently found in homozygous alpha+‐thalassaemic (71%) than in non‐thalassaemic children (50%; odds ratio, 2.42; 95% confidence interval, 1.01–5.8). Among children with CQ in blood and despite similar drug concentrations, alpha+‐thalassaemic individuals had fewer infections below the threshold of microscopy which were detectable by PCR only, and they had a higher prevalence of elevated parasitaemia than non‐thalassaemic children. No such differences were discernible among drug‐free children. CQ displays a lowered efficacy in the suppression of P. falciparum parasitaemia in alpha+‐thalassaemic children; hence protection against malaria due to alpha+‐thalassaemia may be obscured in areas of intense CQ usage. Moreover, alpha+‐thalassaemia may contribute to the expansion of CQ resistance.
Intestinal parasitic diseases in Riyadh, Saudi Arabia: prevalence, sociodemographic and environmental associates
Authors: Al‐Shammari S. , Khoja T. , El‐Khwasky F. , Gad A.
Published: March 2003

Summary Our objectives were to assess the prevalence of intestinal parasitic infections in Riyadh and to determine associated sociodemographic and environmental factors. The study was conducted through a household survey. Three health centres were chosen from each of the five Riyadh urban regions and 15 from rural areas. Based on the average family size, a random sample of households were chosen. All household members were asked to participate in the study. Data were collected using a pre‐designed questionnaire eliciting data on sociodemographic and environmental factors. A stool specimen of each individual was examined microscopically for the presence of trophozoites and cysts. Six thousand and twelve participants with a mean age of 23.3 ± 17.4 (median 19 years, 48.6% males) were studied and 32.2% were infected. The infection rate was high in urban areas (33.3%), among children <12 years (34.4%), non‐Saudis (42.2%), single persons (34.9%), illiterate individuals (33.8%), those who obtained drinking water from tankers (36.1%) and those who disposed of sewage in open channels (47.1%). Stratified analysis showed that for Saudis <12 years parasitic infections were significantly higher among tanker users (39.5%) and septic tank users (36.8%). For Saudis≥12 years low education, water storage and open sewage disposal were statistically associated with parasitic infections (P < 0.05). Among expatriates, infections were high among males (47.6%), urban residents (48.3%), single persons (46.9%), tanker users (39.5%) and septic tank users (78.6%). Multivariate logistic regression analysis showed that age <12 years, non‐Saudi nationalities, educational level below secondary school, tanker as source of water and open sewage disposal were independently associated with high intestinal parasitic infection.
Evaluation of quinolone derivatives for antitrypanosomal activity
Authors: Keiser J. , Burri C.
Published: March 2003

About 160 fluoroquinolones and derivatives were tested for antitrypanosomal activity in a drug sensitivity assay followed by fluorometric evaluation. The most active quinolone compounds had IC50 values in the range from 100 to 900 ng/ml, while several derivatives were not active at a concentration of 100 μg/ml. In a structure activity relationship study, modification of the quinolones at position R1, R2, R3 and R8 did not influence trypanocidal activity. An exchange of the fluor at position 6 may contribute to an increase in activity but does not entirely control it. Pyrrolidine substituents at position R7 generally were more active than other substituents at this position. Tetracyclic quinolone derivatives were amongst the most active compounds with IC50 values in the range of 0.3–8.8 μg/ml. The in vitro cytotoxicity on HT‐29 cells was determined for active compounds with IC50 values below 1 μg/ml. In addition, six drugs with an IC50 below 1 μg/ml and a selectivity index of more than 10 were chosen for in vivo experiments. Dose escalation experiments with a maximum dose of 100 mg/kg/bid were performed in a mouse model without central nervous system involvement. For unknown reasons the in vitro effect of the drugs could not be confirmed in vivo, but the class of compound remains of interest for their mode of action, the low toxicity, pharmacological properties and the availability of a large number of synthesized compounds.
The story of CGP 40 215: studies on its efficacy and pharmacokinetics in African green monkey infected with Trypanosoma brucei rhodesiense
Authors: Brun R. , Burri C. , Gichuki C. W.
Published: March 2003

CGP 40 215 is an inhibitor of S‐adenosylmethionine decarboxylase, a key enzyme in trypanosomal polyamine biosynthesis. It is highly active against Trypanosoma brucei rhodesiense and T. b. gambiense in vitro and in the corresponding rodent models, and therefore was a promising candidate for further development as a new drug against human African trypanosomiasis. We conducted initial pharmacokinetic and efficacy studies in African green monkeys: based on two dose‐finding studies, an infection‐treatment and a pharmacokinetic study in eight monkeys infected with T. b. rhodesiense in the 1st stage of infection. PK analysis revealed curative drug levels in the serum but complete absence of the drug in the cerebrospinal fluid. No adverse effects of the drug were observed, although in rats CGP 40 215 had caused hypotension. The following PK parameters were calculated using a two‐compartment model: t1/2=1.8 h, VSS/f=0.4 l/kg, CL/f=3.0 ml/min × kg and AUC=21 900 ng × h/ml. Six of the eight monkeys were cured, one animal relapsed on day 222 and one animal died of unknown reasons, but was aparasitaemic. The study confirmed the curative potential of CGP 40 215 for 1st stage T. b. rhodesiense infection. Unfortunately, it was also found that the compound did not pass the blood–brain barrier, a pre‐requisite for cure of 2nd stage (CNS) infection. As the majority of sleeping sickness patients seeking treatment are in the 2nd stage of the disease, further development of the compound was stopped.
Lymphatic filariasis in Ghana: entomological investigation of transmission dynamics and intensity in communities served by irrigation systems in the Upper East Region of Ghana
Authors: Appawu Maxwell A. , Dadzie Samuel K. , Baffoe‐Wilmot Aba , Wilson Michael D.
Published: March 2003

We conducted an entomological study to document the effect of irrigation on the vectors and transmission dynamics of lymphatic filariasis in the Upper East Region of Ghana. Mosquitoes were collected by indoor spraying of houses in a cluster of communities located around irrigation projects (Tono and Vea) and others without reservoirs (Azoka). Anopheles gambiae s.s. was the dominant species and major vector, followed by An. funestus. Anopheles arabiensis constituted 9–14% of the An. gambiae complex but none were infective. Culex quinquefasciatus was also not infective in these communities. Chromosomal examinations showed that >60% (n=280–386) of the An. gambiae s.s. in irrigated communities were Mopti forms whilst 73% (n=224) in the non‐irrigated area were Savannah forms. Infectivity rates (2.3–2.8 vs. 0.25), worm load (1.62–2.04 vs. 1.0), annual bites per person (6.50–8.83 vs. 0.47) and annual transmission potential (13.26–14.30 vs. 0.47) were significantly higher in irrigated communities.
Dynamics of egg counts and circulating antigen levels in a recent Schistosoma mansoni focus in northern Senegal
Authors: Polman K. , Stelma F. F. , De Vlas S. J. , Sow S. , Fathers L. , Le Cessie S. , Talla I. , Deelder A. M. , Gryseels B.
Published: March 2003

Serum circulating anodic antigen (CAA) levels were compared with faecal egg counts in four subsequent population samples, randomly selected at 8‐month intervals, in a recent Schistosoma mansoni focus in northern Senegal. In all four samples, antigen levels showed the same age‐intensity profiles as egg counts, with a strong decline in adults. Also across population samples, a consistent relationship was found between egg counts and antigen levels. Assuming the level of CAA to be a direct reflection of worm burden, these findings support the idea that the observed egg count patterns and levels indeed reflect dynamics of worm burdens, and not of egg excretion or worm fecundity. Remarkably similar levels of both egg counts and CAA were observed in the first and last sample, collected in the same season (August–September), but 2 years apart. This suggests that a steady state of S. mansoni infection had already been reached shortly after the onset of the epidemic in this focus (3 years). Significantly lower infection levels were found in the intermediate population samples collected in January and April. The differences in infection levels across the four population samples may be because of seasonal transmission patterns. They would indicate a substantial turnover of worm populations, with an estimated average life span of only 7 months, probably less, in this recently emerged, intense S. mansoni focus.
Susceptibility to development of Mycobacterium ulcerans disease: review of possible risk factors
Authors: Stienstra Y. , Van Der Graaf W. T. A. , Te Meerman G. J. , The T. H. , De Leij L. F. , Van Der Werf T. S.
Published: March 2003

Mycobacterium ulcerans disease, also known as Buruli ulcer (BU), is a disease of subcutaneous fat tissue. BU is prevalent in riverine and swamp areas of the tropical zone in Africa, Asia and South America, and a few scattered foci in Australia. The mode of transmission of M. ulcerans has not been fully elucidated, but inoculation into the subcutaneous tissues probably occurs through penetrating skin trauma. BU has not been linked with HIV infection. Antimycobacterial drug treatment is ineffective, and treatment is surgical. Patients eventually develop scars and contractures, with resulting disabilities, and the disease imposes a large burden on affected populations. The incidence of BU has dramatically increased in West African countries over the last decade. There is an urgent need for research into host and environmental risk factors for BU in order to develop effective strategies to combat this disease. We review possible genetic host susceptibility factors for BU that are relevant in other mycobacterial diseases: natural resistance‐associated macrophage protein‐1 (NRAMP‐1), HLA‐DR, vitamin D3 receptor, mannose binding protein, interferon‐gamma (IFN‐γ) receptor, tumour necrosis factor alpha (TNF‐α), interleukin (IL)‐1α, 1β and their receptor antagonists; and IL‐12. Schistosoma haematobium infection is highly endemic in many BU foci in West Africa, with a striking increase in transmission after river dams were constructed. This observation, and the observations from interaction of schistosomiasis and tuberculosis, have fuelled our hypothesis that schistosomiasis is a risk factor for BU by driving the host immune response towards a predominantly Th‐2 pattern, away from a Th‐1 preponderant protection against mycobacterial infection. If the latter hypothesis is confirmed, enhanced schistosomiasis control should impact on BU.
Susceptibility of Schistosoma japonicum to praziquantel in China
Authors: Liang You‐Sheng , Dai Jian‐Rong , Ning An , Yu Dong‐Bao , Xu Xing‐Jian , Zhu Yin‐Chang , Coles Gerald C.
Published: March 2003

To look for possible evidence of the development of resistance in Schistosoma japonicum to praziquantel, we conducted a field study in China. During the non‐transmission period of schistosomiasis a random sample of 2860 individuals from six villages in three provinces of China were examined using a parasitological stool examination. Of the 372 stool‐positive subjects, 363 subjects were treated with a single oral dose of 40 mg/kg of praziquantel. Six to Seven weeks after treatment, of 334 subjects examined using the same stool examination, stool‐negative results were found in 319 patients which represents a 95.5% parasitologic cure rate. Fifteen subjects still excreting eggs were treated a second time with the same dose of praziquantel. All stool samples, including those from participants re‐treated with praziquantel, were re‐examined 12 weeks after the first treatment and no stool‐positive subjects were found. The results indicate that there was no evidence for reduced susceptibility of S. japonicum to praziquantel despite its extensive use in the main endemic areas of China for more than 10 years. The in vitro responses to praziquantel of cercariae, miracidia and eggs of S. japonicum compared with S. mansoni demonstrate that the cercariae, miracidia and eggs of S. japonicum are more sensitive to praziquantel than those of S. mansoni. More sensitive worms would be less likely to develop resistance and this could explain why no evidence for resistance was found in S. japonicum in China.
Geographic differences in hepatosplenic complications of schistosomiasis mansoni and explanatory factors of morbidity
Authors: Boisier P. , Ramarokoto C‐E. , Ravoniarimbinina P. , Rabarijaona L. , Ravaoalimalala V. E.
Published: March 2003

In a study in three neighbouring villages of southern Madagascar, where Schistosoma mansoni is hyperendemic, ultrasound examination using the Niamey protocol showed marked differences in the burden of disease from one village to another. Hepatosplenic schistosomiasis was more frequent in the village with the highest geometric mean egg counts and the earliest onset of infections, demonstrating that the morbidity induced by S. mansoni may vary greatly within a given area. True representativeness of study populations, a keystone of epidemiological studies, is mandatory to obtain a clear picture of a wide area. Ultrasound examinations in a small number of villages, or even a single one, may be a questionable approach. Using logistic regression analysis, the explanatory variables found to be significantly associated with a risk of severe hepatosplenic disease in our study were sex, age, village of residence and S. mansoni egg counts. On the other hand, a concurrent infection with an intestinal helminth seems to reduce the risk of severe hepatosplenic disease. Further studies should assess the role and possible impact of intestinal helminths on S. mansoni associated‐morbidity.
The Maternal and Neonatal Programme Effort Index (MNPI)
Authors: Ross J. A. , Campbell O. M. R. , Bulatao R.
Published: March 2003

A new index is presented that measures the effort levels of national programmes to reduce maternal and neonatal mortality. These indices come from a questionnaire instrument composed of 14 major headings and 81 items. Forty‐nine countries including most of the population in each geographical region are covered. Data were collected from 10 to 25 raters in each country, who rated the 81 items for both the current year and 3 years ago, using a 0–5 scale running from no adequacy to full adequacy. The raters were drawn from a variety of positions and backgrounds, and were identified by a consultant retained in each country for that purpose. On average, country programmes score at about half of the maximum score, but this varies considerably across the 14 components of effort, from very low scores for access to treatment by rural women, to high scores for neonatal care. Regional averages are not far apart for the overall score, although South Asia scores are especially low and East Asia’s are especially high. To a considerable extent regions agree in the relative stress they give to each of the 14 components. Over the 3‐year period, average scores rose by about 10%. When countries are divided into three groups by their maternal mortality levels, most of the 14 components distinguish the high from the medium mortality countries; and about half of the components distinguish the medium from the low mortality countries. This new Maternal and Neonatal Programme Effort Index (MNPI) appears to yield useful measures for various dimensions of programme effort, and it relates sensibly to the output measure of maternal mortality, at least as it is currently measured.
Plasmodium falciparum pfcrt and pfmdr1 polymorphisms are associated with the pfdhfr N108 pyrimethamine‐resistance mutation in isolates from Ghana
Authors: Mockenhaupt Frank P. , Eggelte Teunis A. , Till Holger , Bienzle Ulrich
Published: March 2003

The Plasmodium falciparum chloroquine resistance transporter gene (pfcrt) T76 and multidrug resistance gene analogue (pfmdr1) Y86 mutations are associated with chloroquine(CQ)‐resistance. In isolates from 172 pregnant women living in the area of Agogo, Ghana, pfcrt T76 was detected in 69% and pfmdr1 Y86 in 66%. Pfcrt T76 but not pfmdr1 Y86 was more prevalent in samples from women with residual CQ in urine or serum. Parasite densities and multiplicity of infection of pfmdr wild type but not of resistant isolates were reduced by CQ. Adjusted for CQ and pyrimethamine (PYR) in urine, the P. falciparum dihydrofolate reductase (pfdhfr) N108 mutation which confers PYR‐resistance was 3.1 and 3 times, respectively, more likely to be detected in isolates containing pfcrt and pfmdr1 mutations than in those comprising wild type alleles. Pfcrt, pfmdr, and pfdhfr mutations are frequent in P. falciparum from this part of Ghana which may limit the choice of drugs for the prevention of malaria in pregnancy. The association of CQ‐ and PYR‐resistance mutations independent of recent drug use could indicate accelerated development of resistance to structurally unrelated drugs. Alternatively, it may reflect selection of resistance in persisting infections due to no longer detectable drug pressure.
Are poor responses to praziquantel for the treatment of Schistosoma mansoni infections in Senegal due to resistance? An overview of the evidence
Authors: Gryseels B. , Mbaye A. , De Vlas S. J. , Stelma F. F. , Guissé F. , Van Lieshout L. , Faye D. , Diop M. , Ly A. , Tchuem‐Tchuenté L. A. , Engels D. , Polman K.
Published: March 2003

This paper summarizes and concludes in‐depth field investigations on suspected resistance of Schistosoma mansoni to praziquantel in northern Senegal. Praziquantel at 40 mg/kg usually cures 70–90% of S. mansoni infections. In an initial trial in an epidemic S. mansoni focus in northern Senegal, only 18% of the cases became parasitologically negative 12 weeks after treatment, although the reduction in mean egg counts was within normal ranges (86%). Among other hypotheses to explain the observed low cure rate in this focus, the possibility of drug resistance or tolerance had to be considered. Subsequent field trials with a shorter follow‐up period (6–8 weeks) yielded cure rates of 31–36%. Increasing the dose to 2 × 30 mg/kg did not significantly improve cure rates, whereas treatment with oxamniquine at 20 mg/kg resulted in a normal cure rate of 79%. The efficacy of praziquantel in this focus could be related to age and pre‐treatment intensity but not to other host factors, including immune profiles and water contact patterns. Treatment with praziquantel of individuals from the area residing temporarily in an urban region with no transmission, and re‐treatment after 3 weeks of non‐cured individuals within the area resulted in normal cure rates (78–88%). The application of an epidemiological model taking into account the relation between egg counts and actual worm numbers indicated that the low cure rates in this Senegalese focus could be explained by assuming a 90% worm reduction after treatment with praziquantel; in average endemic situations, such a drug efficacy would result in normal cure rates. Laboratory studies by others on the presence or absence of praziquantel resistance in Senegalese schistosome strains have so far been inconclusive. We conclude that there is no convincing evidence for praziquantel‐resistant S. mansoni in Senegal, and that the low cure rates can be attributed to high initial worm loads and intense transmission in this area.
Malaria in pregnancy in rural Mozambique: the role of parity, submicroscopic and multiple Plasmodium falciparum infections
Authors: Saute Francisco , Menendez Clara , Mayor Alfredo , Aponte John , Gomez‐Olive Xavier , Dgedge Martinho , Alonso Pedro
Published: March 2003

BACKGROUND Falciparum malaria affects pregnant women, especially primigravidae, but before malaria control programmes targeted to them can be designed, a description of the frequency and parity pattern of the infection is needed. There is little information on the frequency and effect of submicroscopic malaria infection, as well as on multiplicity of Plasmodium falciparum genotypes in pregnancy. This study aimed to describe the prevalence of malaria parasitaemia and anaemia and their relation to parity and age in pregnant women, during two malaria transmission seasons in a rural area of southern Mozambique. It also tried to assess the frequency and effect on anaemia of submicroscopic and multiple falciparum infections.

METHODS A total of 686 pregnant women were enrolled in three cross‐sectional community‐based surveys during different transmission seasons in rural southern Mozambique. In each survey a questionnaire was administered on previous parity history, the gestational age was assessed, the axillary temperature recorded and both haematocrit and malaria parasitaemia were determined. We used polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analysis to determine submicroscopic and multiple P. falciparum infections in a subsample of women.

FINDINGS A total of 156 women (23%) had microscopic parasitaemia, of which 144 (92%) were asexual forms of P. falciparum. The prevalence of clinical malaria was 18 of 534 (3%), that of anaemia, 382 of 649 (59%). In a multivariate analysis age but not parity was associated with an increased risk of microscopic parasitaemia. Anaemia was associated with microscopic P. falciparum parasitaemia. Both malaria parasitaemia and anaemia were more frequent during the rainy season. Although not statistically significant, submicroscopic infections tended to be more frequent among grand‐multiparous pregnant women. Subpatent infections were not associated with increased anaemia. Multiplicity of infection was not associated with either parity, age or anaemia. Likewise, there was no correlation between P. falciparum density and multiplicity of infection.

INTERPRETATION We did not observe a clear parity pattern of malaria and anaemia in our study. It is possible although unlikely that selection bias may have influenced these findings; but in which direction is unclear. The importance of locally based research before implementation of public health measures needs to be highlighted. According to our findings, a more cost‐effective malaria control approach in this area would be targeting all pregnant women regardless of their parity. This would be also more feasible logistically as it would not rely on accurate ascertainment of parity, something that is not always easy in busy antenatal clinics.
Time travel with Oliver Twist –
Authors: Razum Oliver , Twardella Dorothee
Published: March 2003

First‐generation immigrant populations in industrialized countries frequently have a lower mortality than the host population, a finding that is unexpected and often dismissed as the result of bias. We propose an alternative explanation for a real, albeit temporal, mortality advantage. We base our argument on two premises: First, that there are differences in the progression of the health transition between the immigrants’ countries of origin and industrialized host countries; and, second, that there are differences in the speed at which changes in mortality from various causes occur after migration. Mortality from treatable communicable and maternal conditions, still high in many countries of origin, quickly declines to levels close to those of the host country. Mortality from ischaemic heart disease, the most common cause of death in the host countries, takes years or decades to rise to comparable heights. This is because of the time lag between increases in risk factor levels and an increased risk of coronary death. Hence, first‐generation immigrants may initially experience a lower mortality than the host population, a point that has so far been under‐appreciated in discussions of immigrant mortality. After adopting a western lifestyle immigrants face an increasing risk of ischaemic heart disease. The increase occurs on top of a persisting risk from conditions associated with childhood deprivation, e.g. stomach cancer and stroke – the unfinished agenda of the health transition that immigrants experience.
Community factors associated with malaria prevention by mosquito nets: an exploratory study in rural Burkina Faso
Authors: Okrah Jane , Traoré Corneille , Palé Augustin , Sommerfeld Johannes , Müller Olaf
Published: March 2003

Malaria‐related knowledge, attitudes and practices (KAP) were examined in a rural and partly urban multiethnic population of Kossi province in north‐western Burkina Faso prior to the establishment of a local insecticide‐treated bednet (ITN) programme. Various individual and group interviews were conducted, and a structured questionnaire was administered to a random sample of 210 heads of households in selected villages and the provincial capital of Nouna.Soumaya, the local illness concept closest to the biomedical term malaria, covers a broad range of recognized signs and symptoms. Aetiologically,soumayais associated with mosquito bites but also with a number of other perceived causes. The disease entity is perceived as a major burden to the community and is usually treated by both traditional and western methods. Malaria preventive practices are restricted to limited chloroquine prophylaxis in pregnant women. Protective measures against mosquitoes are, however, widespread through the use of mosquito nets, mosquito coils, insecticide sprays and traditional repellents. Mosquito nets are mainly used during the rainy season and most of the existing nets are used by adults, particularly heads of households. Mosquito nets treated with insecticide (ITN) are known to the population through various information channels. People are willing to treat existing nets and to buy ITNs, but only if such services would be offered at reduced prices and in closer proximity to the households. These findings have practical implications for the design of ITN programmes in rural areas of sub‐Saharan Africa (SSA).
A controlled study of postpartum depression among Nepalese women: validation of the Edinburgh Postpartum Depression Scale in Kathmandu
Authors: Regmi Shishir , Sligl Wendy , Carter Diana , Grut William , Seear Michael
Published: March 2003

OBJECTIVES To measure the prevalence of depression amongst postpartum and non‐postpartum Nepalese women in Kathmandu using the Edinburgh Postpartum Depression Scale (EPDS) and to assess the ease of use and validity of the scale compared with Diagnostic and Statistical Manual of Mental Disorders (DSM‐IV) criteria for major depression.

METHODS We screened 100 women 2–3 months post‐delivery and 40 control women using the EPDS. All those who screened positive for depression and 20% of the negatives also underwent a structured interview to assess depression by DSM‐IV criteria.

RESULTS Predictive errors were minimized by using an EPDS score ≥13 to define depression. Using this threshold, there was no difference in depression prevalence between postpartum women (12%) and the control group (12.5%) (Fisher's exact test, P > 0.05). Compared with DSM‐IV, the sensitivity, specificity and positive predictive values were 100, 92.6 and 41.6%, respectively.

CONCLUSIONS The prevalence of postpartum depression (PPD) in Nepalese women and the validity and ease of use of the EPDS in the setting of a postnatal clinic in Kathmandu are all surprisingly similar to the results of numerous studies in developed countries. Despite poor living conditions, PPD is no more common than the background depression rate amongst Nepalese women. It can be reliably detected by trained clinical nurses using the EPDS screening test. These results may have implications for the planning of mental health resources for women in other developing countries.
Neonatal tetanus elimination in Mpumalanga Province, South Africa
Authors: Idema C. D. , Harris B. N. , Ogunbanjo G. A. , Dürrheim D. N.
Published: March 2003

Neonatal tetanus (NNT) is a serious but preventable disease, and the World Health Organization (WHO) wants to eliminate NNT globally by reducing its incidence to <1 case per 1000 live births. South Africa adopted this goal in 1995, but Mpumalanga, a rural province, has consistently reported cases of NNT despite an appropriate vaccination strategy to eliminate the disease. The aim of the study was to investigate the completeness of the passive notification system and to explore reasons for ongoing NNT cases despite implementation of the provincial vaccination strategy. We reviewed all hospital admissions in the province between 1996 and 2000 meeting the case definition for NNT and interviewed mothers of the NNT cases reported in 2000. We identified 26 NNT cases, of which only 14 (54%) were reported through the routine notification system. Most cases occurred as a result of the cultural practice of applying cow dung or rat faeces to the umbilical stump in the neonatal period. Although all districts met the WHO elimination target during the review period, there is scope to prevent unnecessary NNT deaths through culturally acceptable public awareness campaigns aimed at changing harmful practices, and encouraging hygienic births and postnatal cord care.
Efficacy and sustainability of a footcare programme in preventing acute attacks of adenolymphangitis in Brugian filariasis
Authors: Suma T. K. , Shenoy R. K. , Kumaraswami V.
Published: March 2003

Lymphatic filariasis is associated with considerable disability related to the intensity and frequency of acute adenolymphangitis (ADL) attacks. The global programme for elimination of lymphatic filariasis emphasizes the need to combine transmission control with alleviation of disability. Footcare aimed at the prevention of secondary bacterial infections is the mainstay of disability alleviation programmes. We evaluated the efficacy and sustainability of an unsupervised, personal footcare programme by examining and interviewing 127 patients who had previously participated in a trial that assessed the efficacy of diethylcarbamazine, penicillin and footcare in the prevention of ADL. During the trial period these patients had been educated in footcare and were supervised. During the unsupervised period, which lasted 1 year or longer, 47 patients developed no ADL, and ADL occurred less frequently in 72.5%. Most patients were practising footcare as originally advised, unsupervised and without cost, which proves that such a programme is sustainable and effective.
Do insecticide‐treated bednets have an effect on malaria vectors?
Authors: Takken Willem
Published: March 2003

The use of insecticide‐treated bednets (ITNs) has been widely adopted as an important method for malaria control. Few data exist on effects of ITNs on mosquito biology and ecology, other than the development of insecticide resistance against the insecticides used. There is no hard evidence that the insecticide resistance recorded is the result of insecticidal use on bednets or from agricultural use. Resistance against pyrethroids, the preferred class of insecticides for ITN use, has been recorded from countries in Asia, Africa and South America. Resistance is expressed as reduced excito‐repellency and mortality of mosquitoes exposed to insecticide‐treated materials. In the absence of resistance, however, most studies on ITN effects report a reduced survival of adult mosquitoes as well as mass killing. Other effects are highly variable, and shifts in time of biting, feeding site and blood hosts have occasionally been reported, but not in proportion to the scale of ITN use. In general, a reduced sporozoite rate is recorded in ITN programmes. Because many of the anticipated behavioural effects caused by insecticidal use will be avoided by the use of untreated nets, studies on the efficacy of untreated nets are required. Examples are presented in which untreated nets provided a reasonable degree of protection against malaria.
Human water contacts patterns in Schistosoma mansoni epidemic foci in northern Senegal change according to age, sex and place of residence, but are not related to intensity of infection
Authors: Scott J. T. , Diakhaté M. , Vereecken K. , Fall A. , Diop M. , Ly A. , De Clercq D. , De Vlas S. J. , Berkvens D. , Kestens L. , Gryseels B.
Published: March 2003

In an epidemic focus in northern Senegal, adults had lower intensities of infection than adolescents, a phenomenon that could not be attributed to immunity acquired over the previous 10–15 years of exposure to the parasite because all age groups had had the same number of years' experience of the worm. This article considers whether this pattern could have been because of higher levels of exposure to the parasite in younger age groups. Personal contact with infected water was recorded using a questionnaire in Schistosoma mansoni foci not more than 3 years old and in another, 10‐year‐old focus. Many aspects of contact (e.g. frequency, duration or time of day of contact) may contribute to the number of encounters with infective cercariae (true exposure), so various assumptions regarding the relationship between water contact and true exposure were tested resulting in a range of exposure indices. People reported a mean of 4.4 separate contacts, and spent a median of 57 min per day in water. Patterns of water contact differed depending on the exposure index used, e.g. considering duration, males spent a longer time in water than females (P < 0.001). But using frequency, females had more contacts with water than males in most villages (P < 0.001). Generally, exposure levels dropped as people become aged (P < 0.001) and residents of the older focus were more exposed than residents of other foci (P < 0.002). Intensity of (re)infection was not related to exposure either alone or in models incorporating age, sex and/or village irrespective of the index used. There is therefore evidence that age, sex and place of residence determine exposure but none to suggest that exposure had an influence on the relationship between these factors and intensity of infection. We propose therefore that in this population other factors have principal importance in determining intensity of infection.
Plasma glucose and tumour necrosis factor‐α in adult patients with severe falciparum malaria
Authors: Manish R. , Tripathy R. , Das B. K.
Published: March 2003

Plasma glucose was assessed in 81 patients with severe falciparum malaria at the time of presentation along with tumour necrosis factor‐α (TNF‐α). The lowest plasma glucose value was 3.38 mmol/l and none of the patients had hypoglycaemia at admission. Plasma glucose values were not significantly lower in those with multiple organ dysfunction (MOD) than in patients with single organ dysfunction (cerebral malaria only) and in those who died compared with patients who survived. Conversely, TNF‐α showed a good correlation with depth of coma and was significantly higher in patients who had MOD and those who died. There was no correlation between plasma glucose and TNF‐α values.
Comparison of two diagnostic tests for canine atopy using monoclonal anti‐IgE antibodies
Authors: Hämmerling  , de Weck
Published: March 2003

In 66 dogs of various races consulting the veterinary clinic for skin problems suspicious of atopic dermatitis, parallel skin tests with two commercial brands of allergens and serological tests with the CMG IMMUNODOT system and with an ELISA assay using monoclonal anti‐IgE antibodies were performed. The most frequent sensitivities found were towards house dust (44%) and storage mites (50%). Depending upon the cut‐off point chosen, the CMG IMMUNODOT test was shown to have sensitivity, in respect to the skin test, varying from 54 to 100%, in an inverse relationship to specificity. The ELISA assay was found to be slightly less sensitive. These investigations also revealed some major discrepancies in skin test results among allergen extracts of different origins, confirming that skin test results should no longer be considered as the sole ‘gold standard’ in diagnosis of IgE‐mediated allergy. The experience gained confirms that modern serological tests using monoclonal anti‐IgE antibodies for detection of allergen‐specific IgEs in the dog are useful in the diagnosis of dog allergy.
Mupirocin, fusidic acid and bacitracin: activity, action and clinical uses of three topical antibiotics
Authors: Werner A.H. , Russell A.D.
Published: March 2003

Antibiotics applied to the skin must be formulated in a base that is nonirritant and nontoxic. They may have a narrow or fairly wide spectrum of activity but should produce no local reaction or sensitization; the commensal flora should not be affected unduly. Three antibiotics that have been used topically in humans and animals are fusidic acid, mupirocin and bacitracin, all of which have a narrow antibacterial spectrum. When applied to intact skin, fusidic acid penetrates more rapidly than other antibiotics. Clinically, the frequency of staphylococcal resistance to it and to mupirocin has remained low. Fusidic acid and mupirocin have been recommended for the treatment of acute staphylococcal skin lesions. However, the use of topical antibiotics for the treatment of chronic or recurring dermatitis and surgical or infected wounds may be inappropriate because of possible development of resistance and sensitization. Topical use of bacitracin may produce treatment failure and sensitization.
Use of induced cutaneous immediate‐type hypersensitivity reactions to evaluate anti‐inflammatory effects of triamcinolone topical solution in three dogs
Authors: DeBoer Douglas J. , Cooley James A.
Published: March 2003

The anti‐inflammatory effect of a triamcinolone topical solution (TTS) was evaluated by use of induced cutaneous immediate‐type hypersensitivity reactions in dogs. Healthy dogs (n = 3) were treated on one side of the lateral thorax with TTS, and on the contralateral side with vehicle solution. After 7 days of treatment, serial dilutions of inflammatory stimuli (histamine, compound 48/80, anticanine IgE, substance P, and morphine sulphate) were injected intradermally on both sides. Resulting immediate reactions were subjectively scored, their diameters were measured in millimetres, and microcirculatory blood flow at each site was measured using laser Doppler velocimetry. The magnitude of the differences between TTS and vehicle‐treated sides varied with the type of measurement and the stimulus used. With compound 48/80, anti‐IgE, substance P, and morphine sulphate‐injected sites, for at least one concentration, the reaction scores and sizes were notably less on the TTS‐treated sides. Punch skin biopsy specimens were obtained from selected sites 24 h after injection. A pathologist examined stained tissue sections and scored each section as to degree of late‐phase dermal cellular infiltrate. Dermal infiltrate scores were generally lower at the TTS‐treated sites; the composite score from all TTS‐treated sites was 30% lower than that from the vehicle‐treated sites. Observations suggest that TTS may be effective in decreasing some aspects of the inflammatory response in canine skin.
Canine atopic dermatitis: a retrospective study of 266 cases examined at the University of California, Davis, 1992–1998. Part I. Clinical features and allergy testing results
Authors: Zur Gila , Ihrke Peter J. , White Stephen D. , Kass Philip H.
Published: March 2003

AbstractThe medical records of 266 dogs diagnosed as having atopic dermatitis were reviewed. Statistical data were evaluated referable to breed predilections, clinical signs and positive reactions to allergens. Positive reactions were most common to house dust mites (more common with clinical signs in the fall) followed by moulds (more common with clinical signs in the fall and spring). Dogs with positive reactions to moulds, trees or cultivated plants were more likely to have skin and ear yeast infections. Dogs with positive reactions to cultivated plants were more likely to have otitis externa and pedal lesions. Positive reactions to house dust were more common in dogs with early onset of signs and in those tested early in the disease. Dogs had more positive reactions to weeds when allergy tests were performed in the summer and fall. Positive reactions to flea antigen were highly correlated with the clinical diagnosis of flea allergy dermatitis.
Comparison of flaming and infrared radiation techniques for thermal weed control
Authors: ASCARD
Published: March 2003

The effectiveness of two types of thermal weeder was evaluated in field experiments on Sinapis alba L. as the test species. Both thermal weeders used propane combustion to provide heat from either a covered flamer or an infrared radiator. The flamer showed better performance than the infrared radiator on plants at the four‐leaf stage, but the opposite was true on plants at the cotyledon stage. Both thermal weeders required an effective dose of propane of about 60 kg ha−1 to obtain 95% reduction of plants at the zero‐ to two‐leaf stage. The effective speed was slightly higher for the flame weeder than for the infrared radiator, mainly because the propane consumption per unit working width was higher for the flamer. Temperatures under the thermal weeders were measured by thermocouples in the laboratory. At equivalent propane doses, the flamer gave higher temperatures than the infrared radiator at 1 cm above ground, but temperatures were similar at 3·5 cm height. There was a highly positive correlation between the temperature sum and control of S. alba by flaming and infrared radiation based on temperatures measured at the upper position. It is concluded that evaluating thermal weeders based solely on indiscriminate temperature measurements is unreliable: proper comparison has to take into account the weed species, plant size and the propane consumption per unit working width.
A survey of mineral composition of weed seeds
Authors: TANJI  , ELGHAROUS
Published: March 2003

Seeds of 43 weed species from 13 families were collected from mature plants in barley (#Hordeum
Size and composition of the weed seedbank under different management systems for continuous maize crop
Authors: BÀRBERI  , COZZANI  , MACCHIA  , BONARI
Published: March 2003

The size and composition of the weed seedbank after 5 years of maize (Zea mays
Influence of soil moisture on the competitive ability and seed dormancy of Sinapis arvensis in spring wheat
Authors: Wright K J , Seavers G P , Peters N C B , Marshall M A
Published: March 2003

Two experiments were carried out, one in 1995 and one in 1997, to investigate the competitive abilities of two spring wheat cultivars with Sinapis arvensis L. The spring wheat cultivars (Baldus and Canon) of contrasting growth habit were grown with and without S. arvensis under two different moisture regimes (10% and 70% of field capacity). In 1995, S. arvensis was found to be less competitive when subjected to moisture stress, resulting in smaller wheat yield losses in dry soil than in moist soil. In both years, seed production of S. arvensis was reduced by competition and moisture stress, and the seeds produced by plants that had been grown in drier soil were small and had negligible dormancy. Hence, in dry conditions, the competitiveness of S. arvensis and its potential to produce persistent seed may be reduced. Some differences between the two wheat cultivars were evident: cv. Baldus was more competitive against S. arvensis than cv. Canon. This could be attributed to differences in canopy structure.
Integration of soil, crop and weed management in low‐external‐input farming systems
Authors: Liebman  , Davis
Published: March 2003

Greater adoption and refinement of low‐external‐input (LEI) farming systems have been proposed as ways to ameliorate economic, environmental and health problems associated with conventional farming systems. Organic soil amendments and crop diversification are basic components of LEI systems. Weed scientists can improve the use of these practices for weed management by improving knowledge of four relevant ecological mechanisms. First, multispecies crop rotations, intercrops and cover crops may reduce opportunities for weed growth and regeneration through resource competition and niche disruption. Secondly, weed species appear to be more susceptible to phytotoxic effects of crop residues and other organic soil amendments than crop species, possibly because of differences in seed mass. Thirdly, delayed patterns of N availability in LEI systems may favour large‐seeded crops over small‐seeded weeds. Finally, additions of organic materials can change the incidence and severity of soil‐borne diseases affecting weeds and crops. Our research on LEI sweetcorn and potato production systems in central and northern Maine (USA) suggests that these mechanisms can reduce weed density and growth while maintaining crop yields. Low‐external‐input farming systems will advance most quickly through the application of interdisciplinary research focused on these and other ecological mechanisms.