bluuebunny/crossref_metadata_2025 huggingface dataset:
The morbidity attributable to Schistosoma japonicum infection in 3 villages in Dongting Lake region, Hunan Province, PR China
Authors: Booth Mark , Guyatt Helen L. , Li Yuesheng , Tanner Marcel
Published: August 2010

In common with other helminth infections, symptoms associated with Schistosoma japonicum infection have a low specificity, and many infections are asymptomatic. The presence of the parasite in a sick individual from an endemic area does not mean that S. japonicum is the aetiological agent. However, estimates of the proportion of all symptomatic episodes in a community attributable to S. japonicum infection can be used to determine its public health impact. Using parasitological and morbidity survey data from 3 villages in China, the fractions of diarrhoea, bloody stool, and abdominal pain episodes that were attributable to S. japonicum infection were estimated. The association between hepatomegaly and S. japonicum infection was also assessed. For all morbidity indicators, it was found that individuals with higher infection intensities were at greater risk of morbidity. The highest risk indicator of morbidity associated with S. japonicum infection was bloody stools. Logistic regression revealed that factors related to village and sex were important confounders of the relation between infection and the risk of morbidity. The fraction of the population in each village estimated to be suffering morbidity attributable to S. japonicnm infection was low, due to the low prevalence of infection. However, the results suggest that some sick individuals may have been diagnosed as false negatives for S. japonicum infection.
Use of a new glass microfibre histamine release method to study the modulation of the host response in human schistosomiasis mansoni. Individuals with different degrees of exposure to the disease show differing antibody biological function
Authors: Satti Mohamed Ziado , Ebbesen Finn , Vennervald Birgitte , Lind Peter , Ghalib Hashim , Sulaiman Suad , Daffalla Asim , Skov Per Stahl
Published: August 2010

A new glass microfibre histamine release method was used to study the modulation of the host response in human schistosomiasis mansoni to improve our understanding of the role of basophils in the development of immunity in schistosomiasis mansoni. The histamine release from umbilical cord blood basophils sensitized with sera from Sudanese individuals infected with Schistosoma mansoni was measured. Schistosomiasis sera (n=113) were able to passively sensitize basophils and induce a positive histamine release in response to whole worm homogenate (WWH)(χ=40.5, P<0.0001) and soluble egg antigen (SEA) (χ=16.3, P<0.0001). However, worm antigen induced significantly higher histamine release in adults than egg antigen (Z= 4.83, P<0.0001). Basophil cell sensitivity to WWH was inversely related to the intensity of infection. A correlation was observed between basophil cell sensitivity and IgE antibodies in response to WWH. Chronically infected canal cleaners (n=16) showed a significant increase in basophil cell sensitivity 3 months after praziquantel treatment (Z= 1–73, P<0.05). Normally exposed adults (n= 29) showed a significant decrease in basophil cell sensitivity 1 year after treatment. When serum fractions were used, chronically infected canal cleaners showed a significant increase in histamine release after IgG removal (P<0.05)

Comparison between the different study groups with regard to resistance and susceptibility to reinfection, their basophil sensitizing ability and antibody response showed a difference in the biological function of the IgE to WWH in the different groups. Direct histamine release results from S. mansoni infected individuals from outside the endemic area (Danish) showed the possibility of using the glass microfibre histamine release method in the diagnosis of schistosomiasis.
Survey of blindness in rural communities of south‐western Nigeria
Authors: Adeoye Adenike
Published: August 2010

A population based survey of rural communities in the Akinlalu‐Ashipa ward of Ife North Local Government in Osun State, Nigeria, was conducted to determine the prevalence and causes of blindness. 2921 inhabitants were screened by a random cluster sample technique, out of whom 27 were blind in both eyes. The overall prevalence rate of blindness (best corrected visual acuity less than 3/60 in the better eye) was found to be 0.9% (95% confidence interval 0.84–0.96%).

The rate of blindness increased with age, especially from age 60. The major causes of blindness were cataract and its sequelae (48.1%), onchocerciasis (14.8%), primary open angle type glaucoma (11.1%), corneal scar/phthisis bulbi (7.4%) and optic atrophy (7.4%). About half of the blindness is potentially curable through cataract surgery, and a third preventable through health education, early diagnosis and prompt treatment.
Feeding practices of mothers during childhood diarrhoea in a rural area of Nigeria
Authors: Jinadu M. K. , Odebiyi O. , Fayewonyom B. A.
Published: August 2010

Our main objective was the identification of different types of foods given or withheld for various kinds of childhood diarrhoea. The study was conducted in rural Yoruba communities of Osun State, Nigeria. Questionnaires and focus group discussions were used and a total of 335 randomly selected mothers with children under 5 years of age were interviewed. The diets chosen by the mothers reflect cultural perceptions of the aetiology of illness and of the therapeutic properties of local foodstuffs. Raw corn starch is believed to be an anti‐diarrhoeal agent and therefore given for all types of diarrhoea, while rice is avoided. Sugar, sweet foods and groundnut preparations, which are perceived as causes of bloody diarrhoea and related illnesses, are proscribed. Sixty per cent of mothers would reduce the intake of fluids for the most common types of diarrhoea. Their level of education does not make any significant difference. To ensure adequate home management of childhood diarrhoea, educational interventions must take into account prevailing beliefs in the community.
Maternal mortality in the main referral hospital in The Gambia, West Africa
Authors: Hoestermann C. F. L. , Ogbaselassie G. , Wacker J. , Bastert G.
Published: August 2010

A retrospective analysis of 78 maternal deaths was performed during 1991–1992 to estimate maternal mortality at the maternity unit of the main tertiary level hospital in The Gambia. The non‐abortion maternal mortality ratio (MMR) was 736 per 100 000 live births. Among the direct causes, haemorrhage caused most deaths (24%), followed by hypertensive disorders in pregnancy (HDP) (21%). Sepsis was the main cause of death in 15%. Anaemia led among the indirect causes of death (8%) and was a co‐factor in 41% of all deaths. Substandard care factors other than medical causes were determined involving health care facilities, staff, drugs and equipment, and patient‐related factors. Well known risk factors of low age ( 19 years) and nulliparity were highly represented in the maternal death group, and delivery by Caesarean section occurred more than threefold compared to the overall Caesarean section rate. Taking haemorrhage as an example, it is demonstrated that the way diagnoses are grouped significantly affects the statistical elaboration of maternal deaths.
Provision of health information by British travel agents
Authors: Grabowski Peter , Behrens Ron H.
Published: August 2010

A study to assess the frequency of health related advice provided by travel consultants to customers planning to travel to the tropics was undertaken. A total of 202 agencies throughout the UK were visited by covert researchers requesting a package holiday for 2 weeks to Kenya or a flight to India. In a face to face consultation, the researchers recorded any health related information provided. If none were forthcoming, the agent was prompted using a standardized prompt. Thirty per cent of the agencies were based in South‐east England and London and the remainder in the North, the Midlands and the South‐west. No spontaneous health warnings were given in 61% (123) of consultations for malarious destinations. After prompting, 71% of agents gave general health advice, 67% suggested seeking malaria advice from a general practitioner and 37% of agents brought up the need for malaria prophylaxis for the journey. 63% of consultations included a mention of malaria after being prompted. The study reveals that travel agents provide health advice inconsistently and mention health risks only when prompted. For travellers' safety and to meet new consumer regulations, the travel industry needs to draw attention to health risks associated with its products consistently and effectively.
Citation analysis for measuring the value of scientific publications: quality assessment tool or comedy of errors?
Authors: Schoonbaert Dirk , Roelants Gilbert
Published: August 2010

The basic concepts of citation analysis and Journal impact factors are discussed in the light of quality assessment of scientific publications, individual scientists and research units. The major controversies concerning this topic are addressed: technical limitations, database selectivity, time and discipline‐related biases, language and publication type biases, multiple authorship merits and citing motivations. Both positive and negative aspects are put into perspective. The authors conclude that citation analysis, even when based on Journal impact factors, can be a worthwhile criterion for evaluating publication records of individual scientists or research units, as long as some of the problems discussed are sufficiently taken into account. However, this conclusion in no way implies that citation analysis may be considered as the one and only evaluation criterion.
Cytotaxonomic identifications of the Simulium damnosum complex (Diptera: Simuliidae) from Nigeria
Authors: Mafuyai H. B. , Post R. J. , Vajime C. G. , Molyneux D. H.
Published: August 2010

Cytotaxonomic analysis of Simulium damnosum s.l. larvae collected from 23 sites across 4 bioclimatic zones in Nigeria revealed the presence of 5 cytospecies (S. damnosum s.str., S. sirbanum, S. squamosum, S. yahense and S. soubrense (including the Beffa form). The biogeographical distribution of the sibling species was mostly similar to that observed further west in the OCP area, although geographic cytotaxonomic variation was recorded in S. squamosum, S. damnosum s.str. and S. sirbanum. Some aspects of the chemical and physical environment of the breeding habitats were investigated.
Evaluation of a monoclonal antibody‐based sandwich‐ELISA for detection of circulating Schistosoma japonicum antigen (SJ31/32) in an endemic area of China
Authors: Li Yong‐long , Liu Shu‐yao , Han Jia‐jung , Ning Cheng‐xiu , Ruppel Andreas
Published: August 2010

A sandwich‐ELISA specific for 31/32 kDa schistosome proteins was used to trace infections in a Chinese population living in a low endemicity area for schistosomiasis japonica. The study population included 304 persons for whom records were available from 1992 onwards. In 1994, 2 individuals were positive in the miracidial hatching assay performed with 30 g of stools. The ELISA gave positive results for 8 individuals, including these 2 with active infections. Of the remaining 6 ELISA‐positive, 5 had excreted eggs and received praziquantel in 1993 and may have harboured residual worms in 1994. It is concluded that this ELISA is able, in a low prevalence situation, to identify the few infected individuals.
Evaluation of the Og4C3 ELISA in Wuchereria bancrofti infection: infected persons with undetectable or ultra‐low microfilarial densities
Authors: Rocha A. , Addiss D. , Ribeiro M. E. , NoroTes J. , Baliza M. , Medeiros Z. , Dreyer G.
Published: August 2010

The recently developed Og4C3 ELISA, which detects circulating Wuchereria bancrofti antigen, appears promising for use in epidemiological surveys, but its sensitivity is unknown in persons with ultra‐low microfilarial densities. We used the Og4C3 to test the sera of 282 persons who were microfilaria‐positive in 1–16 ml of blood, 18 persons who were microfilaria‐negative but who had ultrasonographic or biopsy evidence of adult W. bancrofti infection, and 63 lifelong residents of a non‐endemic area of Brazil. A total of 276 (97·9%) persons with detectable microfilaraemia tested positive (optical density >0·033). At microfilarial densities of <1, 1–30, and >30 microfilariae per ml of blood, the sensitivity of the Og4C3 was 72·2, 97·6 and 100%, respectively (χ2‐test for trend, P<10‐6). The assay was positive in 66·7% of amicrofilaraemic persons with evidence of adult worm infection and in one (1.6%) of 63 residents of the non‐endemic area (specificity, 98·4%). Our findings support the increasingly widespread use of the Og4C3 for field investigations and epidemiological assessments. However, the sensitivity of the assay may be low in persons who are microfilaria‐negative or with densities of <1 microfilaria per ml.
Injection practices in Mwanza Region, Tanzania: prescriptions, patient demand and sterility
Authors: Gumodoka B. , Vos J. , Berege Z. A. , van Asten H. A. , Dolmans W. M. , Borgdorff M. W.
Published: August 2010

This paper describes prescription and sterilization practices in Mwanza Region, Tanzania, before the introduction of interventions aiming at reducing HIV transmission by injections. Sixty‐six health facilities from Mwanza Region were included in the study. Data were collected in interviews and questionnaires, through structured observation, bacteriological culture and record analysis. Criteria for avoidable injections were based on recommendations of the Essential Drugs Programme and on a regional consensus workshop. One in 4 out‐patients received an injection 70% of which were avoidable. Most were given for acute respiratory infections, skin diseases and urinary tract infections. Forty per cent of cultures taken from sterilized needles and syringes yielded growth of microorganisms. Of 120 patients interviewed most preferred to be treated with injections for almost any complaint. Patient demand for injections was felt to be a problem in 85% of the health facilities and may have contributed to overprescription of injectables. Consensus treatment and sterilization guidelines as well as a health education programme were developed and introduced to all health workers through seminars.
The place of ‘the tropics’ in Western medical ideas since 1750
Authors: Arnold David
Published: August 2010

Summary The idea of ‘the tropics’ as a region distinct from the ‘temperate’ world has a long history and derives from European expansion and environmental theories especially from about 1750 onwards. Although the tropics were ascribed some positive attributes, the dominant concept was a negative one and the idea of distinctive tropical diseases and the corresponding need for a separate specialty of tropical medicine largely grew out of this.
The role of low level Plasmodium falciparum parasitaemia in anaemia among infants living in an area of intense and perennial transmission
Authors: Kitua A. Y. , Smith T. A. , Alonso P. L. , Urassa H. , Masanja H. , Kimario J. , Tanner M.
Published: August 2010

Summary Children under one year of age in an area of intense and perennial Plasmodium falciparum transmission were followed up for one year to establish to what extent chronic, low parasitaemia was associated with severe anaemia. There was a significant increase in the prevalence of anaemia (PCV ≥ 25%) with increase in parasite density. PCV levels were related not only to concurrent parasite density but also decreased with densities measured one month previously. At any point in time, the mean PCV level in infants with low parasitaemia (<1000 parasites/μ1) was higher than that of infants with intermediate (1000–9999/μ1) and high parasite densities (≥10 000/μl). After the age of 7 months, infants with low parasite densities tend to recover, probably as a result of developing immunity. At the age of 12 months, they have similar PCV levels to infants with no detectable parasitaemia by microscopy. The maintenance of low parasite density appears crucial to the survival of infants in malaria endemic areas. The findings suggest that interventions which lower parasite densities in areas of intense transmission reduce the development of severe malarial anaemia and thus malaria‐related mortality and morbidity in infants.
Local health services: some lessons from their evolution in Bolivia
Authors: Darras Christian
Published: August 2010

Summary For a decade, numerous projects in Bolivia have tried to put in practice the concept of local health systems. But, so far, no significant changes have been made and local health services still are the ‘poor relation’ of the system. The main components of the project—expansion of health facilities, training of health personnel and institutional decentralization—were not designed to respond to the complexity of the problems encountered. Decentralization was implemented at the level of health districts but not accompanied by redefinition of functions at the central level, and challenged by civil servants' attempts to save their jobs. While training activities did introduce new methods and subjects, they were too often reduced to short workshops or seminars. Health facilities were built without regard for their significance beyond health care. A strategic approach is needed to adapt the planning process to the degree of liberty allowed by society.
Serotype of Nigerian rotavirus strains
Authors: Adah M. I. , Rohwedder A. , Olaleye O. D. , Durojaiye O. A. , Werchau H.
Published: August 2010

Summary Three hundred and fourteen stool samples collected from children >5 years between December 1993 and August 1995 were analysed by PAGE, ELISA, PCR and Dot‐blot hybridization technique for electropherotype and serotype distribution of rotavirus infection among Nigerian paediatric patients. 14.3% of the children were positive for rotavirus antigen. Children aged 6–9 months were most often infected, accounting for 35.6% of all positive samples. 91.1% of rotavirus‐positive samples could be serotyped. Serotypes G2, G4 and G8 were not detected. Serotype G3 predominated (62.5%) in southern Nigeria, while mixed infection specificity was more widespread (63.6%) in northern Nigeria. The presence of some untypeable samples may indicate serotypes which the serotype‐specific primers and cDNA probes used could not detect. Electropherotypes of 26 (57.7%) of the positive samples were determined. Two and 3 migration patterns were observed among the short and long‐pattern electropherotypes, respectively. Implications for vaccine development and utilization in the country are discussed.
Relationship of childhood protein‐energy malnutrition and parasite infections in an urban African setting
Authors: Tshikuka Jose‐Gaby , Gray‐Donald Katherine , Scott Marilyn , Olela Kalumba Nkongolo
Published: August 2010

Summary A clear understanding of protein‐energy malnutrition (PEM), parasite infection and their interactions is essential in formulating health and development policies. We studied the prevalence of PEM indicators and the prevalence and/or intensity of infection in 558 Zairian children aged 4 months to 10 years. Multivariate analyses were used to estimate relationships between PEM indicators and parasitic infection. Stunting was found in 40.3% of children, wasting in 4.9% and kwashiorkor in 5.1%. The risk of stunting was significantly higher in children with Ascaris lumbricoides. The risk of wasting was higher in children with A. lumbricoides or Trichuris trichiura, whereas the risk of kwashiorkor was high with T. trichiura but very reduced in those with A. lumbricoides. Plasmodium infection was not related to nutritional indicators. These relationships highlight important interactions, both synergistic and antagonistic, between nutrition and parasites in central Africa.
T‐DNA tagging reveals a novel cDNA triggering cytokinin‐ and auxin‐independent protoplast division
Authors: Miklashevichs Edvins , Czaja Inge , Cordeiro Alexandra , Prinsen Els , Schell Jeff , Walden Richard
Published: August 2010

Activation T‐DNA tagging was used to generate four cytokinin‐independent cyi1–4 tobacco cell lines. Plants regenerated from the mutant lines displayed similar phenotypes: reduced apical dominance, poorly developed roots, delayed growth and flowering, and male and female sterility. Tissue culture experiments demonstrated that the mutations in the different lines uncouple cell proliferation from the effects of both cytokinin and auxin. No significant increase of cytokinin or auxin was found in transgenic calli in comparison with untransformed callus. The functional plant sequence tagged in one of the mutant lines, cyi1, was used to isolate an active cDNA, cyi1a, that was able to trigger cytokinin‐ and auxin‐independent protoplast division. Northern analysis shows that the transcript corresponding to cyi1a accumulates to high levels in the untransformed protoplasts shortly before the onset of cell division, and that these levels decrease when protoplasts reach maximum rates of cell division. A small putative open reading frame, starting with the first ATG in cyi1a and encoding a 22 amino acid peptide, has the same activity in tobacco protoplasts as the whole cDNA. This activity is destroyed by a frame shift mutation. Apparently cyi1a encodes a peptide which participates in the events downstream of a joint point of cytokinin and auxin action leading to cell division.
Field ecology of sylvaticRhodniuspopulations (Heteroptera, Triatominae): risk factors for palm tree infestation in western Ecuador
Authors: Abad‐Franch F. , Palomeque F. S. , Aguilar H. M. , Miles M. A.
Published: August 2010

MostRhodniusspecies (Triatominae) are primarily associated with palm trees. They maintain enzooticTrypanosoma cruzitransmission and are responsible for human infection (causing Chagas disease) through the Neotropics. Assessing whether individual palm traits (ecological and/or botanical) may increase the risk of palm infestation by triatomines is relevant in areas where bugs invade houses flying from peridomestic palms. We developed a novel fieldwork approach with that objective, and applied it to study infestation by sylvaticRhodnius ecuadoriensisin 110 tagua palms (Phytelephas aequatorialis). Palm infestation (23% overall) was non‐randomly distributed in our sample. Palms located in anthropic landscapes were frequently infested (>27%,n = 92), whereas no bugs were collected from palms surveyed within forest remnants (n = 18;P = 0.01). The presence of abundant decaying vegetable matter (P = 0.001) and (to a lesser extent) epiphytic plants (P = 0.049) on palm crowns and stems increased the probability of infestation and was positively correlated with the apparent density of bug colonies (R2 = 0.68). A trend towards higher infestation rates in male palms (34%vs.18%) could relate to female palm management (removal of infrutescences and vegetable debris) in areas where palm seeds are harvested. An outline of ‘risk palm ecotopes’ and environmental management‐based strategies for the control of peridomestic, palm tree‐living vector populations are proposed.
Efficacy of thermal fog application of deltacide, a synergized mixture of pyrethroids, against Aedes aegypti, the vector of dengue
Authors: Mani T. R. , Arunachalam N. , Rajendran R. , Satyanarayana K. , Dash A. P.
Published: August 2010

We evaluated the efficacy of indoor and peridomestic thermal fog applications of deltacide, a synergized mixture of pyrethroids (S‐bioallethrin 0.7% w/v, deltamethrin 0.5% w/v and piperonyl butoxide 8.9% w/v) against adult populations of Aedes aegypti in Chennai, Tamil Nadu, India. We bioassayed adult caged mosquitoes, counted indoor resting and human landing adult mosquitoes and assessed the percentage of potential breeding sites with Aedes larvae. The bioassay mortalities indicated that the knockdown and killing effect was greater when fogging was applied inside houses rather than around them. Peridomestic thermal fogging reduced the resting and biting populations by 76% and 40%, respectively for the 3 days after treatment, whereas indoor fogging suppressed adult populations for 5 days.
Short communication: High prevalence of the cytochrome P450 2C8*2 mutation in Northern Ghana
Authors: Röwer Susanne , Bienzle Ulrich , Weise Alexander , Lambertz Ulrike , Forst Thomas , Otchwemah Rowland N. , Pfützner Andreas , Mockenhaupt Frank P.
Published: August 2010

Recently, Ghana has changed the first‐line treatment of uncomplicated malaria from chloroquine to amodiaquine (AQ) plus artesunate. AQ may cause adverse events such as agranulocytosis and hepatoxicity. The pro‐drug AQ is transformed by cytochrome P450 CYP2C8 to the active metabolite N‐desethylaminodiaquine. Several polymorphic variants of CYP2C8 are known, some with reduced activity. In 200 randomly selected children from Northern Ghana, we determined the allele frequencies of the CYP2C8 variants CYP2C8*1 (wild type), CYP2C8*2, CYP2C8*3, and CYP2C8*4. We did not detect CYP2C8*3 and CYP2C8*4, but CYP2C8*2 showed an allele frequency of 0.1675. AQ metabolism in patients with CYP2C8*2 may be impaired, and with an increase of AQ based treatment the risk of severe adverse events may mount.
Review: Artificial container‐breeding mosquitoes and cemeteries: a perfect match
Authors: Vezzani Darío
Published: August 2010

Artificial container‐breeding mosquitoes, such asAedes aegypti,Ae. albopictus, andCulex pipiens, are well‐recognized vectors of diseases throughout the world. Cemeteries are considered major sources of mosquitoes and the results of more than 30 studies concerning mosquitoes in cemeteries have been published over the last decade. The characteristics of these environments in regard to the availability of resources for mosquito development were discussed. Also, studies about early detection ofAedesvectors, ecological issues, and mosquito control performed in cemeteries were reviewed. Among 31 mosquito species found breeding in cemeteries from 16 countries, the invasiveAe. aegyptiandAe. albopictuswere the most frequent ones. Species of the genusOchlerotatus,Culex,Toxorhynchites,Culiseta,Armigeres,Lutzia,Uranotaenia, andTripteroideswere also reported. Overall, cemeteries are highly suitable habitats for artificial container‐breeding mosquitoes due to the great availability of the different resources that they need (i.e. sugar substances, blood, shelter and water‐filled containers). In addition, these places are mostly ideal settings to perform studies in urbanized areas because of high mosquito abundance, heterogeneity of macro‐ and microhabitats, and an easier access in comparison with private premises. However, the feasibility of a cemetery as a study area must be evaluated in each case considering the objectives of the study and cemetery characteristics.
Drug policy for visceral leishmaniasis: a cost‐effectiveness analysis
Authors: Vanlerberghe V. , Diap G. , Guerin P. J. , Meheus F. , Gerstl S. , Stuyft P. Van der , Boelaert M.
Published: August 2010

Objective  To facilitate the choice of the best visceral leishmaniasis (VL) treatment strategy for first‐line health services in (VL)‐endemic areas, we compared in a formal decision analysis the cost and the cost‐effectiveness of the different available options.

Methods  We selected four drug regimens for VL on the basis of frequency of use, feasibility and reported efficacy studies. The point estimates and the range of plausible values of effectiveness and cost were retrieved from a literature review. A decision tree was constructed and the strategy minimizing the cost per death averted was selected.

Results  Treatment with amphotericin B deoxycholate was the most effective approach in the baseline analysis and averted 87.2% of all deaths attributable to VL. The least expensive and the most cost‐effective treatment was the miltefosine regimen, and the most expensive and the least cost‐effective was AmBisome® treatment. The cost of drug and medical care are the main determinants of the cost‐effectiveness ranking of the alternative schemes. Sensitivity analysis showed that antimonial was competitive with miltefosine in the low‐resistance regions.

Conclusion  In areas with >94% response rates to antimonials, generic sodium stibogluconate remains the most cost‐effective option for VL treatment, mainly due to low drug cost. In other regions, miltefosine is the most cost‐effective option of treatment, but its use as a first‐line drug is limited by its teratogenicity and rapid resistance development. AmBisome in mono‐ or combination therapy is too expensive to compete in cost‐effectiveness with the other regimens.
Costs and coverage of reproductive health interventions in three rural refugee‐affected districts, Uganda
Authors: Orach Christopher Garimoi , Dubourg Dominique , De Brouwere Vincent
Published: August 2010

Background  Uganda has hosted an estimated 200 000 refugees in post‐emergency phase settlements interspersed within host communities since 1990. However, refugee health service runs parallel to host in most refugee‐affected districts. The process of integration of health services began in 1999.

Objective  To estimate and compare the costs and coverage of reproductive health (RH) interventions in refugee and host populations in three rural West Nile refugee‐affected districts of Uganda.

Methods  Data on costs of RH interventions were collected through a survey in 38/116 (33%) health facilities (3 public hospitals and 35 health centres). Data on coverage of RH interventions were collected from all 116 health facilities in the three rural refugee‐affected districts for 2 years, 2003 and 2004.

Results  The costs and coverage of RH interventions significantly varied between population categories and among levels of refugee and host health facilities. Per capita cost of health care is 2.7 times higher for the refugee than the host population (US$13.12 vs. US$4.85). The cost per RH intervention is higher in the refugee than in the host health system (US$3.02 vs. US$2.73). Significantly more refugees attend antenatal care [99.4% (95% CI, 97.5–100) vs. 53.5% (53.22–53.78); P < 0.0001]. The proportion of births in health facilities was significantly greater among refugees [37.3% (36.12–38.48) vs. 15.2% (15.01–15.39); P < 0.05]. Major obstetrical interventions for absolute maternal indications were significantly more frequent among refugees than the host population living in the same region [1.02% (0.79–1.25) vs. 0.85% (0.80–0.90); P < 0.05].

Conclusions  Our study has shown higher costs and coverage in refugee than host health services. The findings suggest policy recommendations for improving the capacity, financing, organization and the performance of host health system in the refugee‐affected settings.
Feasibility of measuring compliance to annual ivermectin treatment in the African Programme for Onchocerciasis Control
Authors: Brieger William R. , Okeibunor Joseph C. , Abiose Adenike O. , Ndyomugyenyi Richard , Kisoka William , Wanji Samuel , Elhassan Elizabeth , Amazigo Uche V.
Published: August 2010

The African Programme for Onchocerciasis Control (APOC) sponsors annual distribution of ivermectin to control onchocerciasis. Ivermectin should be taken annually by 65% of community members for a number of years to eliminate the disease as a public health problem. While many community coverage surveys have been undertaken during project monitoring, individual compliance could not be studied until several annual rounds of distribution had occurred. This paper reports on the efforts to determine whether adequate records could be found to enable a compliance study. A step‐down process from project to district to community level was used to identify project sites where continuous ivermectin distribution up through 2004 had occurred. The first step consisted of selecting 17 of 25 projects by APOC. The second step determined adequacy of districts where distribution had occurred on a regular annual basis. Among 121 districts 58.6% undertook distribution in all 7 years. A total 852 villages were visited and community level records were found in all but three. Records showed that distribution had occurred for a minimum of five consecutive times in 429 villages, and ultimately 10 projects. While the feasibility study found an adequate number of villages to study compliance, the large number of projects, districts and villages that did not qualify for the follow‐on compliance study should lead National Onchocerciasis Control Programme managers to strengthen the overall coverage and consistency of their efforts.
Evaluation of pooled screening for anti‐HCV in two blood services set‐ups
Authors: Novack Lena , Shinar Eilat , Safi Jamal , Soliman Hassan , Yaari Arieh , Galai Noya , Pliskin Joseph S. , Sarov Batia
Published: August 2010

Objective Screening blood donations for anti‐HCV is only partially performed in many developing countries due to the relatively high costs of testing. The screening expenditures can be reduced by testing donations in pools.

This study evaluates the accuracy and feasibility of pooled screening procedure for anti‐HCV in blood banks in Israel and the Palestinian Authority.

Methods The sensitivity and specificity of tests performed on pool sizes of 6–24 samples were compared to singleton immunoassay testing. All negative samples and those positive for anti‐HCV were obtained from the routine work of Magen David Adom Blood Services in Israel and Shifa Hospital blood bank in Palestinian Authority. The experiments were run in parallel with different technologies.

Results  The sensitivity of pooled‐testing for anti‐HCV by Magen David Adom was 94–97% for verified samples. In the Shifa Hospital, the sensitivity was estimated as 96–97% for non‐verified samples. Cost‐analysis showed benefits up to $2 per donation screened for anti‐HCV in Shifa Hospital.

Conclusions  We recommend using manually created pools of up to 6 samples when testing for anti‐HCV, but at the cost of 3% loss in sensitivity. Pooling can be considered, in countries which do not perform routine screening, due to their limited economic resources.
Rapid point‐of‐care HIV testing in pregnant women: a systematic review and meta‐analysis
Authors: Pai Nitika Pant , Tulsky Jacqueline Peterson , Cohan Deborah , Colford John M. , Reingold Arthur L.
Published: August 2010

Rapid, point‐of‐care human immunodeficiency virus (HIV) testing has the potential to enhance strategies to prevent mother‐to‐child transmission (MTCT) of HIV infection. Rapid tests need minimal laboratory infrastructure and can be performed by health workers with minimal training. In our systematic review and meta‐analysis, we aimed to summarize the overall diagnostic accuracy of rapid HIV tests in pregnancy, and outcomes such as acceptability, patient preference, feasibility and impact of rapid testing. We searched four major databases, identified and screened 1377 citations, and included 17 studies that met our eligibility criteria. Analyses of these studies suggested that the overall sensitivity and specificity of blood‐based rapid tests was high compared with oral rapid tests. A two‐step testing strategy, particularly parallel testing, was found to be superior to single‐test strategy in labour and delivery settings. Acceptability of rapid tests and patient preference was variable across studies. Overall, rapid HIV testing was highly accurate compared with conventional tests and offer a clear advantage of enabling the implementation of timely interventions to reduce MTCT of HIV. To improve diagnostic accuracy and to reduce false‐positive results, it may be necessary to use two rapid tests during labour and delivery.
Fracture treatment by bonesetters in central Ghana: patients explain their choices and experiences
Authors: Ariës Marcel J. H. , Joosten Hanneke , Wegdam Harry H. J. , Van Der Geest Sjaak
Published: August 2010

Objective  To understand factors influencing patients’ decisions to choose either fracture treatment by a bonesetter or in the hospital and to explore patients’ experiences with bonesetter treatment.

Method  In‐depth interviews with 46 patients with a radiological proven fracture in a district hospital in central Ghana.

Results  Traditional healers, such as bonesetters, play a substantial role in the Ghanaian healthcare system. Over a period of 3 months, 14 patients with a proven fracture left hospital for treatment by a bonesetter. The hospital is considered the only institution where emergency care can be provided and reliable, extensive diagnostic and treatment facilities are available for fracture treatment. Patients opting for bonesetter treatment are guided by the severity of the fracture, availability of the service, their financial status and past experiences. The healing methods used by different bonesetters are based on mutual comparable principles.

Conclusion  Fracture treatment can serve as a model for respectful and efficient co‐existence of traditional and biomedical medicine.
Malaria deaths as sentinel events to monitor healthcare delivery and antimalarial drug safety
Authors: Mehta U. , Durrheim D. N. , Blumberg L. , Donohue S. , Hansford F. , Mabuza A. , Kruger P. , Gumede J. K. , Immelman E. , Sánchez Canal A. , Hugo J. J. , Swart G. , Barnes K. I.
Published: August 2010

Objectives  To identify case management, health system and antimalarial drug factors contributing to malaria deaths.

Method  We investigated malaria‐related deaths in South Africa's three malaria endemic provinces from January 2002 to July 2004. Data from healthcare facility records and a semi‐structured interview with patients’ contacts were reviewed by an expert panel, which sought to reach consensus on factors contributing to the death. This included possible health system failures, adverse reactions to antimalarials, inappropriate medicine use and failing to respond to treatment.

Results  Approximately 177 of 197 cases met inclusion criteria for the study. Delay in seeking formal health care was significantly longer for patients who sought traditional health care [median 4; inter‐quartile range (IQR) 3–7 days] than for patients who did not (median 3; IQR 1–5 days; P = 0.033). Patients with confirmed or suspected HIV/AIDS were significantly more likely to use traditional approaches (25%) than those with other comorbidities (0%; P = 0.002). Malaria was neither suspected nor tested for at a primary care facility in 23% of cases with adequate records. Initial hospital assessment was considered inadequate in 74% of cases admitted to hospital and in‐patient monitoring and management was adequate in only 27%. There were 32 suspected adverse reactions to antimalarial therapy.

Conclusion  A confidential enquiry into malaria‐related deaths is a useful tool for identifying preventable factors, health system failures and adverse events affecting malaria case management.
A correlative study of ultrasound with serology in an area in China co‐endemic for human alveolar and cystic echinococcosis
Authors: Yang Y. R. , Craig P. S. , Ito A. , Vuitton D. A. , Giraudoux P. , Sun T. , Williams G. M. , Huang Z. , Li Z. , Wang Y. , Teng J. , Li Y. , Huang L. , Wen H. , Jones M. K. , McManus D. P.
Published: August 2010

We correlated ultrasound (US) imaging classifications for human alveolar echinococcosis (AE) and cystic echinococcosis (CE) with serology (ELISA and immunoblotting (IB) incorporating native and recombinant/purified echinococcal antigens) in community surveys (2001–2003) and follow‐up (2002 and 2003) of US‐confirmed cases in Ningxia, China. One hundred and seventy‐one cases (96 with AE, 75 with CE) were identified; of these, US classification and serological data were obtained for 142 and 112 cases, respectively. Seropositive‐rates increased in CE patients with highly viable unilocular cyst lesions (Types CL, CE 1 or CE 2) to degenerating primary lesions (CE 3), but then decreased in subjects with inactive (CE 4) or dead (CE 5) cysts. In contrast, there was a constant increase in seropositivity from the early (P1, P2) to the advanced stages (P3, P4) with AE cases. For US‐confirmed cases, follow‐up by US combined with serology is invaluable for studying the clinical progression of echinococcosis and for detecting recurrent cysts or reinfection post‐treatment.
A multiplex PCR assay that separates Rhodnius prolixus from members of the Rhodnius robustus cryptic species complex (Hemiptera: Reduviidae)
Authors: Pavan M. G. , Monteiro F. A.
Published: August 2010

Rhodnius prolixus is one of the most important primary vectors of human Chagas disease in Latin America. Its morphology is, however, identical to that of the members of the Rhodnius robustus cryptic species complex, which includes secondary vectors. The correct identification of these taxa with differential vector competence is, therefore, of great epidemiological relevance. We used the alignment of 26 mitochondrial cytochrome b haplotypes (663 bp) to select for PCR‐amplifiable species‐specific regions. We designed one forward primer on a region conserved across all haplotypes, and three reverse primers that anneal to species‐specific regions and amplify fragments of different lengths for R. prolixus (285 bp) and for members of the two major R. robustus lineages: group I (349 bp) and groups II–IV (239 bp). These fragments were easily identifiable on regular 1.5% agarose gels. This multiplex PCR assay was successfully tested on 81 specimens from six Latin American countries, and used to determine the phylogeographic boundaries for each species. It is a simple, objective, and cost‐effective assay. Its PCR‐based nature makes it applicable to any insect developmental stage, as well as to dried specimens, and insect remains. It should be particularly useful in areas where representatives of these Rhodnius species occur in sympatry.
Field trial of a low cost method to evaluate hand cleanliness
Authors: Luby Stephen P. , Agboatwalla Mubina , Billhimer Ward , Hoekstra Robert M.
Published: August 2010

Objective  To evaluate a simple low cost method for measuring hand contamination as an objective assessment of handwashing practices.

Method  As part of a larger randomized controlled trial of handwashing promotion with soap conducted in squatter settlements of Karachi, Pakistan, a randomly selected subset of 52 mothers in households receiving soap and handwashing promotion and 28 mothers in control households directly pressed three fingers of their right hand onto MacConkey agar plates on weekly unannounced visits from April to September 2002, and monthly from October 2002 to March 2003. The MacConkey plates were incubated at 44 °C for 24 h, and evaluated for growth of thermotolerant coliform bacteria.

Results  The proportion of samples that had detectable thermotolerant coliforms (50%) was similar in households that received soap and control households (52%, P = 0.40). In the week after evaluation of the mothers’ hands, the proportion of households that reported diarrhoea was similar regardless of whether or not the mother had thermotolerant coliforms detected by direct finger imprint (18.6%vs. 19.1%, Relative Risk 0.99, 95% CI 0.96, 1.03).

Conclusions  A three finger direct imprint test using MacConkey agar for thermotolerant coliforms was not a useful method to assess regular handwashing practices with soap in Karachi. Developing better measures of handwashing behaviour remains an important research priority.
Factors determining use of pre‐travel preventive health services by West African immigrants in The Netherlands
Authors: Schilthuis Herbert J. , Goossens Ingrid , Ligthelm Robert J. , De Vlas Sake J. , Varkevisser Corlien , Richardus Jan H.
Published: August 2010

Objective  To determine for what reasons West African immigrants, who contribute the largest single group of malaria cases in the Netherlands, visit pre‐travel preventive health services and whether use of such services is likely to improve use of preventive measures.

Methods  Semi‐structured interviews with eligible participants recruited through West African churches and societies and at a large festival.

Results  A total of 70% of the total non‐random sample of 292 participants said that they always use pre‐travel preventive health services before travelling. Being from Ghana (OR = 2.5), having legal residency status (OR = 2.5), visiting friends and relatives rather than going for business or funeral (OR = 6.7), and living in Amsterdam (OR = 5.1) were all independently associated with using pre‐travel preventive health services, as were taking general preventive measures (OR = 3.0), and self‐reported use of malaria prophylaxis. Higher use of pre‐travel preventive health services was not associated with better knowledge of malaria as such.

Conclusions  West Africans, in particular non‐Ghanaians, illegal immigrants and West African immigrants leaving at short notice should be encouraged to use pre‐travel preventive health services. Adequate methods to reach these groups need to be developed, including health education on the importance of prevention in general.
Predictors of death from severe pneumonia among children 2–59 months old hospitalized in Bohol, Philippines: implications for referral criteria at a first‐level health facility
Authors: Lupisan S. P. , Ruutu P. , Erma Abucejo‐Ladesma P. , Quiambao B. P. , Gozum L. , Sombrero L. T. , Romano V. , Herva E. , Riley I. , Simoes E. A. F. ,   ARIVAC Consortium
Published: August 2010

Objective  To determine predictors of death among children 2–59 months old admitted to hospital with severe pneumonia.

Methods  Prospective observational study from April 1994 to May 2000 to investigate serious infections in children less than 5 years old admitted to a tertiary care government hospital in a rural province in central Philippines. The quality of clinical and laboratory work was monitored. The WHO classification for severe pneumonia was used for patient enrolment.

Results  There were 1249 children with severe pneumonia and no CNS infection. Thirty children died. Using univariate analysis, the following factors were significantly associated with death: age 2–5 months, dense infiltrates on chest radiography and presence of definite bacterial pathogens in the blood. Stepwise logistic regression analysis revealed the following independent predictors of death: age 2–5 months, weight for age z‐score less than −2 SD, dense infiltrates on chest radiography and definite pathogens isolated in the blood. When the results of chest radiographs and blood cultures were not included to mimic facilities available at first‐level facilities, age 2–5 months and weight for age z‐score less than −2 SD remained independent predictors of death.

Conclusion  When resources are limited, children with lower chest wall indrawing (severe pneumonia) who are 2–5 months old or moderately to severely malnourished should be referred for immediate higher‐level care.
Migrants’ access to antiretroviral therapy in Thailand
Authors: Saether Simen Tellemann , Chawphrae Usawadee , Zaw Maw Maw , Keizer Cornelieke , Wolffers Ivan
Published: August 2010

Objective  To investigate migrants’ access to antiretroviral therapy (ART) and assess the applicability of ART guidelines to migrants.

Methods  Six focus group discussions (FGD) were conducted in Thailand with 74 Burmese migrants: factory workers in Mae Sot and Bangkok, construction site workers in Chiang Mai and unemployed and undocumented HIV‐positive migrants in Mae Sot. Thirteen key stakeholders and migrants were interviewed for triangulation.

Results  (1) Present criteria for in‐/exclusion restrict migrants’ access to ART. (2) Leading ART guidelines are not applicable for migrants in general. (3) Migrants are likely to experience more problems with adherence to ART than local patients, which increases the importance of ART guidelines.

Conclusions  Without ART guidelines that take into consideration the specific circumstances that limit migrants’ access to ART, health care providers will continue to render HIV‐positive migrants ineligible. Interventions are needed to both make the ART guidelines applicable to migrants and to overcome obstacles restricting migrants’ access to ART. This will greatly improve migrants’ access to ART and help to save the lives of thousands of HIV‐positive migrants.