bluuebunny/crossref_metadata_2025 huggingface dataset:
Cellular immune responses of a Senegalese community recently exposed to Schistosoma mansoni: correlations of infection level with age and inflammatory cytokine production by soluble egg antigen‐specific cells
Authors: Marguerite M. , Gallissot M.‐C. , Diagne M. , Moreau C. , Diakkhate M.‐M. , Roberts M. , Remoue F. , Thiam A. , Decam CH. , Rogerie F. , Cottrez F. , Neyrinck J.‐L. , Butterworth A. E. , Sturrock R. F. , Piau J.‐P. , Daff B. , Niang M. , Wolowczuk I. , Riveau G. , Auriault C. , Capron A.
Published: March 2003

Summary A recently reported epidemic of Schistosoma mansoni infection in Senegal provided an opportunity to study the dynamics of the development of immunity to human schistosomiasis. We report here on the cell‐mediated immune response in a population of 99 females and 95 males, with particular emphasis on the relationship between intensity of infection and age. We found that the intensity of infection correlated negatively with age in females but not in males. In men and women, both Th1‐and Th2‐type cytokines were detected upon in vitro stimulation of PBMCs with soluble egg antigen (SEA) or soluble adult worm antigens (SWAP). In the female group, SEA‐induced PBMC proliferation was associated with the production of IFN‐γ, IL‐2 and IL‐5, all of which correlated negatively with intensity of infection. Most cytokine production correlated positively with age. Spontaneous production of TNF‐α, IL‐6 and IL‐10 was higher in the infected population than in an uninfected control group. Our results suggest that immunity to infection could be more pronounced in the female population and associated with a Th0/1 + 2 pattern of cytokine secretion mediated by soluble egg antigen (SEA).
The impact of population level deworming on the haemoglobin levels of schoolchildren in Tanga, Tanzania
Authors: Beasley N. M. R. , Tomkins A. M. , Hall A. , Kihamia C. M. , Lorri W. , Nduma B. , Issae W. , Nokes C. , Bundy D. A. P.
Published: March 2003

Summary The impact of albendazole (400 mg) and praziquantel (40 mg/kg body weight) treatment of schoolchildren was compared with placebo according to the presence of anaemia (haemoglobin concentration < 11.0 g/dl) and heavy (> 5000 epg) or light (< 5000 epg) hookworm egg load. The study was conducted in rural Tanga. Medication was administered in September 1994 and children were followed‐up in January 1995. Overall, anthelminthic treatment reduced the fall in haemoglobin concentration compared with that observed in the placebo group (− 0.11 g/dl vs. − 0.35 g/dl; P = 0.02). Anthelminthic treatment was of greatest benefit to the 9% of children with both anaemia and heavy hookworm egg load (+ 0.67 g/dl vs. − 0.67 g/dl) and was also of significant benefit to the 38% of children with anaemia and light hookworm egg load (+ 0.07 g/dl vs. − 0.21 g/dl). It was of no significant benefit to children who were not anaemic. This study suggests that single‐dose anthelminthic treatment distributed in schools in this area achieves haematological benefits in nearly half of children infected with S. haematobium and geohelminths (37% of total population).
Poverty and eosinophilia are risk factors for endomyocardial fibrosis (EMF) in Uganda
Authors: Rutakingirwa Maurice , Ziegler John L. , Newton Robert , Freers Jurgen
Published: March 2003

objective  To determine the relative risks of socio‐demographic, dietary, and environmental factors for endomyocardial fibrosis (EMF) in Uganda. method Unmatched case control study in Mulago Hospital, Kampala. Cases (n=61) were sequential patients hospitalized with an echocardiographic diagnosis of EMF from June 1995 to March 1996. Controls (n 120) were concurrent patients with other forms of heart disease (heart controls, n 59) and subjects admitted for trauma or elective surgery (hospital controls, 61). All consenting subjects answered a structured questionnaire administered by trained interviewers. Complete blood counts, malaria films and stool examination for ova and parasites were performed. Questionnaires elicited information on home address, economic circumstances, variables concerned with environmental exposures and usual diet before becoming ill. results  After adjustment for age and sex, cases were significantly more likely than controls to have Rwanda/Burundi ethnic origins ( 0.008). Compared with controls, cases had a lower level of education 0.001 for heart controls and 0.07 for hospital controls), were more likely to be peasants 0.001), and to come from Luwero or Mukono Districts ( 0.003). After further adjustment for peasant occupation, cases were more likely than controls to walk barefoot ( 0.015), consume cassava as their staple food 0.001) and to lack fish or meat in dietary sauces ( 0.02). Cases were more likely to exhibit absolute eosinophilia ( 0.006). The effect of cassava diet was more marked in the younger age group, while the effect of eosinophilia was greater in adults. Socio‐economic disadvantage is a risk for EMF. Absolute eosinophilia is a putative cause of EMF, a finding not explained by parasitism. conclusion  Data indicate that relative poverty and environmental factors triggering eosinophilia appear to act in a geographically restricted region of Uganda in the aetiology of EMF.
HIV heterogeneity and proximity of homestead to roads in rural South Africa: an exploration using a geographical information system
Authors: Tanser Frank , LeSueur David , Solarsh Geoff , Wilkinson David
Published: March 2003

Summary objective  To describe heterogeneity of HIV prevalence among pregnant women in Hlabisa health district, South Africa and to correlate this with proximity of homestead to roads.

methods  HIV prevalence measured through anonymous surveillance among pregnant women and stratified by local village clinic. Polygons were created around each clinic, assuming women attend the clinic nearest their home. A geographical information system (GIS) calculated the mean distance from homesteads in each clinic catchment to nearest primary (1°) and to nearest primary or secondary (2°) road.

results  We found marked HIV heterogeneity by clinic catchment (range 19–31% (P < 0.001). A polygon plot demonstrated lower HIV prevalence in catchments remote from 1° roads. Mean distance from homesteads to nearest 1° or 2° road varied by clinic catchment from 1623 to 7569 m. The mean distance from homesteads to a 1° or 2° road for each clinic catchment was strongly correlated with HIV prevalence (r = 0.66; P = 0.002).

conclusions  The substantial HIV heterogeneity in this district is closely correlated with proximity to a 1° or 2° road. GIS is a powerful tool to demonstrate and to start to analyse this observation. Further research is needed to better understand this relationship both at ecological and individual levels, and to develop interventions to reduce the spread of HIV infection.
Correlation of in vivo‐resistance to chloroquine and allelic polymorphisms in Plasmodium falciparum isolates from Uganda
Authors: Flüeck T. P. F. , Jelinek T. , Kilian A. H. D. , Adagu I. S. , Kabagambe G. , von Sonnenburg F. , Warhurst D. C.
Published: March 2003

Summary

The efficacy of chloroquine in the treatment of uncomplicated falciparum malaria in Africa is heavily compromised by high levels of drug resistance. The occurrence of active site mutations in the Plasmodium falciparum multi drug resistance‐gene 1 (pfmdr1) has been associated with development of resistance to chloroquine. This study investigates the occurrence of several mutations at codons 86, 1042 and 1246 of the pfmdr1‐gene in infected blood samples taken from Ugandan children before treatment with chloroquine and their relationship to clinical and parasitological resistance. Even though a clear association of CQR to one certain pfmdr1 single point mutation could not be substantiated, the frequency of resistance was consistently higher for samples revealing any of the mutations than among wild type samples, and 90% of the clinically resistant samples did present a mutation. Thus detection of these allelic pfmdr1 polymorphisms is not a decisive factor for prediction of clinical chloroquine resistance, but an interplay of the different mutations with unknown cofactors is to be assumed and the possible role of other genetic alterations remains to be investigated.
Efficacy of sulphadoxine‐pyrimethamine for acute uncomplicated malaria due to Plasmodium falciparum in Malawian children under five years old
Authors: Nwanyanwu Okey C. , Ziba Charles , Macheso Allan , Kazembe Peter
Published: March 2003

Summary In 1993, Malawi replaced chloroquine (CQ) with sulphadoxine‐pyrimethamine (SP) as its first‐line treatment for uncomplicated malaria in children < 5 years of age. To assess the efficacy of SP after 5 years of widespread use, we undertook this study at 7 sites in 6 districts of Malawi. Febrile children < 5 years attending the outpatient clinics of selected hospitals whose parents consented were enrolled in the study if they had an axillary temperature of ≥ 37.5 °C and pure Plasmodium falciparum parasitaemia of ≥ 2000 asexual parasites/mm3. They were then followed for 14 days or until clinical failure. Parasitological resistance rates (RII and RIII) ranged from 7% to 19%. Resistance was higher in the north than in the central and southern regions, although this difference was not statistically significant. Resistance rates were a mean 19% during the rainy season vs. 12% in the dry season (P > 0.05). 80% of parasitological resistance was at the RII level. Of all children who failed parasitologically (90/641), 84 (93%) had no fever on day 7 and their mothers did not report them as being ill; only 6 of 641 (0.9%) patients met the WHO criteria for clinical treatment failure. Regardless of study site, 75% of mothers reported their children as having improved by day 3; 90% reported improvement by day 7, and all reported improvement by day 14. None of the children experienced any serious adverse reactions and none died. We found that after more than 5 years of widespread use of SP in Malawi, its efficacy remains acceptable for treatment of uncomplicated malaria, and it should therefore be retained as first‐line treatment.
Review of the evidence base for the ‘F’ and ‘E’ components of the SAFE strategy for trachoma control
Authors: Emerson P. M. , Cairncross S. , Bailey R. L. , Mabey D. C. W.
Published: March 2003

Summary Community control of trachoma as a blinding disease is based on the SAFE strategy of Surgery, Antibiotic therapy, Facial cleanliness and Environmental improvement. Surgery and antibiotic therapy currently dominate most programmes. Blindness from trachoma results from frequent infections repeated over many years, so ultimate success requires the reduction of transmission. This is only likely to be sustainable through the F and E components of SAFE. Environmental improvement with access to water, enhanced hygiene and better sanitation reduces trachoma transmission and the blinding sequelae eventually disappear. Transmission routes and factors that cause this are not known and consequently no single specific tool for F and E is in place. Evidence from intervention studies shows that the promotion of face‐washing gave modest gains for intense effort and a pilot study showed that trachoma transmission was reduced in the absence of eye‐seeking flies. Other studies have shown that latrines and improved access to water are associated with a lower prevalence of active trachoma. There is likely to be a long‐term beneficial effect of a combination of improved water supplies, provision of latrines, facial hygiene promotion through established infrastructure and control of eye‐seeking flies. Each of these interventions offers additional public health and other benefits in its own right. Further research on the routes of transmission, the role of hygiene and means of sustainable fly control should be a priority.
Hepatitis B virus infection in Thai children
Authors: Kozik Christine A. , Vaughn David W. , Snitbhan Rapin , Innis Bruce L.
Published: March 2003

Summary We studied hepatitis B virus (HBV) transmission among 7416 Thai children from 148 schools in Kamphaeng Phet province, a rural part of northern Thailand. Their age ranged from 2 to 16 years (median 9 years). Between May 1991 and June 1992, 61 of 2593 (2.4%) in the cohort of susceptible children acquired anti‐HBc immunoglobulin. Forty‐seven of the 148 schools had children who acquired anti‐HBc. School seroconversion rates to anti‐HBc varied from 0% to 23%. There was no correlation between percent of carriers in schools and percent of anti‐HBc acquisition. Of the 61 children who acquired anti‐HBc, eight (13%) became HBsAg carriers but only two were symptomatic, for a clinical to subclinical infection ration of 1 : 30. One of the two symptomatic children became an HBsAg carrier. Three (38%) of the eight who were persistently antigenemic developed antibody to hepatitis B virus e antigen. Males were 2.5 times (95% CI 1.4–4.3) more likely to acquire anti‐HBc than females. Risk factors for acquisition of HBc in Thailand over a 9‐month period were examined in a subset of 2412 susceptible children and later in a case‐control study of 22 children who acquired anti‐HBc and 59 age and sex‐matched controls. Risks for acquiring anti‐HBc were male gender and a history of bleeding gums. In comparing this study to an earlier pilot study among 9848 children from the same area in Thailand, the yearly antibody acquisition rate to anti‐HBc among Thai children dropped from 5.7% in 1989 to 2.4% in 1992. A random sample of children in the pilot study showed that 16% were HBsAg positive and 27% had anti‐HBc at the beginning of the study. 34% had markers for either anti‐HBc or HBsAg. 12% were repeatedly positive for HBsAg a year later.
Antibiotic medication and bacterial resistance to antibiotics: a survey of children in a Vietnamese community
Authors: Larsson Mattias , Kronvall Göran , Thi Kim Chuc Nguyen , Karlsson Inga , Lager Fredrik , Duc Hanh Hoang , Tomson Göran , Falkenberg Torkel
Published: March 2003

Summary objective  To investigate antibiotic use and antibiotic susceptibility of respiratory tract pathogens in children aged 1–5 years in Bavi, Vietnam.

method  Nasopharynx and throat specimens were collected from 200 children from randomly selected households in a demographically defined population. Respiratory isolates were tested for antibiotic susceptibility according to the standard disk diffusion method. A questionnaire survey of carers elicited information on type of antibiotic used, duration of treatment, where the antibiotics had been purchased, type of treatment information retained by carers and episodes of illness preceding the study.

results  82% of the children had at least one symptom of acute respiratory tract infection (ARI) in the 4 weeks prior to the study, and of these 91% were treated with antibiotics. The most commonly used antibiotics were ampicillin (74%), penicillin (12%), amoxicillin (11%), erythromycin (5%), tetracycline (4%) and streptomycin (2%). Ampicillin was used for 3.3 days on average (SD:1.8) and penicillin for 2.6 days (SD:0.7). When deciding which antibiotic to use, 67% of the carers consulted the pharmacy seller, 11% decided themselves and 22% followed the doctor's prescription. The carrier rate of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis was 50%, 39% and 17%, respectively. Isolates from 145 children were susceptibility tested, and 74% were found to carry resistant pathogens. Of the tested isolates, 90% of S. pneumoniae, 68% of H. influenzae and 74% of M. catarrhalis were resistant to at least one antibiotic. The mean number of antibiotics (susceptible strains excluded) to which resistance was found was 2.0 (SD:1.2), 2.5 (SD:1.8) and 2.1 (SD:0.9), respectively. S. pneumoniae and H. influenzae showed high resistance to tetracycline (88% and 32%, respectively), trimethoprim/sulphonamide (32% and 44%), and chloramphenicol (25% and 24%). 23% of S. pneumoniae were erythromycin‐resistant and 18% of H. influenzae isolates were resistant to ampicillin. There was a significant difference in ampicillin and penicillin resistance between the group of children previously treated with beta lactam antibiotics and the group of children who did not receive antibiotics.

conclusion  As reported by the carers, children in Bavi are treated with antibiotics frequently. Most antibiotics were obtained without consulting a doctor. High levels of antibiotic resistance and high prevalence of multidrug‐resistant strains were found among respiratory pathogens. The existence of a large reservoir of resistance genes among children in low‐income countries represents a threat to the success of antibiotic therapy throughout the world. Multi‐faceted programmes to improve rational use of antibiotics in Vietnam are urgently needed.
Utility of history, examination and laboratory tests in screening those returning to Europe from the tropics for parasitic infection
Authors: Whitty Christopher J. M. , Carroll Bernadette , Armstrong Margaret , Dow Carol , Snashall David , Marshall Thomas , Chiodini Peter L.
Published: March 2003

Summary objectives  To examine the utility of the different elements of screening expatriates and travellers returned from the tropics for parasitic disease (exposure history, symptoms, examination and laboratory tests).

methods  In phase 1 (conducted prospectively 1990–91), 1029 asymptomatic returnees had a detailed questionnaire and interview on risk‐behaviour, physical examination and laboratory tests. In phase 2 (1997–98), 510 consecutive patients referred for routine screening (276 symptomatic and 234 asymptomatic) were screened with laboratory tests.

results  Exposure history did not correlate reliably with parasite burden. In phase 1 physical examination revealed 387 abnormalities, only three of which indicated parasitic disease. Schistosomal serology was positive in 11% (CI 9–13) of these asymptomatic cases including patients with light or no reported freshwater exposure. Stool microscopy was positive in 19% (CI 16–22) of cases not correlated with reported eating habits, and eosinophilia was present in 8% (CI 6–10). In phase 2 reported symptoms did not correlate with parasitic disease. Schistosomiasis was present in 15% (CI 13–24) of asymptomatic and 18% (CI 13–22) of symptomatic individuals (OR 1.2 P = 0.46); stool microscopy was positive in 14% of both symptomatic and asymptomatic patients, and eosinophilia in 9% of symptomatic and 6% of asymptomatic individuals.

conclusion  Potentially serious asymptomatic infection is common in travellers. Detailed exposure history, symptom history and physical examination added little to detecting cases. Stool microscopy, schistosomal serology and eosinophil count all had good yield. Filarial serology had low yield in patients without eosinophilia.
Using evidence to change antimalarial drug policy in Kenya
Authors: Shretta R. , Omumbo J. , Rapuoda B. , Snow R. W.
Published: March 2003

Summary Chloroquine resistance was first detected in Kenya in 1978 and escalated during the 1980s. Chloroquine remained the treatment of choice for uncomplicated malaria infections until revised guidelines were launched in 1998 despite a plethora of scientific evidence on failure. This review analyses the range and quality of the evidence base that was used to change the drug policy in Kenya from chloroquine to SP and examines the process of consensus building and decision making. Our review illustrates the difficulties in translating sensitivity data with gross geographical, temporal and methodological variations into national treatment policy. The process was complicated by limited options, unknown adverse effects of replacement therapies, cost, as well as limited guidance on factors pertinent to changing the drug policy for malaria. Although > 50% of the studies showed parasitological failures by 1995, there was a general lack of consensus on the principles for assessing drug failures, the inclusion criteria for the study subjects and the relative benefits of parasitological and clinical assessments. A change in international recommendations for assessment of drug efficacy in 1996 from parasitological to clinical response further perplexed the decisions. There is an urgent need for international standards and evidence‐based guidelines to provide a framework to assist the process by which decision‐makers in malaria‐endemic countries can make rational choices for antimalarial drug policy change.
Efficacy of praziquantel against Schistosoma mansoni with particular consideration for intensity of infection
Authors: Utzinger Jürg , N'goran Eliézer K. , N'dri Amani , Lengeler Christian , Tanner Marcel
Published: March 2003

Summary Chemotherapy with praziquantel is the cornerstone of schistosomiasis control. In view of recent concern about tolerance or resistance to praziquantel, monitoring its efficacy in different epidemiological settings is required. We report a study among 253 schoolchildren in an area highly endemic for Schistosoma mansoni in western Côte d'Ivoire. After examining four consecutive stool specimens from each child, the first praziquantel treatment at 60 mg/kg divided into two doses was administered. Four weeks later, stool specimens were again screened over 4 consecutive days and revealed a cure rate of 71.6% and an egg reduction rate of 79.9%. There was a significant association between cure rate and intensity of infection prior to treatment with highest cure rates observed in light infections (P < 0.01). Praziquantel, at a single dose of 40 mg/kg, was again administered 35 days after the first treatment. The overall cure and egg reduction rates increased considerably. The association between cure rate and intensity of infection prior to the second treatment was significant but less pronounced. Twenty‐two children remained S. mansoni positive after the two chemotherapy campaigns, and interestingly, many of these were only identified after repeated stool examinations. We argue that pre‐patent infections may account for some of these ‘treatment failures’. However, further studies in other endemic settings are needed, with parasitological diagnoses having a high sensitivity.
Sleeping sickness surveillance: an essential step towards elimination
Authors: Cattand Pierre , Jannin Jean , Lucas Pierre
Published: March 2003

In the last decades, with little or no surveillance sleeping sickness has returned to alarming levels comparable to the early twentieth century. Sixty million people are considered at risk but only 3–4 million are under surveillance, yielding some 45 000 new cases annually. It is estimated that at least 300 000–500 000 people are presently infected. Despite the almost universal presence of the vector in sub‐Saharan Africa and the existence of an animal parasite reservoir, it is technically feasible to control and eliminate the disease as a public health problem. The authors describe, step‐by‐step, a surveillance method based on the epidemiological status of the village and using several approaches ranging from passive to active surveillance. Co‐ordinated by the WHO, such surveillance has been incepted in several countries. Epidemiological data is spatially linked to the village, whose geographical co‐ordinates are collected using a Global Positioning Systems (GPS). Information is transmitted to WHO through internet. Data analysis and mapping is carried out using Geographical Information System (GIS) software and thematic maps are generated to illustrate epidemiological status. Examples from Central African Republic (CAR), Cameroon and Gabon illustrate the process and mapping.
Cancer incidence in Blantyre, Malawi 1994–1998
Authors: Banda L. T. , Parkin D. M. , Dzamalala C. P. , Liomba N. G.
Published: March 2003

In this paper, we report the first results from the population‐based cancer registry for Blantyre district, Malawi, for the period 1994–1998. In this 5‐year period, 1245 cases were recorded in males (an estimated age‐standardized incidence of 92.0 per 100,000) and 1003 in females (an age standardised rate (ASR) of 88.8 per 105). The overall percentage of cases with histological verification was just 41.8%, indicating that case‐finding outside the laboratory had been quite successful; nevertheless the rather low rates suggest possible underdiagnosis of cancer, as well as cases missed. As in other reports from the region, the contemporary pattern is dominated by Kaposi’s sarcoma (KS) (55.2% cancers in men, 28% in women), the effect of the evolving epidemic of AIDS. The incidence of cervix cancer in women is high (ASR 26.2 per 105), and there are moderately high rates of oesophageal cancer (ASR 15.4 per 105 in men, 9.3 per 105 in women). In childhood, the cancer profile is dominated by Burkitt’s lymphoma, which accounts for 42.4% of cancers; KS is now the second most frequent cancer of childhood.
Poor food hygiene and housing as risk factors for typhoid fever in Semarang, Indonesia
Authors: Gasem M. Hussein , Dolmans W. M. V. W. M. V. , Keuter M. M. , Djokomoeljanto R. R.
Published: March 2003

To identify risk factors for typhoid fever in Semarang city and its surroundings, 75 culture‐proven typhoid fever patients discharged 2 weeks earlier from hospital and 75 controls were studied. Control subjects were neighbours of cases with no history of typhoid fever, not family members, randomly selected and matched for gender and age. Both cases and controls were interviewed at home by the same trained interviewer using a standardized questionnaire. A structured observation of their living environment inside and outside the house was performed during the visit and home drinking water samples were tested bacteriologically. Univariate analysis showed the following risk factors for typhoid fever: never or rarely washing hands before eating (OR=3.28; 95% CI=1.41–7.65); eating outdoors at least once a week (OR=3.00; 95% CI=1.09–8.25); eating outdoors at a street food stall or mobile food vendor (OR=3.86; 95% CI=1.30–11.48); consuming ice cubes in beverage in the 2‐week period before getting ill (OR=3.00, 95% CI=1.09–8.25) and buying ice cubes from a street vendor (OR=5.82; 95% CI=1.69–20.12). Water quality and living environment of cases were worse than that of controls, e.g. cases less often used clean water for taking a bath (OR=6.50; 95% CI= 1.47–28.80), for brushing teeth (OR=4.33; 95% CI=1.25–15.20) and for drinking (OR=3.67; 95% CI=1.02–13.14). Cases tended to live in houses without water supply from the municipal network (OR=11.00; 95% CI=1.42–85.2), with open sewers (OR=2.80; 95% CI=1.0–7.77) and without tiles in the kitchen (OR=2.67; 95% CI=1.04–6.81). Multivariate analysis showed that living in a house without water supply from the municipal network (OR=29.18; 95% CI=2.12–400.8) and with open sewers (OR=7.19; 95% CI=1.33–38.82) was associated with typhoid fever. Never or rarely washing hands before eating (OR=3.97; 95% CI=1.22–12.93) and being unemployed or having a part‐time job (OR=31.3; 95% CI=3.08–317.4) also were risk factors. In this population typhoid fever was associated with poor housing and inadequate food and personal hygiene.
Efficacy and cost‐effectiveness of environmental management for malaria control
Authors: Utzinger Jürg , Tozan Yesim , Singer Burton H.
Published: March 2003

Roll back malaria (RBM) aims at halving the current burden of the disease by the year 2010. The focus is on sub‐Saharan Africa, and it is proposed to implement efficacious and cost‐effective control strategies. But the evidence base of such information is scarce, and a notable missing element is the discussion of the potential of environmental management. We reviewed the literature and identified multiple malaria control programmes that incorporated environmental management as the central feature. Prominent among them are programmes launched in 1929 and implemented for two decades at copper mining communities in Zambia. The full package of control measures consisted of vegetation clearance, modification of river boundaries, draining swamps, oil application to open water bodies and house screening. Part of the population also was given quinine and was sleeping under mosquito nets. Monthly malaria incidence rates and vector densities were used for surveillance and adaptive tuning of the environmental management strategies to achieve a high level of performance. Within 3–5 years, malaria‐related mortality, morbidity and incidence rates were reduced by 70–95%. Over the entire 20 years of implementation, the programme had averted an estimated 4173 deaths and 161 205 malaria attacks. The estimated costs per death and malaria attack averted were US$ 858 and US$ 22.20, respectively. Over the initial 3–5 years start‐up period, analogous to the short‐duration of cost‐effectiveness analyses of current studies, we estimated that the costs per disability adjusted life year (DALY) averted were US$ 524–591. However, the strategy has a track record of becoming cost‐effective in the longer term, as maintenance costs were much lower: US$ 22–92 per DALY averted. In view of fewer adverse ecological effects, increased sustainability and better uses of local resources and knowledge, environmental management – integrated with pharmacological, insecticidal and bednet interventions – could substantially increase the chances of rolling back malaria.
Evaluation of a comprehensive home‐based midwifery programme in South Kalimantan, Indonesia
Authors: Ronsmans Carine , Endang Achadi , Gunawan Supratikto , Zazri Ali , McDermott Jeanne , Koblinsky Marge , Marshall Tom
Published: March 2003

We report the findings of an evaluation of a programme in three districts in South Kalimantan, Indonesia, which consisted of the training, deployment and supervision of a large number of professional midwives in villages, an information, education and communication (IEC) strategy to increase use of village midwives for birth, and a district‐based maternal and perinatal audit (MPA). Before the programme, the midwives had limited ability to manage obstetric complications, and 90% of births took place at home. Only 37% were attended by a skilled attendant. By 1998–99, 510 midwives were posted in the districts and skilled attendance at delivery had increased to 59%. Through in‐service training, continuous supervision and participation in the audit system midwives also gained confidence and skills in the management of obstetric complications. Despite this, the proportion admitted to hospital for a caesarean section declined from 1.7 to 1.4% and the proportion admitted to hospital with a complication requiring a life‐saving intervention declined from 1.1% to 0.7%. The strategy of a midwife in every village has dramatically increased skilled birth attendance, but does not yet provide specialized obstetric care for all women needing it. The high cost of emergency obstetric interventions may well be the most important obstacle to the use of hospital care.
Prevalence of polymorphisms in the dihydrofolate reductase and dihydropteroate synthetase genes of Plasmodium falciparum isolates from southern Mauritania
Authors: Eberl K. J. , Jelinek T. , Aida A. O. , Peyerl‐Hoffmann G. , Heuschkel C. , El Valy A. O. , Christophel E. M.
Published: March 2003

The increasing resistance of Plasmodium falciparum in the treatment of uncomplicated malaria with pyrimethamine/sulphadoxine has been associated in several studies with the occurrence of point mutations in the genes of dihydrofolate reductase (DHFR) and dihydropteroate synthetase (DHPS). In this study, the prevalence of these mutations was examined in samples from south‐east Mauritania, where atypically strong rainfalls in 1998 and 1999 led to a severe outbreak of falciparum malaria. We analysed 386 samples by polymerase chain reaction (PCR) for infection with P. falciparum, of which 162 (41.97%) were positive. These isolates were examined for point mutations in the genes of DHFR (codons 16, 51, 59, 108 and 164) and DHPS (codons 436, 437, 540, 581 and 613) by nested PCR and subsequent mutation‐specific restriction enzyme digest. We found a low overall prevalence of DHFR gene mutations (up to 18.6% of isolates), but a high overall prevalence of DHPS gene mutations (up to 49.1% of isolates). Thus, emerging resistance to antifolate drugs may be expected to develop soon in the investigated area. This study demonstrates the utility of simple, relatively rapid and inexpensive molecular methods and their application in surveillance programmes. Testing for prevalence of point mutations conferring antifolate resistance might help to identify the developing of drug resistance at a very early stage.
Authentication of artemether, artesunate and dihydroartemisinin antimalarial tablets using a simple colorimetric method
Authors: Green Michael D. , Mount Dwight L. , Wirtz Robert A.
Published: March 2003

The recent and widespread appearance of counterfeit antimalarial tablets in South–east Asia prompted the search for simple field assays to identify genuine drugs. In a recently described colorimetric assay for artesunate, Fast red TR salt reacted with an alkali‐decomposition product of artesunate to produce a distinct yellow colour. However, that assay is specific for artesunate and it cannot be used to test for artemether. Because of potential concerns over artemether tablet counterfeiting, the colorimetric assay was modified to detect artemether, dihydroartemisinin and artesunate tablets. Other common antimalarials (artemisinin, chloroquine diphosphate, mefloquine HCl, sulphadoxine and pyrimethamine), as well as aspirin and acetaminophen, were negative in the assay, indicating its specificity for artemether, dihydroartemisinin and artesunate. The colorimetric method can be used to obtain a rapid visual assessment of tablet authenticity. The method can also be used to quantify the drug content of tablets, when used in conjunction with a spectrophotometer.
Predicting the distribution of urinary schistosomiasis in Tanzania using satellite sensor data
Authors: Brooker Simon , Hay Simon I. , Issae Wahab , Hall Andrew , Kihamia Charles M. , Lwambo Nicholas J. S. , Wint William , Rogers David J. , Bundy Don A. P.
Published: March 2003

In this paper, remotely sensed (RS) satellite sensor environmental data, using logistic regression, are used to develop prediction maps of the probability of having infection prevalence exceeding 50%, and warranting mass treatment according to World Health Organization (WHO) guidelines. The model was developed using data from one area of coastal Tanzania and validated with independent data from different areas of the country. Receiver operating characteristic (ROC) analysis was used to evaluate the model’s predictive performance. The model allows reasonable discrimination between high and low prevalence schools, at least within those geographical areas in which they were originally developed, and performs reasonably well in other coastal areas, but performs poorly by comparison in the Great Lakes area of Tanzania. These results may be explained by reference to an ecological zone map based on RS‐derived environmental data. This map suggests that areas where the model reliably predicts a high prevalence of schistosomiasis fall within the same ecological zone, which has common intermediate‐host snail species responsible for transmission. By contrast, the model’s performance is poor near Lake Victoria, which is in a different ecological zone with different snail species. The ecological map can potentially define a template for those areas where existing models can be applied, and highlight areas where further data and models are required. The developed model was then used to provide estimates of the number of schoolchildren at risk of high prevalence and associated programme costs.
Female genital cutting in southern urban and peri‐urban Nigeria: self‐reported validity, social determinants and secular decline
Authors: Snow R. C. , Slanger T. E. , Okonofua F. E. , Oronsaye F. , Wacker J.
Published: March 2003

Despite growing public resistance to the practice of female genital cutting (FGC), documentation of its prevalence, social correlates or trends in practice are extremely limited, and most available data are based on self‐reporting. In three antenatal and three family planning clinics in South‐west Nigeria we studied the prevalence, social determinants, and validity of self‐reporting for FGC among 1709 women. Women were interviewed on social and demographic history, and whether or not they had undergone FGC. Interviews were followed by clinical examination to affirm the occurrence and extent of circumcision. In total, 45.9% had undergone some form of cutting. Based on WHO classifications by type, 32.6% had Type I cuts, 11.5% Type II, and 1.9% Type III or IV. Self‐reported FGC status was valid in 79% of women; 14% were unsure of their status, and 7% reported their status incorrectly. Women are more likely to be unsure of their status if they were not cut, or come from social groups with a lower prevalence of cutting. Ethnicity was the most significant social predictor of FGC, followed by age, religious affiliation and education. Prevalence of FGC was highest among the Bini and Urhobo, among those with the least education, and particularly high among adherents to Pentecostal churches; this was independent of related social factors. There is evidence of a steady and steep secular decline in the prevalence of FGC in this region over the past 25 years, with age‐specific prevalence rates of 75.4% among women aged 45–49 years, 48.6% among 30–34‐year olds, and 14.5% among girls aged 15–19. Despite wide disparities in FGC prevalence across ethnic, religious and educational groups, the secular decline is evident among all social subgroups.
Educational attainment and HIV‐1 infection in developing countries: a systematic review
Authors: Hargreaves James R. , Glynn Judith R.
Published: March 2003

OBJECTIVES  To assess whether educational status is associated with HIV‐1 infection in developing countries by conducting a systematic review of published literature.

METHODS  Articles were identified through electronic databases and hand searching key journals. Studies containing appropriately analysed individual level data on the association between educational attainment and HIV‐1 status in general population groups were included.

RESULTS  Twenty‐seven articles with appropriately analysed results from general population groups in developing countries were identified, providing information on only six countries. Large studies in four areas in Africa showed an increased risk of HIV‐1 infection among the more educated, whilst among 21‐year‐old Thai army conscripts, longer duration of schooling was strongly protective against HIV infection. The association between education and schooling in Africa was stronger in rural areas and in older cohorts, but was similar in men and women. Serial prevalence studies showed little change in the association between schooling and HIV over time in Tanzania, but greater decreases in HIV prevalence among the more educated in Uganda, Zambia and Thailand.

CONCLUSIONS  In Africa, higher educational attainment is often associated with a greater risk of HIV infection. However, the pattern of new HIV infections may be changing towards a greater burden among less educated groups. In Thailand those with more schooling remain at lower risk of HIV infection.
Domestic transmission routes of pathogens: the problem of in‐house contamination of drinking water during storage in developing countries
Authors: Jensen Peter Kjær , Ensink Jeroen H. J. , Jayasinghe Gayathri , Van Der Hoek Wim , Cairncross Sandy , Dalsgaard Anders
Published: March 2003

Even if drinking water of poor rural communities is obtained from a `safe' source, it can become contaminated during storage in the house. To investigate the relative importance of this domestic domain contamination, a 5‐week intervention study was conducted. Sixty‐seven households in Punjab, Pakistan, were provided with new water storage containers (pitchers): 33 received a traditional wide‐necked pitcher normally used in the area and the remaining 34 households received a narrow‐necked water storage pitcher, preventing direct hand contact with the water. Results showed that the domestic domain contamination with indicator bacteria is important only when the water source is relatively clean, i.e. contains less than 100 Escherichia coli per 100 ml of water. When the number of E. coli in the water source is above this value, interventions to prevent the domestic contamination would have a minor impact on water quality compared with public domain interventions. Although the bacteriological water quality improved, elimination of direct hand contact with the stored water inside the household could not prevent the occasional occurrence of extreme pollution of the drinking water at its source. This shows that extreme contamination values that are often thought to originate within the domestic domain have to be attributed to the public domain transmission, i.e. filling and washing of the water pitchers. This finding has implications for interventions that aim at the elimination of these extreme contaminations.
The effect of six rounds of single dose mass treatment with diethylcarbamazine or ivermectin on Wuchereria bancrofti infection and its implications for lymphatic filariasis elimination
Authors: Ramaiah K. D. , Vanamail P. , Pani S. P. , Yuvaraj J. , Das P. K.
Published: March 2003

Annual mass treatment with single‐dose diethylcarbamazine (DEC) or ivermectin (IVM) in combination with albendazole (ALB) for 4–6 years is the principal tool of lymphatic filariasis (LF) elimination strategy. This placebo‐controlled study examined the potential of six rounds of mass treatment with DEC or IVM to eliminate Wuchereria bancrofti infection in humans in rural areas in south India. Apercentage of 54–75 of the eligible population (≥15 kg body weight) received treatment during different rounds of treatment – 27.4% in the DEC arm and 30.7% in the IVM arm received all six treatments, 4.8% and 5.6% received none, and the remainder received one to five treatments. After six cycles of treatment, the microfilaria (Mf) prevalence in treated communities dropped by 86% in the DEC arm (P < 0.01) (n = 5 villages) and by 72% in the IVM arm (P < 0.01) (n = 5 villages), compared with 37% in the placebo arm (P < 0.05) (n = 5 villages). The geometric mean intensity of Mf fell by 91% (t = 8.11, P < 0.05), 84% (t = 6.91, P < 0.05) and 46% (t = 2.98, P < 0.05) in the DEC, IVM and placebo arms, respectively. The proportion of high‐count Mf (>50 Mf per 60 mm3 of blood) carriers was reduced by 94% (P < 0.01) in the DEC arm and by 90% (P < 0.01) in the IVM arm. Among those who received all six treatments, 1.4% in the DEC arm and 2.4% in the IVM arm remained positive for Mf. Two of five villages in the DEC arm and one of five in the IVM arm showed zero Mf prevalence, but continued to have low levels of transmission of infection. The results also indicate that DEC is as effective as or slightly better than IVM against microfilaraemia. Results from this and other recent operational studies proved that single‐dose treatment with antifilarials is very effective at community level, feasible, logistically easier and cheap and hence a highly appropriate strategy to control or eliminate LF. Higher treatment coverage than that observed in this study and a few more than six cycles of treatment and more effective treatment tools/strategies may be necessary to reduce microfilaraemia to zero level in all communities, which may lead to elimination of LF.
Recognition of pallor associated with severe anaemia by primary caregivers in western Kenya
Authors: Desai M. R. , Phillips‐Howard P. A. , Terlouw D. J. , Wannemuehler K. A. , Odhacha A. , Kariuki S. K. , Nahlen B. L. , Ter Kuile F. O.
Published: March 2003

objectives  To explore which pallor signs and symptoms of severe anaemia could be recognized by primary caregivers following minimal instructions.

methods  Data from three community‐based cross‐sectional surveys were used. Test characteristics to predict haemoglobin (Hb) concentrations < 5 and < 7 g/dl were compared for different combinations of pallor signs (eyelid, tongue, palmar and nailbed) and symptoms.

results  Pallor signs and haemoglobin levels were available for 3782 children under 5 years of age from 2609 households. Comparisons of the sensitivity and specificity at a range of haemoglobin cut‐offs showed that Hb < 5 g/dl was associated with the greatest combined sensitivity and specificity for pallor at any anatomical site (sensitivity = 75.6%, specificity = 63.0%, Youden index = 38.6). Higher or lower haemoglobin cut‐offs resulted in more children being misclassified. Similar results were obtained for all individual pallor sites. Combining a history of soil eating with pallor at any site improved the sensitivity (87.8%) to detect Hb < 5 g/dl with a smaller reduction in specificity (53.3%; Youden index 41.1). Other combinations including respiratory signs or poor feeding resulted in lower accuracy.

conclusion  Primary caregivers can recognize severe anaemia (Hb < 5 g/dl) in their children, but only with moderate accuracy. Soil eating should be considered as an additional indicator of severe anaemia. The effect of training caretakers to improve recognition of severe anaemia and care‐seeking behaviour at the household level should be assessed in prospective community‐based studies.
The molecular epidemiology of malaria
Authors: Greenwood Brian
Published: March 2003

This review discusses how the use of molecular genetic techniques such as the polymerase chain reaction are helping in the management and prevention of malaria.
Therapeutic efficacy of chloroquine plus sulphadoxine/ pyrimethamine compared with monotherapy with either chloroquine or sulphadoxine/pyrimethamine in uncomplicated Plasmodium falciparum malaria in Laos
Authors: Schwöbel Babett , Jordan Sabine , Vanisaveth Viengsay , Phetsouvanh Rattanaxay , Christophel Eva‐Maria , Phompida Samlane , Von Sonnenburg Frank , Jelinek Tomas
Published: March 2003

In a southern border province of Lao PDR, we compared the efficacy of antimalarial drug combinations in patients aged ≥1 year with uncomplicated Plasmodium falciparum malaria: monotherapy with either mefloquine (MQ), chloroquine (CQ), or sulphadoxine/pyrimethamine (SP) vs. the combination of both CQ and SP. Follow‐up time was 14 days. Of 265 P. falciparum positive patients, 119 were enrolled in the drug trial. Significantly more patients treated with CQ than with SP developed early or late treatment failure [44.8%vs. 17.9%, relative risk (RR) = 2.51, 95% CI 1.03–6.12]. In the SP group, 82.1% were sensitive and 17.9% were treatment failures. The combination treatment CQ plus SP resulted in 83.3% sensitivity and 16.7% treatment failures. Combination treatment has no advantage over monotherapy with SP (RR = 1.01, 95% CI 0.8–1.3). All patients who received MQ for treatment (total dose 25 mg/kg) were cured within the 14 days of follow‐up. The findings of this study suggest that use of CQ as first‐line treatment of uncomplicated malaria in the Lao PDR has to be reconsidered. The combination of both CQ and SP has been discussed as a cost‐effective alternative treatment, but in our patient population achieved no better results than single therapy with SP.
Hybridoma cell agglutination as a novel test to detect circulating antigen of Schistosoma japonicum
Authors: Li Yong‐long , Liu Wenqi , Ruppel Andreas
Published: March 2003

We developed a serodiagnostic test which is based on the agglutination of hybridoma cells. In the presence of specific antigen, agglutination of the fixed and stained cells occurs and can be visualized in analogy to traditional erythrocyte agglutination. The procedures were developed with a murine cell line producing a monoclonal antibody against a schistosome gut protein and sera of patients and mice infected with Schistosoma japonicum. This test is capable of detecting circulating antigen during pre‐patency in mice infected with 50 cercariae. Its sensitivity was high with acute schistosomiasis japonica (97%, n = 32) and moderate with chronic cases (75%, n = 57). No positive reactions were obtained with healthy persons (n = 78) or patients infected with other parasites (Chlonorchis sinensis, n = 20; Paragonimus westermani, n = 20; Plasmodium vivax, n = 10) or suffering from lupus erythomatodus (n = 5) or mononucleosis (n = 10).