bluuebunny/crossref_metadata_2025 huggingface dataset:
Rift valley fever surveillance in the lower Senegal river basin: update 10 years after the epidemic
Authors: Thonnon Jocelyn , Picquet Michel , Thiongane Yaya , Lo Mustapha , Sylla Roughy , Vercruysse Jozef
Published: March 2003

Summary After the Rift valley fever (RVF) epidemic of 1987 in the Senegal River Basin, RVF surveillance based on serosurveys has been conducted for 10 years. Serum samples were obtained from 1336 persons and from sheep and goats in selected areas, and these were tested for IgG/IgM RVF antibodies by ELISA. After a period of regular decrease in RVF prevalence in domestic animals until 1993, an epizootic was observed in all herds in 1994–95 with increases in IgM levels and abortions. During the same period, no human cases or RVF IgM were detected. The RVF IgG prevalence significantly correlated with date of birth: children born after 1987 have a low prevalence (5%) in clear contrast to the older population (25.3%) in Podor district. A retrospective analysis of rainfall and RVF prevalence in small domestic animals over the last 10 years showed that the re‐emergence correlated with heavy rainfall. A general analysis of the risk of re‐emergence and the efficiency of this RVF surveillance system are presented.
The current epidemiological status of bovine theileriosis in eastern Zambia
Authors: Billiouw Michel , Berkvens Dirk
Published: March 2003

Summary Results of a longitudinal study conducted in the eastern province of Zambia from 1994 to 1997 indicate that it is doubtful whether a state of endemic stability of East Coast fever (ECF) can be reached in the near future. Even in endemic areas, the mortality of Theileria parva infections is still estimated above 50%. The main factors limiting progress towards endemic stability are high innate susceptibility of the Zebu cattle, the virulence of the parasite and the climate. The unimodal rainfall pattern results in restricted activity of Rhipicephalus appendiculatus instars and year‐to‐year variation in rainfall causes fluctuations in tick phenology and T. parva transmission. Adult tick activity invariably peaks during the rains and is associated with the highest ECF incidence. Nymphal transmission of T. parva to cattle appears to be less important. Second periods of activity of both adult and nymphal instars are pronounced only when the climate is suitable. These second waves of tick activity ensure a more continuous and efficient transmission of T. parva and also play a key role in the dynamics of prolonged outbreaks in epidemic areas. ECF control methods may have an important influence on ECF epidemiology. Immunizations as well as chemotherapy of clinical cases create a reservoir of virulent parasites in susceptible cattle, resulting in artificial endemic stability.
Epidemiological uses of a population model for the tick Rhipicephalus appendiculatus
Authors: Randolph Sarah
Published: March 2003

Summary The spatial and temporal risk of tick‐borne disease depends fundamentally on the distribution, abundance and seasonal dynamics of the vector ticks. The latter factor exerts a major quantitative influence on the transmission dynamics of tick‐borne parasites. The population model for Rhipicephalus appendiculatus applies throughout the range of this tick in eastern Africa, and predicts all three fundamental risk factors on the basis of the local temperature and rainfall conditions. Satellite imagery can provide more detailed, real‐time measures of environmental conditions over extensive areas than climatic data. There is preliminary evidence to suggest that the population model could be driven by satellite‐derived surrogates of its climatic predictors, thus providing wide‐scale predictive risk maps of theileriosis.
Spatial and temporal variation in Rhipicephalus appendiculatus size in eastern Zambia
Authors: Chaka G. , Billiouw M. , Geysen D. M. , Berkvens D. L.
Published: March 2003

Summary The size of Rhipicephalus appendiculatus collected at different altitudes in the Eastern Province of Zambia between February 1985 and May 1986 and between October 1994 and December 1996 showed distinct variation dependent on altitude and season. The ticks were smallest during the dry season and at the start of the rains, and specimens were larger as the rainy season progressed. Second‐generation adults where on average smaller than first‐generation ticks. At higher altitudes, where a one‐generation‐per‐annum phenology dominates, ticks were larger than at intermediate altitudes, where two generations per year are common. Larger size, associated with increased survival, is also favoured in low‐lying, drier areas. Selective mortality of smaller adult ticks in years with a delayed rainy season appears to play an important role in the variation in size between years.
Theileriosis control modelling (experiences from Southern Province, Zambia)
Authors: Penne K. , D'haese L.
Published: March 2003

Summary Effects of different tick‐borne disease control strategies on cattle productivity are simulated based on a 30‐year herd projection, calculated by a modified Markov Chain model. Input data can be grouped in technical, economic and epidemiological parameters. The output is a set of economic parameters such as benefit/cost ratio (BCR), net present value (NPV) of the profit, internal rate of return (IRR), total economic cost (TEC) as well as graphs showing animal production over time. Shadow prices are obtained for input and output in kind. Throughout the calculations a distinction is made between transactions in cash and transactions in kind. A case study was run for Southern Province, Zambia, to illustrate the model. Either vector control or treatment, or a combination of these, controls theileriosis at farm level after natural infection. Preventive immunization against the parasite is also possible. Although the calculations are based on a mixture of data obtained from literature, field experience, expert opinion and assumptions, the importance of theileriosis control is clearly indicated. Immunization gives better economic results than chemotherapy. Vector control can only be used as a last resort.
Evaluation of recombinant sporozoite antigen SPAG‐1 as a vaccine candidate against Theileria annulata by the use of different delivery systems
Authors: Boulter Nicola , Brown Duncan , Wilkie Gwen , Williamson Susanna , Kirvar Erol , Knight Pamela , Glass Elizabeth , Campbell John , Morzaria Subhash , Nene Vish , Musoke Anthony , D'oliveira Christine , Gubbels Marc‐Jan , Jongejan Frans , Hall Roger
Published: March 2003

Summary The major sporozoite surface antigen of Theileria annulata (SPAG‐1) is a candidate for inclusion in a subunit vaccine. In this paper we summarize the results of 4 vaccination experiments using recombinant SPAG‐1 expressed in different systems and presented in different adjuvants. The antigen has been presented as either a C terminal 108 amino acid peptide (called SR1) expressed as both β‐galactosidase and hepatitis B core antigen fusions or as a full‐length form expressed as a GST fusion with an N terminal His6 tag. We used different adjuvants, namely Freund's, saponin, ISCOMs and a proprietary adjuvant supplied by SmithKline Beecham, which we call SKBA. The data point to the conclusion that SPAG‐1 can elicit partial protection and is therefore suitable for inclusion in an eventual multicomponent subunit vaccine.
An enzyme‐linked immunosorbent assay for detection of IgG1 antibodies specific to human cystic echinococcosis in Egypt
Authors: Ramzy Reda M. R. , Helmy Hanan , El Zayyat Elham A. , Rifaat Manal M. A. , Abdel Hameed Dina M. , Abdel‐Baki Mohamed H.
Published: March 2003

Summary Human cystic hydatidosis (cystic echinococcosis) is a chronic zoonotic disease that results from infection with the dog tapeworm Echinococcus granulosus. In Egypt, cystic echinococcosis (CE) is recognized in slaughtered livestock by veterinarians, however, there is little information about human CE infection rates. We describe an immunological assay useful for the diagnosis of human cystic hydatidosis. Sera were collected from surgically confirmed hydatid cases (34), nonendemic subjects free from parasitic infection (20) and from subjects (109) infected with other helminths (Hymenolepis nana, Schistosoma mansoni, Fasciola hepatica and Ancylostoma duodenale). Hydatid cyst fluid (HCF) of camel origin was used as antigen in an ELISA format to measure total E. granulosus specific IgG antibodies and IgG subclasses. Sensitivity measurements of total IgG, and IgG1–4 were 100, 100, 79.4, 61.8 and 55.9%, respectively, whereas respective specificity reached 65.1, 97.7, 98.4, 96.1 and 83.7%. The diagnostic value of measuring IgG1 (97.7%), as assessed by a rating index (J) for combined sensitivity and specificity, was superior to total IgG (65.1%) and IgG2–4 (77.8, 57.9 and 39.6%, respectively). These findings set the stage for field evaluation of the IgG1 assay in areas endemic with human cystic hydatidosis.
Impairment of natural killer cell activity in Chlamydia trachomatis infected individuals
Authors: Mavoungou Elie , Poaty‐Mavoungou Virginie , Touré Fousseyni S. , Sall Aïcha , Delicat André , Yaba Philippe , Mandeme Yvette , Nabias René , Lansoud‐Soukate Joseph
Published: March 2003

Summary Natural killer (NK) cell activity is impaired in Chlamydia trachomatis‐infected patients. The mechanisms behind the altered NK functions are not clear, but data concerning NK and antibody‐dependent cellular cytotoxicity (ADCC) activity have been reported. To investigate whether this impairment is related to a defect at the target cell binding and/or the postbinding level, we evaluated highly purified NK cells obtained from 125 C. trachomatis‐infected patients and compared them with 101 normal controls for their ability to kill K‐562 and U‐937 cell lines using a 51Cr release assay; release tumour necrosis factor‐alpha (TNF‐α) and interferon‐gamma (IFN‐γ); and kill anti‐IgM preincubated P‐815 cell line (ADCC activity). We found a decrease in the lytic capability of NK cells from C. trachomatis‐infected patients against target cell lines; decreased ability to kill bound target cells; and low levels of released TNF‐α and INF‐γ after incubation with U‐937 cells. Taken together, these findings suggest that the impaired NK cell reaction during chlamydial infection is related to defects both at the target and postbinding levels. However, the precise mechanisms remain to be determined. The inability to restore normal NK activity after long‐term culture in the presence of high levels of recombinant IL‐2 support the hypothesis of an anergic process during chlamydial infection.
Strategies to enhance the use of health systems research for health sector reform
Authors: Sauerborn R. , Nitayarumphong S. , Gerhardus A.
Published: March 2003

Summary In spite of frequent claims to the contrary, there is very little evidence that health systems research actually influences policy‐making. Based on a case study from Thailand and a literature review, we develop a stakeholder‐oriented model of policy‐making. We argue that only if stakeholders' needs are taken into consideration during design and implementation of scientific projects and dissemination of the results, research will have a chance to influence the policy process. From this model, we derive a five‐step approach to enhance the use of research by various stakeholders. We then propose institutional arrangements and conditions to make the use of research for policy‐making more sustainable.

  'The world of ideas and the world of action are not separate, but inseparable parts of each other. Ideas are true forces that change the tangible world. The man and woman of action has no less responsibility to understand the world than the scholar'. Donabedian (1986)
Bednet impregnation for Chagas disease control: a new perspective
Authors: Kroeger A. , OrdoÃ±ez‐Gonzalez J. , Behrend M. , Alvarez G.
Published: March 2003

background  To determine the efficacy and acceptability of deltamethrin‐impregnated bednets in controlling Chagas disease in South America.

methods  In three endemic departments of Colombia, a qualitative study on people's knowledge about Chagas disease, vectors, preventive measures and their willingness for collaboration in control oper‐ ations was undertaken. Additionally, in an entomological study with 100 laboratory‐bred Chagas vectors (Rhodnius prolixus), vectors were released for 5 nights (20 each night) in an experimental room, with the human bait protected for one night by an unimpregnated and for four nights by a deltamethrin‐impregnated bednet (13 mg/m2). Vectors were stained with fluorescent powder for observation, collected after 10 h exposure in the experimental room and observed for a further 72 h.

results  The study population did not know anything about Chagas disease, but believed the vector to transmit cutaneous leishmaniasis. Therefore willingness to take part in control operations was high. The experimental hut study showed a vector mortality rate of 95% in a room with impregnated nets and of 10% in a room with unimpregnated nets.

conclusion  This study opens a new perspective for Chagas disease control in integrated vector borne disease prevention programmes.
Field trial of a haemoglobin colour scale: an effective tool to detect anaemia in preschool children
Authors: Montresor Antonio , Albonico Marco , Khalfan Nassor , Stoltzfus Rebecca J. , Tielsch James M. , Chwaya Hababu M. , Savioli Lorenzo
Published: March 2003

Summary The objective of this study was to evaluate the performance of the Haemoglobin Colour Scale, developed by Stott and Lewis, to diagnose anaemia in a primary health care setting where anaemia was prevalent and severe. Three measures of anaemia were compared in 535 preschool children: haemoglobin based on the Haemoglobin Colour Scale, clinical assessment in three sites (conjunctiva, palm and nail bed) and haemoglobin based on a digital haemoglobinometer (HemoCue method) taken as gold standard. A statistically significant correlation (r = 0.80, coefficient = 0.77 and Y intercept = 2.33) was obtained between the results of the Haemoglobin Colour Scale and the HemoCue. In more than 80% of cases, the difference between the colour scale readings and the results of the HemoCue was within 1 g/dl. Of 415 anaemic children (Hb < 11 g/dl by HemoCue), 85.2% were so identified by the Haemoglobin Colour Scale and 19.7% were classified anaemic by clinical pallor. Of 19 severely anaemic children (Hb < 7 g/dl by HemoCue), 73.6% were identified as severely anaemic and 100% were classified as anaemic by the colour scale, 61.1% were classified as anaemic using clinical pallor. We found the Haemoglobin Colour Scale to be a useful tool in identifying anaemic and severely anaemic children. Efficiencies in term of cost, accuracy and time make it an important resource in primary health care settings in developing countries. Further testing with other staff in other settings is recommended to determine the usefulness of large‐scale distribution.
A health club for a community school in south‐eastern Nigeria: influence on adult perception of onchocerciasis and compliance with community‐based ivermectin therapy
Authors: Shu E. N. , Onwujekwe E. O. , Lokili P. , Okonkwo P. O.
Published: March 2003

Summary The impact of a school health club on adult perception of onchocerciasis and compliance with ivermectin was evaluated in an onchocerciasis‐endemic community in southeastern Nigeria. Venous blood was collected from each of 26, 32 and 124 randomly selected subjects during ivermectin distribution programmes in 1995 1996 and 1997 respectively. Ivermectin concentrations were measured in the samples. Data was also collected from 334 and 319 randomly selected household heads or their representatives (aged 24 to 65 years) before and after health talks by schoolchildren, using interviewer‐administered questionnaires. There was an increasing number of subjects who participated in control programmes (116 in 1995, 437 in 1996 and 2055 in 1997). Compliance with ivermectin treatment was low (53.9%) in 1995 but increased dramatically (90.1%) in 1997. A significant proportion (χ2= 108.7, df = 1, P < 0.0001) of respondents knew about onchocerciasis after health education, predominantly from health workers (64.5%) before the tests and children (92.3%) after. Knowledge and beliefs about causative agents (χ2= 266.4, df = 5, P < 0.0001), diagnostic method (χ2= 207.4, df = 3, P < 0.0001), prevention (χ2= 67.0, df = 4, P < 0.0001) of onchocerciasis and the effectiveness of ivermectin (χ2= 40.4, df = 1, P < 0.0001) also differed significantly between the periods before and after tests. The school health club increased adult knowledge about onchocerciasis and its treatment. Schoolchildren could therefore supplement the information, education and communication (IEC) aspect of health care delivery in a community through such health clubs.
Outcome of meningitis caused by Streptococcus pneumoniae and Haemophilus influenzae type b in children in The Gambia
Authors: Goetghebuer Tessa , West T. Eoin , Wermenbol Vanessa , Cadbury Anna Louise , Milligan Paul , Lloyd‐Evans Nellie , Adegbola Richard A. , Mulholland E. Kim , Greenwood Brian M. , Weber Martin W.
Published: March 2003

Summary In developing countries, endemic childhood meningitis is a severe disease caused most commonly by Streptococcus pneumoniae or Haemophilus influenzae type b (Hib). Although many studies have shown that fatality rates associated with meningitis caused by these organisms are high in developing countries, little is known about the long‐term outcome of survivors. The purpose of this study was to assess the importance of disabilities following pneumococcal and Hib meningitis in The Gambia. 257 children aged 0–12 years hospitalized between 1990 and 1995 with culture‐proven S. pneumoniae (n = 134) or Hib (n = 123) meningitis were included retrospectively in the study. 48% of children with pneumococcal meningitis and 27% of children with Hib meningitis died whilst in hospital. Of the 160 survivors, 89 (55%) were followed up between September 1996 and October 1997. Of the children with pneumococcal meningitis that were traced, 58% had clinical sequelae; half of them had major disabilities preventing normal adaptation to social life. 38% of survivors of Hib meningitis had clinical sequelae, a quarter of whom had major disabilities. Major handicaps found were hearing loss, mental retardation, motor abnormalities and seizures. These data show that despite treatment with effective antibiotics, pneumococcal and Hib meningitis kill many Gambian children and leave many survivors with severe sequelae. Hib vaccination is now given routinely in The Gambia; an effective pneumococcal vaccine is needed.
Willingness to pay for the retreatment of mosquito nets with insecticide in four communities of south‐eastern Nigeria
Authors: Onwujekwe Obinna , Shu Elvis , Chima Reginald , Onyido Angus , Okonkwo Paul
Published: March 2003

Summary objectives  To determine the willingness to pay (WTP) for the retreatment of insecticide‐treated nets (ITN) in four malaria holoendemic communities of Nigeria.

methods  Contingent valuation method. The study tool was a pretested interviewer‐administered questionnaire. Randomly selected households were the study units and household heads or their representatives were interviewed by locally trained interviewers.

results  Most households were willing to pay for annual ITN retreatment in all four communities. The proportion of those willing to pay ranged from 79% to 91%. WTP amounts ranged from $0.05 to $5.26. The median from the aggregated data from the four communities was $0.21. Multivariate analysis showed that many explanatory variables were statistically significantly related to WTP for ITN retreatment.

conclusion  WTP for ITN retreatment exists. The difficulty lies in implementing this. One possibility would be a community‐based ITN retreatment programme.
Evaluation of the ICT whole blood antigen card test to detect infection due to nocturnally periodic Wuchereria bancrofti in South India
Authors: Pani S. P. , Hoti S. L. , Elango A. , Yuvaraj J. , Lall R. , Ramaiah K. D.
Published: March 2003

Summary The commercially available ICT Card Test for bancroftian filariasis was evaluated for its sensitivity and specificity in detecting microfilaria carriers among 189 individuals each in filariasis‐endemic and nonendemic areas in South India, and compared to both conventional night blood finger prick thick blood smear examination and venous blood membrane filtration. Though the specificity of the test was 100% in comparison to both, the sensitivity was 98.5% against the finger prick thick blood smear and 71.9 compared to the membrane filtration technique. Similarly, the positive predictive value was 100% against both techniques, but the negative predictive values were 99.5% against the finger prick thick blood smear and 88.3% compared to the membrane filtration technique. The test's lower sensitivity compared to the filtration technique requires further investigation.
Case report: Intramural haemorrhage of the colon
Authors: Eke Ndubuisi
Published: March 2003

Summary Two cases of acute abdominal crisis due to intramural haemorrhage of the colon are presented with a review of the literature. One was a 10‐year‐old Nigerian boy; the haemorrhage occurred in the caecum and ascending colon. The other was a 69‐year‐old Caucasian woman with a haemorrhage in the colonic splenic flexure and descending colon. Both had a one‐stage resection with anastomosis. The child survived; the woman died two days after the operation. The preoperative diagnosis of bleeding colonic lesions remains difficult especially when facilities for investigation are scarce. It is re‐emphasized that in patients with acute abdomen it is not necessary to insist on accurate preoperative diagnosis before offering appropriate treatment.
Getting to know HIV
Authors: Weiss Robin A.
Published: March 2003

Summary Since the Human Immunodeficiency Virus was first isolated in 1983, we have come to know it in exquisite detail. Yet we still do not understand sufficiently how it causes disease. Neither do we know why chimpanzees and some African monkeys, which are the natural reservoir of the precursors of HIV‐1 and HIV‐2, can harbour similar levels of virus without becoming ill. Our knowledge of the replication cycle of HIV as a retrovirus has been pivotal in the development of antiviral drugs. Our knowledge of the cellular tropism and cell surface receptors exploited by the virus help to explain the pattern of immune deficiency, wasting and dementia that make up the clinical dimensions of AIDS. The extraordinary rate of genetic and phenotypic evolution of the virus – both within the infected individual and across the worldwide pandemic – partially explains why no vaccine constructs to date have been successful. HIV comprises just 9 genes but represents one of humanity's most formidable foes.
Therapeutic interventions in HIV infection – a critical view
Authors: Darbyshire Janet
Published: March 2003

Summary The introduction of highly effective combination regimens of antiretroviral drugs has led in recent years to substantial improvements in morbidity and mortality. As yet immune‐based therapies have had little if any impact. However it is clear that eradication of HIV is not achievable with existing anti‐HIV drugs and in spite of the major advances there remain many challenges in the clinical management of HIV‐infected individuals. These benefits are unlikely to be extended to resource poor countries in the foreseeable future. The barriers are primarily but not only the costs. In resource‐rich countries there are concerns about long term toxicities and many people have already exhausted all of the current therapeutic options. There is an urgent need for new drugs, ideally attacking new targets or with no cross resistance to existing drugs, and which are well tolerated and safe, easy to take and cheap. Many important questions still remain unanswered, in particular when to start antiretroviral therapy.
'Killer' canines: the morbidity and mortality of ebino in northern Uganda
Authors: Iriso Robert , Accorsi Sandro , Akena Stephen , Amone Jackson , Fabiani Massimo , Ferrarese Nicoletta , Lukwiya Matthew , Rosolen Teresa , Declich Silvia
Published: March 2003

Summary In northern Uganda, unerupted primary canine teeth are commonly extracted because they are believed to cause diarrhoea, vomiting, and fever. This practice, known as ebino, is performed under very crude conditions often using unclean tools. To evaluate the morbidity and mortality of complications related to ebino, we retrospectively analysed discharge records from the paediatric ward of Lacor Hospital, Gulu. In the period 1992–98, ebino‐related complications, mainly sepsis and anaemia, were among the leading causes of admission (n = 740) and hospital death (n = 156, case fatality rate = 21.1%, proportional mortality rate = 3.3%). Discouraging the adoption of deeply rooted traditional practices that are potentially hazardous to health should be a public health priority in northern Uganda. This could be done by educating not only the general public, but also traditional healers and community and religious leaders, who could convey the knowledge to their people.
Peripartum referrals to korle bu teaching hospital, Ghana – a descriptive study
Authors: Nkyekyer Kobinah
Published: March 2003

Summary A 6‐week prospective study of women referred to Korle Bu Teaching Hospital during labour and delivery was conducted to determine the sources of and indications for referral, and to assess the adequacy of various aspects of the referral mechanisms. Of 396 women referred, 86% were referred from polyclinics (which are state‐owned) and private midwives. The commonest indications were failure to progress (21.5%) and hypertensive disease (15.7%). A total of 35 (8.8%) women were referred with third‐stage or immediate postpartum complications. Referrals constituted 17.6% of hospital deliveries. Significant deficiencies were identified in the referral mechanisms. 72.7% of the patients travelled by public or private means of transport and 54.2% were not accompanied by any staff during transfer. Only 16.7% of those expected to have partographs came with one and 55.6% of women with complications of vaginal bleeding did not have intravenous infusions sited. However, in almost 90% of patients, the general condition on arrival in the hospital was good, and some referrals could probably have been avoided. Efforts must be made to improve patient transport and to evaluate labour management practices in the referring centres.
Diagnostic accuracy and case management of clinical malaria in the primary health services of a rural area in south‐eastern Tanzania
Authors: Font F. , Alonso González M. , Nathan R. , Kimario J. , Lwilla F. , Ascaso C. , Tanner M. , Menéndez C. , Alonso P. L.
Published: March 2003

Malaria control continues to rely on the diagnosis and prompt treatment of both suspected and confirmed cases through the health care structures. In south‐eastern Tanzania malaria is one of the leading causes of morbidity and mortality. The absence of microscopic examination in most of the health facilities implies that health workers must rely on clinical suspicion to identify the need of treatment for malaria. Of 1558 randomly selected paediatric consultations at peripheral health facilities throughout Kilombero District, 41.1% were diagnosed by the attending health worker as clinical malaria cases and 42.5% prescribed an antimalarial. According to our malaria case definition of fever or history of fever with asexual falciparum parasitaemia of any density, 25.5% of all children attending the health services had malaria. This yielded a sensitivity of 70.4% (IC95%=65.9–74.8%) and a specificity of 68.9% (IC95%=66.2–71.5%). Accordingly, 30.4% of confirmed cases left with no antimalarial treatment. Among malaria‐diagnosed patients, 10% were underdosed and 10.5% were overdosed. In this area, as in many African rural areas, the low diagnostic accuracy may imply that the burden of malaria cases may be overestimated. Greater emphasis on the functioning and quality of basic health services in rural endemic areas is required if improved case management of malaria is to help roll back this scourge.
Extending anthelminthic coverage to non‐enrolled school‐age children using a simple and low‐cost method
Authors: Montresor Antonio , Ramsan Mahdi , Chwaya Hababu M. , Ameir Haji , Foum Ali , Albonico Marco , Gyorkos Theresa W. , Savioli Lorenzo
Published: March 2003

School health programmes are the basis of the strategy defined by WHO to reduce morbidity due to soil‐transmitted nematodes and schistosomes in school age populations in developing countries. However, low rates of school enrolment can be a major factor limiting their success.

In the present study enrolled children were informed by teachers on the date of the next deworming compaign and were invited to pass along this information to parents, siblings and friends of school‐age.

On the day of the deworming campaign, teachers were instructed to administer anthelminthics to enrolled and not enrolled school‐age children present at school. In the month following the treatment day, information about coverage was collected by questionnaire in 257 households in two regions of Unguja Island, Zanzibar. Over 89% of school age children resulted treated (98.9% of those enrolled plus 60% of those not enrolled). The additional cost of treating non‐enrolled is limited to the cost of providing additional doses of anthelminthic drug in each school.

Non‐enrolled school age children can easily, successfully and inexpensively included in school based deworming campaign. Managers of control programmes are invited to test this method adapting it in their particular and cultural environment.
Chlorproguanil‐dapsone (LAPDAP) for uncomplicated falciparum malaria
Authors: Winstanley Peter
Published: March 2003

The synergistic antifolate combination of chlorproguanil with dapsone (CPG–DDS; LAPDAP) is being developed by a public–private partnership as a low‐cost treatment for uncomplicated falciparum malaria. LAPDAP is rapidly eliminated from the body, giving it low selection pressure for drug resistance. Clinical cases with sulphadoxine‐pyrimethamine (SP)‐resistant infections acquired in Africa have been predicted to be responsive to LAPDAP, and clinical evidence is available to support this. A regulatory dossier is being prepared for simultaneous submission to the UK Medicines Control Agency and African licencing authorities. The team working on LAPDAP has also started to develop the triple combination of chlorproguanil–dapsone–artesunate (CDA) as a low‐cost combination therapy for uncomplicated falciparum malaria. Although LAPDAP does not have regulatory approval (and development of CDA is at an early stage), the development team is keen to communicate with public health scientists to try to anticipate the policy and implementation hurdles that lie ahead. This short paper outlines the current stages that LAPDAP and CDA have reached, and sketches the anticipated public health issues.
Genetic diversity of Plasmodium falciparum and its relationship to parasite density in an area with different malaria endemicities in West Uganda
Authors: Peyerl‐Hoffmann G. , Jelinek T. , Kilian A. , Kabagambe G. , Metzger W. G. , Von Sonnenburg F.
Published: March 2003

Field populations of Plasmodium falciparum can be effectively genotyped by PCR‐amplification of selected fragments of the Merozoite Surface Proteins 1 and 2 (MSP1 and MSP2). Genetic diversity of P. falciparum populations in areas with different transmission levels (holo‐ vs. mesoendemic) was investigated in Kabarole District, West Uganda. 225 samples positive for P. falciparum were analysed by amplification of polymorphic regions and classified according to prevalence of allelic families. A large number of alleles was detected for each locus: 22 for MSP1 block 2 and 24 for MSP2 and, 175 (78%) of MSP1 alleles and 143 (64%) of MSP2 showed multiple infections within a range of 2–8 clones. Significant differences between holoendemic and mesoendemic areas in regards of population structure and number of multiclonal infections of P. falciparum were not apparent. However, a significant correlation between parasite density, selected MSP2 loci and differences between parasite density in monoclonal vs. multiclonal infections occurred. Multiplicity of infection was age‐dependent.
Combined benefits of annual mass treatment with ivermectin and cattle zooprophylaxis on the severity of human onchocerciasis in northern Cameroon
Authors: Seidenfaden R. , Fischer A. , Bonow I. , Ekale D. , Tanya V. , Renz A.
Published: March 2003

We studied the effect of 10 annual distributions of ivermectin for control of human onchocerciasis on the reduction of Onchocerca volvulus transmission by Simulium vector flies. Prevalence and infection load in the human population decreased, whilst the annual biting rates (ABR) of the vector remained unchanged. The annual transmission potential of infective larvae of O. volvulus fell to 40% of the pre‐intervention level, but was still sufficient to maintain endemicity. However, recent immigration of herds of nomadic cattle into the study area has diverted the flies from man to cattle, creating an additional zooprophylactic effect. The predominant transmission of the bovine filaria O. ochengi to man also provides some concomitant cross‐protective immunity against further infestations with O. volvulus. The effects of ivermectin on O. volvulus, combined with the zooprophylactic effects of the increased cattle population, have produced a complex beneficial influence on the transmission of human onchocerciasis.
Malaria in pregnancy: adverse effects on haemoglobin levels and birthweight in primigravidae and multigravidae
Authors: Shulman C. E. , Marshall T. , Dorman E. K. , Bulmer J. N. , Cutts F. , Peshu N. , Marsh K.
Published: March 2003

BACKGROUND In areas of endemic transmission, malaria in pregnancy is associated with severe maternal anaemia and low birthweight babies. The prevalence of infection is highest in primigravidae (PG), and hence control efforts are usually geared towards this high risk group. Using a sensitive measure of placental infection, we investigated the relationship between active‐acute, active‐chronic and past placental infection with maternal anaemia and low birthweight in women of all gravidities.

METHODS Between January 1996 and July 1997, 912 women delivering in Kilifi District Hospital, Kenya, were recruited. Haemoglobin and peripheral malaria slides were taken prior to delivery, placental biopsies and smears were taken at the time of delivery and birthweight and maternal height and weight were measured soon after birth. Information was obtained on socio‐economic and educational status. The association between placental malaria, severe anaemia and low birthweight was investigated for women of different gravidities.

FINDINGS By placental histology, the prevalence of active or past malaria in all gravidities was high, ranging from 64% in PG to 30% in gravidities 5 and above. In gravidities 1–4, active malaria infection was associated with severe maternal anaemia, adjusted OR 2.21 (95% CI 1.36, 3.61). There was a significant interaction between chronic or past malaria and severe anaemia in their effects on birthweight, whereby the risk of low birthweight was very high in women with both chronic or past placental malaria and severe anaemia: OR 4.53 (1.19, 17.2) in PG; 13.5 (4.57, 40) in gravidities 2–4.

INTERPRETATION In this area of moderate malaria transmission, women of all parities have substantially increased risk of low birthweight and severe anaemia as a result of malaria infection in pregnancy. The risk of low birthweight is likely to be particularly high in areas with a high prevalence of severe anaemia.
A policy for leishmaniasis with respect to the prevention and control of drug resistance
Authors: Bryceson Anthony
Published: March 2003

At the moment no country has a policy designed to control or prevent drug resistance in leishmaniasis. The risk of resistance is high in areas of anthroponotic visceral leishmaniasis, for example North Bihar, India, where the rate in some areas is 60%. Post‐epidemic Sudan is also at risk. Zoonotic areas in which HIV co‐infection is common could also be at risk as sandflies can become infected from co‐infected individuals. Many factors determine the choice of drug for the treatment of visceral leishmaniasis, and drug resistance may not be the over‐riding priority. In anthroponotic areas reduction in transmission through public health measures will be important, but the use of two drugs in combination should be seriously considered. Pharmacokinetic and other features of the drugs available, relevant to their use in combination are discussed and tentative suggestions made concerning trials of possible combinations. These include miltefosine plus paromomycin and allopurinol plus an azole. Lessons may be learnt from the experiences of similar problems in malaria, leprosy and tuberculosis. Guidelines are offered for the introduction of policies to use drugs in combination, which differ between anthroponotic and zoonotic areas of transmission.
The application of GIS technology to equitably distribute fieldworker workload in a large, rural South African health survey
Authors: Tanser F. C.
Published: March 2003

A method is presented that has numerous applications to health systems provision in developing countries where limited physical access to primary health care is a major factor contributing to the poor health of populations. An accessibility model within a geographical information system (GIS) is used to predict average inter‐homestead walking times and subdivide the study area into units of equal completion time. The method could be used to ergonomically design home‐based care and tuberculosis directly observed treatment programmes and inform the siting of health facilities. The paper highlights the use of GIS technology as a powerful tool in developing countries.
Use of clinical algorithms for diagnosing malaria1
Authors: Chandramohan Daniel , Jaffar Shabbar , Greenwood Brian
Published: March 2003

Several attempts have been made to identify symptoms and signs based algorithms for diagnosing malaria. In this paper, we review the results of published studies and assess the risks and benefits of this approach in different epidemiological settings. Although in areas with a low prevalence the risk of failure to treat malaria resulting from the use of algorithms was low, the reduction in the wastage of drugs was trivial. The odds of wastage of drugs increased by 1.49 (95% confidence limit 1.45–1.51) for each 10% decrease in the prevalence of malaria. In highly endemic areas the algorithms had a high risk of failure to treat malaria. The odds of failure to treat increased by 1.57 (95% confidence limit 1.50–1.65) for each 10% increase in the prevalence. Furthermore, the best clinical algorithms for diagnosing malaria were site‐specific. We conclude that the accuracy of clinical algorithms for diagnosing malaria is not sufficient to determine whether antimalarial drugs should be given to children presenting with febrile illness. In highly endemic areas where laboratory support is not available, the policy of offering antimalarial drugs to all children presenting with a febrile illness recommended by the integrated child management initiative is appropriate.
Female genital cutting in Kilimanjaro, Tanzania: changing attitudes?
Authors: Msuya Sia E. , Mbizvo Elizabeth , Hussain Akhtar , Sundby Johanne , Sam Noel E. , Stray‐Pedersen Babill
Published: March 2003

OBJECTIVES To study the prevalence, type, social correlates and attitudes towards female genital cutting (FGC) among urban women in Kilimanjaro, Tanzania; and to examine the association between FGC and gynaecological problems, reproductive tract infections (RTIs) and HIV.

METHODS In 1999, 379 women attending reproductive health care clinics were interviewed and underwent pelvic examination. Specimens for RTI/HIV diagnosis were taken.

RESULTS Seventeen per cent had undergone FGC, mostly clitoridectomy (97%). Female genital cutting prevalence was significantly lower among educated, Christian and Chagga women. Women aged ≥35 were twice as likely to be cut as those < 25 years. Seventy‐six per cent of those who had undergone FGC intend not to perform the procedure on their daughters. Age < 25 years (P < 0.0001) and low parity (P < 0.01) were predictors of that intention. There was no association between RTIs, HIV or hepatitis B and FGC.

CONCLUSION FGC is still fairly common but there is evidence of a change of attitude towards the practice, especially among young women. The opportunity to educate women who attend reproductive health care facilities on FGC should be taken.
Adherence to treatment guidelines in primary health care facilities in Botswana
Authors: Boonstra E. , Lindbaek M. , Khulumani P. , Ngome E. , Fugelli P.
Published: March 2003

OBJECTIVES To assess the quality of nurses' prescribing through an assessment of their prescription in relation to diagnosis, and to investigate trends in drug use in Botswana primary health care.

METHODS Key data regarding nurses' adherence to national prescription and treatment guidelines were obtained through participatory observation using a questionnaire, related to each consultation. Adherence was categorized into (i) Full adherence, (ii) acceptable adherence, (iii) acceptable adherence, but one or more useless, but not dangerous, drugs and (iv) insufficient or dangerous treatment. The study comprises data on nurses' prescriptions, diagnoses and quality of dispensing in 2994 consecutive consultations in 30 primary health care facilities in three districts of Botswana: Ngami East, Gaborone and Kgalagadi North.

RESULTS The average number of drugs prescribed per patient was 2.3. Antibiotics were prescribed in 27% of all encounters. Full adherence was found in 44%, acceptable compliance in 20%, `acceptable, but one or more useless, but not dangerous, drugs' in 33% and `insufficient or dangerous treatment' in 3% of the consultations. Four factors were found to be independently associated with full adherence: patient age 16–31 years, specified diagnosis, type of health facility and nurses' years of practice (4–11 years best).

CONCLUSION Although Botswana's health workers perform relatively well in terms of drug use indicators, there is a clear potential for improving health workers' adherence to national treatment guidelines.
Insecticide‐treated bednet use, anaemia, and malaria parasitaemia in Blantyre District, Malawi
Authors: Holtz Timothy H. , Marum Lawrence H. , Mkandala Christopher , Chizani Nyson , Roberts Jacquelin M. , Macheso Allan , Parise Monica E. , Kachur S. Patrick
Published: March 2003

OBJECTIVE To evaluate the use of insecticide‐treated bednets and the effectiveness of social marketing for their distribution.

METHODS Systematic cluster sample survey of 1080 households in 36 census enumeration areas across Blantyre district, Malawi, in February 2000.

RESULTS A total of 672 households had one or more children under 5. Bednet ownership was low (20.5% of households) overall, and significantly lower in rural areas than urban areas (6.4 vs. 29.8%, P=0.001). Only 3.3% of rural children under 5 had slept under a net the previous night, compared with 24.0% of urban children (P < 0.001). When asked why they did not own a net, nearly all (94.9%) caretakers in households without nets stated they had no money to buy them. In multivariate statistical models that controlled for the influence of house structure, urban vs. rural location, gender of the head of household, and the primary caretaker's education, rural children under 5 in households without nets experienced a statistically significant higher prevalence of malaria parasitaemia [RR (risk ratio) 4.9, 95% CI (confidence interval) 2.3–10.5] than children in households with at least one bednet. This was also true for urban children under 5 (RR 2.1, 95% CI 1.0–4.2, P=0.04).

CONCLUSION Social marketing approaches to promoting insecticide‐treated nets in Blantyre District may have produced measurable health benefits for children in those households in which residents bought and used the products. Market‐based approaches may take years to achieve high levels of coverage and may exaggerate inequities between urban and rural populations.
Simple method for long‐term copro‐preservation of Cryptosporidium oocysts for morphometric and molecular analysis
Authors: Jongwutiwes Somchai , Tiangtip Rattana , Yentakarm Sutin , Chantachum Nutaros
Published: March 2003

Preservation of Cryptosporidium oocysts in faecal specimens containing 75% ethanol is suitable for subsequent morphometric and molecular analysis. No significant morphologic alteration occurred after storage at ambient temperatures, ranging from 22 to 38 °C, for more than 2 years. After washing, sugar floatation and DNA extraction, a nested polymerase chain reaction targeting the small subunit ribosomal RNA gene successfully amplified Cryptosporidium DNA in all 15 isolates examined. The sensitivity of detection by polymerase chain reaction (PCR) was found to be as high as 1.25 oocysts per reaction (mean=3.01, SD=1.14). Importantly, a 2.2‐kb of the complete DNA sequence of a gene encoding Cryptosporidium thrombospondin‐related adhesive protein (TRAP‐C1) was also consistently amplified by PCR in all isolates. The PCR‐amplified product can be used as a good template for sequencing. Therefore, this simple procedure should be useful for epidemiological analysis of clinical samples from outbreaks, endemic or sporadic cases of cryptosporidiosis when long‐term storage of oocysts is required.
High fascioliasis infection in children linked to a man‐made irrigation zone in Peru
Authors: Esteban J. Guillermo , González Carolina , Bargues M. Dolores , Angles René , Sánchez Clemente , Náquira César , Mas‐Coma Santiago
Published: March 2003

We detected 10 protozoan and nine helminth species in surveys of 338 5–15 year‐old Quechua schoolchildren in three communities of the Asillo zone of the Puno region, located at a very high altitude of 3910 m in the Peruvian Altiplano. The area proved to be hyperendemic for human fascioliasis with a 24.3% overall mean prevalence of Fasciola hepatica, local prevalences ranging between 18.8 and 31.3%, and infection intensities of up to 2496 eggs per gram of faeces (epg), with 196–350 epg (mean: 279 epg) and 96–152 epg (123 epg) as arithmetic and geometric means, respectively. Prevalences did not significantly vary between schools and in relation to sex. No statistical differences were found in intensities between schools, nor according to sex or age groups between and within schools, although the highest overall egg counts were detected in girls and in the youngest age group. Asillo zone is a man‐made irrigation area built only recently to which both liver fluke and lymnaeid snails have quickly adapted. The region appears to be isolated from the Northern Bolivian Altiplano natural endemic area. Such man‐made water resources in high altitude areas of Andean countries pose a high fascioliasis risk. Significant positive association of F. hepatica with protozooses following a one host life cycle, such as Giardia intestinalis, suggests that human infection mainly occurs through drinking water. This is supported by additional evidence such as the absence of typical aquatic vegetation in the drainage channels inhabited by lymnaeid snails, the absence of aquatic vegetables in the traditional nutrition habits of the Quechua inhabitants, and the lack of potable water systems inside dwellings, which requires inhabitants to obtain water from irrigation canals and drainage channels.