bluuebunny/crossref_metadata_2025 huggingface dataset:
Inverted repeat of a heterologous 3′‐untranslated region for high‐efficiency, high‐throughput gene silencing
Authors: Brummell David A. , Balint‐Kurti Peter J. , Harpster Mark H. , Palys Joseph M. , Oeller Paul W. , Gutterson Neal
Published: March 2003

This report describes a method for the easy generation of inverted repeat constructs for the silencing of genes of unknown sequence which is applicable to high‐throughput studies. This improved procedure for high‐efficiency gene silencing is specific for a target gene, but does not require inverted repeat DNA of the target gene in the construct. The method employs an inverted repeat of the 3′‐untranslated region (3′‐UTR) of a heterologous gene, and has been demonstrated using the 3′‐UTR region of the nopaline synthase (nos) gene from Agrobacterium tumefaciens, which is often used as the 3′‐UTR for transgene constructs. In a population of independent tomato primary transformants harboring a stably integrated polygalacturonase (PG) transgene driven by a constitutive promoter and linked to an inverted repeat of the nos 3′‐UTR, 51 of 56 primary transformants (91% of the population) showed highly effective post‐transcriptional silencing of the PG gene, with PG mRNA abundance in ripe fruit reduced by 98% or more. The method was also effective in Arabidopsis, where two different, relatively uncharacterized plant transcription factors were also targeted effectively. This method has the advantage of ease and rapidity in preparation of the constructs, since a gene of interest can be inserted into a binary vector already containing the promoter and the inverted nos domain in a single‐cloning step, and does not require any knowledge of the DNA sequence. The approach is suitable for high‐throughput gene silencing studies, where it is necessary to investigate the function of hundreds to thousands of uncharacterized genes.
Function of a mitogen‐activated protein kinase pathway in N gene‐mediated resistance in tobacco
Authors: Jin Hailing , Liu Yidong , Yang Kwang‐Yeol , Kim Cha Young , Baker Barbara , Zhang Shuqun
Published: March 2003

The active defense of plants against pathogens often includes rapid and localized cell death known as hypersensitive response (HR). Protein phosphorylation and dephosphorylation are implicated in this event based on studies using protein kinase and phosphatase inhibitors. Recent transient gain‐of‐function studies demonstrated that the activation of salicylic acid‐induced protein kinase (SIPK) and wounding‐induced protein kinase (WIPK), two tobacco mitogen‐activated protein kinases (MAPKs) by their upstream MAPK kinase (MAPKK), NtMEK2 leads to HR‐like cell death. Here, we report that the conserved kinase interaction motif (KIM) in MAPKKs is required for NtMEK2 function. Mutation of the conserved basic amino acids in this motif, or the deletion of N‐terminal 64 amino acids containing this motif significantly compromised or abolished the ability of NtMEK2DD to activate SIPK/WIPK in vivo. These mutants were also defective in interacting with SIPK and WIPK, suggesting protein–protein interaction is required for the functional integrity of this MAPK cascade. To eliminate Agrobacterium that is known to activate a number of defense responses in transient transformation experiments, we generated permanent transgenic plants. Induction of NtMEK2DD expression by dexamethasone induced HR‐like cell death in both T1 and T2 plants. In addition, by using PVX‐induced gene silencing, we demonstrated that the suppression of all three known components in the NtMEK2–SIPK/WIPK pathway attenuated N gene‐mediated TMV resistance. Together with previous report that SIPK and WIPK are activated by TMV in a gene‐for‐gene‐dependent manner, we conclude that NtMEK2–SIPK/WIPK pathway plays a positive role in N gene‐mediated resistance, possibly through regulating HR cell death.
Supernatant from stored red cells activates neutrophils
Authors: Chin‐Yee  , Keeney  , Krueger  , Dietz  , Moses
Published: March 2003

Bioreactive substances including cytokines and lipids accumulate during storage of red blood cells (RBCs) but their clinical importance is uncertain. The goal of this study was to evaluate the effect of stored RBC supernatant on neutrophil activity in vitro. Packed RBCs (PRBCs) were collected and divided into two aliquots, one leukodepleted and the other nonleukodepleted. Plasma supernatant from PRBCs were collected on days 1, 8, 15, 29 and 35 and its effect on neutrophil expression of CD11b, CD16 and oxidative burst was measured by flow cytometry. Levels of tumour necrosis factor alpha (TNFα) and interleukin‐8 (IL8) were also measured. The supernatant from PRBC units stored for greater than 15 days activated and primed neutrophils as evidenced by an increase CD11b and CD16 expression and oxidative burst. The greatest effect was seen in the oldest concentrates (35‐day‐old) (P < 0.008). Leukodepletion abrogated the effects of stored supernatant on CD11b and CD16 expression (P < 0.02) but did not reduce priming of the neutrophil oxidative burst (P > 0.1). Very low levels of IL8 and TNFα were detected in stored supernatants. Stored PRBC supernatant contains substances which directly enhance neutrophil expression of adhesion protein CD11b, CD16 and prime neutrophil oxidative burst. The exceedingly low level of IL8 and TNFα found in this study suggests that other factors may play a more important role in neutrophil priming and activation.
Decay‐accelerating factor (CD55) deficiency phenotypes in Japanese
Authors: Daniels  , Green  , Mallinson  , Okubo  , Hori  , Kataoka  , Kaihara
Published: March 2003

Decay‐accelerating factor (DAF, CD55) is a complement regulatory glycoprotein that expresses the Cromer‐system blood group antigens. Two, very rare, inherited DAF‐deficiency phenotypes, Inab and Dr(a–), were identified in Japanese propositi. Red cells of the Inab phenotype propositus had no Cromer‐system antigens and did not bind monoclonal anti‐DAF. The Inab propositus was homozygous for a DAF non‐sense mutation, converting the Trp53 codon to a stop codon; her parents were heterozygous for this mutation. This is the same mutation as that previously found in the original Inab phenotype propositus. Haemagglutination‐inhibition titrations of the serum of the Inab propositus with soluble‐recombinant DAF demonstrated that anti‐IFC represents a mixture of antibodies to all four DAF short consensus repeat domains. The Dr(a–) individual had very low levels of Cromer‐system antigens and DAF on her red cells. Loss of a TaqI restriction site from DAF exon 5 suggested that she has a previously detected mutation, encoding a Ser165Leu substitution. Red cells of the two propositi did not show abnormal levels of lysis in an acid lysis test, but after blocking of CD59 with monoclonal antibody, Inab phenotype red cells showed more lysis than Dr(a–) red cells, and Dr(a–) cells showed substantially more lysis than control cells.
Allele‐related variation in minisatellite repeats involved in the transcription of the blood group ABO gene
Authors: Irshaid  , Chester  , Olsson
Published: March 2003

Since the cloning in 1990 of cDNA corresponding to mRNA transcribed at the blood group ABO locus, polymorphisms at the ABO locus and phenotype–genotype correlation have been analysed by several investigators. An enhancer‐active minisatellite motif reported to contain four 43‐bp repeats has been analysed by PCR in blood samples from 160 random Swedish blood donors. Different sizes of the DNA fragments obtained led to further analysis by direct sequencing. Fragments with either one or four 43‐bp repeats were identified. A nucleotide substitution (G→A) at nt. 41 of 43 was found in all alleles with only one repeat. Correlation with the ABO genotypes of the samples, as determined by a panel of ABO genotyping techniques, revealed an allele‐related variable number of tandem repeats (VNTR). The A1 and the infrequent O2 allele had only one repeat whilst A2, B, O1 and O1v had four repeats and thus generated longer (by 129 bp) fragments. A further 74 samples obtained from various geographical areas/ethnic groups indicated a widespread correlation with few exceptions. In conclusion, a novel ABO polymorphism located in the 5′‐nontranslated region involved in transcriptional regulation of the ABO gene is reported and its relationship to common alleles at this locus defined.
The risk debate in blood transfusion: how perceptions, beliefs and behaviours can be shaped by an efficient communication
Authors: Hossenlopp C.
Published: March 2003

The issues of risk and safety have been of prime importance in our field over the last decade. The profession has considered the question of risk assessment and risk management in depth, concentrating first and foremost on technical (biological) approaches, a little less on economy and least of all on the social aspect of the question.

Transfusion therapy is probably safer than it has ever been, but public perception and the increase in litigations may suggest the opposite. Transfusion professionals must re‐inspire confidence in the field.

In transfusion medicine, informing the patient about to receive blood products is part of the fundamental relationship that associates the duties of the physician and the patient's rights.

It has been shown that the basic principles of the communication process constitute a transfer of information. In order to be effective, the communication process should include a feedback, i.e. dialogue between the sender and the receiver of the information.

This paper first introduces the notion of risk and the theories about its perception. It then presents the results of a study carried out in a French hospital, aiming to evaluate the effectiveness of the communication process between patients about to receive blood products and the physician/surgeon in charge of the patients. The discussion considers how efficient communication can shape the perception of risks and make blood transfusion risks ‘socially acceptable’.
Successful long‐term erythrocytapheresis therapy in a patient with symptomatic sickle‐cell disease using an arterio‐venous fistula
Authors: Hartwig D. , Schläger F. , Bucsky P. , Kirchner H. , Schlenke P.
Published: March 2003

Summary The use of long‐term automated erythrocytapheresis via an arterio‐venous fistula for the prevention of recurrent ischaemic stroke in a child with sickle‐cell disease (SCD) has not been described previously. We report the successful use of this technique in a 13‐year‐old boy. A procedure was performed every 36 ± 6 days, transfusing six units of donor packed red blood cells (RBCs) and discarding 1318 ± 174 mL of exchanged erythrocytes (Hct 60%). After transfusion of 85 units over 17 months, there is no evidence for iron‐overload, red cell alloimmunization, transfusion‐transmitted infections, or other complications. Until now, no cerebrovascular ischaemia has been observed.
Providing feedback to users on unacceptable practice in the delivery of a hospital transfusion service – a pilot study
Authors: Galloway M. , Woods R. , Whitehead S. , Gedling P.
Published: March 2003

Summary The Serious Hazards of Transfusion Scheme's (SHOT) annual report continues to emphasize the importance of investigating serious transfusion errors. It is now recognized that lessons can also be learnt from near‐miss events as these occur more frequently than serious errors in transfusion. One of the key features in developing a culture that can promote safety in relation to transfusion is providing feedback to staff on what is acceptable and unacceptable practice. We have developed a scoring system based on the number of serious errors and near misses that occur in the transfusion service to provide feedback to staff on their performance in relation to the administration of blood components and blood products. This was developed as part of an ongoing error logging system that we have previously described. The implementation of this feedback has resulted in an increased awareness within our organization of safety issues in relation to transfusion, and has highlighted the importance of the detection and correction of less serious errors.
Intervention to promote appropriate blood use in India
Authors: Bray T. J. , Salil P. , Weiss H. A. , Porter J. D. H.
Published: March 2003

Summary The decision to transfuse should be guided by information on the risks and benefits of transfusion. Safer alternatives should be considered. Properly screened blood or components from a reputable source should be used. In this study, a simple, self‐educating transfusion request form was developed, and its effects on transfusion practice were assessed, using a cluster‐randomized trial. Transfusions at six study hospitals and six control hospitals at four locations in India (Delhi, Bangalore, Nasik and Imphal) were monitored over a 4‐month pre‐intervention period and a 5‐month post‐intervention period. During the trial, 56 171 units were transfused to in‐patients at the participating hospitals. Among the six intervention hospitals, there was some evidence of a nonsignificant post‐intervention reduction in all the three main outcome measures: number of transfusion requests per admission (P = 0·09), number of units transfused per admission (P = 0·11) and number of crossmatches per admission (P = 0·06). No such changes were seen at control sites over the same period.

Simple interventions to promote good clinical practice can have an effect, but may be better placed within longer term, broad‐based strategies that are able to consider some of the background factors. Lack of clinical training, the hospital environment and fragmented blood bank services influence the way blood is used in India. It is thought that the intervention was ultimately unsuccessful because these factors remained as detrimental influences. A focus on education, policy and infrastructure in line with the new National Blood Policy will be important in coming years.
Key indicators for the monitoring and evaluation of control programmes of human African trypanosomiasis due to Trypanosoma brucei gambiense
Authors: Bouchet  , Legros  , Lee
Published: March 2003

Very little research has been devoted to the design of epidemiological tools for the monitoring and evaluation of National Human African Trypanosomiasis (HAT) Control Programmes and daily management decisions are made in the absence of accurate knowledge of the situation. This paper identifies key indicators necessary to make decisions in the field and constantly adjust control activities to changing situations. Examples are derived from the Médecins Sans Frontières (MSF) HAT Control Programme in Adjumani, Uganda. Based on the principles of quality assurance, the focus is placed on process indicators. A conceptual framework derived from a system view/planning cycle perspective is also described for the construction of indicators. Finally, some specific challenging aspects of the epidemiology of HAT are presented and the limitations of the interpretation of the indicators discussed.
A community randomized controlled trial of insecticide‐treated bednets for the prevention of malaria and anaemia among primigravid women on the Kenyan coast
Authors: Shulman  , Shulman  , Dorman  , Dorman  , Talisuna  , Lowe  , Lowe  , Nevill  , Nevill  , Snow  , Snow  , Jilo  , Peshu  , Bulmer  , Graham  , Marsh  , Marsh
Published: March 2003

SummaryThe effectiveness of insecticide‐treated bednets (ITBN) in preventing malaria and anaemia among primigravidae living in Kilifi District, Kenya, was assessed by a randomized controlled trial between September 1994 and November 1995. All residents within 28 community clusters received ITBN in July 1993, whilst residents of another 28 clusters served as contemporaneous controls. All resident primigravid women with singleton pregnancies attending antenatal care at Kilifi District Hospital were eligible for recruitment. 503 primigravidae were recruited. 91.4% were anaemic antenatally (Hb < 11 g/dl): 91.0% from the intervention arm and 92.0% from the control arm. Severe anaemia (Hb < 7 g/dl) was found among 15.1% of intervention women and 20.1% of control women (P= 0.28). No significant differences were observed in reports of febrile illness or the presence of chloroquine in the serum or peripheral parasitaemia during the third trimester between the two groups. In the women delivering in hospital (n= 130), there was no association between placental malaria infection and the intervention: 77.4% of placentas from control women had evidence of past or active infection, compared with 72.0% of placentas from intervention women (P= 0.76). Similarly, in the women delivering in hospital, ITBN did not improve birth weight, and there were no differences in perinatal mortality between the two study groups. Despite ITBN having a great impact on paediatric severe malaria and mortality in this transmission setting, there was very little impact of ITBN on the morbidity associated with malaria infection in primigravidae. Alternative strategies are required to tackle this continued public health problem for pregnant women living in endemic areas similar to the Kenyan Coast.
Filarial elephantiasis among Haitian women: social context and behavioural factors in treatment
Authors: Coreil Jeannine , Mayard Gladys , Louis‐Charles Jacky , Addiss David
Published: March 2003

Few studies have addressed the social and behavioural aspects of lymphatic filariasis. The research reported here investigated the ethnographic context of filarial elephantiasis among women in Léogane, Haiti, and focused on explanatory models of the illness, the impact of the disease on women's lives, and the difficulties patients experienced in following a therapeutic regimen provided at a local hospital. Qualitative data were collected through focus group and individual interviews and direct observation of patients enrolled in the treatment programme. Results indicate that traditional understanding and treatment for the disease are prevalent in the community, although biomedical explanations are gaining credence as a consequence of long‐term filariasis control activities in this area. Women's lives are substantially burdened both socially and economically by the physical impairment of elephantiasis, most notably in the loss of income due to restrictions on mobility. The degree of social discrimination encountered varies by the timing of onset of symptoms in the life course. Difficulties encountered with the physical therapy regimen included maintenance of the compressive bandage and availability of suitable foot wear. Similarities between these findings and those reported for other parts of the world are noted. Recommendations from the study cite the need for community education and peer support activities to provide a knowledge base and support structure for current and future intervention programmes.
Quinine pharmacokinetics: ototoxic and cardiotoxic effects in healthy Caucasian subjects and in patients with falciparum malaria
Authors: Claessen  , Van Boxtel  , Perenboom  , Tange  , Wetsteijn  , Kager
Published: March 2003

Summary
objective To study the pharmacokinetic behaviour of quinine in Caucasians with and without malaria.

method Quinine‐dihydrochloride was administered intravenously as a single dose of 300 mg to 12 healthy subjects and as multiple doses of 600 mg in 4 h every 8 h in 10 patients with falciparum malaria. Plasma quinine concentrations were measured by high‐performance liquid chromatography.

results Quinine pharmacokinetics are time‐dependent: the apparent elimination halftime is shorter in the accumulation phase than in the elimination phase; in malaria patients the maximal quinine concentration was reached in half the time calculated on the basis of the elimination phase after the last quinine infusion. Nevertheless a loading dose seemed advisable to reach adequate therapeutic levels quickly. In malaria patients the highest plasma concentrations during or at the end of the infusions were positively correlated with body weight. There was no correlation between body weight and the volume of distribution of quinine as calculated during the elimination phase. Hearing loss was audiometrically documented in 9 healthy subjects at a mean maximal plasma quinine concentration of only 2 mg/l. All malaria patients suffered serious cochlear hearing impairment. The ototoxic effects in both healthy subjects and patients appeared to be reversible. No electrographic changes were noted in the healthy subjects, whereas a clinically insignificant mean lengthening of the corrected QT interval was seen in the malaria patients.

conclusion Intravenous quinine pharmacokinetics in healthy Caucasians were similar to those reported for Nigerian or Thai subjects. At effective doses quinine causes considerable but reversible cochlear hearing losses in both healthy persons and in patients. Our findings do support the need for a loading dose. The fact that in malaria patients there was no correlation between body weight and quinine VD as calculated during the elimination phase renders questionable the usefulness of dosing quinine according to body weight.
A comprehensive assessment of the quality of immunization services in one major area of Dhaka City, Bangladesh
Authors: Perry Henry , Perry Henry , Weierbach Robert , El‐Arifeen Shams , Hossain Iqbal
Published: March 2003

This report assesses the quality of service inputs, service processes and service outcomes (with the exception of coverage and effectiveness) for immunization services in Zone 3 of Dhaka City. The results indicate that in general, the providers of immunization services are knowledgeable, friendly and give technically appropriate immunizations. Client ratings of the quality of services are quite good. Access is 90% for childhood immunizations and 89% for tetanus toxoid (TT) immunizations for women with a child < 1 year old. Three areas were identified as needing attention: frequently missed opportunities for the promotion or provision of immunizations; uneven distribution and utilization of immunization sites, and some fundamental weaknesses of the TT immunization programme (lack of awareness among women of reproductive age about the importance of TT immunization, low access to it among women of reproductive age who do not have a child < 1 year of age, and confusion among women and service providers about the purpose of TT immunization and the dosage schedule). Efforts to monitor and strengthen the quality of EPI activities will facilitate further decline in the numers of deaths and illnesses from vaccine‐preventable diseases. The approaches used in this study and the typology for quality assessment are widely applicable elsewhere.
Who dies from what? Determining cause of death in South Africa's rural north‐east
Authors: Kahn Kathleen , Tollman Stephen M. , Garenne Michel , Gear John S. S.
Published: March 2003

Summary Information on cause of death is essential for rational public health planning, yet mortality data in South Africa is limited. In the Agincourt subdistrict, verbal autopsies (VA) have been used to determine cause of death. A VA is conducted on all deaths recorded during annual demographic and health surveillance. Trained lay fieldworkers interview a close caregiver to elicit signs and symptoms of the terminal illness. Each questionnaire is reviewed by three medical practitioners blind to each other's assessment, who assign a ‘probable cause of death’ where possible. Of 1001 deaths of adults and children identified between 1992 and 1995, 932 VAs were completed. The profile of deaths reflects a mixed picture: the ‘unfinished agenda’ of communicable disease and malnutrition (diarrhoea and kwashiorkor predominantly) are responsible for over half of deaths in under‐fives, accidents are prominent in the 5–14 age‐group, while the ‘emerging agenda’ of violence and chronic degenerative disease (particularly circulatory disease) is pronounced among the middle‐aged and elderly. This profile shows the social and demographic transition to be well underway within a rural, underdeveloped population. Validation of VA findings demonstrate that the cause of death profile derived from VA can be used with confidence for planning purposes. Findings of note include the high death rates from kwashiorkor and violence, emerging AIDS and pulmonary tuberculosis, and circulatory deaths in the middle‐aged and young elderly. A deeper understanding of the causal factors underlying these critical health problems is needed to strengthen policy and better target interventions.
In vitro antiplasmodial activity of Central American medicinal plants
Authors: Jenett‐Siems Kristina , Mockenhaupt Frank P. , Bienzle Ulrich , Gupta Mahabir P. , Eich Eckart
Published: March 2003

Summary The in vitro antiplasmodial activities of 14 plant species traditionally used in Central America for the treatment of malaria or fever were evaluated. Lipophilic extracts of Piper hispidum, Siparuna andina, S. pauciflora, S. tonduziana, and Xylopia cf. frutescens, proved to be active against both a chloroquine‐sensitive and a resistant strain of Plasmodium falciparum. IC50 values ranged between 3.0 μg/ml and 21.9 μg/ml; however, moderate cytotoxicity of active extracts was observed. Bioactivity‐guided fractionation of Piper hispidum yielded 2′,4,6′‐trihydroxy‐4′‐methoxydihydrochalcone (asebogenin) as an active compound.
Maintenance and sustained use of insecticide‐treated bednets and curtains three years after a controlled trial in western Kenya*
Authors: Kachur S. Patrick , Phillips‐Howard Penelope A. , Odhacha Amos M. , Ruebush Trenton K. , Oloo Aggrey J. , Nahlen Bernard L.
Published: March 2003

Summary In large experimental trials throughout Africa, insecticide‐treated bednets and curtains have reduced child mortality in malaria‐endemic communities by 15%–30%. While few questions remain about the efficacy of this intervention, operational issues around how to implement and sustain insecticide‐treated materials (ITM) projects need attention. We revisited the site of a small‐scale ITM intervention trial, 3 years after the project ended, to assess how local attitudes and practices had changed. Qualitative and quantitative methods, including 16 focus group discussions and a household survey (n = 60), were employed to assess use, maintenance, retreatment and perceptions of ITM and the insecticide in former study communities. Families that had been issued bednets were more likely to have kept and maintained them and valued bednets more highly than those who had been issued curtains. While most households retained their original bednets, none had treated them with insecticide since the intervention trial was completed 3 years earlier. Most of those who had been issued bednets repaired them, but none acquired new or replacement nets. In contrast, households that had been issued insecticide‐treated curtains often removed them. Three (15%) of the households issued curtains had purchased one or more bednets since the study ended. In households where bednets had been issued, children 10 years of age and younger were a third as likely to sleep under a net as were adults (relative risk (RR) = 0.32; 95% confidence interval (95%CI) = 0.19, 0.53). Understanding how and why optimal ITM use declined following this small‐scale intervention trial can suggest measures that may improve the sustainability of current and future ITM efforts.
Prevalence and distribution of soil‐transmitted helminth (STH) infections in urban and indigenous schoolchildren in Ortigueira, State of Paranà, Brasil: implications for control
Authors: Scolari Carla , Torti Carlo , Beltrame Anna , Matteelli Alberto , Castelli Francesco , Gulletta Maurizio , Ribas Milton , Morana Serenella , Urbani Carlo
Published: March 2003

Summary Soil‐transmitted helminth (STH) infections represent a major public health problem in poor and developing countries. During the period September‐October 1998 we conducted an epidemiological survey of STH infections in schoolchildren of an urban area (group A) and an indigenous reserve (group B), in the Municipality of Ortigueira, State of Paranà, Brazil, to assess potential benefits of mass treatment. Stool samples were examined for helminth eggs by quantitative (Kato‐Katz) technique to determine the prevalence and intensity of intestinal parasitic infection. Moreover, we examined the relationship between prevalence and intensity of STH infections and housing/hygienic factors (by means of a 7‐item questionnaire). 236 schoolchildren aged 5–15 years were enrolled, 136 in group A and 100 in group B. The prevalence of STH infections was significantly higher in group B (93%) than in group A (22%) (P < 0.001). Detected parasites were: A. lumbricoides (16.1% prevalence in group A, 88% in group B, P < 0.001), hookworms (5.8% in group A, 52% in group B, P < 0.001) and T. trichiura (5.1% in group A, 2% in group B, P= 0.2). Heavy infections were detected in 2.9% and 23% of the children in group A and B, respectively (P < 0.001). Housing/hygienic indicators were significantly poorer in group B. A statistically significant correlation was observed between total prevalence of STH infections and prevalence of high‐intensity infections with most housing/hygienic variables. On the basis of these results, mass treatment and educational interventions were suggested for the indigenous community, whereas target treatment and educational interventions were suggested for the urban community. Even in a geographically homogeneous area different epidemiological realities can be found, which in turn can influence infection levels and control programmes.
The health and nutritional status of school children in two rural communities in Sri Lanka
Authors: Fernando S. D. , Paranavitane S. R. , Rajakaruna J. , Weerasinghe S. , De Silva D. , Wickremasinghe A. R.
Published: March 2003

SummaryThere is growing evidence of considerable burden of morbidity and mortality due to infectious diseases and undernutrition in school children. This study describes the nutritional status and parasitic infections of school children in two areas of rural Sri Lanka. All children in four primary schools in the Moneragala district of Sri Lanka were included in the study. The height and weight of children were measured and anthropometric indices calculated. Stool and blood samples were examined for evidence of intestinal helminthiasis, malaria and anaemia. A greater proportion of boys than girls were underweight, wasted and stunted. Over 80% of the children were anaemic but did not apparently have iron deficiency anaemia according to their blood picture. The prevalence of parasitic infections such as hookworm and Plasmodium spp that may contribute to anaemia was low.
Men's sexual health matters: promoting reproductive health in an international context
Authors: Hawkes Sarah , Hart Graham
Published: March 2003

Summary Recent concern regarding the control of sexually transmitted infections (STIs) has resulted in an increased interest in the sexual health of men. This interest has primarily focused on strategies to ‘encourage and enable men to take responsibility for their sexual and reproductive behaviour and their social and family roles’ (
United Nations 1994). Whilst men are deemed to have ‘responsibilities’, women are said to have ‘rights’ with regard to making choices about reproductive health and accessing appropriate and effective services. Here it is argued that, whilst provision of services and interventions against STIs in men should never be at the expense of those for women, it is often clinically easier and more effective to diagnose and treat men with STIs compared to women in resource‐poor settings. Indeed, this may prove to be an effective strategy in controlling the spread of STIs, and hence reducing the disproportionate burden of their complications suffered by women. The paper reviews key issues in relation to improved service delivery for sexual and reproductive health in men, notably: the heterogeneity of male populations; current knowledge regarding men's sexual behaviour; the role of sexuality; methods of studying sexual behaviour in resource poor countries; men's own concerns in relation to sexual and reproductive health; and where and how they access treatment. It is argued that the time has now come to determine and address men's sexual health needs if we are to expect them to participate fully as responsible partners in improving and protecting their own and others' sexual and reproductive health.
Follow‐up of Card Agglutination Trypanosomiasis Test (CATT) positive but apparently aparasitaemic individuals in Côte d'Ivoire: evidence for a complex and heterogeneous population
Authors: Garcia André , Jamonneau Vincent , Magnus Eddy , Laveissière Claude , Lejon Veerle , N'guessan Paul , N'dri Louis , Van Meirvenne Nestor , Büscher Philippe
Published: March 2003

Summary The aetiological diagnosis of human African trypanosomiasis (HAT) is based on the detection of the parasite, but currently available parasitological tests have low sensitivity and are hampered by fluctuating parasitaemia. The identification of seropositive individuals on whom to focus parasitological examination is based on antibody detection by means of the Card Agglutination Trypanosomiasis Test (CATT/T.b.gambiense). A complicating phenomenon is the occurrence of serologically positive but parasitologically unconfirmed results (isolated CATT positivity). This work presents a two‐year longitudinal serological, parasitological and molecular follow‐up of CATT‐positive individuals including repeated examinations of each individual, to study the evolution over time of seropositivity at both the population and the individual levels. At the population level, the rate of seropositivity decreased during the first months of the survey, and afterwards showed remarkable stability. At the individual level, the results reveal the extreme heterogeneity of this population, with subjects showing fluctuating results, others with a short transient CATT positivity, and subjects that maintain their seropositivity over time. The stability of seropositivity and the pattern of results obtained with both immunological and parasitological examinations support the view that individual factors, such as immune response to infection, might be involved in the isolated CATT positivity phenomenon.
Rapid therapeutic response onset of a new pharmaceutical form of chloroquine phosphate 300 mg: effervescent tablets
Authors: Yanze Maximun Frédéric , Duru Christian , Jacob Maurice , Bastide Jean Marie , Lankeuh Marguerite
Published: March 2003

OBJECTIVE To compare the efficiency, safety and taste of two pharmaceutical forms of chloroquine phosphate 300 mg: effervescent tablets against uncoated tablets.

METHOD An open randomized study with 60 adults who suffered from acute uncomplicated Plasmodium falciparum malaria in three health centres in Nkongsamba health district, Cameroon.

RESULTS Mean times to fever clearance, symptoms clearance and asexual parasites clearance were longer in the uncoated tablets group: 36 h (range 24–48 h, SD=16.8) vs. 60 h (range 24–96 h, SD=31.2, P=0.001) for fever clearance, 36 h (24–48 h, SD=16.8) vs. 48 h (24–72, SD=24, P=0.001) for symptoms clearance and 48 h (24–72, SD=1) vs. 72 h (48–96, SD=24, P=0.001) for parasitaemia clearance. Uncoated tablets took significantly longer to achieve 50% reduction of the initial asexual parasite density: (mean/SD) 19.2 h/7 vs. 52.8 h/16.8, P < 0.00001. The adverse effects in the two groups were similar, P > 0.05. The cure rate at day 7 in the two groups was similar, P > 0.05. There was no chloroquine resistance in the effervescent tablets group but one RI and one RII resistance in the uncoated tablets group. The taste of the two pharmaceutical forms was significantly different, P < 0.00001. Effervescent tablets tasted sweet (score=7.93), whereas uncoated tablets were bitter (score=2.07).

CONCLUSION Effervescent tablets of chloroquine phosphate 300 mg work faster than uncoated tablets and because of their safe use and sweet taste achieve good therapeutic compliance.
Lymphatic filariasis: an infection of childhood
Authors: Witt C. , Ottesen E. A.
Published: March 2003

Lymphatic filariasis (LF), already recognized as a widespread, seriously handicapping disease of adults, was generally thought to occur only sporadically in children. New, highly sensitive diagnostic tests (antigen detection, ultrasound examination) now reveal, however, that LF is first acquired in childhood, often with as many as one‐third of children infected before age 5. Initial damage to the lymphatic system by the parasites generally remains subclinical for years or gives rise only to non‐specific presentations of adenitis/adenopathy; however, especially after puberty the characteristic clinical features of the adult disease syndromes (lymphoedema, hydrocoele) manifest themselves. Recognizing that LF disease starts its development in childhood has immediate practical implications both for management and prevention of the disease in individual patients and for the broader public health efforts to overcome all childhood illnesses. For the new World Health Organization (WHO)‐supported, public‐/private‐sector collaboration (Global Alliance) to eliminate LF through once‐yearly drug treatment, this recognition means that children will be not only the principal beneficiaries of LF elimination but also a population particularly important to target in order for the programme to achieve its twin goals of interrupting transmission and preventing disease.
Biochemical and molecular mechanisms of drug resistance in parasites
Authors: Ouellette Marc
Published: March 2003

Drug resistance is complicating the treatment of parasitic diseases. We review here the basic mechanisms of parasite resistance in malaria, sleeping sickness, leishmaniasis and common helminthiases. Parasites resort to multiple biochemical means to achieve resistance and we have begun to isolate and characterize the genes/proteins implicated in resistance. Understanding drug resistance is essential for the control of parasitic diseases.
Evaluation of staff performance and material resources for integrated schistosomiasis control in Northern Senegal
Authors: Van Der Werf Marieke J. , Mbaye Amadou , Sow Seydou , Gryseels Bruno , De Vlas Sake J.
Published: March 2003

BACKGROUND A project to improve integrated control of schistosomiasis in the primary health care system of Northern Senegal was implemented from February 1995 until September 1999, shortly after a Schistosoma mansoni outbreak. The activities included additional training of doctors and nurses in symptom‐based treatment and making praziquantel (PZQ) available for an affordable price.

OBJECTIVE To investigate staff performance and the availability and costs of diagnostic materials and PZQ at the end of this intervention project.

METHODS We performed structured interviews with staff from 55 health care facilities in five districts.

RESULTS Respondents from 23 health care facilities reported both S. haematobium and S. mansoni in the coverage area, 32 reported only S. haematobium and three only S. mansoni. The average cost to patients for consultation, diagnosis, treatment and transportation to a referral health care facility was approximately 1.60 Euro. Fifty‐seven per cent of the health care facilities with reported S. haematobium in the coverage area treated patients presenting with haematuria on symptoms; 56% of the health care facilities with reported S. mansoni in the coverage area treated patients presenting with blood in stool on symptoms. Thirteen per cent performed a diagnostic test for patients presenting with haematuria and 12% for patients presenting with blood in stool. The remainder, approximately one‐third of the health care facilities, referred their patients to another facility for a diagnostic test. Implementation of symptom‐based treatment in all health care facilities will reduce the total costs by 0.43 Euro (29%) for patients infected with S. haematobium and 0.78 Euro (46%) for patients infected with S. mansoni. Of the 53 health care facilities with schistosomiasis in their area, 37 had PZQ in stock of which 33 (88%) sold PZQ for the recommended retail price of 0.15 Euro per tablet (or 0.60 Euro per course of four tablets) or lower.

CONCLUSION Four years after the start of the intervention project, patients presenting with schistosomiasis related symptoms can generally expect proper diagnosis and treatment at all levels of the health care system in Northern Senegal, either at the initial visited health care facility or after referral. However, a further reduction of the total costs of treatment is still possible by a better implementation of symptom‐based treatment and further reduction of the costs of PZQ.
Examining out‐of‐pocket expenditure on health care in Nouna, Burkina Faso: implications for health policy
Authors: Mugisha Frederick , Kouyate Bocar , Gbangou Adjima , Sauerborn Rainer
Published: March 2003

OBJECTIVE To examine household out‐of‐pocket expenditure on health care, particularly malaria treatment, in rural Burkina Faso.

METHOD Comprehensive analysis of out‐of‐pocket expenditure on health care through a descriptive analysis and a second, multivariate analysis using the Tobit model with emphasis on malaria, based on 800 urban and rural households in Nouna health district.

RESULTS Households will spend less on malaria, either in or outside the health facility, if given the choice to do so, because they feel confident to self‐treat malaria. Seeking health care from a qualified health worker incurs more out‐of‐pocket expenditure than self‐treatment and traditional healers, and if necessary, households sell off assets to offset the expenditure. More than 80% of household out‐of‐pocket expenditure is allocated to drugs.

CONCLUSION This has policy implications for malaria control and the Roll Back Malaria Initiative. Communities need to be educated on the risks of malaria complications and the potential risk of inappropriate diagnosis and treatment. Drug or health services pricing policy needs to create an incentive to use the health services. In the fight against malaria, building alliances between households, traditional healers and health workers is essential.
Socially marketed insecticide‐treated nets improve malaria and anaemia in pregnancy in southern Tanzania
Authors: Marchant Tanya , Schellenberg Joanna Armstrong , Edgar Tabitha , Nathan Rose , Abdulla Salim , Mukasa Oscar , Mponda Hadji , Lengeler Christian
Published: March 2003

OBJECTIVES To study the uptake of socially marketed insecticide‐treated nets (ITNs) and their impact on malaria and anaemia in pregnancy; and to report on a discount voucher system which aimed to increase coverage in pregnancy.

METHODS A 12‐month cross‐sectional study of women in the second or third trimester of pregnancy. ITN use and other factors were assessed by questionnaire and a blood sample taken for malaria parasitaemia and anaemia. `Non‐users' of ITNs included both women not using any net and women using untreated nets.

RESULTS Fifty three per cent of pregnant women used ITNs. Women aged 15–19, primigravidae, unmarried women, and those with no access to cash had the lowest ITN use. Fewer ITN users were positive for malaria than ITN non‐users (25 vs. 33%: P=0.06), and the protective efficacy (PE) for parasitaemia was 23% (CI 2–41). Multiparous ITN users had a twofold decrease in parasite density compared with multiparous non‐ITN users (625parasites/μl vs. 1173 parasited/μl: P=0.01). Fewer ITN users were anaemic (Hb < 11 g/dl) than ITN non‐users (72 vs. 82%: P=0.01). ITNs had a PE of 12% (CI 2–21) against mild anaemia and a PE of 38% (CI 4–60) against severe anaemia (Hb < 8 g/dl). There was a trend in the prevalence of severe, mild and no anaemia, and of high density, low density and no malaria infection by ITN status. Recently treated nets were most effective at preventing malaria and anaemia (prevalence of mild anaemia was 68% compared with 82% for those without nets (P=0.002); prevalence of malaria was 22% compared with 33% for those without nets (P=0.02). Knowledge and reported use of the discount voucher system were low. Further qualitative research is ongoing.

CONCLUSIONS A modest impact of ITNs on pregnancy malaria and anaemia was shown in our high malaria transmission setting. The development of ITN programmes for malaria control should include pregnant women as a specific target group.
Risk factors for presentation to hospital with severe anaemia in Tanzanian children: a case–control study
Authors: Kahigwa Elizeus , Schellenberg David , Sanz Sergi , Aponte John J. , Wigayi John , Mshinda Hassan , Alonso Pedro , Menendez Clara
Published: March 2003

In malaria endemic areas anaemia is a usually silent condition that nevertheless places a considerable burden on health services. Cases of severe anaemia often require hospitalization and blood transfusions. The objective of this study was to assess risk factors for admission with anaemia to facilitate the design of anaemia control programmes. We conducted a prospective case–control study of children aged 2–59 months admitted to a district hospital in southern Tanzania. There were 216 cases of severe anaemia [packed cell volume (PCV) < 25%] and 234 age‐matched controls (PCV ≥ 25%). Most cases [55.6% (n = 120)] were < 1 year of age. Anaemia was significantly associated with the educational level of parents, type of accommodation, health‐seeking behaviour, the child's nutritional status and recent and current medical history. Of these, the single most important factor was Plasmodium falciparum parasitaemia [OR 4.3, 95% confidence interval (CI) 2.9–6.5, P < 0.001]. Multivariate analysis showed that increased recent health expenditure [OR 2.2 (95% CI 1.3–3.9), P = 0.005], malnutrition [OR 2.4 (95%CI 1.3–4.3), P < 0.001], living > 10 km from the hospital [OR 3.0 (95% CI 1.9–4.9), P < 0.001], a history of previous blood transfusion [OR 3.8 (95% CI 1.7–9.1), P < 0.001] and P. falciparum parasitaemia [OR 9.5 (95% CI 4.3–21.3), P < 0.001] were independently related to risk of being admitted with anaemia. These findings are considered in terms of the pathophysiological pathway leading to anaemia. The concentration of anaemia in infants and problems of access to health services and adequate case management underline the need for targeted preventive strategies for anaemia control.
How better drugs could change kala‐azar control. Lessons from a cost‐effectiveness analysis
Authors: Boelaert M. , Le Ray D. , Van der Stuyft P.
Published: March 2003

Conditional on correct diagnosis and treatment, current drug regimens for visceral leishmaniasis (VL) will only prevent about 90% of deaths. Furthermore, the cost of pentavalent antimonials, the long duration of the regimen and its parenteral administration are major obstacles for patients. Poor patient compliance and the use of counterfeit drugs contribute to therapeutic failure, amplification of the reservoir and the appearance of drug resistance. We assessed the impact of potential improvements in chemotherapy on the cost‐effectiveness of VL test‐treatment strategies. Competing test‐treatment strategies were compared in a formal decision analysis – from the viewpoint of the clinician facing a VL suspect –, with avoided VL‐mortality and cost as outcomes of interest. Sensitivity analysis was done involving the following parameters: efficacy, toxicity and cost of treatment including patient care. When safer and more efficacious drugs are considered, they only result in a more cost‐effective strategy if the total cost of treatment falls below US$ 390 per patient. A serological test‐treatment strategy remains the optimal choice, also when better drugs become available.