bluuebunny/crossref_metadata_2025 huggingface dataset:
Faecal and protozoan parasite contamination of water spinach (Ipomoea aquatica) cultivated in urban wastewater in Phnom Penh, Cambodia
Authors: Anh Vuong Tuan , Tram Nguyen Thuy , Klank Lise Tønner , Cam Phung Dac , Dalsgaard Anders
Published: August 2010

Objective  To identify the level of contamination with thermotolerant coliforms (ThC), intestinal helminth eggs and protozoan parasites in water spinach (Ipomoea aquatica) cultivated in a wastewater‐fed lake in Phnom Penh, Cambodia.

Methods  The investigation was carried out from July 2004 to May 2005 in Boeng Cheung Ek lake, a main recipient of wastewater from the city of Phnom Penh. Water spinach samples were collected near two wastewater entry points in the northern part of the lake and near a wastewater exit point in the southern part of the lake, where water is discharged from the lake into a stream. Water spinach samples were harvested at each of the three locations with and without wastewater contact according to the normal practices of farmers, and analysed for ThC, protozoan parasites (Giardia, Cryptosporidium and Cyclospora), and helminth eggs (Ascaris lumbricoides, Trichuris trichura and hookworm) using standard methods. Wastewater samples were also collected at each of the three locations and analysed for ThC and helminth eggs.

Results  High concentrations of ThC (approximately 105–107/g) were found in water spinach samples. ThC mean counts did not differ significantly, neither between sample types at each location, nor between locations. ThC mean concentration of water spinach samples collected in the rainy season of 2005 was higher than that in the dry season of 2004. Protozoan parasites were detected in the samples from all three locations and in water spinach harvested with and without wastewater contact. Giardia spp. were present in 56% (20) of samples with an average cyst concentration of 6.6/g. Mean counts of Giardia were not significantly associated with wastewater contact status of water spinach. Cryptosporidium oocysts were found in 17% (six) of samples with an average concentration of 0.5 oocyst per gram of water spinach. Cyclospora oocysts were detected in 8% (three) of samples. Four (11%) water spinach samples contained helminth eggs (average concentration: 0.1 egg per gram). Water samples contained approximately 104–107 ThC per 100 ml and a mean of 27.4 helminth eggs per litre. There was a 2–3 log reduction of ThC between the water samples collected at the wastewater entry and exit point(s) of the lake.

Conclusions  Water spinach cultivated in the lake was highly contaminated with feces, as indicated by high ThC concentrations and the presence of protozoan parasites. A reduction in ThC numbers almost to WHO guideline levels for irrigation water occurred through natural biological and physical processes in the lake, as shown by differences in ThC counts at wastewater entry and exit points.
Helminth infections among people using wastewater and human excreta in peri‐urban agriculture and aquaculture in Hanoi, Vietnam
Authors: Trang Do Thuy , Mølbak Kåre , Cam Phung Dac , Dalsgaard Anders
Published: August 2010

Objective  To assess the prevalence of helminth infections and their associated risks in a community using both wastewater and human excreta in agriculture and aquaculture.

Methods  A cross‐sectional study was conducted in a peri‐urban area in Hanoi, Vietnam. Data on the demography, socioeconomics and sanitation were collected from a survey of 400 agricultural households. Parasitological examination for the eggs of Ascaris sp., Trichuris sp. and hookworm was performed on single stool specimens obtained from study household members’ 15–70 years and 0–72 months of age.

Results  Of 807 stool samples collected from 620 adults and 187 children, 39% were infected with helminths. The prevalence of infections with Ascaris sp., Trichuris sp. and hookworm was 21.6%, 9.8% and 21.8%, respectively. Univariate and multivariate analyses showed that being an adult, female gender, living in a household without a latrine, excreta composted for less than 1 month and use of fresh human excreta were significantly associated with co‐infection with all three helminths. Being an adult was an independent determinant for infections with individual helminths. The absence of a latrine and use of stored urine for irrigation were associated with an increased risk of Ascaris infection. Risk factors for Trichuris infection were inadequately composted excreta and year‐round wastewater contact; risk factors for hookworm infection were female gender, household without a latrine and use of fresh human excreta.

Conclusion  Wastewater exposure did not pose a major risk for helminth infection in this community. Instead, lack of sanitation facilities and use of fresh or inadequately composted human excreta in agriculture were important risk factors.
Private practitioners and tuberculosis case detection in Jogjakarta, Indonesia: actual role and potential
Authors: Mahendradhata Yodi , Utarini Adi , Lazuardi Upiek , Boelaert Marleen , Stuyft Patrick Van der
Published: August 2010

Background  Indonesia has a high tuberculosis (TB) prevalence and a large private health sector.

Objectives  To explore the potential of private practitioners (PP) in TB control in Jogjakarta by assessing their load of TB suspects and case‐management practices.

Methods  We conducted a cross‐sectional telephone survey of a random sample of 164 PP, weighted to the local proportions of specialists, general practitioners (GP), nurses and midwives. We investigated their knowledge of directly observed treatment, short‐course (DOTS), whether they see TB suspects, whether they refer such patients and how they possibly diagnose and treat TB.

Results  We sampled 174 PP, of which 164 (94.3%) completed the interview. Most PP (63.4%) reported to have seen TB suspects in their private practice, and 62.8% were also employed in a DOTS facility. Specialists saw on average 18 suspects, GP 11 suspects, and nurses–midwives three suspects in a year. Many PP (45.2%) always relied on National Tuberculosis Control Programme (NTP) services for diagnosis. Fewer PP (41.5%) used, by themselves, diagnostic procedures complying with the NTP guidelines. The majority (63.6%) always referred confirmed cases for treatment, mainly (71.4%) to NTP services. Most PP (72.7%) who treated TB patients themselves did not prescribe the NTP standard regimen.

Conclusion  The study shows that the TB case load per PP is low in Jogjakarta, where the NTP already involves public and private hospitals besides public health centres. Initiatives to engage all PP might only marginally contribute in increasing the TB case detection.
Macrofilaricidal effect of 4 weeks of treatment with doxycycline on Wuchereria bancrofti
Authors: Debrah Alexander Yaw , Mand Sabine , Marfo‐Debrekyei Yeboah , Batsa Linda , Pfarr Kenneth , Buttner Marcelle , Adjei Ohene , Buttner Dietrich , Hoerauf Achim
Published: August 2010

Objective  To evaluate the efficacy of doxycycline as a macrofilaricidal agent against Wuchereria bancrofti.

Method  In the Western Region of Ghana, 18 patients infected with W. bancrofti were recruited and treated with 200 mg doxycycline per day for 4 weeks. Seven untreated patients served as controls. Four months after doxycycline treatment, all patients received 150 μg/kg ivermectin. Patients were monitored for Wolbachia and microfilaria loads, antigenaemia and filarial dance sign (FDS).

Results  Four months after doxycycline treatment, cases had a significantly lower Wolbachia load than controls; and 24 months after treatment, microfilaraemia, antigenaemia and frequency of FDS were significantly lower in cases than controls. Most importantly, 4 weeks of doxycycline killed 80% of macrofilariae, which is comparable with the results of a 6‐week regimen. Circulating filarial antigenaemia and FDS were strongly correlated.

Conclusion  A 4‐week regimen of doxycycline seems sufficient to kill adult W. bancrofti and could be advantageous for the treatment of individual patients, e.g. in outpatient clinics.
Utility of measuring serum levels of anti‐PGL‐I antibody, neopterin and C‐reactive protein in monitoring leprosy patients during multi‐drug treatment and reactions
Authors: Silva E. A. , Iyer A. , Ura S , Lauris J. R. , Naafs B. , Das P. K. , Vilani‐Moreno F.
Published: August 2010

Objective  To verify the validity of measuring the levels of Mycobacterium leprae‐specific anti‐phenolic glycolipid (PGL)‐I antibody, neopterin, a product of activated macrophages, and C‐reactive protein (CRP), an acute phase protein, in serial serum samples from patients for monitoring the leprosy spectrum and reactions during the course of multi‐drug treatment (MDT).

Methods  Twenty‐five untreated leprosy patients, 15 multi‐bacillary (MB) and 10 paucibacillary (PB), participated. Eight patients developed reversal reaction and five developed erythema nodosum leprosum (ENL) during follow‐up. The bacterial index (BI) in slit‐skin smears was determined at diagnosis and blood samples collected by venipuncture at diagnosis and after 2, 4, 6 and 12 months of MDT. PGL‐I antibody and neopterin were measured by enzyme‐linked immunosorbent assay, whereas the CRP levels were measured by the latex agglutination method.

Results  The levels of PGL‐I antibodies and neopterin were higher in the sera of MB than PB patients, which correlated with the patients’ BI. The serum levels of CRP did not differ significantly between the MB and PB patients. The serum levels of PGL‐I and neopterin were no higher in reactional patients than non‐reactional patients prone to such reactions. However, ENL patients had higher serum CRP levels than non‐reactional MB patients. The serum PGL‐I antibody levels declined significantly during MDT, in contrast to neopterin and CRP levels.

Conclusion  Measuring the serum levels of PGL‐I antibodies and neopterin appeared to be useful in distinguishing MB from PB patients, whereas monitoring the levels of PGL‐I antibodies appeared to be useful in monitoring MB patients on MDT. Measuring serum CRP, although not useful in monitoring the patients, has limited significance in detecting ENL reactional patients.
Same‐day smears in the diagnosis of tuberculosis
Authors: Hirao S. , Yassin M. A. , Khamofu H. G. , Lawson L. , Cambanis A. , Ramsay A. , Cuevas L. E.
Published: August 2010

Objective  To assess the feasibility of completing the diagnosis of tuberculosis (TB) in 1 day by collecting only on‐the‐spot specimens.

Methods  Individuals with suspected TB attending district hospitals in Abuja submitted three sputum samples for routine diagnosis (the standard approach). One additional sample was collected 1 h after the first sputum (the same‐day approach). One sputum sample was cultured. Blood samples were tested for HIV.

Results  Two hundred and twenty‐four patients with chronic cough had 135/672 (20%) positive on‐the‐spot smears and 47/224 (21%) positive morning smears. The same‐day and internationally recommended approaches identified 44 and 45 of the 78 patients with positive cultures, respectively. 106/194 (55%) patients were HIV positive. Only 9–11% of their smears were positive compared with 30–32% for HIV negatives (P < 0.01).

Conclusion  It could be possible to diagnose TB in a single day by examining two spot specimens, but the feasibility needs to be confirmed on a larger scale.
Missed opportunities to address reproductive health care needs among HIV‐infected women in antiretroviral therapy programmes
Authors: Myer Landon , Rebe Kevin , Morroni Chelsea
Published: August 2010

Objectives  To investigate the delivery of reproductive health care services in an antiretroviral therapy (ART) programme in Cape Town, South Africa.

Methods  A cross‐sectional survey was conducted among 227 consecutive women attending a hospital‐based ART outpatient service who had been on ART for at least one month. Semi‐structured interviews investigating reproductive health issues and services received were conducted in participants’ home language by a trained interviewer.

Results  Sixty‐seven per cent of the women were younger than 30 years and 75% were sexually active. The use of both condoms (70%) and hormonal contraceptives (31%) decreased with age, while the prevalence of sterilization (13%) increased with age. Few women knew about emergency contraception (EC) (7%) or termination of pregnancy (TOP) (13%). Approximately 45% of women had had a Papanicolau smear, and this was constant across all age groups. One in 10 women had experienced verbal or physical abuse by an intimate partner since their HIV diagnosis. More than 80% of women had discussed the use of condoms and other forms of contraception with a health care provider since their HIV diagnosis, but less than 5% had discussed EC or TOP, and no woman had discussed issues of partner violence.

Discussion  These data delineate the large unmet need for reproductive health services among HIV‐infected women receiving ART in this setting. While issues related to condom and contraceptive use are relatively well addressed, reproductive health services related to unintended pregnancy and partner violence appear to be neglected. The integration of a broad range of reproductive health services into ART programmes requires urgent attention in both research and policy‐making circles.
Short communication: The cost‐effectiveness of cutaneous leishmaniasis patient management during an epidemic in Chaparral, Colombia in 2004
Authors: Vega Juan Carlos , Sanchez Boris Fernando , Montero Luz Mery , Montaña Rafael , Del Pilar Mahecha Mercedes , Dueñes Bladimir , Baron Ángela Rocío , Reithinger Richard
Published: August 2010

We calculated ranges for the cost per disability adjusted life year (DALY) averted for cutaneous leishmaniasis (CL) treatment during an ongoing epidemic of CL in Chaparral, Colombia. Using operational clinical and cost data, we calculated that the cost of treating leishmaniasis patients with standard pentavalent antimony was US$345 (95% CI 277–488) per patient treated and cured. The cost per DALY averted per patient cured with antimony was estimated to be approximately US$15 000 (95% CI 12 226–21 532).
Insecticide‐treated bednets to control dengue vectors: preliminary evidence from a controlled trial in Haiti
Authors: Lenhart Audrey , Orelus Nicolas , Maskill Rachael , Alexander Neal , Streit Thomas , McCall P. J.
Published: August 2010

Objectives  Insecticide‐treated bednets (ITNs) are effective in preventing nocturnally transmitted vector‐borne diseases, but their effect on diurnally active dengue vectors has never been studied. We investigated the efficacy of ITNs in reducing Aedes aegypti populations and dengue transmission.

Methods  A cluster‐randomized trial was carried out in Leogane, Haiti between July 2003 and July 2004. The study area (1017 houses) was divided into 18 sectors (clusters): nine received ITNs (Olyset® long‐lasting insecticidal bednets) and nine were untreated controls. Entomological surveys [measuring Breteau (BI), house (HI), container (CI) and pupae per person (PPI) indices and oviposition activity] were undertaken at baseline and at 1 and 5 months post‐intervention. All houses were georeferenced to enable spatial analysis. Control sectors received ITNs at 6 months, and a final entomological and attitudinal survey was undertaken at 12 months after baseline. Anti‐dengue IgM seropositivity rates were measured at baseline and after 12 months. Efficacy of ITNs was assessed by WHO cone bioassays.

Results  At 1‐month post‐intervention, entomological indices fell in all sectors, with HI and BI in the bednet sectors reduced by 6.7 (95% CI −10.6, −2.7; P < 0.01) and 8.4 (95% CI −14.1, −2.6; P < 0.01) respectively. Moreover at 1 month, ovitraps in control sectors were significantly more likely to be positive than in bednet sectors (P < 0.01). By 5 months, all indices remained low and HI, CI and BI were also significantly lower than that of baseline in the control arm. Curiously, at 5 months, HI, CI and BI were lower in the control arm than that in the bednet arm. A final survey, 12 months after the initial baseline study (5 months after bednets had been given to all households) indicated that all indices were significantly lower than that at baseline (P < 0.001). Control houses located within 50 m of a bednet house had significantly lower CI (Z = −2.67, P = 0.008) and PPI (Z = −2.19, P = 0.028) at 1 month, an effect that extended to 100 m by 5 months (Z = −2.03, P = 0.042 and Z = −2.37, P = 0.018 respectively), suggesting a spill‐over effect of the bednets. An IgM serosurvey showed a 15.3% decrease (95% CI 5.0–25.5%, P < 0.01) in the number of IgM‐positive individuals from baseline to12 months later.

Conclusions  Insecticide‐treated bednets had an immediate effect on dengue vector populations after their introduction, and over the next 5–12 months, the presence of ITNs may have continued to affect vector populations and dengue transmission.
A decade of Japanese encephalitis surveillance in Sarawak, Malaysia: 1997–2006
Authors: Wong See C. , Ooi Mong H. , Abdullah Abdul R. , Wong See Y. , Krishnan Shekhar , Tio Phaik H. , Pek Peng C. , Lai Boon F. , Mohan Anand , Muhi Jamail , Kiyu Andrew , Arif Mohamad T. , Cardosa Mary J.
Published: August 2010

Japanese encephalitis virus (JEV) is an important encephalitis virus in Asia, but there are few data on Malaysia. A hospital‐based surveillance system for Japanese encephalitis (JE) has been in operation in Sarawak, Malaysia, for the last 10 years. JEV is endemic in Sarawak, with cases occurring throughout the year and a seasonal peak in the last quarter (one‐way anova, P < 0.0001). Ninety‐two per cent of 133 cases were children aged 12 years or younger; the introduction of JE vaccination in July 2001 reduced the number of JE cases (84 in the four seasons prior to vs. 49 in the six seasons after, McNemar’s test, P = 0.0001). After implementation of the programme, the mean age of infected children increased from 6.3 to 8.0 years (Student’s t‐test, P = 0.0037), suggesting the need for a catch‐up programme.
Prevalence of hantavirus infection in wild Rattus norvegicus and R. rattus populations of Buenos Aires City, Argentina
Authors: Cueto Gerardo Rubén , Cavia Regino , Bellomo Carla , Padula Paula Julieta , Suárez Olga Virginia
Published: August 2010

Objective  To determine the prevalence of infection with hantaviruses in wild Rattus norvegicus and R. rattus populations in areas of Buenos Aires city.

Methods  Norway rats and black rats were trapped from 2003 to 2005 at 10 sites throughout Buenos Aires city. Blood samples for serological analysis were collected by cardiac puncture from all individuals captured and tested by enzyme‐linked immunosorbent assay for Seoul hantavirus‐ and Andes virus‐specific IgG antibodies.

Results  Hantavirus seroprevalence was 11.9% in R. norvegicus (n = 151), varying between 0% and 26.1% depending on the site. Bigger sexually active males were more likely to be infected with Seoul virus than females or juvenile individuals. No antibody‐reactive rodents were detected among 33 R. rattus analysed.

Conclusion  Hantavirus infections are geographically widespread in Buenos Aires city and confirm that they have been enzootic there for at least 20 years.
Measuring stigma associated with tuberculosis and HIV/AIDS in southern Thailand: exploratory and confirmatory factor analyses of two new scales
Authors: Van Rie Annelies , Sengupta Sohini , Pungrassami Petchawan , Balthip Quantar , Choonuan Sophen , Kasetjaroen Yutichai , Strauss Ronald P. , Chongsuvivatwong Virasakdi
Published: August 2010

Objective  To develop scales to measure tuberculosis and HIV/AIDS stigma in a developing world context.

Methods  Cross‐sectional study of tuberculosis patients in southern Thailand, who were asked to rate their agreement with items measuring TB and HIV/AIDS stigma. Developing the scales involved exploratory and confirmatory factor analyses, internal consistency, construct validity, test–retest reliability and standardized summary scores.

Results  Factor analyses identified two sub‐scales associated with both tuberculosis and HIV/AIDS stigma: community and patient perspectives. Goodness‐of‐fit was good (TLI = 94, LFI = 0.88 and RMSEA = 0.11), internal consistency was excellent (Cronbach’s alphas 0.82–0.91), test–retest reliability was moderate, and construct validity showed an inverse correlation with social support.

Conclusion  Our scales have good psychometric properties that measure stigma associated with tuberculosis and HIV/AIDS and allow assessment of stigma from community and patient perspectives. Their use will help document the burden of stigma, guide the development of interventions and evaluate stigma reduction programmes in areas with a high HIV/AIDS and tuberculosis burden.
Polymorphisms in HIV‐1 subtype C proteases and the potential impact on protease inhibitors
Authors: Bessong Pascal Obong
Published: August 2010

Objectives  (i) To review data on the genetic profile of the protease (PR) gene of human immunodeficiency virus (HIV)‐1‐C primary isolates relative to HIV‐1‐B; (ii) to examine data on the susceptibility of HIV‐1‐C isolates harbouring polymorphisms to PR inhibitors (PI) and the development of resistance; and (iii) to identify gaps required for an improved understanding of the role of polymorphisms in resistance development of HIV‐1‐C to PI.

Method  Literature review.

Results  Significant differences exist between the baseline nucleotide and amino acid sequences of PR of HIV‐1‐B and HIV‐1‐C. Some of the amino acid substitutions seen in HIV‐1‐B when exposed to PI occur naturally in HIV‐1‐C isolates. Studies used different methodologies and interpretation systems to evaluate the phenotypic significance of polymorphisms seen in subtype C viruses, with conflicting outcomes. The evolutionary path to the resistance of HIV‐1‐C to PI may be different from that of HIV‐1‐B.

Conclusions  Infection with HIV‐1‐C is driving the AIDS epidemic in regions of the world with the most urgent needs for the management of the disease. More and more individuals will require PR inhibitors in second‐line therapies, as access to antiretrovirals progresses. It is proposed that a standardized protocol be adopted to evaluate the phenotypic significance of the highly polymorphic HIV‐1‐C PR to PR inhibitors with the aim of better informing the tailoring of treatment regimens for optimal clinical benefit.
Association of atopy, asthma, allergic rhinoconjunctivitis, atopic dermatitis and intestinal helminth infections in Cuban children
Authors: Wördemann Meike , Diaz Raquel Junco , Heredia Lenina Menocal , Madurga Ana Maria Collado , Espinosa Aniran Ruiz , Prado Raul Cordovi , Millan Irai Atencio , Escobedo Angel , Rivero Lazara Rojas , Gryseels Bruno , Gorbea Mariano Bonet , Polman Katja
Published: August 2010

Objective  To examine the relationship of past and current intestinal helminth infections with asthma, allergic rhinoconjunctivitis, atopic dermatitis and atopy.

Methods  Cross‐sectional study of 1320 children aged 4–14 years from two Cuban municipalities. Helminth infections were determined by stool examination and parental questionnaire. Asthma, rhinoconjunctivitis and atopic dermatitis were diagnosed by International Study of Asthma and Allergies in Childhood questionnaire, asthma additionally by spirometry, atopy by skin prick testing.

Results  Questionnaire‐based frequencies were 21% for asthma, 14% for allergic rhinoconjunctivitis and 8% for atopic dermatitis. According to spirometry, 4% had asthma; 20% had a positive skin prick test. A history of infection for Enterobius vermicularis was associated with increased risk of atopic dermatitis (OR 1.88, P = 0.001) and allergic rhinoconjunctivitis (OR 1.34, P = 0.046), and hookworm with increased risk of allergic rhinoconjunctivitis (OR 2.77, P = 0.021). A positive stool examination for Ascaris lumbricoides infection was negatively associated with atopic dermatitis (OR 0.22, P = 0.007). Asthma and atopy were unrelated to helminth infections.

Conclusion  Current A. lumbricoides infection protects against atopic dermatitis in Cuban children, while past infection with E. vermicularis and hookworm are risk factors for allergic rhinoconjunctivitis and/or atopic dermatitis. Apparently, interactions differ depending on the type of helminth and atopic disease and on the time of helminth infestation.
Diagnosis of Mycobacterium ulcerans infection (Buruli ulcer) at a treatment centre in Ghana: a retrospective analysis of laboratory results of clinically diagnosed cases
Authors: Mensah‐Quainoo Ernestina , Yeboah‐Manu Dorothy , Asebi Caroline , Patafuor Francis , Ofori‐Adjei David , Junghanss Thomas , Pluschke Gerd
Published: August 2010

Clinical diagnosis of Mycobacterium ulcerans infection is currently accepted as sufficient basis for treating the disease. Inadequate laboratory resources in the highly endemic areas of Africa often limit possibilities for in‐country confirmation of clinical judgement. We analysed records of 99 Buruli ulcer (BU) patients diagnosed clinically and treated surgically at Amasaman Health Centre in Ghana, for whom post‐treatment diagnostic laboratory tests were performed. Comparison of clinical diagnoses with test results obtained by an in‐country laboratory on samples of excised tissue showed a high specificity of clinical judgement. Among lesions with three laboratory tests (microscopy for acid fast bacilli, culture and IS2404 polymerase chain reaction) done, 94% tested positive at least once and 83% twice. Thus correct clinical diagnosis of BU by well trained health workers is achievable, although the quality of clinical diagnosis should be monitored by intermittent testing in national reference laboratories. However, being retrospective, this study did not permit sensitivity and negative predictive value analysis.
Access and barriers to measures targeted to prevent malaria in pregnancy in rural Kenya*
Authors: Gikandi Priscilla W. , Noor Abdisalan M. , Gitonga Carol W. , Ajanga Antony A. , Snow Robert W.
Published: August 2010

Objectives  To evaluate barriers preventing pregnant women from using insecticide‐treated nets (ITN) and intermittent presumptive treatment (IPT) with sulphadoxine‐pyrimethamine (SP) 5 years after the launch of the national malaria strategy promoting these measures in Kenya.

Methods  All women aged 15–49 years were interviewed during a community survey in four districts between December 2006 and January 2007. Women pregnant in the last 12 months were asked about their age, parity, education, use of nets, ITN, antenatal care (ANC) services and sulphadoxine‐pyrimethamine (SP) (overall and for IPT) during pregnancy. Homestead assets were recorded and used to develop a wealth index. Travel time to ANC clinics was computed using a geographic information system algorithm. Predictors of net and IPT use were defined using multivariate logistic regression.

Results  Overall 68% of pregnant women used a net; 52% used an ITN; 84% attended an ANC clinic at least once and 74% at least twice. Fifty‐three percent of women took at least one dose of IPT‐SP, however only 22% took two or more doses. Women from the least poor homesteads (OR = 2.53, 1.36–4.68) and those who used IPT services (OR = 1.73, 1.24–2.42) were more likely to sleep under any net. Women who used IPT were more likely to use ITNs (OR = 1.35, 1.03–1.77), while those who lived more than an hour from an ANC clinic were less likely (OR = 0.61, 0.46–0.81) to use ITN. Women with formal education (1.47, 1.01–2.17) and those who used ITN (OR: 1.68, 1.20–2.36) were more likely to have received at least one dose of IPT‐SP.

Conclusion  Although the use of ITN had increased 10‐fold and the use of IPT fourfold since last measured in 2001, coverage remains low. Provider practices in the delivery of protective measures against malaria must change, supported by community awareness campaigns on the importance of mothers’ use of IPT.
The northward spread of leishmaniasis in Italy: evidence from retrospective and ongoing studies on the canine reservoir and phlebotomine vectors
Authors: Maroli Michele , Rossi Luca , Baldelli Raffaella , Capelli Gioia , Ferroglio Ezio , Genchi Claudio , Gramiccia Marina , Mortarino Michele , Pietrobelli Mario , Gradoni Luigi
Published: August 2010

Visceral leishmaniasis (VL) incidence has been increased in Italy in humans and dogs since the 1990s, with new foci being detected within traditional boundaries of endemic transmission but also in northern regions previously regarded as non‐endemic. To monitor the putative VL spreading, surveillance was implemented in northern continental Italy comprising: analysis of human cases recorded from 1990 through 2005; retrospective literature analysis of canine leishmaniasis (CanL) and phlebotomine sandfly records through 2002; prospective investigations in dogs from 2003 through 2005 and surveys on sandflies in 2003 and 2004. Two‐hundred‐thirty human cases (11% of Italian cases) were recorded. Their stratification by age and HIV status disclosed a sharp decrease of HIV/VL co‐infections paralleled by concomitant increase of paediatric and HIV‐negative adult patients during the study period. Four patients had no travel history. Seven leishmaniasis foci were retrospectively identified since 1990, whereas prospective investigations in dogs disclosed 47 autochthonous clinical cases and 106 autochthonous seropositives among 5442 dogs (2.1%) from 16 foci of six regions. Parasites were typed asLeishmania infantumMON‐1. Four vector species were identified among 1696Phlebotomus(Larroussius) collected specimens. Comparisons with historical data showed thatP. perniciosusandP. neglectushave increased in density and expanded their geographic range in the study area. Northern continental Italy is now focally endemic for VL and a moderate risk for human disease does exist, although the intensity of transmission seems to be lower than in traditional settings of Mediterranean VL.
Comparing the performance of indicators of hand‐washing practices in rural Indian households
Authors: Biran A. , Rabie T. , Schmidt W. , Juvekar S. , Hirve S. , Curtis V.
Published: August 2010

Objective  To compare the results obtained from 26 proxy indicators of domestic hand‐washing practices with those obtained from direct, ‘structured’ observation of hand‐washing in a sample of 387 households and to assess the potential of these indicators for use in the evaluation of hygiene promotion campaigns.

Methods  Fieldwork in rural India between February 2005 and April 2006. Household‐level data on hand‐washing practices and the availability of soap and water were collected by structured observation, questionnaire survey, pocket voting, hand‐wash demonstration and environmental check. Between them these techniques produced 27 binary indicators of hand‐washing practices, each of which was used to classify households as ‘hand‐washing’ or ‘non‐hand‐washing. To assess the extent to which household classification based on each of 26 proxy indicators concurred with classification based on observation, we used the kappa statistic. The prevalence of households defined as ‘hand‐washing’ according to each indicator was compared statistically with the prevalence according to structured observations by testing for a significant difference between two proportions.

Results  Agreement between all the proxy indicators and the observation data was poor and all but two of the indicators produced estimates of hand‐washing prevalence that were significantly different from that resulting from observation.

Conclusion  Although some interventions may be able to use proxy indicators as a guide to the magnitude and direction of their impact, these indicators do not provide an accurate guide to the actual practice or prevalence of hand‐washing. Structured observation remains the best indicator of those tested.
Uptake of HIV voluntary counselling and testing services in rural Tanzania: implications for effective HIV prevention and equitable access to treatment
Authors: Wringe Alison , Isingo Raphael , Urassa Mark , Maiseli Griter , Manyalla Rose , Changalucha John , Mngara Julius , Kalluvya Samuel , Zaba Basia
Published: August 2010

Objective  To describe the associations between socio‐demographic, behavioural and clinical characteristics and the use of HIV voluntary counselling and testing (VCT) services among residents in a rural ward in Tanzania.

Methods  Eight thousand nine hundred and seventy participants from a community‐based cohort were interviewed, provided blood for research HIV testing, and were offered VCT. Univariate and multivariate logistic regression was used to identify socio‐demographic, clinical and behavioural factors associated with VCT use.

Results  Although 31% (1246/3980) of men and 24% (1195/4990) of women expressed an interest in the service, only 12% of men and 7% of women subsequently completed VCT. Socio‐demographic factors, such as marital status, area of residence, religion and ethnicity influenced VCT completion among males and females in different ways, while self‐perceived risk of HIV, prior knowledge of VCT, and sex with a high‐risk partner emerged as important predictors of VCT completion among both sexes. Among males only, those infected with HIV for 5 years or less tended to self‐select for VCT compared to HIV‐negatives (adjusted odds ratio = 1.43; 95% CI: 0.99–2.14). This contributed to a higher proportion of HIV‐positive males knowing their status compared to HIV‐positive females.

Conclusions  In this setting, a disproportionate number of HIV‐positive women are failing to learn their status, which has implications for equitable access to onward referral for care and treatment services. Evidence that some high‐risk behaviours may prompt VCT use is encouraging, although further interventions are required to improve knowledge about HIV risk and the benefits of VCT. Targeted interventions are also needed to promote VCT uptake among married women and rural residents.
Defaulters from antiretroviral treatment in Jimma University Specialized Hospital, Southwest Ethiopia
Authors: Deribe Kebede , Hailekiros Fikre , Biadgilign Sibhatu , Amberbir Alemayehu , Beyene Biruk Kebede
Published: August 2010

Objective  To determine the prevalence of and factors associated with defaulting from antiretroviral treatment (ART) in Jimma, Ethiopia.

Methods  Unmatched case control study: cases were individuals who had missed two or more clinical appointments (i.e. had not been seen for the last 2 months) between January 2005 and February 2007; controls were individuals who had been on ART at least for 1 year and were rated as excellent adherers by the providers. Data were collected from patient records, and by telephone call and home visit to identify the reason for defaulting.

Results  Of 1270 patients who started ART, 915 (72.0%) were active ART users and 355 (28.0%) had missed two or more clinical appointments. The latter comprised 173 (13.6%) defaulters, 101 (8.0%) who transferred out, 75 (5.9%) who died, and 6 (0.5%) who restarted ART. Reasons for defaulting were unclear in most cases. Reasons given were loss of hope in medication, lack of food, mental illness, holy water, no money for transport, and other illnesses. Tracing was not successful because of incorrect address on the register in 61.6% of the cases. Taking hard drugs (cocaine, cannabis and IV drugs), excessive alcohol consumption, being bedridden, living outside Jimma town and having an HIV negative or unknown HIV status partner were associated with defaulting ART.

Conclusion  A significant proportion of patients defaulted from ART treatment. ART clinics should ensure that patients’ addresses are correct and complete. Programmatic and counseling efforts to decrease ART defaulting should address illicit drug and excessive alcohol use, decentralise ART services, institute home‐based treatment options for seriously ill and bedridden patients, and address patients concerns.
Use of proxy measures in estimating socioeconomic inequalities in malaria prevalence
Authors: Somi Masha F , Butler James R , Vahid Farshid , Njau Joseph D , Kachur S P , Abdulla Salim
Published: August 2010

Objectives  To present and compare socioeconomic status (SES) rankings of households using consumption and an asset‐based index as two alternative measures of SES; and to compare and evaluate the performance of these two measures in multivariate analyses of the socioeconomic gradient in malaria prevalence.

Methods  Data for the study come from a survey of 557 households in 25 study villages in Tanzania in 2004. Household SES was determined using consumption and an asset‐based index calculated using Principal Components Analysis on a set of household variables. In multivariate analyses of malaria prevalence, we also used two other measures of disease prevalence: parasitaemia and self‐report of malaria or fever in the 2 weeks before interview.

Results  Household rankings based on the two measures of SES differ substantially. In multivariate analyses, there was a statistically significant negative association between both measures of SES and parasitaemia but not between either measure of SES and self‐reported malaria. Age of individual, use of a mosquito net, and wall construction were negatively and significantly associated with parasitaemia, whilst roof construction was positively associated with parasitaemia. Only age remained significant when malaria self‐report was used as the measure of disease prevalence.

Conclusions  An asset index is an effective alternative to consumption in measuring the socioeconomic gradient in malaria parasitaemia, but self‐report may be an unreliable measure of malaria prevalence for this purpose.
Primary health care supervision in developing countries
Authors: Bosch‐Capblanch Xavier , Garner Paul
Published: August 2010

Objectives  To (a) summarise opinion about what supervision of primary health care is by those advocating it; (b) compare these features with reports describing supervision in practice; and (c) to appraise the evidence of the effects of sector performance.

Methods  Systematic review. Reports were classified into three groups and summarised using appropriate methods: policy and opinion papers (narrative summary), descriptive studies (systematically summarised) and experimental or quasi‐experimental studies (design and outcomes systematically summarised). Data presented as narrative summaries and tables.

Results  74 reports were included. In eight policy and opinion papers, supervision was conceptualised as the link between the district and the peripheral health staff; it is important in performance and staff motivation; it often includes problem solving, reviewing records, and observing clinical practice; and is usually undertaken by visiting the supervisees place of work. In 54 descriptive studies, the setting was the primary health care (PHC) or specific services and programmes. Supervisor‐supervisee dyads were generally district personnel supervising health facilities or lay health workers. Supervision mostly meant visiting supervisees, but also included meetings in the centre; it appeared to focus on administration and checking, sometimes with checklists. Problem solving, feedback and clinical supervision, training and consultation with the community were less commonly described in the descriptive studies. Supervision appears expensive from studies that have reported costs. In 12 quasi‐experimental trials, supervision interventions generally showed small positive effects in some of the outcomes assessed. However, trial quality was mixed, and outcomes varied greatly between studies.

Conclusions  Supervision is widely recommended, but is a complex intervention and implemented in different ways. There is some evidence of benefit on health care performance, but the studies are generally limited in the rigor and follow up is limited. Further research delineating what supervision consists of and evaluating it in the context of unbiased comparisons would guide the implementation of effective supervision as part of the management of PHC.
Socio‐cultural, psychosexual and biomedical factors associated with genital symptoms experienced by men in rural India
Authors: Gautham Meenakshi , Singh Rajesh , Weiss Helen , Brugha Ruairi , Patel Vikram , Desai Nimesh G , Nandan Deoki , Kielmann Karina , Grosskurth Heiner
Published: August 2010

Biomedical, anthropological and psychiatric frameworks have been used to research different elements of men’s sexual health – sexually transmitted infections, psychosexual concerns and psychological distress – but rarely within the same study. We combined these in a study in rural north India. In Tehri Garhwal and Agra districts, we explored male perceptions of genital and sexual symptoms through focus group discussions and then conducted a clinic‐based survey of 366 symptomatic men who presented at rural private provider clinics. Men’s urine specimens were tested for gonorrhoea and chlamydia infection using polymerase chain reaction techniques. Researchers screened them for probable psychological distress by administering the General Health Questionnaire (12‐ items). Results revealed that local and traditional notions of health influenced men’s symptom perceptions, with semen loss their predominant concern. Dhat, commonly perceived as an involuntary semen loss, corresponded most closely with the symptom of urethral discharge, but was attributed mainly to non‐infectious causes. It could also manifest as a syndrome with physical weakness and mental lethargy. FGD participants lacked correct and complete information on reproductive health. Around 75% of the symptomatic men presented with dhat, but only 5.5% tested positive for gonorrhoea or chlamydia. Application of syndromic sexually transmitted infection (STI) guidelines in these settings could result in over diagnosis and over treatment with antibiotics. In contrast, there was a significant association between dhat and probable psychological distress as detected by the GHQ (Adjusted OR, GHQ case positive: 2.66, 95% CI: 1.51–4.68). Our study confirms the existence of a dhat syndrome in rural India, which is culturally influenced and reflects heightened psychosexual concerns as well as mental distress states. Comprehensive health services for men should include assessments of their psychosexual needs and be supported by reproductive/sexual health education. STI treatment guidelines for urethral symptoms should be revised and be based on epidemiological data.
Changing pattern of malaria in Bissau, Guinea Bissau
Authors: Rodrigues Amabelia , Schellenberg Joanna Armstrong , Kofoed Poul‐Erik , Aaby Peter , Greenwood Brian
Published: August 2010

Objective  To describe the epidemiology of malaria in Guinea‐Bissau, in view of the fact that more funds are available now for malaria control in the country.

Methods  From May 2003 to May 2004, surveillance for malaria was conducted among children less than 5 years of age at three health centres covering the study area of the Bandim Health Project (BHP) and at the outpatient clinic of the national hospital in Bissau. Cross‐sectional surveys were conducted in the community in different malaria seasons.

Results  Malaria was overdiagnosed in both health centres and hospital. Sixty‐four per cent of the children who presented at a health centre were clinically diagnosed with malaria, but only 13% of outpatient children who tested for malaria had malaria parasitaemia. Only 44% (963/2193) of children admitted to hospital with a diagnosis of malaria had parasitaemia. The proportion of positive cases increased with age. Among hospitalized children with malaria parasitaemia, those less than 2 years old were more likely to have moderate anaemia (RR = 1.27; 95% CI: 1.02–1.56) (P = 0.03) or severe anaemia (RR = 1.67; 95% CI: 1.25–2.24) (P = 0.0005) than older children. The prevalence of malaria parasitaemia in the community was low (3%, 53/1926).

Conclusion  In Bissau, the prevalence of malaria parasitaemia in the community is now low and malaria is over‐diagnosed in health facilities. Laboratory support will be essential to avoid unnecessary use of the artemisinin combination therapy which is now being introduced as first‐line treatment in Bissau with support from the Global Fund.
Low carriage rate of group B streptococcus in pregnant women in Maputo, Mozambique
Authors: De Steenwinkel Florentien D. O. , Tak Henrike V. , Muller Anouk E. , Nouwen Jan L. , Oostvogel Paul M. , Mocumbi Sibone M.
Published: August 2010

The prevalence of group B streptococcus (GBS) carriage varies strongly with geographical region. A study was done to determine the prevalence of GBS in women in Maputo, Mozambique. The method used was a rectovaginal swab which was taken from women between 35 and 37 weeks of pregnancy who visited the clinic for antenatal consultation. GBS was cultured from 2 out of 113 samples, yielding a prevalence of 1.8% (95% Cl: 0.0–4.0). In conclusion, the prevalence of GBS carriage among pregnant women in Maputo, Mozambique was low.
Distribution and antibiotic susceptibility of Shigella isolates in Bangui, Central African Republic
Authors: Bercion Raymond , Njuimo Siméon P. , Boudjeka Prisca Megne , Manirakiza Alexandre
Published: August 2010

We conducted a prospective study in four urban health care centres between January 2004 and November 2005 to determine the distribution and susceptibility patterns of Shigella strains causing invasive diarrhoea in Bangui, Central African Republic. Of the 155 Shigella isolated, Shigella flexneri (51%) and Shigella dysenteriae (30%) were the most common and the most resistant to usual antibiotics, including amoxicillin, sulphamethoxazole–trimethoprim and chloramphenicol. Though multi‐drug resistance was common, no strains were resistant to quinolone and fluoroquinolones. We conclude that short‐course treatments with ciprofloxacin can be recommended in Bangui for treatment of invasive diarrhoea.
Cryptosporidium and Giardia infection and drinking water sources among children in Lege Dini, Ethiopia
Authors: Ayalew D. , Boelee E. , Endeshaw T. , Petros B.
Published: August 2010

We assessed the prevalence of Cryptosporidium and Giardia infections among children using protected and unprotected water sources in the Lege Dini watershed, Eastern Ethiopia, in November 2005 and May 2006. Of 655 children examined, 80 (12.2%) were infected with Cryptosporidium and 231 (35.3%) with Giardia. No difference was observed in the prevalence of cryptosporidiosis and giardiasis (P > 0.05) between children drinking water from protected and unprotected sources.
Increased mortality of male adults with AIDS related to poor compliance to antiretroviral therapy in Malawi
Authors: Chen Solomon Chih‐Cheng , Yu Joseph Kwong‐Leung , Harries Anthony David , Bong Chin‐Nam , Kolola‐Dzimadzi Rose , Tok Teck‐Siang , King Chwan‐Chuen , Wang Jung‐Der
Published: August 2010

Objective  To investigate the effect of gender on mortality of HIV‐infected adults receiving antiretroviral therapy (ART) and its possible reasons.

Methods  A retrospective study to review the records for outcomes of adult cases receiving ART at Mzuzu Central Hospital, Malawi, between July 2004 and December 2006.

Results  Over the study period, 2838 adult AIDS patients received ART. Of these, 2029 (71.5%) were alive and still on ART, 376 (13.2%) were dead and 433 (15.3%) were lost to follow‐up. Survival analysis with Kaplan–Meier estimator showed significantly higher survival rates among females than males in WHO stage 1, 2 and 3 (both P < 0.0001) and borderline in stage 4 (P = 0.076). The Cox model revealed a death hazard ratio (males vs. females) of 1.70 (95% confidence interval 1.35–2.15) after controlling for WHO clinical stages, body mass index and age. More men than women were lost to follow‐up in all occupations except health workers.

Conclusions  The most important reasons for a higher mortality in male patients starting ART may relate to their seeking medical care at a more advanced stage of immunodeficiency and poorer compliance with therapy. The issue needs to be addressed in scaling up ART programmes in Africa.