bluuebunny/crossref_metadata_2025 huggingface dataset:
Control strategies for sleeping sickness in Central Africa: a model‐based approach
Authors: Artzrouni Marc , Gouteux Jean‐Paul
Published: August 2010

Vector control and the detection (followed by treatment) of infected individuals are the two methods currently available for the control of sleeping sickness. The basic reproduction rate of a compartmental model is used to analyse and compare the two strategies. The efficiency of each strategy will depend on two epidemiologic parameters; the intrinsic contamination rate Q (closely related to the index of new contaminations) that captures the potential spread of the disease, and the intrinsic removal rate from the first stage (intrinsic to the particular trypanosome strain and to the population's susceptibility). The model shows that when the intrinsic removal rate is low (that is, when there is a long first stage characteristic of an endemic situation) the detection of sick individuals is more efficient than vector control. The situation is reversed when the removal rate is high (in an epidemic situation). The conclusions of the analysis are shown to be in general agreement with results obtained in two different sleeping sickness foci of Central Africa.
In vitro antitrypanosomal activity of African plants used in traditional medicine in Uganda to treat sleeping sickness
Authors: Freiburghaus Franziska , Ogwal Elizabeth N. , Nkunya Mayunga H. H. , Kaminsky Ronald , Brun Reto
Published: August 2010

In Uganda, as in many other African countries, herbal treatment of various diseases is still common. In the present study, 9 plant species collected from Tanzania and Uganda and used by traditional healers in southern‐eastern Uganda for the treatment of human African trypanosomiasis (sleeping sickness) were extracted and screened for their in vitro activity against Trypanosoma brucei rhodesiense, one of the two causative agents of sleeping sickness. Eight lipophilic extracts of 5 plants revealed very promising antitrypanosomal activity with IC50 values below 1 µg/ml; among them were extracts prepared from Albizia gummifera (2), Ehretia amoena (1), Entada abyssinica (2), Securinega virosa (1) and Vernonia subuligera (2). Activity with IC50 values between 1 and to µg/ml was determined for 15 further extracts. Cytotoxicity of active extracts, tested on a human fibroblast cell line (WI‐38), was found to be high, and therefore selectivity indices resulted in less favourable ranges than those for the few commercially available drugs. Nevertheless, the results confirm the potential of ethnobotanically selected plants as remedies against sleeping sickness and call for phytochemical studies.
ParaSight‐F test to diagnose malaria in hypo‐endemic and epidemic prone regions of Vietnam
Authors: Verlé P. , Binh L. N. , Lieu T. T. , Yen P. T. , Coosemans M.
Published: August 2010

The antigen capture Para Sight‐F test was evaluated during a drug sensitivity survey in a hypoendemic region of northern Vietnam. When only asexual blood forms of P. falciparum were considered, sensitivity of ParaSight‐F was 100%, specificity 88% (95% CI 95–80%), positive predictive value 68% (95% CI 85–50%) and negative predictive value 100%. ParaSight‐F proved very convenient for rapid screening and selection of patients to enrol in a drug sensitivity study. In northern Vietnam, the introduction of the test as a routine diagnostic tool is not justified, considering its high cost, the necessity to carry out the treatment of presumptive Plasmodium vivax cases and the persistence of positive reactions following treatment. However, the test will be a valuable tool in remote areas in emergency situations, where rapid confirmation of a P. falciparum outbreak is required.
A comparative study of the efficacies of chloroquine and a pyrimethamine‐dapsone combination in clearing Plasmodium falciparum parasitaemia in school children in Tanzania
Authors: Mshinda H. , Font F. , Hirt R. , Mashaka M. , Ascaso C. , Menendez C.
Published: August 2010

A randomized study on the in vivo efficacies of chloroquine and a pyrimethamine‐dapsone combination (Maloprim) in clearing P. falciparum parasitaemia was carried out in 77 asymptomatic semi‐immune schoolchildren in the Kilombero District of Tanzania. Children were randomized to receive either chloroquine at a dose of 25 mg/kg over three days, or Maloprim (6·25 mg pyrimethamine+50 mg dapsone for children under 10 years, and 12.5 mg pyrimethamine+100 mg dapsone for children TO or more years old) as a single dose. Children were followed‐up for malaria parasitaemia at days 2, 7 and 14 after screening, randomization and treatment. The slide positivity rate was lower in the Maloprim group at all cross‐sectional surveys (23 vs 37% at day 2; 9 vs 20% at day 7; 21 vs 32% at day 14) but none of these differences reached statistical significance. No cases in the Maloprim group showed RII resistance, whereas in the chloroquine group, 2 cases showed RII resistance and a further 2 cases RIII resistance (6%). No major side‐effects were reported. The combination of pyrimethamine‐dapsone appears to be a better choice than chloroquine as a chemoprophylactic regimen for malaria in this area. Although they need to be confirmed in a larger study, these results may be of interest to the policy‐makers as well as researchers.
Chloroquine resistance of Plasmodium falciparum malaria in Ethiopia and Eritrea
Authors: Alene Getu D. , Bennett Steve
Published: August 2010

We report on the first 2 years of operation of a new strategy for treatment for P. falciparum malaria patients who were not cured by a standard course of chloroquine. Any such patient who returned to a malaria treatment and detection post within 2 weeks was treated daily under supervision with chloroquine. Patients whose parasitaemia had not decreased below 25% of the initial level by day 3 or cleared completely by day 7 were given sulphadoxine/pyrimethamine (Fansidar). Of 39 824 patients treated initially with chloroquine, 4% returned to the malaria post within 2 weeks of treatment; 87% of these were chloroquine resistant and treated with Fansidar and 28% of the returning patients were RIII resistant.

Resistance was associated with geographical area, initial parasite density and age. Earlier studies had shown resistance to be confined to border areas, but we found that it was highest in the centre of the region, notably in the lowlands of the Shewa and Arsi provinces, and lowest in the west. Although imported cases have been held responsible for the development of resistance in border areas, other factors are likely to be important in the middle of the region. The implications of these findings for a treatment policy of P. falciparum malaria in the region are discussed.
Chloroquine resistant Plasmodium vivax malaria in India
Authors: Dua V. K. , Kar P. K. , Sharma V. P.
Published: August 2010

In India, 1·2‐1·5 million new cases of Plasmodium vivax occur each year. These cases are successfully treated with 600 mg chloroquine (adult dose). We report the results of malaria treatment of a 13‐year‐old girl from the Indian Oil Corporation (IOC), Mathura, India who contracted P. vivax infection. The infection failed to respond to 2 cycles of standard chloroquine therapy. The concentrations of chloroquine were monitored with high performance liquid chromatography (HPLC). The plasma and whole blood chloroquine concentrations were 260 and 106 ug/1 respectively, while a 15 µg/1 plasma concentration is considered lethal to P. vivax. Resistance in P. vivax to chloroquine was found at the IOC, Mathura.
First case of Lagochilascaris minor infection in Bolivia
Authors: Ollé‐Goig Jaime E. , Recacoechea Mario , Feeley Teresa
Published: August 2010

Few cases of human infection with Lagochilascaris minor have been reported in the literature. They occurred in Central and South America and the Caribbean. We describe the first patient with this nematode infection in Bolivia.
Isolation of Vibrio cholerae O139 from the drinking water supply during an epidemic of cholera
Authors: Ramakrishna B. S. , Kang G. , Rajan D. P. , Mathan M. , Mathna V. I.
Published: August 2010

In mid 1994, the public water supply was investigated in a medium‐sized town in south India during an epidemic of cholera due to Vibrio cholerae O139. Vibrio cholerae O139 was isolated from the public water supply including one of the wells supplying the town, the central overhead tank, and domestic taps connected to the public supply. Following chlorination, the organism was no longer isolated from the water supply and the epidemic subsided. This demonstration of V. cholerae O139 in the drinking water supply of a town underlines the need for adequate treatment of the water supply.
Assessment of vector microfilarial uptake as a comparatively non‐invasive technique for monitoring onchocerciasis treatment campaigns in the Americas
Authors: Davies John B. , Luján Ricardo , López‐Martinez Luis A. , Paniagua‐Alvarez Aura J. , Morales‐Hernández Byron E. , Sherlock K.
Published: August 2010

Summary Since 1992, efforts have been made to combat onchocerciasis in Guatemala through mass distribution of ivermectin. The impact of the campaign is assessed by taking skin‐snips from sentinel groups within selected communities. This method gives an estimate of the prevalence and intensity of infection, and thus the efficacy of the treatment. In some communities people are becoming reluctant to volunteer for skin‐snipping, and so there is a need for an alternative technique that will give quantitative results. In most hyperendemic communities in Guatemala, biting blackflies are so ubiquitous that few people object to allowing 10 to 20 flies to engorge upon them. We examined data on the quantitative uptake of microfilariae by Simulium ochraceum before and after ivermectin distribution to see whether results similar to skin‐snip data could be obtained. Counts of microfilariae ingested by S. ochraceum are compared to the numbers found in skin‐snips from the same volunteers.

In a group of 31 untreated infected persons, a skin‐snip survey detected 64.5% positive, while feeding flies (vector microfilarial uptake, VmfU) detected 96.8%. Post‐treatment, in a sample of 58 of whom 52 (89.7%) had a history of infection, both skin‐snips and VmfU detected 54.2%. Vector blood meals contained more microfilariae than a mg of skin before treatment, but both recorded about equal numbers after treatment. When the data set was subdivided to compare samples taken at 2–3, 6–8 and 14–17 months post‐treatment, the effect of ivermectin was still apparent at 6–8 months, but had virtually disappeared by 14 months post‐treatment. A surprising observation was that the flies ingested fewer microfilariae from treated persons than was expected from the skin densities as estimated by skin‐snip. This effect lasted for over 8 months, and could indicate that ivermectin has a greater effect on transmission than previously suspected. We conclude that VmfU could be used as an alternative to skin‐snipping, and discuss the ethical implications.
Laryngeal involvement during post kala‐azar dermal leishmaniasis in India
Authors: Nandy A. , Addy Manjulika , Banerjee D. , Guha S. K. , Maji A. K. , Saha A. M.
Published: August 2010

Summary Post kala‐azar dermal leishmaniasis (PKDL) involving the mucus membranes is relatively rare on the Indian sub‐continent. We describe 3 cases of PKDL presenting with hoarseness of voice. In one case the skin, nasal, oral, oropharyngeal and laryngeal mucosa had nodular and nodulo‐ulcerative lesions; in the 2 other cases, genitalia and anorectal mucosa were also affected. Laryngoscopic examination revealed nodular lesions on the vocal cords. Biopsy smear and culture confirmed their leishmanial origin.
Ivermectin for the chemotherapy of bancroftian filariasis: a meta‐analysis of the effect of single treatment
Authors: Cao Wu‐chun , Van der Ploeg Catharina P. B. , Plaisier Anton P. , van der Sluijs I. J. Sivera , Habbema J. Dik F.
Published: August 2010

Summary The efficacy and safety of ivermectin in the treatment of filariasis due to Wuchereria bancrofti was assessed by a meta‐analysis of the results from 15 published clinical trials. Seven hundred and forty‐eight microfilaraemic patients were enrolled in 7 dose‐finding and 8 comparative studies. Administered as a single dose, ivermectin induced nearly complete clearance of microfilariae from the blood from the first day to 30 days post‐treatment, followed by gradual recurrence of microfilaraemia and increase in its intensity. Higher doses of ivermectin showed greater clearance effects and maintained lower microfilaraemia levels for a longer time. The adverse reactions caused by the drug were flu‐like, transient, generally mild and well tolerated by patients. The frequency and intensity of adverse reactions were strongly associated with pretreatment microfilaria counts in the blood, but independent of dose. The findings of the meta‐analysis suggest that ivermectin given at a single annual dose of 200 μg/kg body weight or higher, whether or not in combination with DEC, has great potential for therapeutic strategies to control bancroftian filariasis.
Can source reduction of mosquito larval habitat reduce malaria transmission in Tigray, Ethiopia?
Authors: Yohannes Mekonnen , Haile Mituku , Ghebreyesus Tedros A. , Witten Karen H. , Getachew Asefaw , Byass Peter , Lindsay Steve W.
Published: August 2010

The development of irrigation schemes by dam construction has led to an increased risk of malaria in Tigray, Ethiopia. We carried out a pilot study near a microdam to assess whether environmental management could reduce malaria transmission by Anopheles arabiensis, the main vector in Ethiopia. The study took place in Deba village, close to a dam; Maisheru village, situated 3–4 km away from the dam, acted as a control. Baseline entomological and clinical data were collected in both villages during the first 12 months. Source reduction, involving filling, draining and shading of potential mosquito‐breeding habitats was carried out by the community of Deba in the second year and routine surveillance continued in both villages during the second year. Anopheles arabiensis was highly anthropophilic (Human Blood Index = 0.73), biting early in the night before people went to bed. The major breeding habitats associated with the dam were areas of seepage at the dam base (28%), leaking irrigation canals (16%), pools that formed along the bed of streams from the dam (13%), and man‐made pools (12%). In the pre‐intervention year, 5.9–7.2 times more adult vectors were found in the dam village compared with the control village. There was a 3.1% higher prevalence of an enlarged spleen in children under 10 years in the dam village than in the control village during the pre‐intervention period, but no statistically significant difference was found in the incidence of falciparum malaria between the two villages during the same period. Source reduction was associated with a 49% (95% CI = 46.6–50.0) relative reduction in An. arabiensis adults in the dam village compared with the pre‐intervention period. There were very few cases of malaria during the intervention period in both villages making it impossible to judge whether malaria incidence had been reduced. These preliminary findings suggest that in areas of low intensity transmission community‐led larval control may be a cheap and effective method of controlling malaria. Further, large‐scale studies are needed to confirm these findings.
Risk factors for mortality in Paraguayan children with pneumococcal bacterial meningitis
Authors: Lovera Dolores , Arbo Antonio
Published: August 2010

Background  Over the last decade Streptococcus pneumoniae has emerged as the most common bacterial pathogen for meningitis in all age groups, beyond the neonatal period.

Objective  To determine the epidemiological and clinical characteristics; and risk factors for mortality of pneumoccocal meningitis in children in a developing transitional country.

Materials and methods  A retrospective study that included patients <15 years of age admitted at the Instituto de Medicina Tropical of Paraguay, from January 1990 until December 2003 with the diagnosis of bacterial meningitis caused by S. pneumoniae. Clinical and laboratory data were collected and analysed in order to identify risk factors associated with morbidity and mortality outcomes of this infection.

Results  Seventy‐two patients (between the ages of 35 days and 14 years) were identified. Forty‐two per cent of patients had seizures prior to or at the time of admission, 36% were admitted in a comatose state, and 19% with shock. Mortality was 33% (24/72), and 18% of the survivors (11/60) developed severe sequelae. Upon admission, the following variables were strongly correlated with mortality: age <12 months (P = 0.007), the presence of seizures (P = 0.0001) or development of seizures 48 h after admission (P = 0.01), a cerebrospinal fluid (CSF) glucose level of <10 mg/dl (P = 0.01), CSF albumin >200 mg/dl (P = 0.0003), an absolute blood neutrophil count <2000/mm3 (P = 0.006) and a haemoglobin value of <9 g/dl (P = 0.0001).

Conclusions  This study confirms the high morbidity and mortality associated with S. pneumoniae meningitis in Paraguay. Certain clinical parameters and laboratory findings in blood and CSF at the time of admission could be used as predictors for mortality or severe sequelae among survivors.
A multi‐country cluster randomized controlled effectiveness evaluation to accelerate the introduction of Vi polysaccharide typhoid vaccine in developing countries in Asia: rationale and design
Authors: Acosta Camilo J. , Galindo Claudia M. , Ali Mohammad , Elyazeed Remon Abu , Leon Ochiai R. , Carolina Danovaro‐Holliday M. , Page Anne‐Laure , Thiem Vu Dinh , Jin Yang , Park Jin Kyung , Lee Hyejon , Puri Mahesh K. , Ivanoff Bernard , Agtini Magdarina D , Soeharno Rooswanti , Simanjuntak Cyrus H. , Punjabi Narain H. , Canh Do Gia , Sur Dipika , Nizami Qamaruddin , Manna Byomkesh , Bai‐qing Dong , Anh Dang Duc , Honghui Yang , Bhattacharya Sujit Kumar , Bhutta Zulfikar , Trach Dang Duc , Xu Zhi‐Yi , Pang Tikki , Donner Allan , Clemens John D.
Published: August 2010

Phase‐III vaccine efficacy trials typically employ individually randomized designs intended to ensure that measurements of vaccine protective efficacy reflect only direct vaccine effects. As a result, decisions about introducing newly licensed vaccines into public health programmes often fail to consider the substantially greater protection that may occur when a vaccine is deployed in public health programmes, due to the combination of direct plus indirect vaccine protective effects. Vaccine total protection can be better evaluated with cluster randomized trials. Such a design was considered to generate policy relevant data to accelerate the rationale introduction of the licensed typhoid fever Vi polysaccharide (PS) vaccine in Asia by the Diseases of the Most Impoverished (DOMI) typhoid fever programme. The DOMI's programme multi‐country study is one of the largest cluster randomized vaccine trials ever mounted in Asia, which includes approximately 200 000 individuals. Its main objective is to determine the effectiveness of a licensed Vi PS vaccine. The rationale and design of this study are discussed. Preliminary results are presented that determined the final planning of the trial before immunization. Important methodological and practical issues regarding vaccine cluster randomized designs are illustrated.
Factors associated with functional limitations and subsequent employment or schooling in Buruli ulcer patients
Authors: Stienstra Ymkje , van Roest Margijske H. G. , van Wezel Marieke J. , Wiersma Irene C. , Hospers Ilona C. , Dijkstra Pieter U. , Christian Johnson R. , Ampadu Edwin O. , Gbovi Jules , Zinsou Claude , Etuaful Samuel , Klutse Erasmus Y. , van der Graaf Winette T. A. , van der Werf Tjip S.
Published: August 2010

Objectives  To evaluate former Buruli ulcer disease (BUD) patients to assess the factors associated with functional limitations and subsequent employment or schooling.

Methods  The previously validated Buruli ulcer functional limitation score (BUFLS) questionnaire and interviews about educational and professional consequences incurred by BUD.

Results  Of 638 participants, 362 (57%) had a functional limitation after a median period of almost 4 years after treatment for BUD. A lesion on a joint, older age, female gender, a lesion on a distal part of an extremity and a persistent wound were found to be independent risk factors for stopping work or education. The same risk factors applied to the development of a functional limitation. Both functional limitations and financial difficulties due to BUD disease often led to job loss and school dropout.

Conclusions  Rehabilitation programmes are urgently needed to diminish the suffering from the functional limitations and employment or schooling problems caused by BUD.
Rapid diagnostic tests for dengue and leptospirosis: antibody detection is insensitive at presentation
Authors: Cohen Adam L. , Dowell Scott F. , Nisalak Ananda , Mammen Mammen P. , Petkanchanapong Wimol , Fisk Tamara L.
Published: August 2010

Objective  To determine the performance of rapid diagnostic tests for dengue and leptospirosis that rely on detecting antibodies that may not be produced when patients present for medical treatment.

Methods  We prospectively enrolled 723 patients with undifferentiated febrile illness presenting to rural hospitals in northern and northeastern Thailand over a 1‐year period. We evaluated rapid antibody detection diagnostic tests for dengue and leptospirosis on these patients.

Results  Sensitivity of the tests was low at the acute visit (7.6–21.5%). Sensitivity at the convalescent visit ranged from 25.8% to 81.5% and was significantly higher than at the acute visit for all tests (χ2, P < 0.001).

Conclusions  Low sensitivity of the rapid tests at presentation suggests that their utility in the acute phase of dengue and leptospirosis is limited.
A model to simulate the impact of timing, coverage and transmission intensity on the effectiveness of indoor residual spraying (IRS) for malaria control
Authors: Worrall E. , Connor S. J. , Thomson M. C.
Published: August 2010

Objective  (i) To develop a temperature‐ and rainfall‐driven model of malaria transmission capable of prediction. (ii) To use the model to examine the relationship between the intervention timing and transmission intensity on the effectiveness of indoor residual spraying (IRS).

Methods  A dynamic model of malaria transmission was developed from existing models of malaria transmission dynamics. The model was used to retrospectively predict actual malaria cases from Hwange district in Zimbabwe using actual meteorological and IRS timing and coverage data. Simulations of alternative intervention scenarios (timing and coverage) examined the effectiveness of earlier and later interventions, at higher and lower coverage levels in epidemic and non‐epidemic years.

Findings  The model was able to predict actual malaria cases in Hwange over a four‐and‐a‐half‐year period with a lead time of 4 months (e.g. January rainfall and temperature predicts April malaria) and a correlation coefficient of 0.825 (r2 = 0.6814). The IRS simulations show that the marginal benefits of increasing IRS coverage are higher in high‐transmission (HT) years relative to lower transmission years. This implies that over a period of years, maximum impact could be achieved with a given quantity of insecticide by increasing coverage in HT years. However, the model also shows that earlier spraying is more effective in all years, especially so in epidemic years, and that IRS has limited impact if it is carried out too late in relation to peak transmission.

Conclusion  Temperature‐ and rainfall‐driven models of malaria transmission have the potential to predict malaria epidemics. Early intervention based on prior knowledge of the magnitude of the malaria season can be more effective and efficient than carrying out routine activities every year. Malaria control planners need improved access to the technology that would allow them to better predict malaria epidemics and develop Malaria Early Warning Systems (MEWS). MEWS can then be linked to intervention planning to reduce the devastating impact of malaria epidemics on populations.
Vitamin A deficiency in a Kenyan prison
Authors: Mathenge Wanjiku , Kuper Hannah , Myatt Mark , Foster Allen , Gilbert Clare
Published: August 2010

Objective  To estimate the prevalence and causes of vitamin A deficiency disorders (VADD) in adult male prisoners in Nakuru, Kenya.

Methods  A total of 1048 male prisoners aged ≥16 years in Nakuru Government of Kenya prison in Nakuru, Kenya were examined by an ophthalmologist for signs of xerophthalmia. Two hundred and forty‐one cases with xerophthalmia and 448 controls randomly selected from the remaining prison population were interviewed about risk factors for xerophthalmia and blood samples were taken to measure serum retinol and haemoglobin.

Results  23.6% (95% CI = 21.1–26.3%) of examined inmates showed at least one sign of xerophthalmia, mostly night blindness (98.8% of cases). In the case–control study, the age‐adjusted analyses showed that xerophthalmia was associated with age, length of imprisonment and previous imprisonment. Men with xerophthalmia were significantly more likely be in poor health characterised by significant illness, recent hospital admission, persistent cough, diarrhoea, fever or chronic illness. After multivariate adjustment, duration of imprisonment remained strongly associated with xerophthalmia (OR comparing >4 years with <6 months = 20.1, 95% CI = 8.3–48.8). Previous imprisonment, fever, diarrhoea, hospital admission and chronic illness were also significant predictors. Serum retinol levels were significantly lower in cases than controls, while there was no difference in haemoglobin levels.

Conclusion  Vitamin A deficiency was a significant public health problem among these Kenyan male prisoners, indicating that it may be important in vulnerable groups other than young children and pregnant or lactating women.
HIV/AIDS and TB: contextual issues and policy choice in programme relationships
Authors: Wang Yan , Collins Charles , Vergis Mercy , Gerein Nancy , Macq Jean
Published: August 2010

Tuberculosis (TB) and HIV/AIDS affect each other closely. Given the rapid spread of the HIV‐driven TB epidemic worldwide, the case for establishing some form of relationship between control activities for HIV/AIDS and TB is clear. However, the question ‘how’ has not been resolved satisfactorily. TB and HIV/AIDS programmes have traditionally maintained their own management, supervision, funding flows and specialist boundaries. This article explores opportunities and challenges for collaboration between the two, through drawing on the expertise in organization and management, policy analysis and disease control of both TB and HIV/AIDS. Based on an extensive literature review, the article investigates how contextual issues affect the design of a collaboration; what the organizational options are; and what impact a collaboration would have. A universal model for organizational change is unlikely and changes may present as both solutions and contradictions. Careful planning and consultation are required before implementing the changes, in order to avoid jeopardizing the function and effectiveness of both disease control programmes and the health service system.
A randomized open study to assess the efficacy and tolerability of dihydroartemisinin–piperaquine for the treatment of uncomplicated falciparum malaria in Cambodia
Authors: Janssens B. , Van Herp M. , Goubert L. , Chan S. , Uong S. , Nong S. , Socheat D. , Brockman A. , Ashley E. A. , Van Damme W.
Published: August 2010

Objectives  To compare the efficacy and tolerability of dihydroartemisinin–piperaquine (DHA–PQP) with that of a 3‐day regimen of mefloquine and artesunate (MAS3) for the treatment of uncomplicated falciparum malaria in Cambodia.

Method  Randomized open‐label non‐inferiority study over 64 days.

Results  Four hundred and sixty‐four patients were included in the study. The polymerase chain reaction genotyping‐adjusted cure rates on day 63 were 97.5% (95% confidence interval, CI, 93.8–99.3) for DHA–PQP and 97.5% (95% CI, 93.8–99.3) for MAS3, P = 1. There were no serious adverse events, but significantly more episodes of vomiting (P = 0.03), dizziness (P = 0.002), palpitations (P = 0.04), and sleep disorders (P = 0.03) reported in the MAS3 treatment group, consistent with the side‐effect profile of mefloquine.

Conclusions  DHA–PQP was as efficacious as MAS3, but much better tolerated, making it more appropriate for use in a routine programme setting. This highly efficacious, safe and more affordable fixed‐dose combination could become the treatment of choice for Plasmodium falciparum malaria in Cambodia.
In vitro assessment of artesunate, artemether and amodiaquine susceptibility and molecular analysis of putative resistance‐associated mutations of Plasmodium falciparum from São Tomé and Príncipe
Authors: Ferreira Isabel D. , Lopes Dinora , Martinelli Axel , Ferreira Conceição , Do Rosário Virgílio E. , Cravo Pedro
Published: August 2010

Objective  To evaluate the basal in vitro responses of Plasmodium falciparum isolates collected in The Democratic Republic of São Tomé and Príncipe to artemether (ATH), artesunate (ATN) and amodiaquine (AMQ).

Methods  The prevalence of given single nucleotide polymorphisms in the pfmdr1, pfcrt, pftctp and pfATPase6 genes was assessed by PCR‐RFLP or DNA sequencing, and gene copy numbers were estimated by real‐time PCR.

Results  Mean IC50s to ATH and ATN were relatively low (1.12 nm and 0.58 nm, respectively). However, 10% of parasites displayed AMQ IC50 values above the accepted resistance threshold of 60 nm and there was a positive association between susceptibility to all three drugs (ATH vs. ATN: R = 0.84; ATH vs. AMQ: R = 0.68; ATN vs. AMQ: R = 0.72). Mutations in the pfcrt and pfmdr1 genes were highly prevalent, while only one synonymous polymorphism was detected in the pfATPase6 gene and no mutations were found in pftctp. All isolates harboured a single copy of the genes studied.

Conclusions  Artemisinin combination treatment in the São Tomé and Príncipe should be efficacious, although a significant number of AMQ‐resistant parasites were detected and the susceptibility to each drug was positively associated with that of the other two. Mutations in the pfcrt and pfmdr1 genes are near fixation, most likely because of high levels of chloroquine resistance, whereas only one protein type of the artemisinin resistance candidate, PfATPase6, was identified.
Temporal trends and epidemiological aspects of ciguatera in French Polynesia: a 10‐year analysis
Authors: Chateau‐Degat Marie‐Ludivine , Dewailly Eric , Cerf Nicole , Nguyen Ngoc Lam , Huin‐Blondey Marie‐Odile , Hubert Bruno , Laudon François , Chansin René
Published: August 2010

Objectives  The purpose of this study was to report the temporal trends of the incidence of ciguatera poisoning from 1992 to 2001 in French Polynesia.

Methods  This retrospective study analysed 7842 cases of ciguatera disease recorded over a period of 10 years.

Results  The annual incidence varied from 26.3 to 41.9 per 10 000 person‐years. An analysis of cases grouped by archipelago revealed differences in incidences (P < 0.0001) with the most remote archipelagos having the highest incidences. A detailed analysis on a sub‐sample of recorded cases for which clinical information was available (n = 1824) confirmed the neurological and gastrointestinal nature of this seafood poisoning.

Conclusion  The incidence of ciguatera poisoning appeared relatively stable during the 10 years of the study period. However, the gradient of remoteness observed suggests an adaptation of management of ciguatera disease to each archipelago.
Thiamin deficiency and uncomplicated falciparum malaria in Laos
Authors: Mayxay Mayfong , Taylor Ann M. , Khanthavong Maniphone , Keola Siamphay , Pongvongsa Tiengkham , Phompida Samlane , Phetsouvanh Rattanaxay , White Nicholas J. , Newton Paul N.
Published: August 2010

Objective  Thiamin deficiency complicates severe Plasmodium falciparum malaria in Thailand and may contribute to acidosis. We therefore estimated the frequency of biochemical thiamin deficiency in patients presenting with uncomplicated falciparum malaria in southern Laos.

Methods  Red cell transketolase activation coefficients (α) were measured in 310 patients presenting with uncomplicated falciparum malaria and 42 days after starting treatment.

Results  Twelve per cent of patients had biochemical evidence of severe deficiency (α values >1.31) at presentation, declining to 3% 42 days later.

Conclusion  Thiamin deficiency was common in Lao patients admitted with uncomplicated P. falciparum infection and was reduced following treatment of malaria and multivitamin supplementation. The role of this preventable and treatable disorder in malaria and other acute infections, and the incidence of beriberi in rural Laos, needs further investigation.
The role of communication between clients and health care providers: implications for adherence to malaria treatment in rural Gambia
Authors: Conteh Lesong , Stevens Warren , Wiseman Virginia
Published: August 2010

Objectives  One of the major barriers to the successful treatment of malaria is the non‐adherence to drug regimens. Work till now has often been based on the assumption that most patients begin their treatment having received adequate or at least similar instructions and information about both the disease itself and the content and course of their treatment. This paper questions such an assumption. We ask whether people do not adhere to treatment in part because they have not understood the diagnosis and subsequent treatment from the outset.

Methods  This study was conducted in the North Bank district of The Gambia, West Africa where a convenience sample of 1337 caretakers with children under 10 years of age were interviewed immediately after their consultation about their recommended treatment.

Results  Findings show a mismatch between caretakers and healthcare providers’ (HCP) interpretations of a child's clinic visit, both in terms of the diagnosis and drug regimen. Less than a third of the caretakers’ responses matched the diagnosis that the HCP had written on the child's medical card. Results also showed a delay in the first important antimalarial dose. A common response was ‘I'm not sure what is wrong with the child but I will start the medicine when I get home’.

Conclusions  The findings from these exit interviews lend weight to the argument that the value of pre‐packaged blisters could potentially provide far greater benefits than their additional cost, especially when coupled with improved communication by HCP.
Clinical features and associated morbidity of scabies in a rural community in Alagoas, Brazil
Authors: Jackson Anne , Heukelbach Jörg , Filho Arthur Ferreira da Silva , Campelo Júnior Evônio de Barros , Feldmeier Hermann
Published: August 2010

Objective  To describe the clinical characteristics of scabies and the associated morbidity in an impoverished rural community in northeast Brazil.

Method  A door‐to‐door survey was made to examine twice the population of an endemic area; first at the end of the rainy season, and a second time in the dry season 4 months later.

Results  In total, 2005 individuals were examined. The overall prevalence of scabies was 9.8% (95% CI 8.5–11.2). Predilection sites with similar relative frequencies in all age groups were the abdomen (83.7%) and the inguinal area/inner part of the thighs (66.3%). Hands, feet, genitals and the scalp/neck/face were significantly more often affected in children <7 years (all P < 0.03). Fifty‐five per cent of the patients showed scabies lesions simultaneously at ≥12 distinct topographic areas. Papular lesions were most commonly found, followed by papular‐crusted lesions. Vesicles were significantly more often observed in children (P = 0.04). Sixty‐four per cent of the patients had three or more types of lesions. Local lymphadenopathy was present in 53.6% and superinfection in 36.7% of the cases. The number of topographic areas affected, as well as the proportion of superinfected lesions, was inversely correlated with age (rho = −0.22, P = 0.002 and rho = −0.358, P < 0.05, respectively). The quantity of skin surface infested, the proportion of superinfected lesions and the presence of a superinfected lesion distal to an enlarged lymphnode were predictors of lymphadenopathy. Seventy‐two per cent of the patients suffered from sleep disorders, mainly because of itching.

Conclusion  Scabies is associated with considerable morbidity in this endemic community. Predilection sites, clinical presentation, quantity of skin surface affected and proportion of secondary infected lesions show a dichotomy between children and adults.
Are mosquitoes diverted from repellent‐using individuals to non‐users? Results of a field study in Bolivia
Authors: Moore S. J. , Davies C. R. , Hill N. , Cameron M. M.
Published: August 2010

Outside sub‐Saharan Africa, Anopheline mosquito exophagic and/or crepuscular behaviour patterns imply that insecticide‐treated nets may provide incomplete protection from malaria‐infective mosquito bites. Supplementary repellent treatment has been recommended in such circumstances, especially where vectors are exophilic and so are not susceptible to residual insecticide spraying. As maintaining complete usage of repellents in a community is unrealistic, the potential negative impact on non‐users of repellent usage by ‘neighbours’ in the same community needs to be addressed in the context of health policy promoting equity. This study quantifies diversion of host‐seeking mosquitoes, from repellent wearing to unprotected individuals, 1 m apart under field conditions in Bolivia. Each of the six volunteer‐pairs sat >20 m apart from other pairs. Volunteers were allocated di‐ethyl toluamide (DEET) or mineral oil in ethanol control. Treatments were rotated, so that during the trial, both pair‐members wore repellent on 72 occasions; both pair‐members wore control on 72 occasions; and on 36 occasions, one pair‐member wore repellent and the other control. Unprotected (control) pair‐members received 36.4% [95% confidence interval (CI): 8.1–72.0%] moreAnopheles darlingilandings (P = 0.0096) and 20.4% (95% CI: 0.6–44.0%) more mosquito landings (P = 0.044), when their ‘partner’ wore repellent than when their partner also wore control. A second, smaller Latin‐square trial using 30% lemongrass (Cymbopogon citratus) repellent, with control, obtained 26.0% (95% CI: 5.2–51.0%) more mosquito landings when controls sat with repellent‐wearers rather than other controls (P = 0.0159). With incomplete community repellent usage, non‐users could be put at an increased risk of malaria. The results also have implications for repellent‐efficacy assay design, as protection will appear magnified when mosquitoes are given a choice between repellent‐users and non‐users.
Molecular genotyping in a malaria treatment trial in Uganda – unexpected high rate of new infections within 2 weeks after treatment
Authors: Mugittu Kefas , Priotto Gerardo , Guthmann Jean‐Paul , Kiguli James , Adjuik Martin , Snounou Georges , Beck Hans‐Peter , Mshinda Hassan , Olliaro Piero L. , Taylor Walter R. J.
Published: August 2010

Polymerase chain reaction (PCR) genotyping of malaria parasites in drug efficacy trials helps differentiate reinfections from recrudescences. A combination therapy trial of one (n = 115) or three (n = 117) days artesunate (1AS, 3AS 4 mg/kg/day) plus sulphadoxine–pyrimethamine (SP) vs. SP alone (n = 153) was conducted in Mbarara, a mesoendemic area of western Uganda. All paired recurrent Plasmodium falciparum parasitaemias on days 7, 14, 21 and 28 post‐treatment were genotyped by PCR amplification and analysis of glutamate‐rich protein (glurp) and merozoite surface proteins (msp) 1 and 2 genes to distinguish recrudescent from new infections. A total of 156 (1AS = 61, 3AS = 35, SP alone = 60) of 199 paired recurrent samples were successfully analysed and were resolved as 79 recrudescences (1AS = 32, 3AS = 8, SP = 39) and 77 as new infections (1AS = 29, 3AS = 27, SP = 21). The ratios of proportions of new to recrudescent infections were 0.2, 0.9, 1.4 and 1.9 on days 7, 14, 21 and 28, respectively (P < 0.001, χ2 test for linear trend). Unexpected high new infection rates were observed early in follow‐up on days 7 [5/26 (19.2%)] and 14 [24/51 (47.1%)]. These results impact significantly on resistance monitoring and point to the value of genotyping all recurrent infections in antimalarial trials.
Social and environmental determinants of Aedes aegypti infestation in Central Havana: results of a case–control study nested in an integrated dengue surveillance programme in Cuba
Authors: Spiegel Jerry M. , Bonet Mariano , Ibarra Ana‐Maria , Pagliccia Nino , Ouellette Veronic , Yassi Annalee
Published: August 2010

Objective  To characterize the social and environmental risk factors associated with the presence of Aedes aegypti in order to improve community dengue control.

Methods  A case–control study with ‘cases’ being households with entomologically confirmed A. aegypti infestation; personal interviews in Central Havana, a densely populated inner city area characterized by overcrowded housing and irregular water service. The participants were residents of 278 houses with infestation and 556 houses without infestation.

Results  Greater risk of infestation was associated with lack of preventive measures, such as no larvicide in the water tanks (OR = 2.21) and use of flower vases for religious practice (1.93), not being economically active (1.64), vulnerable populations with higher risks in households with older people (1.52) and households with children (1.94).

Conclusions  Efforts to reduce infestations should continue to focus on water tank sanitation and improving housing conditions, but also engage community religious leaders to help promote safe practices. Vulnerable populations should be especially targeted by prevention activities. A surveillance programme can produce evidence to guide interventions.
Exposure to mixed asymptomatic infections with Trypanosoma cruzi, Leishmania braziliensis and Leishmania chagasi in the human population of the greater Amazon
Authors: Mendes Daniella G. , Lauria‐Pires Liana , Nitz Nadjar , Lozzi Silene P. , Nascimento Rubens J. , Monteiro Pedro S. , Rebelo Manuel M. , Rosa Ana de Cássia , Santana Jaime M. , Teixeira Antonio R. L.
Published: August 2010

Lack of conservation of the Amazon tropical rainforest has imposed severe threats to its human population living in newly settled villages, resulting in outbreaks of some infectious diseases. We conducted a seroepidemiological survey of 1100 inhabitants of 15 villages of Paço do Lumiar County, Brazil. Thirty‐five (3%) individuals had been exposed to Trypanosoma cruzi (Tc), 41 (4%) to Leishmania braziliensis (Lb) and 50 (4.5%) to Leishmania chagasi (Lc) infections. Also, 35 cases had antibodies that were cross‐reactive against the heterologous kinetoplastid antigens. Amongst these, the Western blot assays revealed that 11 (1%) had Tc and Lb, that seven (0.6%) had Lc and Tc, and that 17 (1.6%) had Lb and Lc infections. All of these cases of exposures to mixed infections with Leishmania sp, and eight of 11 cases of Tc and Lb were confirmed by specific PCR assays and Southern hybridizations. Two cases had triple infections. We consider these asymptomatic cases showing phenotype and genotype markers consistent with mixed infections by two or more kinetoplastid flagellates a high risk factor for association with Psychodidae and Triatominae vectors blood feeding and transmitting these protozoa infections. This is the first publication showing human exposure to mixed asymptomatic kinetoplastid infections in the Amazon.
Poorer health and nutritional outcomes in orphans and vulnerable young children not explained by greater exposure to extreme poverty in Zimbabwe
Authors: Watts Helen , Gregson Simon , Saito Suzue , Lopman Ben , Beasley Michael , Monasch Roeland
Published: August 2010

Objective  To describe patterns of association between different groups of young orphans and vulnerable children (OVC) and their nutritional and health outcomes; and to develop a theoretical framework to analyse the determinants of child malnutrition and ill‐health, and identify the different mechanisms which contribute to these outcomes in such children.

Methods  We developed and tested a theoretical framework to explain why orphans and vulnerable children experience more ill‐health and malnutrition based on statistical analysis of data on 31 672 children aged 0–17 years (6753 aged under 5 years) selected from the Zimbabwe OVC Baseline Survey 2004.

Results  28% of children aged 0–4 years at last birthday were either orphans or vulnerable children. They were more likely than non‐vulnerable children to have suffered recently from diarrhoeal illness (age‐ and sex–adjusted odds ratio, AOR, 1.27; 95% CI 1.09–1.48) and acute respiratory infection (1.27; 1.01–1.59) and to be stunted (1.24; 1.09–1.41) and underweight (1.18; 1.02–1.36). After further adjustment for exposure to extreme poverty, OVC remained at greater risk of diarrhoeal disease (AOR 1.25; 1.07–1.46) and chronic malnutrition (1.21; 1.07–1.38). In 0–17‐year‐olds, OVC with acute respiratory infection were more likely not to have received any treatment even after adjusting for poverty (AOR 1.29; 95% CI 1.16–1.43).

Conclusion  Differences in exposure to extreme poverty among young children by OVC status were relatively small and did not explain the greater malnutrition and ill‐health seen in OVC.
Delayed cord clamping and haemoglobin levels in infancy: a randomised controlled trial in term babies
Authors: Van Rheenen Patrick , De Moor Lette , Eschbach Sanne , De Grooth Hannah , Brabin Bernard
Published: August 2010

Objectives  This study was carried out to assess whether delaying umbilical cord clamping is effective in improving the haematological status of term infants living in a malaria‐endemic area, and whether this is associated with complications in infants and mothers.

Methods  We randomly assigned women delivering term babies in Mpongwe Mission Hospital, Zambia, to delayed cord clamping (DCC, n = 46) or immediate cord clamping (controls, n = 45) and followed their infants on a bi‐monthly basis until the age of 6 months. We compared the haemoglobin (Hb) change from cord values and the proportion of anaemic infants. Secondary outcomes related to infant and maternal safety.

Results  Throughout the observation period infant Hb levels in both groups declined, but more rapidly in controls than in the DCC group [difference in Hb change from baseline at 4 months 1.1 g/dl, 95% confidence interval (CI) 0.2; 2.1]. By 6 months, this difference had disappeared (0.0 g/dl, 95% CI −0.9; 0.8). The odds ratio for iron deficiency anaemia in the DCC group at 4 months was 0.3 (95% CI 0.1; 1.0), but no differences were found between the groups at 6 months. No adverse events were seen in infants and mothers.

Conclusion  Our findings indicate that DCC could help improve the haematological status of term infants living in a malaria‐endemic region at 4 months of age. However, the beneficial haematological effect disappeared by 6 months. This simple, free and safe delivery procedure might offer a strategy to reduce early infant anaemia risk, when other interventions are not yet feasible.