bluuebunny/crossref_metadata_2025 huggingface dataset:
Molecular analysis of chloroquine resistance in Plasmodium falciparum in Yunnan Province, China
Authors: Yang Zhaoqing , Zhang Zaixin , Sun Xiaodong , Wan Wenlin , Cui Long , Zhang Xiang , Zhong Daibin , Yan Guiyun , Cui Liwang
Published: August 2010

Resistance of Plasmodium falciparum to chloroquine (CQ) is determined by the mutation at K76T of the P. falciparum chloroquine resistance transporter (pfcrt) gene and modified by other mutations in this gene and in the P. falciparum multidrug resistance 1 (pfmdr1) gene. To determine the extent of polymorphisms in these genes in field P. falciparum isolates from Yunnan province of China, we genotyped the pfcrt codon 76, pfmdr1 codons 86 and 1246. Our results showed that although CQ has been withdrawn from treating falciparum malaria for over two decades, 90.3% of the parasites still carried the pfcrt K76T mutation. In contrast, mutations at pfmdr1 codons 86 and 1246 were rare. Sequencing analysis of the pfcrt gene in 34 parasite field isolates revealed CVIET at positions 72–76 as the major type, consistent with the theory of Southeast Asian origin of CQ resistance in the parasite. In addition, two novel pfcrt haplotypes (75D/144Y/220A and 75E/144Y/220A) were identified. Real‐time polymerase chain reaction was used to determine pfmdr1 gene amplification, which is associated with mefloquine resistance. Our result indicated that in agreement with that mefloquine has not been used in this area, most (>90%) of the parasites had one pfmdr1 copy. Genotyping at two hypervariable loci showed relatively low levels of genetic diversity of the parasite population. Meanwhile, 28.4% of cases were found to contain mixed clones, which favour genetic recombination. Furthermore, despite a unique history of antimalarial drugs in Yunnan, its geographical connections with three malarious countries facilitate gene flow among parasite populations and evolution of novel drug‐resistant genotypes. Therefore, continuous surveillance of drug resistance in this area is necessary for timely adjustment of local drug policies and more effective malaria control.
Preserving breastfeeding practice through the HIV pandemic
Authors: Coovadia H. M. , Bland R. M.
Published: August 2010

Breastfeeding, particularly for the first 6 months of life, is unquestionably the ideal way to feed most infants. However, the human immunodeficiency virus (HIV) pandemic has caused debate and confusion about the best way for HIV‐positive mothers to feed their children. This review provides recent key findings and opinions around making breastfeeding safer for HIV‐positive women, and argues for preservation of breastfeeding, as opposed to complete avoidance of breastfeeding for all HIV‐positive women.
Economic costs of epidemic malaria to households in rural Ethiopia
Authors: Deressa Wakgari , Hailemariam Damen , Ali Ahmed
Published: August 2010

Objective  To estimate the direct and indirect costs of malaria morbidity among communities in an epidemic area in rural Southcentral Ethiopia.

Methods  Community‐based cross‐sectional study of 2195 households in Adami Tulu district from October to November 2003. Treatment‐seeking behaviour, expenditure on treatment and transportation, interruption of normal activities, time lost from working and household expenditure on preventive methods were ascertained through interview.

Results  Of 12 225 surveyed individuals, 1748 (14.3%) reported perceived malaria during the preceding 2 weeks. 77.1% sought any form of care and 70% had recovered at the time of interview. The average treatment cost per patient at private clinics was Birr 24.00 ($2.76) and Birr 12.50 ($1.44) at public facilities. The average estimated direct cost of malaria per patient was Birr 14.00 ($1.60); the average indirect cost, Birr 35.26 ($4.08). Only 5% of all households reported any preventive expenditure in the preceding month, with a mean of Birr 0.76 ($0.09).

Conclusion  Malaria poses a significant economic burden on rural households and individuals both through out‐of‐pocket payment and person‐days lost. The promotion and implementation of insecticide‐treated nets would alleviate the economic consequences of the disease.
Viewpoint: A framework for decision‐making in integrated vector management to prevent disease
Authors: Van Den Berg Henk , Takken Willem
Published: August 2010

Integrated vector management (IVM) aims to extend the basis of disease control by involving other sectors and local communities in control action. It is vital that decisions on IVM are made locally for two reasons: first, the epidemiology of disease can vary at a small spatial scale, suggesting the need for precise targeting and second, a number of disease determinants relate to the actions and conditions of local communities, suggesting the need for their increased participation. This requires a shift from centrally managed, sector‐specific operations to the facilitation of multi‐partner programmes at the district and local level. We propose a methodology for involving local partners outside the health sector in describing and mapping the local determinants and conditions of disease, analysing control options, and consolidating a joint strategy of control. Thus determinants that often lie outside the domain of the health sector are tackled.
Short communication: Detecting depression after pregnancy: the validity of the K10 and K6 in Burkina Faso
Authors: Baggaley R. F. , Ganaba R. , Filippi V. , Kere M. , Marshall T. , Sombié I. , Storeng K. T. , Patel V.
Published: August 2010

Objective  The K10 and K6 are short rating scales designed to detect individuals at risk for depressive disorder, with or without anxiety. Despite being widely used, they have not yet been validated for detecting postnatal depression. We describe the validity of these scales for the detection of postnatal depression in Burkina Faso.

Method  The English language version of the K10 questionnaire was translated into West African French and local languages for use in Burkina Faso. Scores for 61 women were compared with the diagnostic interview made by a local psychiatrist within 3 days of administering the K10.

Results  Clinical assessment found that 27 (44%) women were probable cases of depression. Internal consistency of K10 and K6 scores, defined by Cronbach’s alpha coefficient, was 0.87 and 0.78, respectively, indicating satisfactory reliability. The performance of the scores was not significantly different, with areas under the curve of 0.77 and 0.75 for the K10 and K6, respectively. To estimate prevalence of depression, we suggest cut‐offs of ≥14 for the K10 and between ≥9 and ≥11 for the K6 for identifying women at high risk of depression. At ≥14, the K10 has 59% sensitivity, 91% specificity; at ≥10, the K6 has 59% sensitivity and 85% specificity.

Conclusion  This study suggests that K10 and K6 are reasonably valid measures of depression among postpartum women in Burkina Faso and can be used as relatively cheap tools for estimating prevalence of postnatal depression in developing countries.
A 84‐month follow up of adherence to HAART in a cohort of adult Senegalese patients
Authors: Etard Jean‐François , Lanièce Isabelle , Fall Mame Basty Koita , Cilote Vannina , Blazejewski Laure , Diop Karim , Desclaux Alice , Ecochard René , Ndoye Ibra , Delaporte Eric ,   ANRS 1215/1290 Study Group
Published: August 2010

Objectives  To assess long‐term adherence of the first HIV‐1 patients receiving highly active antiretroviral therapy (HAART) in Senegal, and to identify the main determinants of adherence.

Methods  The first 180 patients enrolled in the Senegalese HAART initiative between August 1998 and April 2001 followed up for at least 30 days were eligible. Adherence was assessed monthly at each drug dispensation between November 1999 and November 2006 by a pharmacist using a pill count completed by a questionnaire. Adherence was expressed as the proportion of tablets taken to prescribed tablets. An adherence of 95% was considered to be good. A random‐intercept logit model was fitted to identify the main determinants of adherence.

Results  Adherence data were available for 158 of 167 eligible patients. Twenty‐nine patients died during the study period and 10 were lost to follow‐up. Median treatment duration was 78 months, accruing to 6657 person‐months of observation. Overall, mean adherence reached 91% [median: 100%, interquartile range (IQR) 96‐100%] and adherence exceeded 95% in 78% [95% CI 77‐79%] of observations. After 4 years of treatment mean adherence stabilized around 90% and adherence 95% stabilized around 70%. Treatment duration and protease inhibitor (PI)‐based regimen (indinavir) had a negative effect on adherence, but adherence tended to improve with time for patients receiving a PI. Patient‐level variance was highly significant and accounted for a third of total variance.

Conclusions  This work demonstrates that good long‐term adherence can be achieved in the sub‐Saharan context given close monitoring and adherence support measures, confirms the worse adherence for indinavir and underlines the importance of patient heterogeneity.
Assessment of antigenic fractions of varying hydrophobicity from Taenia solium metacestodes for the diagnosis of human neurocysticercosis
Authors: Machado Gleyce Alves , Santiago Fernanda Maria , Mineo José Roberto , Costa‐Cruz Julia Maria
Published: August 2010

Objective  To evaluate the detergent and aqueous phases of crude saline extract (crude) of Taenia solium metacestodes extracted with Triton X‐114, for the detection of immunoglobulin G (IgG) antibodies by enzyme‐linked immunosorbent assay (ELISA) and immunoblot for the laboratory diagnosis of human neurocysticercosis.

Method  Serum samples were collected from 138 individuals and tested; 40 were diagnosed with neurocysticercosis (NC; group 1), 58 presented other parasitic diseases (group 2) and 40 were apparently healthy (group 3).

Results  The detergent phase showed only one dominant component (70–50 kDa), while the aqueous phase showed four (116, 110, 97 and 77 kDa) by silver staining. ELISA sensitivity and specificity were 92.5% and 84.5% for crude phase, 92.5% and 93.3% for detergent phase and 72.5% and 72.6% for aqueous phase.

Conclusions  The immunoblot of the antigens confirmed the results obtained by ELISA. Detergent phase purified from T. solium metacestodes was an important source of specific peptides and was efficient in detecting T. solium metacestodes antibodies in serum samples. This phase can be used for detecting IgG antibodies to T. solium metacestodes in seroepidemiological investigations and in the diagnostic screening of NC patients.
Epidemiology and clinical features of pneumonia according to radiographic findings in Gambian children
Authors: Enwere Godwin , Cheung Yin Bun , Zaman Syed M. A. , Akano Alieu , Oluwalana Claire , Brown Okoko , Vaughan Adeola , Adegbola Richard , Greenwood Brian , Cutts Felicity
Published: August 2010

Objective  To assess the effect of vaccines against pneumonia in Gambian children.

Methods  Data from a randomized, controlled trial of a 9‐valent pneumococcal conjugate vaccine (PCV) were used. Radiographic findings, interpreted using WHO definitions, were classified as primary end point pneumonia, ‘other infiltrates/abnormalities’ pneumonia and pneumonia with no abnormality. We calculated the incidence of the different types of radiological pneumonia, and compared clinical and laboratory features between these groups.

Results  Among children who did not receive PCV, the incidence of pneumonia with no radiographic abnormality was about twice that of ‘other infiltrates’ pneumonia and three times that of primary endpoint pneumonia. Most respiratory symptoms, reduced feeding and vomiting occurred most frequently in children with primary endpoint pneumonia. These children were more likely to be malnourished, to have bronchial breath sounds or invasive bacterial diseases, and to die within 28 days of consultation than children in the other groups. Conversely, a history of convulsion, diarrhoea or fast breathing, malaria parasitaemia and isolation of salmonellae were commoner in children with pneumonia with no radiographic abnormality. Lower chest wall indrawing and rhonchi on auscultation were seen most frequently in children with ‘other infiltrates/abnormalities’ pneumonia.

Conclusion  Primary endpoint pneumonia is strongly associated with bacterial aetiology and severe pneumonia. Since this category of pneumonia is significantly reduced after vaccination with Hib and pneumococcal vaccines, the risk‐benefit of antimicrobial prescription for clinical pneumonia for children with increased respiratory rate may warrant re‐examination once these vaccines are in widespread use.
Expanding access to voluntary HIV counselling and testing in sub‐Saharan Africa: alternative approaches for improving uptake, 2001–2007
Authors: Matovu Joseph K.B. , Makumbi Fredrick E.
Published: August 2010

The changing face of the HIV/AIDS epidemic has resulted in new opportunities to increase access to voluntary HIV counselling and testing (VCT), especially during the past 7 years (2001–2007). As access to HIV treatment becomes more widely available in sub‐Saharan Africa, the need for enhanced access to VCT would become even greater. When given the opportunity, many more adults in sub‐Saharan African would accept VCT, and many clearly express the desire to learn their HIV sero‐status. However, in most parts of sub‐Saharan Africa, fewer than one in 10 people know their HIV status. Stigma, fear of receiving an HIV‐positive status, lack of confidentiality, long distances to VCT sites, and long delays in returning HIV test results limit people’s access to traditional VCT systems. Alternative VCT delivery models, such as mobile VCT, routine offer of VCT and home‐based VCT increase access to and uptake of VCT. We recommend that these alternative models be implemented in more settings and on a much larger scale in sub‐Saharan Africa, where VCT uptake rates remain low.
Short communication: Patterns of chronic and acute diseases after natural disasters – a study from the International Committee of the Red Cross field hospital in Banda Aceh after the 2004 Indian Ocean tsunami
Authors: Guha‐Sapir Debarati , Van Panhuis Willem Gijsbert , Lagoutte Joel
Published: August 2010

Objective  To assess the pattern of diseases in a natural disaster, which are not necessarily a direct consequence of the event but can impact on the way health assistance is to be provided.

Methods  Cross‐sectional, record‐based study in the International Committee of the Red Cross field hospital in Aceh, Indonesia, established immediately after the tsunami in 2004. Patients who presented to hospital from January 15 to 31, and whose diagnoses were available, were included in the study.

Results  One thousand one hundred and eighty‐eight residents of Aceh participated. 43.5% of the diagnoses was chronic diseases. The odds of chronic vs. acute diseases increased by 16.4% per day up to January 23 [95% confidence interval (CI): 7.8–25.6%] and decreased thereafter by 13.1% (95% CI: 6.6–19.1%) per day. The odds of acute diseases were 34% lower among females than males (95% CI: 16–49%) and 4.3 times higher among children than the rest of the population (95% CI: 2.4–7.6). There were relatively few trauma cases among females and children.

Conclusions  Medical teams providing relief after acute disasters should be prepared to provide healthcare for chronic diseases too. A delay in the presentation of many acute conditions has implications for long‐term health consequences of disasters, such as disability.
How affordable are tuberculosis diagnosis and treatment in rural China? An analysis from community and tuberculosis patient perspectives
Authors: Liu Xiaoyun , Thomson Rachael , Gong Youlong , Zhao Fengzeng , Squire S. Bertel , Tolhurst Rachel , Zhao Xinping , Yan Fei , Tang Shenglan
Published: August 2010

Objectives  To assess equity in access to tuberculosis (TB) care by estimating and comparing the direct household costs perceived by community residents with actual costs experienced by TB patients and to identify the factors influencing the financial burden of TB patients.

Methods  Economic study in four provinces of China by means of a survey of 889 TB patients and 2560 community residents and in‐depth interviews with key informants.

Results  The direct household costs for using TB health services perceived by the communities were two to five times higher than the actual costs incurred by the TB patients. Patients had to pay a substantial proportion of their annual income for TB services (12–40%), despite the fact that smear‐positive and some severe smear‐negative patients received free drugs. Repeated outpatient visits before diagnosis, over‐prescription of drugs and prolonged treatments were common.

Conclusions  The heavy financial burden (both perceived and real) on these patients is one of the main reasons that some TB patients fail to access and complete treatment. Pressure to generate revenue through current incentives in health‐care financing and poor competence of health workers at the village and township levels cause delay and high expenses to TB patients and ultimately impede effective TB control in China.
Risk factors and consequences of congenital Chagas disease in Yacuiba, south Bolivia
Authors: Salas N. A. , Cot M. , Schneider D. , Mendoza B. , Santalla J. A. , Postigo J. , Chippaux J. P. , Brutus L.
Published: August 2010

Objective To determine the risk factors of congenital Chagas disease and the consequences of the disease in newborns.

Methods Study of 2712 pregnant women and 2742 newborns in Yacuiba, south Bolivia. Chagas infection was determined serologically in mothers and parasitologically in newborns. Consequences of congenital Chagas disease were assessed clinically.

Results The prevalence of Chagas disease in pregnant women was 42.2%. Congenital transmission was estimated at 6% of infected mothers leading to an incidence rate of 2.6% among newborns. Main risk factors of congenital transmission were mothers’ seropositivity and maternalTrypanosoma cruziparasitaemia. Parity was higher in infected than in non‐infected mothers, but it was not associated with the risk of congenital transmission. The rate of congenital infection was significantly higher in newborns from multiple pregnancies than in singletons. However, we did not observe statistically significant consequences of Chagas disease in newborns from single pregnancies or among twins.

Conclusions The main risk factors for congenital transmission were infection and parasitaemia of mothers. Consequences of the disease seemed mild in newborns from single pregnancies and perhaps more important in multiple births.
Malaria and anaemia among pregnant women at first antenatal clinic visit in Kisumu, western Kenya
Authors: Ouma Peter , Van Eijk Anna M. , Hamel Mary J. , Parise Monica , Ayisi John G. , Otieno Kephas , Kager Piet A. , Slutsker Laurence
Published: August 2010

Objective  To determine the prevalence of malaria and anaemia among urban and peri‐urban women attending their first antenatal clinic (ANC) in an area of perennial malaria transmission.

Methods  Between November 2003 and May 2004 we screened first ANC attenders for malaria and anaemia in a large urban hospital in Kisumu (western Kenya) and interviewed them to obtain demographic and medical information.

Results  Among the 685 study participants, prevalence of malaria parasitaemia was 18.0%, prevalence of any anaemia (haemoglobin < 11 g/dl) was 69.1% and prevalence of moderate anaemia was (haemoglobin < 8 g/dl) 11.8%. Sixteen women were hospitalized during pregnancy, eight because of malaria. In multivariate analysis, young age, living in a house with mud walls, a visit to rural area, peri‐urban residence, second trimester of pregnancy and Luo ethnicity were significant risk factors for malaria parasitaemia. Malaria was an important risk factor for any and moderate anaemia; use of an insecticide‐treated net (ITN) was a protective factor for any anaemia. Married women with a higher level of education, better‐quality housing and full‐time employment were more likely to use an ITN.

Conclusion  Malaria and anaemia are established problems by the time of the first ANC visit. Mechanisms to deliver ITNs to women of child‐bearing age before they become pregnant need to be explored. Early ANC visits are warranted in order for women to benefit from policies aimed at reducing the burden of malaria and anaemia.
Antimicrobial resistance surveillance among commensal Escherichia coli in rural and urban areas in Southern India
Authors: Mathai Elizabeth , Chandy Sujith , Thomas Kurien , Antoniswamy Belavendra , Joseph Inbakumar , Mathai Matthews , Sorensen Thomas L. , Holloway Kathleen
Published: August 2010

Objective  To assess antimicrobial resistance (AMR) in Tamil Nadu, India.

Methods  Data on AMR of commensal and uropathogenic Escherichia coli were collected from one urban (Christian Medical College Hospital, Vellore) and one rural (CMCH Rural Unit for Health and Social Affairs) centre in Tamil Nadu at monthly intervals for 1 year.

Results  Forty‐two per cent of commensal E. coli was resistant to one or more of the tested antimicrobials. 8.4% were resistant to three drugs commonly used for the treatment of urinary tract infections, namely ampicillin, co‐trimoxazole and nalidixic acid. 1.5% of isolates were resistant to nitrofurantoin. There was no significant difference between resistance rates in commensal E. coli collected in rural and urban areas. Resistance was more common in infecting than commensal strains.

Discussion  Resistance to most antimicrobials is high both in urban and rural areas. Higher resistance to antimicrobials used widely for the treatment suggests that drug use contributes to it. Hence unnecessary use of antimicrobials must be avoided. Surveillance among commensal E. coli can be used to monitor changes in AMR over time.
Epidemiology of meningococcal disease in southern Brazil from 1995 to 2003, and molecular characterization of Neisseria meningitidis using multilocus sequence typing
Authors: Baethgen L. F. , Weidlich L. , Moraes C. , Klein C. , Nunes L. S. , Cafrune P. I. , Lemos A. P. , Rios S. S. , Abreu M. F. , Kmetzsch C. , Sperb A. F. , Riley L. W. , Rossetti M. L. R. , Zaha A.
Published: August 2010

Objective  To describe the epidemiology of meningococcal disease (MD) in southern Brazil.

Methods  Retrospective cohort study among 2215 MD cases reported from 1995 to 2003 in Rio Grande do Sul (RS) State.

Results  The overall incidence fell by 50%; the case‐fatality rate during this period was 22%. Even so, the incidence of MD remained high after the epidemic period ended in 1999. Together, the age groups of 1–4 years and infants accounted for 54.1% of reported cases with incidences of 11.3/100 000 and 31.3/100 000, respectively; 69.8% of cases were caused by Neisseria meningitidis serogroup B, which increased significantly. There was a significant decrease in serogroup C cases in the whole period. The phenotypes B:4,7:P1.19,15, B:15:P1.7,16 and B:NT:P1.3 caused almost 50% of all serotyped cases. Fifty‐six isolates obtained from RS patients during the first non‐epidemic year 2000 plus 20 isolates from other southern Brazilian states (Santa Catarina and Paraná), Denmark and France were typed by multilocus sequence typing. Twenty sequence types (STs) were identified, eight of them found only in RS. ST‐33 (27%) and ST‐259 (18%) were the most frequent; both belong to the ST‐32/ET‐5 complex. ST‐259 cases showed a trend towards higher risk of fatal outcome. ST‐259 isolates were not detected among geographic controls or in other studies in Brazil.

Conclusion  Our data suggest that ST‐33 and ST‐259 clones and the emergence of the ST‐103 isolates contributed to the continued high incidence of MD in RS.
Ascertainment of childhood vaccination histories in northern Malawi
Authors: Jahn A. , Floyd S. , Mwinuka V. , Mwafilaso J. , Mwagomba D. , Mkisi R. E. , Katsulukuta A. , Khunga A. , Crampin A. C. , Branson K. , McGrath N. , Fine P. E. M.
Published: August 2010

Objective  To assess factors related to recorded vaccine uptake, which may confound the evaluation of vaccine impact.

Methods  Analysis of documented vaccination histories of children under 5 years and demographic and socio‐economic characteristics collected by a demographic surveillance system in Karonga District, Malawi. Associations between deviations from the standard vaccination schedule and characteristics that are likely to be associated with increased mortality were determined by multivariate logistic regression.

Results  Approximately 78% of children aged 6–23 months had a vaccination document, declining to <50% by 5 years of age. Living closer to an under‐5 clinic, having a better educated father, and both parents being alive were associated with having a vaccination document. For a small percentage of children, vaccination records were incomplete and/or faulty. Vaccination uptake was high overall, but delayed among children living further from the nearest under‐5 clinic or from poorer socio‐economic backgrounds. Approximately 9% of children had received their last dose of DPT with or after measles vaccine. These children were from relatively less educated parents, and were more likely to have been born outside the health services.

Conclusions  Though overall coverage in this community was high and variation in coverage according to child or parental characteristics small, there was strong evidence of more timely coverage among children from better socio‐economic conditions and among those who lived closer to health facilities. These factors are likely to be strong confounders in the association of vaccinations with mortality, and may offer an alternative explanation for the non‐specific mortality impact of vaccines described by other studies.
The role of context: neighbourhood characteristics strongly influence HIV risk in young women in Ndola, Zambia
Authors: Gabrysch Sabine , Edwards Tansy , Glynn Judith R. ,   for the Study Group on heterogeneity of HIV epidemics in African cities
Published: August 2010

Objectives  To examine the effect of neighbourhood socioeconomic factors on human immunodeficiency virus (HIV) prevalence in young women (aged 15–24 years) in Zambia.

Methods  Re‐analysis of a cross‐sectional, population‐based sero‐survey of nearly 2000 adults conducted in 1997/1998 in Ndola, Zambia. Neighbourhood‐level socioeconomic status (SES) was defined using the availability of running water and electricity in addition to educational, employment and occupational characteristics of adults older than 24 years. Neighbourhood‐level and individual‐level risk factors were analysed with a multivariate multilevel logistic regression model using a hierarchical conceptual framework.

Results  Young women living in neighbourhoods of lower or middle SES had higher HIV prevalences than those from higher SES neighbourhoods [lower SES: adjusted odds ratio (OR) 2.4, 95% confidence interval (CI) 1.3–4.5, middle SES: adjusted OR 2.4, 95% CI 1.3–4.7]. Young women living near a market were at increased risk of HIV infection (OR 2.9, 95% CI 1.4–5.9), while proximity to a health centre seemed protective (OR 0.4, 95% CI 0.2–1.0). When controlling for neighbourhood factors, better education was a risk factor for HIV infection (OR 1.5, 95% CI 1.0–2.1), although it was not significant in individual‐level analysis.

Conclusions  Community‐level factors are as important as individual‐level factors in determining HIV infection in young women. Confining analyses to individual‐level factors ignores the underlying causes and the modifying effect of context on individual behaviour and may even lead to different conclusions concerning the role of individual‐level factors.
Eflornithine is a cost‐effective alternative to melarsoprol for the treatment of second‐stage human West African trypanosomiasis in Caxito, Angola
Authors: Robays J. , Raguenaud M. E. , Josenando T. , Boelaert M.
Published: August 2010

Objective  To compare the cost‐effectiveness of eflornithine and melarsoprol in the treatment of human African trypanosomiasis.

Method  We used data from a Médecins Sans Frontières treatment project in Caxito, Angola to do a formal cost‐effectiveness analysis, comparing the efficiency of an eflornithine‐based approach with melarsoprol. Endpoints calculated were: cost per death avoided; incremental cost per additional life saved; cost per years of life lost (YLL) averted; incremental cost per YLL averted. Sensitivity analysis was done for all parameters for which uncertainty existed over the plausible range. We did an analysis with and without cost of trypanocidal drugs included.

Results  Effectiveness was 95.6% for melarsoprol and 98.7% for eflornithine. Cost/patient was 504.6 for melarsoprol and 552.3 for eflornithine, cost per life saved was 527.5 USD for melarsoprol and 559.8 USD for eflornithine without cost of trypanocidal drugs but it increases to 600.4 USD and 844.6 USD per patient saved and 627.6 USD and 856.1 USD per life saved when cost of trypanocidal drugs are included. Incremental cost‐effectiveness ratio is 1596 USD per additional life saved and 58 USD per additional life year saved in the baseline scenario without cost of trypanocidal drugs but it increases to 8169 USD per additional life saved and 299 USD per additional life year saved if costs of trypanocidal drugs are included.

Conclusion  Eflornithine saves more lives than melarsoprol, but melarsoprol is slightly more cost‐effective. Switching from melarsoprol to eflornithine can be considered as a cost‐effective option according to the WHO choice criteria.
Knockdown resistance mutations (kdr) and insecticide susceptibility to DDT and pyrethroids in Anopheles gambiae from Equatorial Guinea
Authors: Moreno M. , Vicente J. L. , Cano J. , Berzosa P. J. , De Lucio A. , Nzambo S. , Bobuakasi L. , Buatiche J. N. , Ondo M. , Micha F. , Do Rosario V. E. , Pinto J. , Benito A.
Published: August 2010

Objectives  To determine the frequency of knockdown resistance (kdr) mutations in the malaria vector Anopheles gambiae s.s. from continental Equatorial Guinea; and to relate kdr genotypes with susceptibility to DDT and pyrethroid insecticides in this vector.

Methods  Female mosquitoes were collected in two villages, Miyobo and Ngonamanga, of mainland Equatorial Guinea. Insecticide susceptibility tests were performed following WHO procedures. Anopheles gambiae complex specimens were identified to species and molecular form by PCR. Genotyping of the kdr locus was performed by allele‐specific PCR and direct sequencing in a subset of samples.

Results  Both M and S molecular forms of A. gambiae were found in Ngonamanga whereas only the S‐form was identified in Miyobo. The two kdr mutations were detected in S‐form samples of both villages, with a higher frequency of the kdr‐e (Leu‐1014‐Ser) allele (Miyobo: 16%; Ngonamanga: 40%). The kdr‐w (Leu‐1014‐Phe) mutation was also detected in 3% of the M‐form. All individuals tested for pyrethroids were susceptible. A mortality rate of 86% was obtained for DDT. An overall kdr allele frequency (i.e. kdr‐e + kdr‐w) of 22% was detected in DDT resistant individuals, whereas susceptible individuals had a kdr frequency of 6%.

Conclusion  The co‐occurrence of both kdr mutations and reduced susceptibility to DDT found in A. gambiae highlights the importance of implementing efficient surveillance of insecticide resistance in Equatorial Guinea.
Urban living and obesity: is it independent of its population and lifestyle characteristics?
Authors: Arambepola Carukshi , Allender Steven , Ekanayake Ruvan , Fernando Dulitha
Published: August 2010

Objectives  Living in an urban area influences obesity. However, little is known about whether this relationship is truly independent of, or merely mediated through, the demographic, socio‐economic and lifestyle characteristics of urban populations. We aimed to identify and quantify the magnitude of this relationship in a Sri Lankan population.

Methods  Cross‐sectional study of adults aged 20–64 years representing the urban (n = 770) and rural (n = 630) populations, in the district of Colombo in 2004. Obesity was measured as a continuous variable using body mass index (BMI). Demographic, socio‐economic and lifestyle factors were assessed. Gender‐specific multivariable regression models were developed to quantify the independent effect of urban/ rural living and other variables on increased BMI.

Results  The BMI (mean; 95% confidence interval) differed significantly between urban (men: 23.3; 22.8–23.8; women: 24.2; 23.7–24.7) and rural (men: 22.3; 21.9–22.7; women: 23.2; 22.7–23.7) sectors (P < 0.01). The observed association remained stable independently of all other variables in the regression models among both men (coefficient = 0.64) and women (coefficient = 0.95). These coefficients equated to 2.2 kg weight for the average man and 1.7 kg for the average woman. Other independent associations of BMI were with income (coefficient = 1.74), marital status (1.48), meal size (1.53) and religion (1.20) among men, and with age (0.87), marital status (2.25) and physical activity (0.96) among women.

Conclusions  Urban living is associated with obesity independently of most other demographic, socio‐economic and lifestyle characteristics of the population. Targeting urban populations may be useful for consideration when developing strategies to reduce the prevalence of obesity.
Dynamics of insecticide resistance in the malaria vector Anopheles gambiae s.l. from an area of extensive cotton cultivation in Northern Cameroon
Authors: Chouaïbou M. , Etang J. , Brévault T. , Nwane P. , Hinzoumbé C. K. , Mimpfoundi R. , Simard F.
Published: August 2010

Objective  To explore temporal variation in insecticide susceptibility of Anopheles gambiae s.l. populations to the four chemical groups of insecticides used in public health and agriculture, in close match with the large‐scale cotton spraying programme implemented in the cotton‐growing area of North Cameroon.

Methods  Mosquito larvae were collected in 2005 before (mid June), during (mid August) and at the end (early October) of the cotton spraying programme. Larvae were sampled in breeding sites located within the cotton fields in Gaschiga and Pitoa, and in Garoua, an urban cotton‐free area that served as a control. Insecticide susceptibility tests were carried out with 4% DDT (organochlorine), 0.4% chlorpyrifos methyl (organophosphate), 0.1% propoxur (carbamate), 0.05% deltamethrin and 0.75% permethrin (pyrethroids).

Results  Throughout the survey, An. gambiae s.l. populations were completely susceptible to carbamate and organophosphate, whereas a significant decrease of susceptibility to organochlorine and pyrethroids was observed during spraying in cotton‐growing areas. Tolerance to these insecticides was associated with a slight increase of knockdown times compared to the reference strain. Among survivor mosquitoes, the East and West African Kdr mutations were detected only in two specimens of An. gambiae s.s. (n = 45) and not in Anopheles arabiensis (n = 150), suggesting metabolic‐based resistance mechanisms.

Conclusions  Environmental disturbance due to the use of insecticides in agriculture may provide local mosquito populations with the enzymatic arsenal selecting tolerance to insecticides.
The neglected ‘m’ in MCH programmes – why mental health of mothers is important for child nutrition
Authors: Rahman Atif , Patel Vikram , Maselko Joanna , Kirkwood Betty
Published: August 2010

In most societies, mothers are the primary providers of nutrition and care to young children. This is a demanding task, and poor physical or mental health in mothers might be expected to have adverse consequences on their children’s health, nutrition and psychological well‐being. Child nutrition programmes do not adequately address maternal mental health. In this article, we consider the evidence from less developed countries on whether maternal mental health influences child growth, with respect to evidence from both observational studies and from clinical trials. We estimate how much of the burden of undernutrition might be averted in one setting, and propose that promoting maternal mental health and treating maternal mental illness offer important new opportunities to tackle the twin scourges of maternal ill‐health and child undernutrition.
High efficacy of two artemisinin‐based combinations (artemether–lumefantrine and artesunate plus amodiaquine) for acute uncomplicated malaria in Ibadan, Nigeria
Authors: Falade C. O. , Ogundele A. O. , Yusuf B. O. , Ademowo O. G. , Ladipo S. M.
Published: August 2010

Objective  To test the hypothesis that artesunate plus amodiaquine (ASAQ) is as effective as artemether–lumefantrine (AL) in the treatment of acute uncomplicated malaria in Nigerian children.

Methods  In an open label, randomized controlled clinical trial, children aged 6 months to 10 years were randomized to receive artesunate (4 mg/kg daily) plus amodiaquine (10 mg/kg daily) or AL (5–14 kg, one tablet; 15–24 kg, two tablets and 25–34 kg, three tablets twice daily). Both drug regimens were given for 3 days and follow‐up was for 28 days.

Results  A total of 132 children (66 in each group) were randomized to receive either ASAQ or AL. Day 28 cure rates in the per protocol (PP) population were 93% for ASAQ and 95% for AL (OR = 0.71, 95% CI = 0.12–3.99, ρ = 0.66). Using Kaplan–Meier product‐limit estimates of failure, the median survival time for ASAQ was 21 days and for AL 28 days (P = 0.294). PCR corrected day 28 cure rate for PP populations were 98.4% for ASAQ and 100% for AL. Both drugs were well‐tolerated.

Conclusion  ASAQ is as effective as AL and both combinations were efficacious and safe.
Invasive Haemophilus influenzae disease in children less than 5 years of age in Manhiça, a rural area of southern Mozambique
Authors: Roca Anna , Quintó Llorenç , Abacassamo Fatima , Morais Luis , Vallès Xavi , Espasa Mateu , Sigaúque Betuel , Sacarlal Jahit , Macete Eusebio , Nhacolo Ariel , Mandomando Inacio , Levine Myron M. , Alonso Pedro L.
Published: August 2010

Objective  To measure the disease burden and epidemiological characteristics of invasive Haemophilus influenzae in rural Mozambican children.

Methods  As part of the clinical management of children admitted to Manhiça District Hospital, blood and cerebrospinal fluid samples were collected between May 2001 and April 2005 for children aged <5 years. The level of antibiotic resistance of the isolates was analysed.

Results  During the surveillance period, there were 106 episodes of invasive H. influenzae disease. The estimated minimum incidence rate of invasive disease among children <5 years of age was 125/100 000 per child‐year‐at‐risk. Fifty‐six (59/106) per cent of cases were infants aged 3 to <12 months. Confirmed meningitis explained 16% of the episodes (n = 17) but was probably underestimated, as meningitis surveillance was not well implemented in the setting during the study. The case‐fatality‐rate was 21%, being highest among children with meningitis (odds ratio = 4.38, P = 0.011). Resistance to the antibiotics most commonly used in Mozambique was high – chloramphenicol 39%, ampicillin 35% and cotrimoxazol 74%– and had increased over the years (P < 0.001 for chloramphenicol).

Conclusion  Invasive H. influenzae disease is of considerable public health importance in Mozambique; implementing H. influenzae type b vaccination in sub‐Saharan Africa has the potential to increase child survival.
Cutaneous leishmaniasis in the Jordanian side of the Jordan Valley: severe under‐reporting and consequences on public health management
Authors: Mosleh Ibrahim M. , Geith Eid , Natsheh Lina , Abdul‐Dayem Muna , Abotteen Nabil
Published: August 2010

Objective  To test if cutaneous leishmaniasis (CL) is under‐reported in the Jordanian Mid Jordan Valley, with resultant serious consequences for drug supply.

Methods  For 2001–2003, prescribed amounts of drug and laboratory log‐books were investigated to estimate CL cases reported in Jordanian Mid Jordan Valley. From April 2004 to May 2005, passive detection and focused active ‘index case cluster’‐directed detection were used.

Results  An average of 75/100 000 cases per year was estimated to have occurred 2001–2003, resulting in under‐reporting by a factor of 47. In 2004/2005, 313/100 000 cases per year were passively detected. Active case‐finding detected additional cases.

Conclusion  Cutaneous leishmaniasis is severely under‐reported in Jordanian Mid Jordan Valley, which impacts its eradication.
Clonal heterogeneity of clinical isolates of vancomycin‐resistant Enterococcus faecium with unique vanS
Authors: Pourshafie Mohammad R. , Talebi Malihe , Saifi Mahnaz , Katouli Mohammad , Eshraghi Saeed , Kühn Inger , Möllby Roland
Published: August 2010

Objective  To examine the clonal diversity of vancomycin‐resistant enterococci (VRE).

Methods  A total of 900 clinical isolates of enterococci were obtained, and VRE isolates were subjected to antimicrobial susceptibility tests, biochemical fingerprinting with the PhPlate system (PhP), ribotyping and pulsed‐field gel electrophoresis (PFGE) typing.

Results  Forty‐nine of all enterococcal isolates were resistant to high levels of vancomycin (MIC ≥ 128) and identified as Enterococcus faecium. Biochemical fingerprinting with PhP showed that the VRE isolates were highly diverse (diversity index, Di = 0.93) and belonged to 24 PhP‐types. The VRE could be separated into 34 and 27 types with PFGE and ribotyping, giving diversity indices of 0.98 and 0.97, respectively. The PFGE method was more discriminatory than ribotyping and PhP system for E. faecium isolates. A combination of either of the two typing methods resulted in at least 44 types. Furthermore, sequencing analysis of vanS of Tn1546 showed one nucleotide mutation (C→A) at position 5727 in comparison with the prototype BM4147, which was found to be unique in all Iranian VRE isolates.

Conclusion  The isolated clinical VRE strains were highly diverse in Tehran.
Case–control study of risk factors associated with hepatitis C virus infection among pregnant women in hospitals of Karachi‐Pakistan
Authors: Khan Uzma R. , Janjua Naveed Z. , Akhtar Saeed , Hatcher Juanita
Published: August 2010

Objective  To identify risk factors for hepatitis C virus (HCV) infection among pregnant women seeking antenatal care in tertiary care hospitals of Karachi, Pakistan.

Methods  We enrolled 119 cases and 238 controls. Cases were enzyme‐linked immunosorbent assay (ELISA III) positive pregnant women for antibodies to HCV; controls were anti‐HCV ELISA negative pregnant women.

Results  The mean age of study subjects was 26 years (SD 5) ranging from 15 to 50 years. The mean number of pregnancies for cases was 4 (SD 3) and for controls was 3 (SD 2). Among cases an average number of injections in any month was 40%, history of hospitalization was 61% and household contact with jaundice or hepatitis was 35%. In the final multivariable logistic regression model, five or more gestations (aOR = 1.99; 95% CI = 1.08–3.33), ≥1 injection (aOR = 2.33; 95% CI = 1.38–3.91) per month, hospitalization (aOR = 1.78; 95% CI = 1.01–2.99) and household contact with jaundice/hepatitis (aOR = 3.32; 95% CI = 1.89–5.83) were independently associated with HCV.

Conclusion  Iatrogenic exposure (health care injections, hospitalizations and gestations) is the major risk factor for transmission of HCV among pregnant women.
Undertaking a complex evaluation of safe motherhood in rural Burkina Faso
Authors: Graham Wendy J. , Conombo S. Ghislaine , Zombré D. Sosthène , Meda Nicolas , Byass Peter , De Brouwere Vincent
Published: August 2010

Evaluations of composite health interventions, such as those attempting to make motherhood safer, are by definition complex, but nevertheless regarded as essential to informing progress in global health. This paper introduces a series of reports which set out the basis of Family Care International’s Skilled Care Initiative in rural Burkina Faso, go on to describe strategies and methods for evaluating it, and present evaluation findings in terms of pregnancy outcomes, utilisation and effects of the intervention and economics. Although there were encouraging findings, no ‘magic bullets’ emerged from these studies, illustrating the reality that sustained and increasing resources are needed to achieve safe motherhood for all. There is no cheap or short‐cut solution.
Methods for evaluating effectiveness and cost‐effectiveness of a Skilled Care Initiative in rural Burkina Faso
Authors: Hounton Sennen , Sombié Issiaka , Meda Nicolas , Bassane Brahima , Byass Peter , Stanton Cynthia , De Brouwere Vincent
Published: August 2010

Introduction  This paper aims to describe the design, methods and approaches used to assess the effectiveness and cost‐effectiveness of the Skilled Care Initiative in reducing pregnancy‐related and perinatal mortality in Ouargaye district, Burkina Faso.

Methods  The evaluation used a quasi‐experimental design, mixed methods and a composite of tools to compare mortality and severe morbidity (near‐miss) of women in reproductive age, perinatal mortality, facility functionality, perceived quality of care, utilisation of maternal health services, and costs borne by families and the health care system for maternal health care in Ouargaye and Diapaga districts. Structured questionnaires and interview guides were developed, pre‐tested and piloted prior to the main survey. The evaluation was carried out from January to July 2006. A household census was used to retrospectively assess pregnancy‐related and perinatal mortality over the previous 5 years, and causes of pregnancy‐related death were identified using a newly developed and tested probabilistic model for interpreting verbal autopsy data. Data were directly entered into Personal Digital Assistant devices at the point of interview. Analyses included univariate and multivariate regressions and incremental cost‐effectiveness ratios.

Results  A population census covering over half a million people, three qualitative surveys and facility surveys in 47 health centres have been carried out.

Conclusion  A partnership with key stakeholders and the use of mixed methods proved feasible for evaluating complex safe motherhood strategies, and the use of hand‐held computers proved possible for direct data capture, even in this remote rural environment.