bluuebunny/crossref_metadata_2025 huggingface dataset:
Antenatal clinic HIV data found to underestimate actual prevalence declines: evidence from Zambia
Authors: Michelo Charles , Sandøy Ingvild , Fylkesnes Knut
Published: August 2010

Objective  To determine to what extent antenatal clinic (ANC)‐based estimates reflect HIV prevalence trends among men and women in a high prevalence urban population.

Methods  Examination of data from serial population‐based HIV surveys in 1995 (n = 2115), 1999 (n = 1962) and 2003 (n = 2692), and ANC‐based surveillance in 1994 (n = 450), 1998 (n = 810) and 2002 (n = 786) in the same site in Lusaka, Zambia. The population‐based surveys recorded refusal rates between 6% and 10% during the three rounds.

Results  Among ANC attendees, prevalence declined by 20% (25.0% to 19.9%; P = 0.101) in the age group 15–24 years and was stable overall. In the general population, the prevalence declined by 49% (P < 0.001) and by 32% (P < 0.001) in age group 15–24 and 15–49, respectively. Among women only, HIV prevalence declined by 44% (22.5% to 12.5%; P < 0.001) and by 27% (29.6% to 21.7%; P < 0.001) in age group 15–24 and 15–49 years, respectively. In addition, prevalence substantially declined in higher educated women aged 15–24 years (20.7% to 8.5%, P < 0.001).

Conclusion  ANC‐based estimates substantially underestimated declines in HIV prevalence in the general population. This seemed to be partially explained by a combination of marked differentials in prevalence change by educational attainment and changes in fertility‐related behaviours among young women. These results have important implications for the interpretation of ANC‐based HIV estimates and underscore the importance of population‐based surveys.
Effects of grinding surgical tissue specimens and smear staining methods on Buruli ulcer microscopic diagnosis
Authors: Affolabi Dissou , Bankolé Honoré , Ablordey Anthony , Hounnouga Julie , Koutchakpo Pierre , Sopoh Ghislain , Aguiar Julia , Dossou Ange , Johnson Roch Christian , Anagonou Séverin , Portaels Françoise
Published: August 2010

To optimize Buruli ulcer (BU) microscopic diagnosis, we compared two smear preparation methods from tissue specimens: smears made with tissue suspension after grinding and smears made directly with unground tissue. We also compared two smear staining methods: auramine and Ziehl–Neelsen (ZN). IS 2404‐PCR was used as reference method. One hundred and thirty‐one surgical tissue specimens from patients suspected of having BU were analyzed. Both smear preparation methods and both staining methods were equivalent in any combination. Thus we recommend ZN stained smears of unground tissue for peripheral treatment centres.
Plasmodium falciparum from Pará state (Brazil) shows satisfactory in vitro response to artemisinin derivatives and absence of the S769N mutation in the SERCA‐type PfATPase6
Authors: Ferreira Isabel D. , Martinelli Axel , Rodrigues Louise A. , Do Carmo Ediclei L. , Do Rosário Virgílio E. , Póvoa Marinete M. , Cravo Pedro
Published: August 2010

Objective  To evaluate the in vitro efficacy of artesunate (ATN) and artemether (ATH) against Plasmodium falciparum isolates from the Brazilian Amazon state of Pará and to search for mutations and/or altered copy numbers in the putative resistance‐associated pfcrt, pfmdr1 and pfATPase6 genes.

Methods  In vitro efficacy of ATN and ATH was successfully measured in 56 freshly collected P. falciparum isolates, using a conventional WHO microtest with minor modifications. Single nucleotide polymorphisms (SNPs) in the same isolates were inspected using DNA sequencing and/or PCR‐RFLP. We used real‐time quantitative PCR to assess gene copy numbers.

Results  ATN and ATH geometric mean IC50s were 0.85 nm, 95% CI (0.55–1.15) and 3.0 nm, 95% CI (1.5–4.5), respectively. There was extremely limited diversity of pfcrt and pfmdr1 genotypes and three SNPs were identified in the pfATPase6 gene: one T to A synonymous mutation at nucleotide 2694 and two non‐synonymous (both G to A) mutations at nucleotides 110 and 1916, causing predicted aminoacid shifts of arginine to lysine and of glycine to aspartate, respectively. The previously reported S769N mutation was not detected in any of the isolates inspected. In addition, no gene amplifications were detected in a subset of eight isolates.

Conclusion  Artemisinin derivatives display satisfactory in vitro activity locally and the pfATPase6 gene is distinct from that reported in French Guiana, suggesting that those haplotypes have not been introduced regionally.
Effectiveness of malaria control during changing climate conditions in Eritrea, 1998–2003
Authors: Graves Patricia M. , Osgood Daniel E. , Thomson Madeleine C. , Sereke Kiros , Araia Afwerki , Zerom Mehari , Ceccato Pietro , Bell Michael , Corral John del , Ghebreselassie Shashu , Brantly Eugene P , Ghebremeskel Tewolde
Published: August 2010

Objective  To assess the effectiveness of impregnated mosquito nets, indoor residual spraying and larval control relative to the impacts of climate variability in the decline of malaria cases in Eritrea.

Methods  Monthly data on clinical malaria cases by subzoba (district) in three zobas (zones) of Eritrea for 1998–2003 were used in Poisson regression models to determine whether there is statistical evidence for reduction in cases by DDT, malathion, impregnated nets and larval control used over the period, while analysing the effects of satellite‐derived climate variables in the same geographic areas.

Results  Both indoor residual spraying (with DDT or malathion) and impregnated nets were independently and significantly negatively associated with reduction in cases, as was larval control in one zoba. Malaria cases were significantly positively related to differences in current and previous months’ vegetation (NDVI) anomalies. The relationship to rainfall differences 2 and 3 months previously was also significant, but the direction of the effect varied by zoba. Standardized regression coefficients indicated a greater effect of climate in the zoba with less intense malaria transmission.

Conclusion  The results support the view that both indoor residual spraying and impregnated nets have been independently effective against malaria, and that larval control was also effective in one area. Thus climate, while significant, is not the only explanation for the recent decline in malaria cases in Eritrea. If appropriate statistical approaches are used, routine surveillance data from cases attending health facilities can be useful for assessing control programme success and providing estimates of the effectiveness of individual control measures. Effectiveness estimates suitable for use in cost‐effectiveness analysis have been obtained.
Future prevalence of WHO grade 2 impairment in relation to incidence trends in leprosy: an exploration
Authors: Meima Abraham , Van Veen Natasja H. J. , Richardus Jan H.
Published: August 2010

Objectives  To explore the relationship between leprosy incidence trends and the future prevalence of World Health Organization (WHO) grade 2 impairment caused by leprosy.

Methods  Three scenarios were defined to estimate incidences and prevalences of leprosy impairment beyond 2000, assuming 6%, 12% and 18% annual declines in case detection rate respectively, and 6% impairment among new patients. Case detection data from 1985 to 2000 were used for projecting leprosy incidences up to 2020. To estimate future prevalences of WHO grade 2 impairment, the survival of existing and new impaired individuals was calculated.

Results  In the 6% scenario, 410 000 new patients will be detected in 2010 and 250 000 in 2020. The number of people living with WHO grade 2 impairment in these years will be 1.3 and 1.1 million, respectively. The 12% scenario predicts that 210 000 new patients will be detected in 2010 and 70 000 in 2020. The grade 2 prevalences will be 1.2 and 0.9 million, respectively. In the 18% scenario, the incidence will be 110 000 in 2010 and 20 000 in 2020, and the grade 2 prevalences will be 1.1 and 0.8 million, respectively.

Conclusions  Declines in numbers of people living with grade 2 impairment lag behind trends in leprosy incidence. The prevalence of people with grade 2 decreases much slower than leprosy incidence and case detection in all three scenarios. This implies that a substantial number of people will live with impairment and will need support, training in self‐care and other prevention of disability interventions in the next decades.
Sleeping sickness in West Africa (1906–2006): changes in spatial repartition and lessons from the past
Authors: Courtin F. , Jamonneau V. , Duvallet G. , Garcia A. , Coulibaly B. , Doumenge J. P. , Cuny G. , Solano P.
Published: August 2010

Objective  To review the geography and history of sleeping sickness (Human African trypanosomiasis; HAT) over the past 100 years in West Africa, to identify priority areas for sleeping sickness surveillance and areas where HAT no longer seems active.

Method  History and geography of HAT were summarized based on a review of old reports and recent publications and on recent results obtained from medical surveys conducted in West Africa up to 2006.

Results/conclusions  Active HAT foci seem to have moved from the North to the South. Endemic HAT presently appears to be limited to areas where annual rainfall exceeds 1200 mm, although the reasons for this remain unknown. There has also been a shift towards the south of the isohyets and of the northern distribution limit of tsetse. Currently, the most severely affected countries are Guinea and Ivory Coast, whereas the northern countries seem less affected. However, many parts of West Africa still lack information on HAT and remain to be investigated. Of particular interest are the consequences of the recent political crisis in Ivory Coast and the resulting massive population movements, given the possible consequences on HAT in neighbouring countries.
Setting up a national reference laboratory for Buruli ulcer: the case of Benin
Authors: Affolabi Dissou , Tanimomo‐Kledjo Blanche , Anyo Gladys , Johnson Roch C. , Anagonou Séverin Y. , Portaels Françoise
Published: August 2010

Objective  To report the experience of Benin, where Buruli ulcer (BU) is endemic, in the implementation of diagnostic laboratory services.

Methods and results  There has been a gradual introduction of biologic diagnostic activities for BU comprising (1) training of a laboratory technician in a highly experienced reference laboratory; (2) acquiring indispensable laboratory start‐up materials; (3) progressive development of diagnostic laboratory activities; (4) regular external quality assessment with an experienced reference laboratory and (5) decentralization of activities to various clinical diagnostic and treatment centres for BU in Benin.

Conclusion  Setting up a reference laboratory for BU is a continuous process, which necessitates motivated personnel and the cooperation of an experienced external reference laboratory.
End‐user errors in applying two malaria rapid diagnostic tests in a remote area of Sudan
Authors: Seidahmed Osama M.E. , Mohamedein Muneir M.N. , Elsir Afrah A. , Ali Fayez T. , Malik El Fatih M. , Ahmed Eldirdieri S.
Published: August 2010

We assessed end‐user practice for numerous procedural steps of two types of RDTs: Core Malaria Pf™ (the cassette format) and OptiMAL IT™ (the dipstick format). Two types of errors occurred: generic errors common to both types of test and specific errors caused by the test design and manufacturer’s instructions. End‐user errors were more frequent with OptiMAL IT™ than Core Pf™ tests. To improve malaria diagnosis with rapid tests, users require training and better manufacturer’s instructions that take into account local conditions.
Antibiotic use and health‐seeking behaviour in an underprivileged area of Perú
Authors: Kristiansson C. , Reilly M. , Gotuzzo E. , Rodriguez H. , Bartoloni A. , Thorson A. , Falkenberg T. , Bartalesi F. , Tomson G. , Larsson M.
Published: August 2010

Objective  To describe the health‐seeking behaviour and use of antibiotics in the urban community of Yurimaguas in the Amazonian area of Peru.

Method  Cross‐sectional survey of caregivers of 798 children aged 6–72 months by interview using a semi‐structured questionnaire. Reported symptoms were classified as illnesses where antibiotics would or would not be recommended based on principles of the integrated management of childhood illnesses algorithm.

Results  Forty‐one per cent of consultations were with health care professionals; 71% of antibiotics were obtained through the formal public health sector and prescribed mainly by medical doctors. All prescribed antibiotics were on the Peruvian essential drugs list. When prescribing, doctors and nurses hardly discriminated between illnesses where antibiotic treatment was or was not indicated; there was no significant difference in antibiotic prescribing rates between the two (doctors, P = 0.24; nurses, P = 0.32). Not all caregivers sought help for children with severe symptoms.

Conclusion  Although most of the antibiotics were prescribed by doctors and nurses, they were commonly prescribed for illnesses where they were not indicated. The use of antibiotics needs to be rationalized, and barriers to health care must be overcome.
Age patterns in undernutrition and helminth infection in a rural area of Brazil: associations with ascariasis and hookworm
Authors: Jardim‐Botelho Anne , Brooker Simon , Geiger Stefan Michael , Fleming Fiona , Souza Lopes Aline Cristine , Diemert David Joseph , Corrêa‐Oliveira Rodrigo , Bethony Jeffrey Michael
Published: August 2010

Objective To investigate the nutritional status of individuals from a rural area of Brazil, and associations with helminth infections in an age‐stratified sample.

Method A total of 1113 individuals aged from 6 months to 83 years from the rural community of Americaninhas in Minas Gerais were investigated. Assessments comprised anthropometric measurements of weight, height and body composition, examining faecal samples for helminth eggs, and peripheral blood assays for albumin, haemoglobin and ferritin concentrations.

Results Ten percent of the participants were underweight, 12.8% were overweight and 28.3% of the children and adolescents were stunted. 11.6% had low lean body mass and 28.8% had low fat body mass. Hypoalbuminaemia was seen in 5.5%, anaemia in 12.5% and iron deficiency in 13.1%, although the prevalence of these two indices increased with age. Multivariate analysis showed that, after controlling for age, sex and socio‐economic status, stunting was significantly associated withAscaris lumbricoidesinfection among children and adolescents, whereas low body mass was significantly associated with hookworm infection among adults and the elderly.

Conclusions Helminth infections are associated with undernutrition in endemic populations, with important differences between the effects of hookworm andA. lumbricoideson age‐related nutritional status.
The use of artemether‐lumefantrine by febrile children following national implementation of a revised drug policy in Kenya
Authors: Gitonga Caroline W. , Amin Abdinasir A. , Ajanga Antony , Kangwana Beth B. , Noor Abdisalan M. , Snow Robert W.
Published: August 2010

Objectives  To examine access to, timing and use of artemisinin‐based combination therapy among rural Kenyan febrile children before and following the introduction of artemether‐lumefantrine (AL) as first‐line antimalarial drug policy.

Methods  In August 2006, a cohort was established within 72 rural clusters in four sentinel districts to monitor the period prevalence of fever and treatment in children aged 0–4 years through four repeat cross‐sectional surveys (one prior to introduction of AL and three post‐AL introduction: January–June 2007). Mothers/guardians of children were asked about fever in the last 14 days and related treatment actions including the timing, drugs used, dosing and adherence supported by visual aids of commonly available drug products.

Results  A total of 2526 child‐observations were recorded during the four survey rounds. The period prevalence of fever was between 20% and 26% with little variation between survey rounds. The overall proportion of children with fever receiving antimalarial drugs for their fever was 31 % (95% CI, 26–36%) and the proportion of febrile children receiving antimalarial drugs within 48 h was 23.3% (95% CI, 18.6–28.0%). The proportion of febrile children who received first‐line recommended AL within 48 h was 10.2% (95% CI, 7.0–13.4%), compared to only 4.6% (95% CI, 3.8–5.4%) of children receiving sulphadoxine‐pyrimethamine first‐line therapy in 2001.

Conclusions  Although Kenya was less than a year into the new policy implementation and AL is restricted to the public formal sector, access to antimalarial drugs among children within 48 h and to the first‐line therapy has improved. But it remains well below national and international targets. The continued use of amodiaquine and artemisinin monotherapies constrains effective implementation of artemisinin‐based combination therapy policy in Kenya.
Detection and modelling of case clusters for urban leptospirosis
Authors: Tassinari Wagner S. , Pellegrini Debora C. P. , Sá Claudio B. P. , Reis Renato B. , Ko Albert I. , Carvalho Marilia S.
Published: August 2010

Objective  To analyse the epidemiological profile of 488 cases of leptospirosis in Rio de Janeiro, Brazil between 1997 and 2002, using a variety of methods of spatial epidemiology, to establish alert guidelines in general hospitals, which might be a tool to improve diagnosis and treatment of leptospirosis to reduce lethality rates.

Methods  Scan statistics identified six space–time clusters, which comprised a range of 2 to 28 cases per cluster. Generalized linear mixed models were used to evaluate risk factors for a cluster case which incorporated individual characteristics and spatial information on environmental and climactic factors in a single model frame.

Results  Cluster case events were associated with heavy rainfall (OR 3.71; 95% CI 1.83–7.51). The model did not identify socioeconomic or environmental covariates that significantly influence the risk of developing a cluster rather than non‐cluster case.

Conclusion  Clustering of leptospirosis in this urban setting appears to be due to transmission during heavy rainfall.
Typhoid fever in children in Africa
Authors: Mweu Evanson , English Mike
Published: August 2010

Estimates for the year 2000 suggested that there were approximately 21.5 million infections and 200,000 deaths from typhoid fever globally each year, making the disease one of the most serious infectious disease threats to public health on a global scale. However, these estimates were based on little data, especially from Africa. Global prominence and high‐profile outbreaks have created the perception in Kenya that typhoid is a common cause of febrile illness. The Widal test is used widely in diagnosis. We have reviewed recent literature, taking the perspective of a healthcare provider, to collate information on the prevalence of typhoid in children particularly, and to explore the role of clinical diagnosis and diagnosis based on a crude, but common, interpretation of the Widal test. Data suggest that typhoid in children in rural Africa is uncommon, perhaps 100 times or 250 times less common than invasive disease because of Haemophilus influenzae or Streptococcus pneumoniae, respectively. Frequent use of the Widal test may result in many hundreds of over‐treatment episodes for every true case treated and may perpetuate the perception that typhoid is common. Countries such as Kenya need better bacterial disease surveillance systems allied to better information for healthcare providers to promote appropriate decision‐making on prevention and treatment strategies.
Desiccated vector mosquitoes used for the surveillance of Japanese encephalitis virus activity in endemic southern India
Authors: Tewari S. C. , Thenmozhi V. , Arunachalam N. , Philip Samuel P. , Tyagi B. K.
Published: August 2010

To monitor Japanese encephalitis virus (JEV) activity in endemic areas of Tamil Nadu, southern India, desiccated vector mosquitoes were screened for JEV antigen using ELISA, from 1996. A total of 133 233 specimens from eight index villages comprising 2816 pools (mainly Culex vishnui subgroup) were tested. Of these, 59 pools (2.1%) were positive for JEV antigen. Control measures were undertaken in positive villages accordingly. The average annual minimum infection rate was 0.8 at the beginning of the study and remained lower for nearly 8 years. A declining trend in JE cases was recorded.
Effectiveness of interventions for the prevention of HIV and other sexually transmitted infections in female sex workers in resource poor setting: a systematic review
Authors: Shahmanesh Maryam , Patel Vikram , Mabey David , Cowan Frances
Published: August 2010

Objective  To systematically review the evidence for effectiveness of HIV and sexually transmitted infection (STI) prevention interventions in female sex workers in resource poor settings.

Method  Published and unpublished studies were identified through electronic databases (Cochrane database, Medline, Embase, and Web of Science), hand searching and contacting experts. Randomized‐controlled‐trials and quasi‐experimental studies were included if they were conducted in female sex workers from low and middle income settings; if the exposure was described; if the outcome was externally measurable, it was after the discovery of HIV, and if follow‐up was longer than 6 months. A priori criteria were used to extract data. Meta‐analysis was not performed due to the heterogeneity of studies.

Results  Twenty‐eight interventions were included. Despite methodological limitations, the evidence suggested that combining sexual risk reduction, condom promotion and improved access to STI treatment reduces HIV and STI acquisition in sex workers receiving the intervention. Strong evidence that regular STI screening or periodic treatment of STIs confers additional protection against HIV was lacking. It appears that structural interventions, policy change or empowerment of sex workers, reduce the prevalence of STIs and HIV.

Conclusion  Rigorous evaluation of HIV/STI prevention interventions in sex workers is challenging. There is some evidence for the efficacy of multi‐component interventions, and/or structural interventions. The effect of these interventions on the wider population has rarely been evaluated.
Timing of default from tuberculosis treatment: a systematic review
Authors: Kruk Margaret E. , Schwalbe Nina R. , Aguiar Christine A.
Published: August 2010

Objectives  To provide a systematic assessment of the timing of default from tuberculosis (TB) treatment which could help to quantify the potential contribution of new shorter duration TB drugs to global TB control.

Methods  We performed a systematic review following QUOROM guidelines. MEDLINE was searched from 1998 to the present using the terms TB and default or drop‐out or compliance or adherence and therapy. A total of 840 articles were returned. A further detailed manual review selected 15 randomized trials and observational studies that reported timing of drop‐out and focused on developing countries.

Results  The selected studies comprised randomized controlled trials, retrospective record reviews, and qualitative assessments and spanned 10 countries. Both directly observed treatment (DOT) and non‐DOT programs were represented. Thus results were highly heterogeneous and not statistically aggregated. Data suggest, but do not conclude, that the majority of defaulters across the studies completed the 2‐month intensive phase of treatment.

Conclusions  There is insufficient high‐quality comparable information on the timing of default from TB treatment to permit any firm conclusions on trends in default. However, a substantial proportion of defaulters appear to leave treatment in the later stages of the current 6‐month regimen, suggesting that new TB chemotherapeutic agents which can reduce the length of treatment have the potential to improve global TB treatment success rates.
Age and gender effects in self‐reported urinary schistosomiasis in Tanzania
Authors: Clements Archie C. A. , Barnett Adrian G. , Nyandindi Ursuline , Lwambo Nicholas J. S. , Kihamia Charles M. , Blair Lynsey
Published: August 2010

Objectives  To characterize age–gender prevalence profiles of urinary schistosomiasis according to the questionnaire responses, compare the profiles to field survey data from selected regions, and determine if the profiles varied spatially throughout Tanzania.

Methods  In 2004, a national school‐based questionnaire survey for self‐reported schistosomiasis and blood in urine (BIU) was conducted in all regions of mainland Tanzania, to assist targeted mass distribution of praziquantel. Field survey data were collected in six north‐western and five coastal regions using microscopic examination of urine samples for the presence of Schistosoma haematobium eggs and assessment of micro‐haematuria with chemical reagent strips. Bayesian logistic regression models were created to calculate age–gender profiles adjusted for demographic and ecological covariates and spatial correlation in the questionnaire data. Separate odds ratios (OR) for age–gender effects were calculated in each administrative area.

Results  Data were obtained from > 2.5 million schoolchildren. Boys had higher prevalence of self‐reported schistosomiasis and BIU than girls. In boys, prevalence according to the questionnaire and field surveys followed similar age profiles. However, in girls, prevalence according to the field surveys increased in older age groups, but flattened out or decreased according to the questionnaire, indicating the latter underestimated prevalence in older girls. In the models, little spatial correlation was evident in the OR for the age–gender effects, suggesting that these did not vary spatially.

Conclusion  Age–gender patterns of urinary schistosomiasis were consistent in different geographical areas of Tanzania. Because the questionnaire underestimated prevalence in older girls, we propose that upward calibration of observed prevalence is done for older females only.
Randomized controlled trial to investigate impact of site‐based safer sex programmes in Kingston, Jamaica: trial design, methods and baseline findings
Authors: Weir S. S. , Figueroa J. P. , Byfield L. , Hall A. , Cummings S. , Suchindran C.
Published: August 2010

Objective  To describe the design, methods and baseline findings of a multi‐level prevention intervention to increase consistent condom use among persons at public social sites in Kingston, Jamaica, who have new or concurrent sexual partnerships.

Methods  A two‐arm randomized controlled trial (RCT) of 147 sites where persons meet new sex partners. Sites were identified by community informants as places where people meet new sexual partners, which include bars, street locations, bus stops, malls and others. Sites were sorted into 50 clusters based on geographic proximity and type of site and randomized to receive a multi‐level site‐based intervention or not. Intervention components include on‐site HIV testing, condom promotion and peer education. Effectiveness of the intervention will be measured by comparing the proportion of persons with new or multiple partners in the past year who report recent inconsistent condom use at intervention vs. control sites.

Results  Baseline surveys were conducted at 66 intervention (711 men, 845 women) and 65 control sites (654 men, 738 women). Characteristics of intervention and control sites as well as the characteristics of patrons at these sites were similar. The outcome variable was balanced with approximately 30% of men and 25% of women at intervention and control sites reporting a new partner or more than one partner in the past year and recent inconsistent condom use.

Conclusions  The baseline findings confirm that the population is an appropriate target group for HIV prevention and that randomization will provide the means to estimate programme effectiveness.
Noble goals, unforeseen consequences: control of tropical diseases in colonial Central Africa and the iatrogenic transmission of blood‐borne viruses
Authors: Pépin Jacques , Labbé Annie‐Claude
Published: August 2010

Background  In southern Cameroon, 40–50% of individuals born before 1945 have antibodies against hepatitis C virus (HCV), suggesting massive iatrogenic transmission of at least one blood‐borne virus in the region of the world where SIVcpz emerged into HIV‐1.

Objective  To estimate the potential role of disease control programs that used intravenous (IV) drugs in the transmission of blood‐borne viruses, especially HCV.

Methods  We reviewed, for 1921–1959, records of health services in Cameroun, Oubangui‐Chari, Gabon and Moyen‐Congo. We calculated the incidence of diseases whose treatment required the administration of IV drugs, and compared these with previously published data on HCV prevalence.

Results  Several IV drugs were used against African trypanosomiasis, leprosy, yaws and syphilis. However, yaws was the only disease whose incidence was high enough so that up to half of some birth cohorts could have acquired HCV. Yaws incidence varied dramatically between regions, and was often >200 per 1000 per year in southern Cameroon, where extremely high HCV prevalence was found. Yaws incidence peaked between 1935 and 1955, a period which coincided with the emergence of HCV and HIV.

Conclusion  Age, geographical and temporal distributions of yaws suggest that the HCV epidemic in Cameroon was driven by campaigns against yaws (and, secondarily, syphilis) using arsenicals and other metallic drugs. The same interventions may have exponentially amplified other blood‐borne viruses, including SIVcpz/HIV‐1.
Helicobacter pylori isolates recovered from gastric biopsies of patients with gastro‐duodenal pathologies in Cameroon: current status of antibiogram
Authors: Ndip Roland N. , Malange Takang Alertia E. , Ojongokpoko Juliet E. A. , Luma Henry N. , Malongue Agnes , Akoachere Jane‐Francis T. K. , Ndip Lucy M. , MacMillan Martin , Weaver Lawrence T.
Published: August 2010

Objective  To determine the prevalence of Helicobacter pylori in patients with gastro‐duodenal pathologies and the susceptibility patterns of isolates to the currently recommended antibiotic treatment regimen used in Cameroon.

Methods  Consecutive dyspeptic patients referred to Douala General Hospital, Cameroon for endoscopy were recruited in the study. Gastric biopsies were collected from the patients and H. pylori isolated and identified following standard microbiology and biochemical techniques. Antibiotic susceptibility was determined by disk diffusion and agar dilution methods against clarithromycin, tetracycline, amoxicillin and metronidazole. Data were analysed using chi‐square test and significance considered at P < 0.05.

Results  Seventy‐one (92.2%) of the 77 patients (mean age 44.5 ± 15.7, range 15–77 years) were positive for H. pylori. The antibiotic susceptibility rates were 56% for tetracycline, 55.3% for clarithromycin, 14.4% for amoxicillin and 6.8% for metronidazole. The prevalence of clarithromycin resistance in males vs. females was 42.1%vs. 46.7%, while for metronidazole it was 89.5%vs. 94.7% (P > 0.05). Antimicrobial susceptibility results also revealed 12 antibiotypes based on resistance to the antimicrobial agents investigated. The resistance pattern, amoxicillin and metronidazole (AMRR METR) was the most common (23.7%) amongst the isolates. More than 60% of the isolates exhibited multi‐drug resistance to three or four antibiotics.

Conclusion  Multi‐drug resistance is common against the current treatment regimen in Cameroon and, therefore, calls for urgent studies involving newer and broad spectrum antibiotics to address the problem.
Who develops severe malaria? Impact of access to healthcare, socio‐economic and environmental factors on children in Yemen: a case‐control study
Authors: Al‐Taiar Abdullah , Jaffar Shabbar , Assabri Ali , Al‐Habori Molham , Azazy Ahmed , Al‐Gabri Arwa , Al‐Ganadi Mohammed , Attal Bothaina , Whitty Christopher J. M.
Published: August 2010

Objective  To investigate the impact of socio‐economic and environmental factors on developing severe malaria in comparison with mild malaria in Yemen.

Method  Case‐control study comparing 343 children aged 6 months to 10 years diagnosed with WHO‐defined severe malaria (cases) at the main children’s hospital in Taiz and 445 children with mild malaria (controls) diagnosed in the health centres, which serve the areas where the cases came from.

Results  In univariate analysis, age <1 year, distance from health centre, delay to treatment and driving time to health centre were associated with progression from mild to severe malaria. In multivariate analysis, distance to nearest health centre >2 km was significantly associated with progression to severe disease. Environmental and vector control factors associated with protection from acquiring malaria (such as sleeping under bednets) were not associated with protection from moving from mild to severe disease.

Conclusions  Innovative ways to improve access to antimalarial treatment for those living more then 2 km away from health centres such as home management of malaria, especially for infants and young children, should be explored in malaria‐endemic areas of Yemen.
Integrating research into routine service delivery in an antiretroviral treatment programme: lessons learnt from a cluster randomized trial comparing strategies of HIV care in Jinja, Uganda
Authors: Jaffar Shabbar , Amuron Barbara , Birungi Josephine , Namara Geoffrey , Nabiryo Christine , Coutinho Alex , Grosskurth Heiner
Published: August 2010

Trials integrated into normal health service delivery are designed to evaluate the effectiveness of interventions under real‐life conditions. However, integrating research into service delivery creates many operational challenges and raises ethical dilemmas. Here we discuss the operational and ethical issues arising from such trials using the example of a cluster randomized trial evaluating two strategies of ART delivery in Jinja, south‐east Uganda.
Associations among handwashing indicators, wealth, and symptoms of childhood respiratory illness in urban Bangladesh
Authors: Luby Stephen P. , Halder Amal K.
Published: August 2010

Objectives  To explore the relationship of easy to collect handwashing indicators with socioeconomic status and reported respiratory disease among children <5 years of age.

Methods  We added several handwashing indicators to a population‐based, cross‐sectional study of respiratory illness in Dhaka, Bangladesh. We constructed a wealth index using 12 household characteristics analysed with principal component analysis to assess socioeconomic status.

Results  Of 6970 households, 92% had a bar of body soap, 41% had a place with water to wash hands inside the house, and 40% had soap present at the most convenient place to wash hands. Handwashing indicators were more common among households with higher socioeconomic status. Within each wealth quintile a place to wash hands within the household was strongly associated with the presence of soap at the handwashing location (odds ratios 13–70). In general estimated equation models that controlled for socioeconomic status, the presence of a place inside the house with water to wash hands was the only handwashing indicator significantly associated with a child in the household who reported cough or difficulty breathing in the preceding 7 days (adjusted odds ratio 0.95, 95% confidence interval 0.93–0.98, P < 0.001).

Conclusion  Handwashing indicators were strongly influenced by socio‐economic status and so would not be an independent measure of handwashing behaviour. Handwashing promotion efforts in urban Dhaka that include specific efforts to provide handwashing facilities inside the house are more likely to improve handwashing behaviour than interventions that ignore this component.
Direct data capture using hand‐held computers in rural Burkina Faso: experiences, benefits and lessons learnt
Authors: Byass Peter , Hounton Sennen , Ouédraogo Moctar , Somé Henri , Diallo Ibrahima , Fottrell Edward , Emmelin Axel , Meda Nicolas
Published: August 2010

Objectives  To assess our experiences of using hand‐held computers (personal digital assistants, PDAs) for direct data capture in a large community‐based geo‐referenced survey in rural Burkina Faso, highlighting benefits and lessons learnt from their use.

Methods  A population‐based geo‐referenced survey of over 500 000 people was undertaken using PDAs with in‐built GPS receivers and the resulting database analysed in terms of successful completion, error rates and interview durations.

Results  Surveys were successfully completed for 84 861 households (98.3%) by 127 interviewers. The data input error rate was assessed at 0.24%, with more than half of the errors being made by less than 10% of the interviewers. Faster interviewers were not less accurate. Time‐stamped and geo‐referenced data allowed reconstruction of particular interviewer‐day activities.

Conclusions  Although the survey setting was challenging, the feasibility of using direct data capture on a large scale was well established. We learnt that, with more experience, we could have made better use of real‐time entry and quality control checking procedures. The work involved in designing and setting up a complex survey on PDAs prior to data collection should not be underestimated.
From evaluating a Skilled Care Initiative in rural Burkina Faso to policy implications for safe motherhood in Africa
Authors: Meda Nicolas , Hounton Sennen , De Brouwere Vincent , Sombié Issiaka , Byass Peter ,   on behalf of the IMMPACT Burkina Evaluation Study Group
Published: August 2010

Evaluation findings from a particular setting need to be generalized into policy implications if they are to find widespread use. Skilled attendance at delivery is widely regarded as one of the most important intervention strategies for safe motherhood in low‐resource settings, particularly in Africa, but implementations of such strategies are often not rigorously evaluated or interpreted into future policy. Initiative for Maternal Mortality Programme Assessment (Immpact) has applied a package of research‐based monitoring and evaluation tools to assess the Family Care International Skilled Care Initiative in Ouargaye District, Burkina Faso. This evaluation research aimed to generate reliable, evidence‐based policies for accelerating safe motherhood programmes in Burkina Faso and elsewhere in Africa. Five policy priorities were identified as representing real chances of improving the safety of motherhood: (1) enhancing national coverage of delivery by professionally skilled attendants; (2) to provide a network of 24‐h basic emergency obstetric care within 5 km; (3) to have an effective referral system, equipped and resourced to undertake a reasonable number of Caesarean sections; (4) to promote community mobilization activities as a lever to increasing delivery care utilization; and (5) to implement strategies to remove financial barriers to delivery care. To meet Millennium Development Goal five by 2015, both supply and demand side constraints on the provision of quality maternity care have to be addressed, which in turn need greater political commitment and funding.
Barriers to access to antiretroviral treatment in developing countries: a review
Authors: Posse Mariana , Meheus Filip , Van Asten Henri , Van Der Ven Andre , Baltussen Rob
Published: August 2010

Objective  To present a review of barriers impeding people living with HIV/AIDS in developing countries from accessing treatment, and to make recommendations for further studies.

Methods  Electronic databases, websites of main global agencies and international AIDS conferences were searched for relevant articles published between 1996 and 2007. Articles were reviewed using the Andersen and May framework of access to health services and barriers were categorized as either population‐level or health system‐level barriers.

Results  A total of 19 studies (7 articles and 12 abstracts) in English were reviewed. The barriers most frequently cited at the population level were lack of information about antiretroviral therapy (ART), perceived high costs for ART and stigma. Barriers most frequently cited at the health system level were long distance from home to the health facility, lack of co‐ordination across services and limited involvement of the community in the programme planning process.

Conclusions  Dissemination of information about HIV/AIDS and alternative related care, and alternative health financing policies seem to be the most relevant policy measures to remove barriers. In view of the paucity of evidence on barriers to access to ART, research should address the relative importance of barriers, include a mix of qualitative and quantitative research methods and evaluate barriers in different settings.
Factors associated with increased risk of progression to respiratory syncytial virus‐associated pneumonia in young Kenyan children*
Authors: Okiro Emelda A. , Ngama Mwanajuma , Bett Ann , Cane Patricia A. , Medley Graham F. , James Nokes D.
Published: August 2010

Objectives  To identify factors associated with developing severe respiratory syncytial virus (RSV) pneumonia and their commonality with all‐cause lower respiratory tract infection (LRTI), in order to isolate those risk factors specifically associated with RSV‐LRTI and identify targets for control.

Methods  A birth cohort of rural Kenyan children was intensively monitored for acute respiratory infection (ARI) over three RSV epidemics. RSV was diagnosed by immunofluorescence of nasal washings collected at each ARI episode. Cox regression was used to determine the relative risk of disease for a range of co‐factors.

Results  A total of 469 children provided 937 years of follow‐up, and experienced 857 all‐cause LRTI, 362 RSV‐ARI and 92 RSV‐LRTI episodes. Factors associated with RSV‐LRTI, but not RSV‐ARI, were severe stunting (z‐score ≤−2, RR 1.7 95%CI 1.1–2.8), crowding (increased number of children, RR 2.6, 1.0–6.5) and number of siblings under 6 years (RR 2.0, 1.2–3.4). Moderate and severe stunting (z‐score ≤−1), crowding and a sibling aged over 5 years sleeping in the same room as the index child were associated with increased risk of all‐cause LRTI, whereas higher educational level of the primary caretaker was associated with protection.

Conclusion  We identify factors related to host nutritional status (stunting) and contact intensity (crowding, siblings) which are distinguishable in their association with RSV severe disease in infant and young child. These factors are broadly in common with those associated with all‐cause LRTI. The results support targeted strategies for prevention.
Long‐lasting insecticidal nets fail at household level to reduce abundance of sandfly vector Phlebotomus argentipes in treated houses in Bihar (India)
Authors: Dinesh Diwakar S. , Das Pradeep , Picado Albert , Davies Clive , Speybroeck Niko , Ostyn Bart , Boelaert Marleen , Coosemans Marc
Published: August 2010

Objective  To determine whether the use of long‐lasting insecticidal nets (LLINS) at household level are effective in reducing the abundance of Phlebotomus argentipes, vector of anthroponotic visceral leishmaniasis in India, Nepal and Bangladesh.

Methods  The impact of two long‐lasting nets (Olyset and PermaNet) on indoor sandfly abundance was evaluated in selected houses of three endemic hamlets in Bihar (India). It was assumed that most sandflies breed inside the houses and that LLINs would progressively reduce the indoor density during the reproduction season. A campaign of indoor spraying with dichloro‐diphenyl‐trichloroethane (DDT) interfered with the trial but did not affect the sandfly population.

Results  Only the density of males of P. argentipes was significantly reduced by both the LLINs but not the females.

Conclusions  These findings suggest that most female sandflies are coming from outside and that LLINs do not reduce their entry rate.
Signs and symptoms associated with Heterobasidion annosum and Armillaria ostoyae infection in dead and dying mountain pine (Pinus mugo ssp. uncinata)
Authors: Bendel M. , Rigling D.
Published: August 2010

Symptoms and signs associated with root rot caused by Heterobasidion annosum or Armillaria ostoyae in mountain pines (Pinus mugo ssp. uncinata) were investigated in the Swiss Alps. A sample of dying or recently dead mountain pine trees (≥12 cm d.b.h.) and saplings (<1.3 m height) was assessed for root pathogen infection by taking root samples followed by isolations in the laboratory. From a subsample, an additional core was taken from the butt of each tree and evaluated in the same fashion. A total of 157 dying or recently dead mountain pine trees and 184 saplings with roots infected by either of the two pathogens or which lacked infection were analyzed using logistic regression models. The main objectives were to determine the most prominent symptoms induced by the fungi (resinosis), signs of the fungi (mycelia, fruiting bodies and rhizomorphs), and tree characteristics (d.b.h./height and evidence of wounds) that would allow an easy and reliable determination of H. annosum and/or A. ostoyae infection of mountain pines in the field. Heterobasidion annosum caused both root and butt rot on mountain pine, whereas A. ostoyae was mostly restricted to the root systems of the trees sampled. The most discriminating sign for the presence of A. ostoyae infection was the presence of characteristic mycelial fans, and for H. annosum root rot the presence of H. annosum mycelia (sheets of paper‐thin mycelium and mycelial pustules). In addition, resinosis was a powerful predictor for A. ostoyae in trees. Symptoms and signs indicating A. ostoyae or H. annosum infections were more reliable for saplings than for mature trees. Armillaria rhizomorphs were not useful in detecting A. ostoyae infection and, if present, were often formed by saprophytic Armillaria species. Heterobasidion annosum fruiting bodies were rarely observed and poorly reflected the widespread occurrence of this pathogen in the mountain pine forests.
Urea Transfer in Ruminants
Authors: E.Borhami B. , Farid M. , Ahmed M. H. , El‐Shazly K. , Naga M. A.
Published: August 2010

Harnstoffumsatz bei Wiederkäuern 2. Harnstoffumsatz bei Schafen unter semi‐ariden Haltungsbedingungen

Erwachsene Barki‐Schafe mit Pansenfisteln erhielten eine Diät mit niedrigem Proteinge‐halt. Die Reation bestand aus Gerstenkleie, Alexandrinerklee‐Heu und Weizenstroh.

Die Schafe wurden 2 verschiedenen Behandlungen unterworfen. Bei der ersten wurde den Tieren vor der Fütterung Wasser gegeben, bei der zweiten erhielten die Tiere nur an jedem 3. Tag Wasser. 7 — 9 mg bzw. 15—18 mg Harnstoff‐N wurden dann direkt in den Pansen infundiert oder es wurden 15—18 mg Harnstoff‐N intravenös injeziert. Die Infusion wurde 12 Stunden nach der Fütterung begonnen und dauerte 10 Stunden. Die Ver‐suchsdauer betrug bei getränkten Tieren 12 Tage und bei Wasserentzug 15 Tage.

Aus den Ergebnissen geht hervor, daß eine intraruminale Harnstoffinfusion den NH3‐N‐Gehalt im Pansen wesentlich erhöht.

Die intravenöse Harnstoffinfusion hatte keine Einwirkung auf den NH3‐N‐Gehalt im Pansen. Wasserentzug erhöht den NH3‐Gehalt im Pansen signifikant.

Wasserentzug führte zu einem deutlich höheren Plasmaharnstoffgehalt als Wasserzu‐gabe. Bei getränkten Schafen betrug der berechnete Harnstoffrückfluß in den Pansen 2,86 g Harnstoff‐N pro Tag gegenüber 0,95 g bei Wasserentzug.

Die Stickstoffbilanz war bei den getränkten Schafen negativ, bei Wasserentzug positiv, nach Harnstoffinfusion positiv.

Die Ausscheidung von Harnstoff über den Harn stieg sowohl bei intraruminaler als auch bei intravenöser Harnstoffinfusion und zwar bei Wasserentzug stärker als bei getränkten Tieren.
Serum sickness following streptokinase
Authors: BANHAM NEIL D G
Published: August 2010

A case of serum sickness following the administration of streptokinase is presented. This has not previously been reported in Australia.

It typically presents, as in this case, seven to 10 days after administration of streptokinase, with a vasculitic rash and arthritis and resolves spontaneously over about a week with conservative management.

Corticosteroids have been advocated for more severe cases.

Mild cases may occur and go unrecognised because of the delayed onset and infrequency of this condition.