bluuebunny/crossref_metadata_2025 huggingface dataset:
Endogenous reactivation and true treatment failure as causes of recurrent tuberculosis in a high incidence setting with a low HIV infection
Authors: Shamputa Isdore Chola , Deun Armand Van , Salim Md Abdul Hamid , Hossain Md Anwar , Fissette Krista , Rijk Pim de , Rigouts Leen , Portaels Françoise
Published: August 2010

Objective  To determine the relative frequencies of reinfection vs. reactivation or treatment failure in patients from a high tuberculosis incidence setting with a low prevalence of HIV infection.

Method  We performed DNA fingerprinting on serial isolates from one and multiple TB episodes from 97 retreatment patients; 35 patients had been previously cured, whereas 62 had not.

Results  DNA fingerprinting patterns of recurrence Mycobacterium tuberculosis isolates of 5 of the 35 previously cured patients did not match with those of the corresponding initial isolates, indicating reinfection. We did not document reinfection during treatment. Isolates from each of the remaining 30 previously cured patients had identical DNA fingerprinting results, indicating reactivation. DNA fingerprinting patterns of isolates from the 62 patients with persistently positive sputum smears were identical, suggesting treatment failure.

Conclusion  These findings suggest that reinfection is not a common cause of relapse and treatment failure in this rural predominantly HIV‐free population despite the high incidence of TB.
Risk factors for Schistosoma mansoni and hookworm in urban farming communities in western Côte d'Ivoire
Authors: Matthys Barbara , Tschannen Andres B. , Tian‐Bi Norbert T. , Comoé Hermann , Diabaté Salia , Traoré Mahamadou , Vounatsou Penelope , Raso Giovanna , Gosoniu Laura , Tanner Marcel , Cissé Gueladio , N'Goran Eliézer K. , Utzinger Jürg
Published: August 2010

Objectives  To identify risk factors for Schistosoma mansoni and hookworm infections in urban farming communities, and to investigate small‐scale spatial patterns of infection prevalence.

Methods  A cross‐sectional survey was carried out in 113 farming households (586 individuals) and 21 non‐farming households (130 individuals) from six agricultural zones in the town of Man, western Côte d'Ivoire. Heads of households were interviewed on common agricultural activities, land and water use, education attainment, socioeconomic status and sanitation facilities. Household members provided stool specimens that were processed by the Kato‐Katz technique and a formol‐ether concentration method and diagnosed for S. mansoni, hookworms and other soil‐transmitted helminths and intestinal protozoa. Bayesian statistics were employed for spatial analyses.

Results  The prevalences of S. mansoni and hookworm in farming households were 51.4% and 24.7%, respectively. Risk factors for a S. mansoni infection comprised living in close proximity to the Kô River, water contact with irrigation wells and ponds and low education attainment. Living in zones of smallholder irrigated rice plots or large rice perimeters, using water from domestic wells, and low socioeconomic status were risk factors for a hookworm infection. We found significant spatial heterogeneity between agricultural zones, with the highest infection prevalences of S. mansoni and hookworm in the zone where there was a large rice perimeter.

Conclusions  In this urban setting, both S. mansoni and hookworm infections were related to specific agricultural activities. Health education and active participation of urban farmers for the control of schistosomiasis and soil‐transmitted helminthiasis is recommended.
Microgeographical and tribal variations in water contact and Schistosoma mansoni exposure within a Ugandan fishing community
Authors: De Moira Angela Pinot , Fulford Anthony J. C. , Kabatereine Narcis B. , Kazibwe Francis , Ouma John H. , Dunne David W. , Booth Mark
Published: August 2010

Objective  To explore patterns of water contact and Schistosoma mansoni exposure by age, sex, tribe and space within a single village.

Methods  For 10 months, we systematically observed water contacts made by the 800 inhabitants of a small Ugandan fishing village. In order to estimate cercarial exposure, times spent in water were weighted by snail infection levels, time of day and degree of immersion.

Results  There were marked differences in water contact patterns between the two main tribes, which inhabited geographically distinct ends of the village resulting in geographically distinct spatial patterns of water contact. The distributions of the intermediate hosts, Biomphalaria sudanica and Biomphalaria stanleyi, also appeared to differ over small distances. This led to quite different exposure patterns between the two tribes, particularly amongst females.

Conclusions  Schistosoma mansoni exposure can vary markedly within a single village. Such non‐homogenous patterns of exposure are likely to have wider implications for schistosomiasis control programmes and research studies.
Neonatal home care practices in rural Egypt during the first week of life
Authors: Darmstadt Gary L. , Hussein Mohamed Hassan , Winch Peter J. , Haws Rachel A. , Lamia Mohsen , El‐Said Mohsen A. , Gipson Reginald F. , Santosham Mathuram
Published: August 2010

Objective  To provide information about home care practices for newborns in rural Egypt, in order to improve neonatal home care through preventive measures and prompt recognition of danger signs.

Method  Survey of newborn home care practices during the first week of life in 217 households in three rural Egyptian Governorates.

Results  Many practices met common neonatal care standards, particularly prompt initial breastfeeding, feeding of colostrum and continued breastfeeding, and most bathing practices. However, several practices could be modified to improve neonatal care and survival. Supplemental substances were given to 44% of newborns as pre‐lacteal feeds, and to more than half during the first week. Nearly half (43%) of mothers reported that they did not wash their hands before neonatal care, and only 7% washed hands after diaper changes. Thermal control was not practiced, although mothers perceived 22% of newborns to be hypothermic.

Conclusions  The practices we observed, which are critical for newborn survival, could be improved with minor modifications. We provide a framework for communicating behaviour change and setting research priorities for improving neonatal health.
Early exposure to yellow fever vaccine during pregnancy
Authors: Cavalcanti Denise P. , Salomão Maria Antonieta , Lopez‐Camelo Jorge , Pessoto Mônica A. ,   The Campinas Group of Yellow Fever Immunization during Pregnancy
Published: August 2010

Objective  To investigate the association of Yellow Fever Vaccination (YFV) during pregnancy with the presence of structural defect in exposed babies.

Methods  An observed/expected frequencies study, before and after the vaccination campaign against YF was designed. 304 babies exposed to YFV during the prenatal period underwent dysmorphological examinations. The expected frequencies of malformations were obtained from a reference population of 10 691 births occurred in the period immediately prior to the vaccination campaign and born in the same region. These frequencies were evaluated using Poisson distribution model.

Results  The major malformation rate found in this study was 3.3% (CI 1.7–6.3%). Minor dysmorphisms, especially naevus, were significantly more frequent (P < 0.001) than in the reference population.

Conclusions  The data here presented provide no indication that immunization with YFV early in pregnancy increases the risk of major malformations. However, the association found between YFV during pregnancy and minor dysmorphisms, especially pigmented naevus, seems to be a bias of evaluation. We suggest, nevertheless, that a reproductive risk hypothesis regarding minor dysmorphisms should be considered in future studies involving YFV.
Short communication: Post‐kala‐azar dermal leishmaniasis – an appraisal
Authors: Ramesh V. , Singh Ruchi , Salotra Poonam
Published: August 2010

This short descriptive paper assesses diagnostics, clinical characteristics and therapy of both Indian and African post‐kala‐azar dermal leishmaniasis.
Patient empowerment in tuberculosis control: reflecting on past documented experiences
Authors: Macq Jean , Torfoss Ted , Getahun Haileyesus
Published: August 2010

Objectives  To review the available published and non‐published literature on patient empowerment in tuberculosis (TB) control, describe what it entails, identify possible trends and conclusions, and suggest areas both for informing policy makers and for orienting further research.

Methods  We searched MEDLINE and PSYCINFO databases, used World Wide Web research tools and included conference abstracts and specific project reports.

Results  Experience shows that operational definitions, potential barriers towards empowerment and contextual issues need to be considered. Four types of experiences were reported: (1) enabling patients to take more responsibility for their health, especially regarding adherence to treatment, (2) organizing TB patients into groups and clubs, (3) building patient‐centred care in TB and general health services, and (4) using TB patients’ advocacy skills to improve TB control.

Conclusion  Patient empowerment conceptions through interventions and studies should primarily involve TB patients themselves. Patients’ activism – their role, the shape it takes and resulting effects – is insufficiently documented.
Dramatically decreased therapeutic efficacy of chloroquine and sulfadoxine‐pyrimethamine, but not mefloquine, in southern Benin
Authors: Aubouy Agnès , Fievet Nadine , Bertin Gwladys , Sagbo Jean C. , Kossou Hortense , Kinde‐Gazard Dorothée , Kiniffo Richard , Massougbodji Achille , Deloron Philippe
Published: August 2010

Objective  To evaluate the in vivo therapeutic efficacy of chloroquine (CQ), sulfadoxine‐pyrimethamine (SP) and mefloquine (MQ) in children presenting with uncomplicated malaria in Benin.

Methods  Drug efficacy was tested according to the WHO in vivo 28‐day protocol. For failures that occurred after 7 days of follow‐up, paired pre‐ and post‐treatment blood samples were genotyped at msp1 and msp2 loci to distinguish new infections and recrudescent strains. Children enrolled were randomly assigned to a therapeutic group (CQ, n = 14; SP, n = 42; MQ, n = 44). The number of CQ treatment was intentionally restricted after 1 month, as its use was considered to constitute a danger for children.

Results  Chloroquine and SP showed very high failure rates (85.7% and 50%, respectively), whereas MQ treatment was successful in 97.5%. The molecular tool allowed to re‐evaluate two new infections previously considered as failures.

Conclusions  Chloroquine should no longer be used to treat children presenting with Plasmodium falciparum malaria in Benin.
Asymptomatic serum cryptococcal antigenemia and early mortality during antiretroviral therapy in rural Uganda
Authors: Liechty Cheryl A. , Solberg Peter , Were Willy , Ekwaru John Paul , Ransom Ray L. , Weidle Paul J. , Downing Robert , Coutinho Alex , Mermin Jonathan
Published: August 2010

Objective  To evaluate the association between a positive serum cryptococcal antigen (CRAG) test at baseline and mortality during the first 12 weeks on antiretroviral therapy (ART). Cryptococcal meningitis is a leading cause of HIV‐related mortality in Africa, but current guidelines do not advocate CRAG testing as a screening tool.

Methods  Between May 2003 and December 2004, we enrolled HIV‐1 infected individuals into a study of ART monitoring in rural Uganda. CRAG testing was conducted retrospectively on stored pre‐ART serum samples of participants whose baseline CD4 cell count was <100 cells/μl and who were without symptoms suggestive of disseminated cryptococcal disease at enrolment.

Results  Of 377 participants, 5.8% had serum CRAG titre ≥1:2. Of these, 23% died during follow‐up. Controlling for CD4 cell count, HIV‐1 viral load, anaemia, active tuberculosis and body mass index, relative risk of death during follow‐up among those with asymptomatic cryptococcal antigenemia at baseline was 6.6 [95% confidence interval (CI) 1.86–23.61, P = 0.0036]. The population attributable risk for mortality associated with a positive CRAG at baseline was 18% (CI 2–33%), similar to that associated with active tuberculosis (19%, CI 1–36%).

Conclusion  Asymptomatic cryptococcal antigenemia independently predicts death during the first 12 weeks of ART among individuals with advanced HIV disease in rural Uganda. Routine screening and provision of azole antifungal therapy prior to or simultaneous with the start of ART should be evaluated for the potential to prevent mortality in this population.
Morbidity and associated factors in rural and urban populations of South Lebanon: a cross‐sectional community‐based study of self‐reported health in 2000
Authors: Sabbah Ibtissam , Vuitton Dominique‐Angèle , Droubi Nabil , Sabbah Sanaa , Mercier Mariette
Published: August 2010

Objective  To assess self‐reported morbidity and its determining factors in South Lebanon, with an emphasis on the influence of the habitat location (urban vs. rural) and gender.

Methods  Cross‐sectional survey in 2000 among 524 South Lebanon residents ≥14 years sampled from a random sample of households using a multi‐level cluster sampling technique. Data on self‐reported morbidity, lifestyle and socioeconomic status were collected through interviews, using a standardized questionnaire. To evaluate deprivation, a new index was created; the modified ‘Living Conditions Index’. Stepwise logistic regression analysis was performed to test the effect of habitat and gender on self‐reported morbidity.

Results  People in one‐fifth of the households lived in precarious conditions. Illiteracy was significantly higher in rural than urban settings. Urban residents reported obesity, varicose veins, anxiety/depression and visual disorders more often. Illiteracy, headaches, lumbar pain, varicose veins and anxiety/depression were more frequently reported by women, whereas ulcers, hearing disorders, cardio‐vascular diseases and their risk factors were more frequently reported by men. Precarious living conditions were associated with headaches, lumbar pains and insomnia. Individuals covered by a health insurance sought care more often than the uninsured.

Conclusion  Habitat location had only a minor influence on self‐reported morbidity; women perceived their health as poorer than men and a number of disease conditions were influenced by deprivation. Our study confirms that the epidemiological transition phenomenon had occurred in South Lebanon in 2000. Our community‐based data can serve as a baseline for monitoring changes in health in South Lebanon in the future and especially those because of the war that emerged in July 2006.
Plot and see! Maternal comprehension of growth charts worldwide
Authors: Roberfroid D. , Pelto G. H. , Kolsteren P.
Published: August 2010

Objective  To evaluate maternal comprehension of growth charts used in growth monitoring and promotion (GMP), a worldwide programme with important budgets but contrasting results.

Methods  Systematic literature review through MEDLINE, POPLINE, Global Health, ERIC and the Cochrane Library with the keywords ‘growth monitoring’ or ‘growth chart’ limited to the title/abstract field and to the 0–5 years age range.

Results  Twenty studies from Asia (8), Africa (8) and Latin America/Caribbean (3) were included in the review. The results of the 14 non‐intervention, cross‐sectional studies provide convincing evidence that a third to three‐fourths of carers in developing countries do not understand the growth charts. Literacy had a strong effect on women’s ability to interpret the cards. Appropriate training and educational activities also increased substantially maternal comprehension as demonstrated in five of the six intervention trials.

Conclusions  Many carers have poor comprehension of growth charts, but their comprehension increases not only with literacy, but also with training. Activities aimed at improving communication skills of health staff and at empowering parents to practice responsive parenting could greatly improve GMP outcomes.
Clinical and laboratory features of disseminated histoplasmosis in HIV patients from Brazil
Authors: Daher Elizabeth F. , Silva Geraldo B. , Barros Fernando A. S. , Takeda Christianne F. V. , Mota Rosa M. S. , Ferreira Marúsia T. , Oliveira Soraya A. , Martins Julieta C. , Araújo Sônia M.H.A. , Gutiérrez‐Adrianzén Oswaldo A.
Published: August 2010

Objectives  To identify the main clinical and laboratory features of disseminated histoplasmosis (DH) in human immunodeficiency virus (HIV) patients and compare them with those of HIV patients with other opportunistic diseases.

Methods  Retrospective study of HIV patients comparing the clinical and laboratory data of patients with and without DH. Univariate and multivariate analyses were performed to verify the risk factors related to DH.

Results  In total, 378 HIV patients were included, 164 with DH and 214 with other opportunistic diseases. Acute renal failure, respiratory insufficiency and septic shock were more frequent in DH patients, who also had a higher mortality (32%vs. 14%, P < 0.001). Independent risk factors for DH were: acute renal failure [odds ratio (OR) 5.2; 95% confidence interval (CI) 3.2–8.5; P < 0.001], splenomegaly (OR 3.4; 95% CI 1.19–9.9; P < 0.001), respiratory insufficiency (OR 2.7 95% CI 1.5–5.0; P < 0.001), proteinuria (OR 2.7; 95% CI 1.3–5.2; P = 0.03), hypotension (OR 2.5; 95% CI 1.2–5.0; P = 0.008), hepatomegaly (OR 2.4; 95% CI 1.2–4.8; P = 0.01), cutaneous lesions (OR, 1.9; 95% CI 1.0–3.3; P = 0.02) and weight loss (OR 1.8; 95% CI 1.0–3.1; P = 0.03).

Conclusion  Our results suggest that DH is a severe opportunistic disease with high mortality rate, which should be promptly recognized in order to provide early specific treatment.
Economic burden of malaria in rural Tanzania: variations by socioeconomic status and season
Authors: Somi Masha F. , Butler James R. G. , Vahid Farshid , Njau Joseph D. , Kachur S. Patrick , Abdulla Salim
Published: August 2010

Objective  To determine the economic burden of malaria in a rural Tanzanian setting and identify any differences by socioeconomic status and season.

Methods  Interviews of 557 households in south eastern Tanzania between May and December 2004, on consumption and malaria‐related costs.

Results  Malaria‐related expenses were significantly higher in the dry, non‐malarious season than in the rainy season. Households sought treatment more frequently and from more expensive service providers in the dry season, when they have more money. Malaria expenses did not vary significantly across socioeconomic status quintiles, but poorer households spent a higher proportion of their consumption in both seasons.

Conclusion  Poorer households bear a greater economic burden from malaria relative to their consumption than better‐off households. Households are particularly vulnerable to malaria in the rainy season, when malaria prevalence is highest but liquidity is lower. Alternative strategies to assist households to cope with seasonal liquidity issues, including insurance, should be investigated.
Individual and village‐level study of water contact patterns and Schistosoma japonicum infection in mountainous rural China
Authors: Seto Edmund Y. W. , Lee Yu J. , Liang Song , Zhong Bo
Published: August 2010

Objective  To describe the exposure patterns related to schistosomiasis transmission in 10 villages in rural Xichang County, Sichuan, China.

Methods  Individual and village‐level study of water contact exposure and Schistosoma japonicum reinfection; after initial infection survey and treatment, reinfection was determined 2 years later for 1604 individuals, of whom 578 also participated in a cross‐sectional survey to assess their water contact behaviours.

Results  The highest intensity of reinfection was observed in farmers aged 20–29 years, with no difference between sexes. While water contact measured as m2‐minutes of contact was not associated with reinfection, an exposure metric computed by spatially weighting water contact by cercarial risk was correlated with both infection status and intensity. Village‐level indicators based on snail density, number of infected snails, mouse bioassay data, and averaged individual‐level exposures were associated with village reinfection rates.

Conclusion  Age‐acquired immunity may be present in this population, but the study lacked sufficient power to discern differences in the exposure infection relationship with age.
Therapeutic efficacy of sulfadoxine–pyrimethamine and the prevalence of molecular markers of resistance in under 5‐year olds in Brazzaville, Congo
Authors: Ndounga Mathieu , Tahar Rachida , Basco Leonardo K. , Casimiro Prisca N. , Malonga David A. , Ntoumi Francine
Published: August 2010

Objective  To test the efficacy of sulfadoxine–pyremethamine (SP) monotherapy and establish the prevalence of mutations in dhfr and dhps in Brazzaville, Congo.

Method  We recruited 97 patients aged 6–59 months with uncomplicated malaria who attended Tenrikyo public health centre. Eighty‐three were followed until day 28. SP efficacy was determined by the WHO 28‐day test and analysis of mutations in the Plasmodium falciparum dihydrofolate reductase (pfdhfr) and dihydropteroate synthase (pfdhps) genes.

Results  There were seven (8.4%) early treatment failures, 23 late treatment failures (27.7%), nine (10.8%) late parasitological failures and 44 (53%) adequate clinical and parasitological responses (ACPR). After polymerase chain reaction (PCR) analysis of 64 available samples, the corrected results there were 44 (68.8%) ACPR and 19 recrudescent cases (31.2%). Approximately, 97.5% of samples bore the Asn51Ile mutation, 66.2% the Cys59Arg mutation and 98.8% the Ser108Asn mutation. Mutations of dhps at positions 437 (Ala–Gly) and 436 (Ser–Ala) were found in 85% and 12.5% of samples. Quadruple mutations (pfdhfr triple mutations in codons 51, 59 and 108+ pfdhps mutation in 437) were found in 42 samples (52.5%) and associated with treatment failures.

Conclusion  This high level of treatment failures and mutations in both genes calls for the urgent application of the new policy for malaria treatment to delay the spread of SP resistance.
Assessing the organisational costs of HIV/AIDS on NGOs in Malawi: results from a pilot study
Authors: James Rick , Wright‐Revolledo Katie , Katundu Brenda
Published: August 2010

Objectives  To assess the social and economic costs of HIV/AIDS infection on the organisational capacities of selected non‐government organisations (NGOs) in Malawi.

Methods  Sixteen semi‐structured interviews with senior staff of four NGOs to estimate the costs paid by the NGO and the loss of management and staff time over the last 12 months because of HIV/AIDS, plus questionnaires filled in by 48 NGO leaders.

Results  Labour costs were an estimated 12.5% higher because of HIV/AIDS, corresponding to a 3% increase in overall budget costs. There was also an estimated 12.4% loss of staff time to address HIV‐related issues such as funerals, sickness and management time.

Conclusions  The organisational costs of HIV/AIDS on NGOs in Malawi may be considerable and more serious than perceived by NGOs, who must develop a workplace response. It also has policy implications for donors, who may need to adjust their funding strategies.
Assessing unmet obstetric need in Mtwara Region, Tanzania
Authors: Hunger C. , Külker R. , Kitundu H. , Massawe S. , Jahn A.
Published: August 2010

Objective  To evaluate maternity care, the feasibility of collecting the relevant data from hospital records, and to assess the usefulness for district health planning in the Mtwara Region, Tanzania.

Method  A prospective study running over 2 years using the unmet obstetric need concept in all four hospitals in the region, covering all women undergoing major obstetric interventions. Data on indications, interventions, and pregnancy outcome were collected. Rates of major obstetric interventions performed for absolute maternal indications among all expected births in the study area were calculated to assess met and unmet need.

Results  Of 2404 interventions, 91% were caesarean sections, most commonly indicated by cephalo‐pelvic disproportion (46%). The rate of major obstetric intervention for absolute maternal indications per 100 expected births was 1.8% overall with wide rural–urban disparities (1.4% vs. 3.3%). Based on the estimated need of at least 2% of births requiring of a major obstetric intervention, seven of 20 divisions reached or surpassed this threshold, seven had a level between 1% and 2% and six did not reach 1%. Data were collected as part of the regular activities of the health staff, but external resources were needed for data management and analysis.

Conclusion  We found a major unmet obstetric need in rural areas with a clear trend towards fewer interventions with longer distance from a hospital. Geographical mapping of the met obstetric need provided a detailed picture of deficiencies in the provision of maternity care and could be useful for priority setting and monitoring.
Viewpoint: Adapting to new international tuberculosis treatment standards with medication monitors and DOT given selectively
Authors: Moulding Thomas S.
Published: August 2010

New international standards no longer require directly observed therapy for all tuberculosis (TB) patients, but state that practitioners must be capable of assessing adherence and addressing poor adherence. Mass‐produced electronic medication monitors, which record removal of medication from a container, could help overcome the problem of assessing treatment adherence accurately even in poor countries. Both health facilities and community workers could dispense drugs for self‐administered treatment in medication monitors and retrieve the adherence record with inexpensive built‐in displays. These devices could keep the adherence record from the beginning of therapy for managing patients who move. Pharmacists using medication monitors could provide surveillance of self‐administered treatment prescribed by private physicians with less adherent patients referred to the health departments. Less adherent patients could be managed with focused counselling, directly observed therapy when necessary, and extensions in treatment duration. Removal of the directly observed therapy burden would encourage patients to seek free high‐quality supervised pubic care and help expand effective TB treatment services. If resources saved by giving less directly observed therapy were focused on poorly adherent patients, medication monitor‐based programmes could create less acquired drug resistance than overwhelmed treatment programmes that attempt but fail to give uninterrupted directly observed therapy to all patients.
Comparison of the therapeutic efficacy of chloroquine and sulphadoxine‐pyremethamine in children and pregnant women
Authors: Tagbor Harry , Bruce Jane , Ord Rosalynn , Randall Anna , Browne Edmund , Greenwood Brian , Chandramohan Daniel
Published: August 2010

Objective  To compare the parasitological failure rates of under‐fives and pregnant women with parasitaemia treated with chloroquine (CQ) or sulphadoxine‐pyrimethamine (SP).

Methods  During a clinical trial of CQ, SP, amodiaquine (AQ) and SP plus AQ combination for malaria treatment in pregnant women in Ghana, a parallel study of treatment of children below 5 years of age with symptomatic malaria with CQ and SP was undertaken. Four hundred and fifty pregnant women with malaria parasitaemia and 203 children with malaria parasitaemia were randomized to receive CQ or SP. They were followed up and parasitological failure by days 14 and 28 after the start of treatment was assessed.

Results  Polymerase chain reaction (PCR)‐uncorrected parasitological failure rates by day 28 after the start of treatment with CQ were 58.5% (55/94), 38.5% (45/117), 31% (13/42) and 8.2% (4/49) in children, primigravidae, secundigravidae and multigravidae, respectively. For those treated with SP the rates by day 28 were 36.4% (32/88), 27.1% (29/107), 6.1% (3/49) and 3.8% (2/52) in children, primigravidae, secundigravidae and multigravidae, respectively. In both CQ and SP treatment arms, children were twice as likely to experience recrudescence as pregnant women (RR 2.1 [95% CI 1.6–2.6] P < 0.0001) by day 28 after the start of treatment.

Conclusions  Parasitological failure rates were significantly lower in asymptomatic pregnant women, particularly in multigravidae, compared with symptomatic children. Reliance on drug sensitivity results observed in children only to decide on antimalarial regimes for pregnant women may not be appropriate.
Molecular markers as indicators of antimalarial drug failure rates
Authors: Hastings Ian M.
Published: August 2010

Several mutations have been identified in Plasmodium falciparum that cause, or contribute to, drug resistance. It is relatively easy to measure their prevalence in human blood samples, so they are often used to infer drug failure rates, clinical and parasitological, that will occur in the human population. One current method of making this inference is through the use of genotypic resistance and genotypic failure indices. These indices are rather sensitive to background drug failures rates (i.e. failures not caused by the mutation), to mutation prevalence, and to the genetic background in which the marker occurs. Extreme care should therefore be taken in the construction and interpretation of these indices.
Epidemiology of congenital malaria in Nigeria: a multi‐centre study
Authors: Falade Catherine , Mokuolu Olugbenga , Okafor Henrietta , Orogade Adeola , Falade Adegoke , Adedoyin Olanrewaju , Oguonu Tagbo , Aisha Maman , Hamer Davidson H. , Callahan Michael V.
Published: August 2010

Objective  To determine the burden of congenital malaria in newborns in Nigeria.

Methods  In a prospective multi‐centre study, 1875 consecutive mother–baby pairs were enrolled over a continuous 12‐month period. Blood smears were prepared from mothers, neonates, placental aspirates and cord blood within 4 h of delivery. Outcome variables were patent parasitaemia in the mother, placenta, cord and neonate in addition to maternal and neonatal haematocrit.

Results  Patent parasitaemia was detected in 95 neonates (5.1%). The occurrence varied between study centres, but was found year round in all sites. The mean parasite density among infected neonates was low (48 asexual forms per μl, range 8–200/μl). Maternal and placental parasitaemia were the most important risk factors for patent neonatal parasitaemia (P < 0.0001). Spontaneous clearance of parasitaemia occurred in 62.1% of neonates before day 2. 33.7% were symptomatic within 3 days of birth.

Conclusion  Congenital malaria is often asymptomatic, clears spontaneously and may not warrant treatment. However, newborns with unexplained fever and refusal to feed in malaria endemic areas should be tested for malaria.
Effect of low‐cost irrigation methods on microbial contamination of lettuce irrigated with untreated wastewater
Authors: Keraita Bernard , Konradsen Flemming , Drechsel Pay , Abaidoo Robert C.
Published: August 2010

Objective  To assess the effectiveness of simple irrigation methods such as drip irrigation kits, furrow irrigation and use of watering cans in reducing contamination of lettuce irrigated with polluted water in urban farming in Ghana.

Methods  Trials on drip kits, furrow irrigation and watering cans were conducted with urban vegetable farmers. Trials were arranged in a completely randomised block design with each plot having all three irrigation methods tested. This was conducted in both dry and wet seasons. Three hundred and ninety‐six lettuce, 72 soil, 15 poultry manure and 32 water samples were analysed for thermotolerant coliforms and helminth eggs.

Results  Lettuce irrigated with drip kits had the lowest levels of contamination, with, on average, 4 log units per 100 g, fewer thermotolerant coliforms than that irrigated with watering cans. However, drip kits often got clogged, required lower crop densities and restricted other routine farm activities. Watering cans were the most popular method. Using watering cans with caps on outlets from a height <0.5 m reduced thermotolerant coliforms by 2.5 log units and helminthes by 2.3 eggs per 100 g of lettuce compared with using watering cans without caps from a height >1 m.

Conclusion  Simple, cheap and easily adoptable irrigation methods have great potential to reduce crop contamination in low‐income areas. When used in combination with other on‐farm and post‐harvest risk reduction measures, these will help to comprehensively reduce public health risks from using polluted water in vegetable farming.
Occurrence and species distribution of fishborne zoonotic trematodes in wastewater‐fed aquaculture in northern Vietnam
Authors: Hop Nguyen Thi , De Nguyen Van , Murrell Darwin , Dalsgaard Anders
Published: August 2010

Objectives  To assess the risk of fishborne zoonotic trematode (FZT) infection in fish reared in wastewater‐fed ponds in peri‐urban areas of northern Vietnam.

Methods  We collected 1200 fish from aquaculture systems receiving wastewater from the cities of Hanoi and Nam Dinh in northern Vietnam and examined them for zoonotic metacercariae. Collection periods were fall (October–November 2005) and spring (April–June 2006). The fish were digested in pepsin and metacecariae, recovered and identified by light microscopy. Data were expressed as both prevalence and intensity of infection.

Results  FZT metacercariae were recovered from fish samples at both sites and during both sampling periods. The overall prevalence of FZT was 5% (2.0% in fall and 6.5% in spring) in fish from Hanoi and 4.6% (2.4% in fall and 5.7% in spring) in fish from Nam Dinh. The higher prevalence in the warmer months was likely due to ecological factors such as temperatures and population dynamics of the snail vectors. All metacercariae recovered were zoonotic intestinal trematodes of the family Heterophyidae. The infected fish included tilapia (Oreochromis niloticus) and three species of carps, including silver carp (Hypophthalmichthys molitrix), which is commonly used for the preparation of raw fish dishes. Intensities of infection were relatively low.

Conclusion  Fish raised in peri‐urban wastewater‐fed aquaculture systems are at risk of infection with trematode parasites, which can be transmitted to humans through consumption of raw or improperly prepared fish. However, the prevalence was low as compared to previous findings of FZT in non‐wastewater fish elsewhere in Vietnam. Studies are needed to assess the relative importance of different risk factors for transmission and control of FZT in wastewater‐fed aquaculture.
Hepatosplenomegaly in Kenyan schoolchildren: exacerbation by concurrent chronic exposure to malaria and Schistosoma mansoni infection
Authors: Wilson Shona , Vennervald Birgitte J. , Kadzo Hilda , Ireri Edmund , Amaganga Clifford , Booth Mark , Kariuki H. Curtis , Mwatha Joseph K. , Kimani Gachuhi , Ouma John H. , Muchiri Eric , Dunne David W.
Published: August 2010

Objectives  Chronic exposure to malaria exacerbates Schistosoma mansoni‐associated hepatosplenomegaly in school‐aged children. However, residual hepatosplenomegaly after treatment of S. mansoni with concurrent mollusciciding suggests malaria could be an underlying cause of hepatosplenomegaly. We investigated the role of chronic malaria in childhood hepatosplenomegaly in the presence and absence of concurrent S. mansoni infection.

Methods  Cross‐sectional study of children in an study area where transmission of S. mansoni, but not malaria, is restricted to the eastern end. Clinical and ultrasound examinations were conducted, and parasitological and serological tests used to determine S. mansoni infection intensities and comparative exposure levels to malaria.

Results  Chronic exposure to malaria, as determined by Pfs‐IgG3 levels, was associated with hepatosplenomegaly even in the absence of S. mansoni infection. Children infected with S. mansoni mostly had light to moderate infection intensities but greater enlargement of the liver and spleen than children who did not have schistosomiasis, and for the left liver lobe this was S. mansoni infection intensity dependent.

Conclusions  Children chronically exposed to malaria but without S. mansoni infection can have hepatosplenomegaly, which even light S. mansoni infections can exacerbate in an intensity‐dependent manner. Thus, concurrent chronic exposure to S. mansoni and Plasmodium falciparum can have an additive or synergistic effect on childhood morbidity.
Short communication: CD4 counts of HIV‐infected pregnant women and their infected children – implications for PMTCT and treatment programmes
Authors: Lebon Ankie , Bland Ruth M , Rollins Nigel C , Coutsoudis Anna , Coovadia Hoosen , Newell Marie‐Louise
Published: August 2010

A considerable proportion of pregnant women and their infected children are likely to be eligible for anti‐retroviral treatment. The antenatal–postnatal divide needs to be bridged with respect to the follow‐up of both HIV‐infected women and their exposed infants.
Determinants of HIV counselling and testing participation in a Prevention of Mother‐to‐Child Transmission programme in rural Burkina Faso
Authors: Sarker M. , Sanou A. , Snow R. , Ganame J. , Gondos A.
Published: August 2010

Objectives  To analyse the factors associated with the uptake of HIV counselling, HIV testing and returning for test results in a rural hospital setting in Nouna, Burkina Faso.

Methods  Cross sectional survey of 435 pregnant women who visited the district hospital for antenatal care, from July to December 2004. Separate multivariate logistic regression analyses including analysis of reported reasons were performed to identify the factors associated with accepting HIV counselling and testing.

Results  HIV testing participation was related to discussing HIV screening with the partner (OR 8.36), and the number of antenatal care (ANC) visits already accomplished (OR 2.23). The quality of pre‐test counselling was very poor as 42% did not understand the process. The absence of doctors and mismanagement of time for post‐test counselling were the main reasons why women did not receive test results. Analysis of participants by discussion status, counselling and test participation revealed that fewer women dropped out at every stage who discussed HIV testing with their partner.

Conclusion  Communication with the partner plays a vital role in the uptake of HIV testing. Encouraging women to engage in a discussion about testing with their partners may be a viable intervention to improve participation. Quality of service needs to be better.
Infant mortality among twins and triplets in rural Bangladesh in 1975–2002
Authors: Alam Nurul , Van Ginneken Jeroen K. , Bosch Alinda M.
Published: August 2010

To examine trends in incidence of multiple births (MB) and their survival in infancy, we used population‐based, longitudinal data derived from the Health and Demographic Surveillance System in Matlab, Bangladesh, from 1975 to 2002. Logistic regression was applied to determine the impact of a number of variables on mortality among MB in the first year of life. MB averaged 2% of all live births, but contributed 10% to all infant deaths. Infant mortality among MB was more than five times higher than among singletons. Mortality among MB declined by 27% in 1975–2002, considerably less than the 51% mortality decline among singletons in the same period. Infant mortality among twins and triplets was particularly high among children who were born to young mothers (<20 years), who were the first live birth, who were born after a short birth interval (<24 months) and whose mothers were unschooled. Mortality of MB was lower in the area with easy access to high‐quality maternal and child‐care services. Thus, good maternity and newborn care will improve the survival of MB.
Tuberculous meningitis: does lowering the treatment threshold result in many more treated patients?
Authors: Moreira Juan , Alarcon Fernando , Bisoffi Zeno , Rivera José , Salinas Robert , Menten Joris , Dueñas Gonzalo , Van den Ende Jef
Published: August 2010

Objective  To determine how many more patients would be treated when lowering the treatment threshold for tuberculous meningitis.

Methods  From 1989 to 2004 findings of patients with symptoms lasting more than 1 week and inflammatory changes of cerebrospinal fluid (CSF) were collected. Several models of latent class analysis were tested. Cumulative numbers of cases were plotted against different cut‐offs for post‐test probability.

Results  In a cohort of 232 patients the prevalence of tuberculous meningitis (TBM) was estimated at 79.8% (95% CI. 67,0–88,1); probabilities above 80% were reached in 73% of patients. Lowering this threshold from 80% to 20% would add 14% more patients to be treated, for a total of 87%. A further lowering of the threshold to 5% would imply 5% more patients to be treated, bringing the cumulative number to 92%. The difference of lowering the threshold from 80% to 5% was 19%.

Conclusion  In this setting, at least 75% of patients showing suggestive symptoms for more than a week and CSF changes very probably had TBM. The number of patients that should be treated does not increase linearly when lowering the threshold.
Plasmodium vivax resistance to chloroquine in Dawei, southern Myanmar
Authors: Guthmann Jean‐Paul , Pittet Anne , Lesage Alexandre , Imwong Mallika , Lindegardh Niklas , Min Lwin Myo , Zaw Than , Annerberg Anna , De Radiguès Xavier , Nosten François
Published: August 2010

Objective  To assess the efficacy of chloroquine in the treatment of Plasmodium vivax malaria in in Dawei District, southern Myanmar.

Methods  Enrolled patients at Sonsinphya clinic >6 months of age were assessed clinically and parasitologically every week for 28 days. To differentiate new infections from recrudescence, we genotyped pre‐ and post‐treatment parasitaemia. Blood chloroquine was measured to confirm resistant strains.

Results  Between December 2002 and April 2003, 2661 patients were screened, of whom 252 were included and 235 analysed. Thirty‐four per cent (95% CI: 28.1–40.6) of patients had recurrent parasitaemia and were considered treatment failures. 59.4% of these recurrences were with a different parasite strain. Two (0.8%) patients with recurrences on day 14 had chloroquine concentrations above the threshold of 100 ng/ml and were considered infected with chloroquine resistant parasites. 21% of failures occurred during the first 3 weeks of follow‐up: early recurrence and median levels of blood chloroquine comparable to those of controls suggested P. vivax resistance.

Conclusions  Plasmodium vivax resistance to chloroquine seems to be emerging in Dawei, near the Thai‐Burmese border. While chloroquine remains the first‐line drug for P. vivax infections in this area of Myanmar, regular monitoring is needed to detect further development of parasite resistance.
Household burden of malaria in South Africa and Mozambique: is there a catastrophic impact?
Authors: Castillo‐Riquelme Marianela , McIntyre Diane , Barnes Karen
Published: August 2010

Objectives  To evaluate treatment‐seeking behaviour, financial impact and time lost due to malaria events, in southern Mozambique and eastern South Africa.

Methods  In‐depth household surveys (828 in Mozambique and 827 in South Africa) were analysed. An asset index was calculated using principal component analysis to allow comparison across socio‐economic groups. Direct costs of seeking care and the time lost due to malaria were determined. The extent of catastrophic payments was assessed using as thresholds the traditional 10% of household income and 40% of non‐food income, as recently recommended by WHO.

Results  Poverty was highly prevalent: 70% of the South African and 95% of Mozambican households studied lived on less than $1 per capita per day. Around 97% of those with recent malaria sought healthcare, mainly in public facilities. Out‐of‐pocket household expenditure per malaria episode averaged $2.30 in South Africa and $6.50 in Mozambique. Analysis at the individual household level found that 32–34% of households in Mozambique, compared with 9–13% of households in South Africa, incurred catastrophic payments for malaria episodes. Results based on mean values underestimated the prevalence of catastrophic payments. Days off work/school were higher in Mozambique.

Conclusions  The high rate of health seeking in public health facilities seems unusual in the African context, which bodes well for high coverage with artemisinin‐based combinations, even if only deployed within the public sector. However, despite no or modest charges for public sector primary healthcare, households frequently incur catastrophic expenditure on a single malaria episode.
Beyond symptom recognition: care‐seeking for ill newborns in rural Ghana
Authors: Bazzano Alessandra N. , Kirkwood Betty R. , Tawiah‐Agyemang Charlotte , Owusu‐Agyei Seth , Adongo Philip Baba
Published: August 2010

Objectives  To assess newborn care‐seeking practices in a rural area of Ghana where most births take place at home in order to inform potential strategies for reducing newborn mortality.

Methods  Qualitative, ethnographic study with quantitative data from a birth cohort collected as part of the surveillance system of an ongoing randomized controlled trial. Data collected comprised 84 h of participant observation (including following an ill newborn through a hospital visit), 14 in‐depth interviews with key informants (older mothers and grandmothers), 45 semistructured interviews with mothers, 28 case histories from women who had recently given birth and 32 expert interviews with local health providers. Thirteen focus groups were held with men and women, and narrative histories of newborn deaths were taken from eight women. Birth cohort data came from 2878 singletons born alive in the study district within the year July 2003–June 2004.

Results  Significant delays in care seeking for ill newborns occur in Kintampo District, Ghana. 2.1% of 2878 newborns in the birth cohort had a serious illness during the first 4 weeks of life, but care was only sought outside the home for 61% of those and from a doctor or hospital for 39%. Barriers to prompt allopathic care seeking include sequential care‐seeking practices, with often exclusive use of traditional medicine as first‐line treatment for 7 days, previous negative experiences with health service facilities, financial constraints and remoteness from health facilities.

Conclusions  Improvements in care seeking are urgently needed. Families should be urged to seek medical care for any symptom of illness in a newborn; financial and socio‐cultural barriers to care seeking for newborns must be addressed in order to improve neonatal survival.
The impact of HIV infection on adult mortality in some communities in Zambia: a cohort study
Authors: Dzekedzeke Kumbutso , Siziya Seter , Fylkesnes Knut
Published: August 2010

Objective  To examine the contribution of human immunodeficiency virus (HIV) to adult death rates between 1995/1996 and 1998/1999 in some urban and rural populations in Zambia.

Method  A cohort of 2592 out of 3013 adults aged 15–49 years enrolled in a baseline survey in 1995/1996 in areas of Chelston Township (HIV prevalence 26.2%) and Kapiri Mposhi district (HIV prevalence 15.6%) were followed up in 1998/1999. Person years of observation (PYO) were calculated for those known to have been alive, dead and migrated between the surveys. Fixed covariates Cox proportional hazard models were fitted to assess survival prospects.

Results  Death rates per 1000 PYO in the rural cohort were 38.1 among those with HIV, 4.8 among those without HIV and 9.8 for all; the population attributable fraction of deaths among those with HIV was 52.3%. Respective estimates in the urban cohort were 53.8, 4.6, 17.2 and 73.6%. The hazard rate (HR) ratio of death for persons infected with HIV was 8.7 times [HR 8.65; 95% confidence interval (CI) 5.28–14.15] higher than for the uninfected after adjusting for age, area of residence, marital status, self‐rated health and years spent on education. HR among those who rated their health good/excellent was 40% less, i.e. HR 0.60 (95% CI: 0.40–0.91) than those who rated it to be poor/fair.

Conclusions  HIV infection was the most important factor accounting for adult deaths in the communities.