bluuebunny/crossref_metadata_2025_split huggingface dataset:
Community‐randomized trial of lambdacyhalothrin‐treated hammock nets for malaria control in Yanomami communities in the Amazon region of Venezuela
Authors: Magris M. , Rubio‐Palis Y. , Alexander N. , Ruiz B. , Galván N. , Frias D. , Blanco M. , Lines J. 
Published: August 2010

SummaryWe conducted a community‐randomized controlled trial in an area of moderate malaria transmission in the Amazon region, southern Venezuela, home of the Yanomami indigenous ethnic group. The aim was to compare the malaria incidence rate in villages with lambdacyhalothrin‐treated hammock nets (ITHN) or with placebo‐treated hammock nets (PTHN). In both arms of the study, intensive surveillance for early case detection was maintained and prompt malaria treatment was administered. Baseline data were collected before the intervention and a population of around 924 Yanomami was followed for 2 years. Despite the recent introduction of nets in the Yanomami villages and the adverse natural conditions in the area, the nets were accepted enthusiastically by the study population, used conscientiously and looked after carefully. The malaria incidence rate per thousand person‐years at risk was 114.6 in the IHTN group and 186.8 in the PTHN group. The adjusted rate ratios indicated that ITHN prevent 56% [IRR: 0.44, 95% confidence interval (CI): 52–59%] of new malaria cases. ITHN reduced the prevalence of parasitaemia by 83% [relative risks (RR): 0.17, 95% CI: 47–100%], according to a cross‐sectional survey carried out during the high transmission season. The prevalence of splenomegaly and anaemia was too low to detect any possible reduction as a result of ITHN. The main conclusion of the present study is that ITHN can reduce malaria incidence in the area and it is the most feasible method for malaria control in a forested area where indigenous villages are scattered over a large territory. This is the first community‐level epidemiological trial to show that ITHN are highly effective against malaria transmitted by Anopheles darlingi.
Association between haemoglobin variants S and C and Mycobacterium ulcerans disease (Buruli ulcer): a case‐control study in Benin
Authors: Nackers Fabienne , Tonglet René , Slachmuylder Véronique , Johnson Roch C , Robert Annie , Zinsou Claude , Glynn Judith R , Portaels Françoise , Gala Jean‐Luc 
Published: August 2010

SummaryRisk factors for Buruli ulcer (BU) are poorly understood. We conducted a case‐control study in southern Benin to investigate the association between haemoglobin variants S or C and BU, and particularly the association between haemoglobinopathies HbSS/SC and BU osteomyelitis. We compared the haemoglobin genotype of 179 patients with BU and 44 with BU osteomyelitis to that of 242 community controls. We found no evidence of an increased risk of BU according to the presence of haemoglobin variants S and/or C [odds ratio adjusted for sex, age, region of residence and ethnicity: 1.24 (95%CI: 0.80–1.93), P = 0.34]. Haemoglobin variants S and C are unlikely to play a role in the BU burden. However, haemoglobinopathies HbSS/SC were more frequent among BU osteomyelitis patients than among controls (6.8%vs. 1.0%, Fisher's exact P‐value = 0.045), which may suggest that those disorders facilitate growth of Mycobacterium ulcerans in the bone matrix.
Editorial: A view from beneath: Community Health Insurance in Africa
Authors: Ndiaye Pascal , Soors Werner , Criel Bart 
Published: August 2010

SummaryThis paper presents an overview of the development of Community Health Insurance (CHI) in sub‐Saharan Africa. In 2003, nearly 600 CHI initiatives were registered in a dozen countries of francophone West Africa alone. At regional level, coordination networks have been created in Africa with the aim to support and monitor the developments of this innovative model of health care financing. At national level, governments are preparing the necessary legal frameworks for CHI implementation. CHI is increasingly seen as a strategy to meet other development goals than only health. It constitutes an interesting model to finance health care, to pool financial resources in a fair way and to empower health care users. The CHI movement however still faces many challenges. The relevance of more professional inputs in the management of CHI and the need for careful subsidy of CHI schemes are increasingly recognized. There is also need to optimize the relationship of CHI with the other actors in the health system and to scale‐up CHI so as to gain in effectiveness and efficiency. The boom in the number of schemes in Africa during the last years is an indicator of the increasing attractiveness of the model. In practice however, enrolment rates per scheme remain low or are only slowly increasing. Context‐specific research is needed on the reasons that prevent people from enrolling in larger numbers. On that basis, relevant action to be taken locally can be identified.
Effect of costing methods on unit cost of hospital medical services
Authors: Riewpaiboon Arthorn , Malaroje Saranya , Kongsawatt Sukalaya 
Published: August 2010

SummaryObjective  To explore the variance of unit costs of hospital medical services due to different costing methods employed in the analysis.Methods  Retrospective and descriptive study at Kaengkhoi District Hospital, Saraburi Province, Thailand, in the fiscal year 2002. The process started with a calculation of unit costs of medical services as a base case. After that, the unit costs were re‐calculated based on various methods. Finally, the variations of the results obtained from various methods and the base case were computed and compared.Results  The total annualized capital cost of buildings and capital items calculated by the accounting‐based approach (averaging the capital purchase prices throughout their useful life) was 13.02% lower than that calculated by the economic‐based approach (combination of depreciation cost and interest on undepreciated portion over the useful life). A change of discount rate from 3% to 6% results in a 4.76% increase of the hospital's total annualized capital cost. When the useful life of durable goods was changed from 5 to 10 years, the total annualized capital cost of the hospital decreased by 17.28% from that of the base case. Regarding alternative criteria of indirect cost allocation, unit cost of medical services changed by a range of −6.99% to +4.05%. We explored the effect on unit cost of medical services in one department. Various costing methods, including departmental allocation methods, ranged between −85% and +32% against those of the base case. Based on the variation analysis, the economic‐based approach was suitable for capital cost calculation. For the useful life of capital items, appropriate duration should be studied and standardized. Regarding allocation criteria, single‐output criteria might be more efficient than the combined‐output and complicated ones. For the departmental allocation methods, micro‐costing method was the most suitable method at the time of study.Conclusions  These different costing methods should be standardized and developed as guidelines since they could affect implementation of the national health insurance scheme and health financing management.
Submicroscopic Plasmodium falciparum gametocyte carriage is common in an area of low and seasonal transmission in Tanzania
Authors: Shekalaghe Seif A. , Teun Bousema J. , Kunei Karaine K. , Lushino Paminus , Masokoto Alutu , Wolters Liselotte R. , Mwakalinga Steve , Mosha Frank W. , Sauerwein Robert W. , Drakeley Chris J. 
Published: August 2010

SummaryObjective:  Recently developed molecular gametocyte detection techniques have shown that submicroscopic Plasmodium falciparum gametocytes are common in symptomatic patients and can infect mosquitoes. The relevance for the infectious reservoir of malaria in the general population remains unknown. In this study, we investigated submicroscopic asexual parasitaemia and gametocytaemia in inhabitants of an area of hypoendemic and seasonal malaria in Tanzania.Methods:  Two cross‐sectional malariometric surveys were conducted in the dry and wet seasons of 2005 in villages in lower Moshi, Tanzania. Finger prick blood samples were taken to determine the prevalence of P. falciparum parasites by microscopy, rapid diagnostic test and real‐time nucleic acid sequence‐based amplification (QT‐NASBA).Results:  2752 individuals participated in the surveys, of whom 1.9% (51/2721) had microscopically confirmed asexual parasites and 0.4% (10/2721) had gametocytes. In contrast, QT‐NASBA revealed that 32.5% (147/453) of the individuals harboured asexual parasites and 15.0% (68/453) had gametocytes. No age dependency or seasonality was observed in submicroscopic parasite carriage.Discussion:  Molecular detection techniques reveal that carriage of submicroscopic asexual parasite and gametocyte densities is relatively common in this low transmission area. Submicroscopic gametocytaemia is likely to be responsible for maintaining malarial transmission in the study area.
Risk factors for treatment denial and loss to follow‐up in an antiretroviral treatment cohort in Kenya
Authors: Karcher Heiko , Omondi Austin , Odera John , Kunz Andrea , Harms Gundel 
Published: August 2010

SummaryObjectives:  To evaluate risk factors for treatment denial and loss to follow‐up in an antiretroviral treatment (ART) cohort in a rural African setting in western Kenya.Method:  Sociodemographic and clinical data of patients enrolled in an ART cohort were collected within 18 months of an observational longitudinal study and analysed by logistic and Cox regression models.Results:  Of 159 patients with treatment indication 35 (22%) never started ART. Pregnancy [adjusted odds ratio (AOR) 3.60, 95% confidence interval (CI) 1.10–11.8; P = 0.035] and lower level of education (AOR 3.80, 95% CI 1.14–12.7; P = 0.03) were independently associated with treatment denial. The incidence of total loss of patients under therapy was 43.2 per 100 person years (pys) (mortality rate 19.2 per 100 pys plus drop out rate 24 per 100 pys). Older age [adjusted hazard ratio (AHR) 1.06, 95% CI 1.01–1.12; P = 0.04], AIDS before starting treatment (AHR 5.83, 95% CI 1.15–29.5; P = 0.03) and incomplete adherence to treatment (AHR 1.05, 95% CI 1.03–1.07; P < 0.001) were independent risk factors for death. Incomplete adherence also independently predicted drop out because of other reasons (AHR 1.06, 95% CI 1.04–1.09; P < 0.001).Conclusion:  Pregnancy and lower level of education, higher age, advanced AIDS stage and impaired compliance to ART were identified as risk factors for treatment denial and death, respectively. Adequate counselling strategies for patients with these characteristics could help to improve adherence and outcome of treatment programmes in resource‐limited settings.
Community participation in Aedes aegypti control: a sociological perspective on five years of research in the health area ‘‘26 de Julio’’, Havana, Cuba
Authors: Pérez D. , Lefèvre P. , Sánchez L. , Sánchez L. M. , Boelaert M. , Kourí G. , Van der Stuyft P. 
Published: August 2010

SummaryObjective:  Effective dengue prevention and Aedes aegypti control is a priority for the Cuban health authorities. To enhance effectiveness, strategies oriented towards a more active involvement of communities in control activities are being tested. This paper presents a sociological perspective on a pilot project conducted in the health area ‘‘26 de Julio’’ (La Havana) in 1999–2004.Methods:  Instrumental case study based on an exhaustive content analysis of project documents and on observations of a sociologist.Results:  The context and the pilot project are systematically described and an analysis of the evolution of the underlying concept of community participation is provided. The pilot experience was a dynamic process influenced by self‐reflection of the research team, feedback from research partners and changes in the epidemiological context (provoked by two dengue outbreaks during the study period). Community participation evolved from being just one component in Aedes aegypti control directed by the health staff into a learning and empowering process for the people. This change in the concept of participation was reflected in different aspects of the pilot project such as the learning and evaluation processes.Conclusion:  Empirical evidence from 5 years of research in the particular context of Cuba showed that moves towards community‐based Aedes aegypti control are feasible. However, in order to be successful, community‐based dengue prevention should be a social learning process, implying a transfer of power and responsibilities to local people. Actions undertaken must be oriented towards creating local capabilities, strengthening existing structures and organizations and promoting group work for learning participation from participation itself.
Early growth of infants of HIV‐infected and uninfected Zambian women
Authors: Makasa M. , Kasonka L. , Chisenga M. , Sinkala M. , Chintu C. , Tomkins A. , Filteau S. 
Published: August 2010

SummaryObjective  Parental HIV infection may affect even those exposed children who remain uninfected. We investigated early growth, an indicator of overall health, of infants born to Zambian mothers recruited for a study of breastfeeding and postpartum health.Methods  HIV‐infected and uninfected women in Lusaka were followed regularly from late pregnancy to 16 weeks postpartum. Infant weight and length were measured at birth, 6 and 16 weeks. Infant HIV status could not be specifically determined in this cohort so comparisons were between all infants of HIV‐uninfected mothers (n = 184) and those infants of HIV‐infected mothers who were known to be alive and showed no clinical evidence of HIV infection at age 2–4 years (n = 85).Results  Most infants were exclusively or predominantly breastfed until 16 weeks. At all time points infants of HIV‐infected mothers tended to have lower weight and length standard deviation (Z) scores (significant for weight at 6 weeks; P = 0.04), even after adjustment for their lower gestational age at birth, compared with infants of uninfected mothers. In multivariate analyses the major factors affecting weight or length at 6 or 16 weeks of age were birth weight or length, and maternal subclinical mastitis, primiparity and weight during pregnancy.Conclusions  Early growth of infants of HIV‐infected mothers is less than that of uninfected mothers, in part associated with subclinical mastitis, and this effect cannot be overcome with intensive support of mothers to follow international recommendations regarding exclusive breastfeeding.
Active dispersal by wild Triatoma infestans in the Bolivian Andes
Authors: Richer Wilfrid , Kengne Pierre , Cortez Mirko Rojas , Perrineau Marie Mathilde , Cohuet Anna , Fontenille Didier , Noireau François 
Published: August 2010

Summary Triatoma infestans is the main vector of Chagas disease and target of control programmes in the Southern Cone countries. So far Bolivia is the only country where true T. infestans wild foci are documented. The dispersal ability for wild T. infestans was studied at microgeographical scale in Bolivian Andes, to assess the possibility for wild populations to actively recolonize insecticide‐treated villages. Nine microsatellite loci were used to detect the extent of gene flow between neighbouring collecting sites. The detection of restricted gene flow between close but distinct sylvatic sites supports the hypothesis that wild T. infestans does not disperse by flying at high altitude (2 750 m asl). It gradually disperses over small distances by walking within a ‘patch’ of continuous land cover. The genetic differentiation detected between sylvatic and domestic populations suggests a limited short‐term role of wild insects in the process of recolonization of insecticide‐treated houses in the Andes.
Characteristics of latrine promotion participants and non‐participants; inspection of latrines; and perceptions of household latrines in Northern Ghana
Authors: Rodgers Ann F. , Ajono Lydia A. , Gyapong John O. , Hagan Maria , Emerson Paul M. 
Published: August 2010

SummaryObjectives To examine characteristics of household heads in two districts of Northern Ghana who had or had not participated in latrine promotion programmes; to inspect latrines; and to explore perceptions of latrine ownership.Methods One hundred and twenty latrine owners and 120 non‐owners were randomly selected from all trachoma‐endemic villages and interviewed. Structured questionnaires assessed demographics, household data, wealth indicators, and perceptions of latrine ownership. Latrines were inspected.Results Latrine owners and non‐owners were similar demographically, but owners were more likely to report any education or wealth indicators: any education OR = 2.0, (95% CI 1.2–3.4); large family size OR = 4.6 (2.6–8.2); children in school OR = 3.8 (1.3–10.5); and metal roof OR = 9.1 (2.0–40.0). All 120 latrine owners were participating in promotion programmes; no latrines had been self‐built without programme support. Inspection showed 73/120 (60.1%) latrines were completed and used. Of the uncompleted latrines 41/47 (87.2%) were more than a year old. Programme participants (regardless of whether they had a completed latrine) had contributed cash (mean $16.74 S.D.18.09) and 117/120 had provided labour and/or construction materials. The most frequently reported advantages of latrine ownership were convenience, cleanliness and health benefits; reported disadvantages were the need for maintenance and cleaning and bad odour.Conclusions Current latrine promotion programmes do not reach all households equally. Joining a latrine programme was expensive and did not guarantee latrine ownership; this may cause people to lose trust in such programmes. Latrines were perceived to be useful, suggesting unmet demand. Reliable and inclusive programmes that provide low cost latrines may receive community support.
Factors affecting home delivery in rural Tanzania
Authors: Mrisho Mwifadhi , Schellenberg Joanna A. , Mushi Adiel K. , Obrist Brigit , Mshinda Hassan , Tanner Marcel , Schellenberg David 
Published: August 2010

SummaryBackground  Studies of factors affecting place of delivery have rarely considered the influence of gender roles and relations within the household. This study combines an understanding of gender issues relating to health and help‐seeking behaviour with epidemiological knowledge concerning place of delivery.Methods  In‐depth interviews, focus group discussions and participant observation were used to explore determinants of home delivery in southern Tanzania. Quantitative data were collected in a cross‐sectional survey of 21 600 randomly chosen households.Results  Issues of risk and vulnerability, such as lack of money, lack of transport, sudden onset of labour, short labour, staff attitudes, lack of privacy, tradition and cultures and the pattern of decision‐making power within the household were perceived as key determinants of the place of delivery. More than 9000 women were interviewed about their most recent delivery in the quantitative survey. There were substantial variations between ethnic groups with respect to place of delivery (P < 0.0001). Women who lived in male‐headed households were less likely to deliver in a health facility than women in female‐headed households (RR 0.86, 95% CI 0.80–0.91). Mothers with primary and higher education were more likely to deliver at a health facility (RR 1.30, 95% CI 1.23–1.38). Younger mothers and the least poor women were also more likely to deliver in a health facility compared with the older and the poorest women, respectively.Conclusions  To address neonatal mortality, special attention should be paid to neonatal health in both maternal and child health programmes. The findings emphasize the need for a systematic approach to overcome health‐system constraints, community based programmes and scale‐up effective low‐cost interventions which are already available.
Combined use of an antigen and antibody detection enzyme‐linked immunosorbent assay for cysticercosis as tools in an epidemiological study of epilepsy in Burundi
Authors: Prado‐Jean A. , Kanobana K. , Druet‐Cabanac M. , Nsengyiumva G. , Dorny P. , Preux P. M. , Geerts S. 
Published: August 2010

SummaryObjective To evaluate the benefits of the detection of both circulating antibodies (Ab) and antigens (Ag) for the diagnosis of cysticercosis in people with epilepsy. Neurocysticercosis is a cause of neurological diseases world‐wide, especially epilepsy. The clinical symptoms of neurocysticercosis are non‐specific and diagnosis is often difficult.Methods Serum samples were collected from subjects in a matched case–control study for epilepsy in the Kiremba area, Burundi, between March and April 2001 (epileptic cases = 303; controls without epilepsy = 606). The enzyme‐linked immunosorbent assay (ELISA) was used for the detection of antibodies (Ab‐ELISA) and circulating Ag (Ag‐ELISA).Results The Ab‐ELISA revealed 58.7% positivity in epilepsy cases and 31.4% in healthy controls; and Ag‐ELISA revealed 38.3% positivity in epilepsy cases and 20.0% in controls. The matched odds ratios were 3.6 (95%CI: 2.5–4.9) for Ab‐ELISA, and 2.9 (95%CI: 2.1–4.3) for Ag‐ELISA.Conclusion Both Ag‐ and Ab‐ELISA detected a significantly higher number of seropositives among people with epilepsy than among controls. The risk of epilepsy was high in cases with a positive Ag‐ELISA, although less important than in cases with positivity for Ab‐ELISA. Dead or degenerating cysticerci appear to be more frequently associated with epilepsy than living cysts. The high number of people with circulating Ag ofTaenia soliumsuggests that the study area is a focus of active transmission of the parasite.
Insular pathways to health care in the city: a multilevel analysis of access to hospital care in urban Kerala, India
Authors: Levesque Jean‐Frédéric , Haddad Slim , Narayana Delampady , Fournier Pierre 
Published: August 2010

SummaryObjectives  To identify individual and urban unit characteristics associated with access to inpatient care in public and private sectors in urban Kerala, and to discuss policy implications of inequalities in access.Methods  We analysed the NSSO survey (1995–1996) for urban Kerala with regard to source and trajectories of hospitalization. Multinomial multilevel regression models were built for 695 cases nested in 24 urban units.Results  Private sector accounts for 62% of hospitalizations. Only 31% of hospitalizations are in free wards and 20% of public hospitalizations involve payment. Hospitalization pathways suggest a segmentation of public and private health markets. Members of poor and casual worker households have lower propensity of hospitalization in paying public wards or private hospitals. There were important variations between cities, with higher odds of private hospitalization in towns with fewer hospital beds overall and in districts with high private–public bed ratios. Cities from districts with better economic indicators and dominance of private services have higher proportion of private hospitalizations.Conclusions  The private sector is the predominant source of inpatient care in urban Kerala. The public sector has an important role in providing access to care for the poor. Investing in the quality of public services is essential to ensure equity in access.