bluuebunny/crossref_metadata_2025_split huggingface dataset:
Could clinical audit improve the diagnosis of pulmonary tuberculosis in Cuba, Peru and Bolivia?
Authors: Siddiqi Kamran , Volz Anna , Armas L. , Otero L. , Ugaz R. , Ochoa E. , Gotuzzo E. , Torrico F. , Newell James N. , Walley J. , Robinson Mike , Dieltiens G. , Van der Stuyft P. 
Published: August 2010

SummaryObjectives  To assess the effectiveness of clinical audit in improving the quality of diagnostic care provided to patients suspected of tuberculosis; and to understand the contextual factors which impede or facilitate its success.Methods  Twenty‐six health centres in Cuba, Peru and Bolivia were recruited. Clinical audit was introduced to improve the diagnostic care for patients attending with suspected TB. Standards were based on the WHO and TB programme guidelines relating to the appropriate use of microscopy, culture and radiological investigations. At least two audit cycles were completed over 2 years. Improvement was determined by comparing the performance between two six‐month periods pre‐ and post‐intervention. Qualitative methods were used to ascertain facilitating and limiting contextual factors influencing change among healthcare professionals’ clinical behaviour after the introduction of clinical audit.Results  We found a significant improvement in 11 of 13 criteria in Cuba, in 2 of 6 criteria in Bolivia and in 2 of 5 criteria in Peru. Twelve out of 24 of the audit criteria in all three countries reached the agreed standards. Barriers to quality improvement included conflicting objectives for clinicians and TB programmes, poor coordination within the health system and patients’ attitudes towards illness.Conclusions  Clinical audit may drive improvements in the quality of clinical care in resource‐poor settings. It is likely to be more effective if integrated within and supported by the local TB programmes. We recommend developing and evaluating an integrated model of quality improvement including clinical audit.
Phylogeny of dengue viruses circulating in Jeddah, Saudi Arabia: 1994 to 2006
Authors: Zaki Ali , Perera David , Jahan Shahrina Shan , Cardosa Mary Jane 
Published: August 2010

SummaryThe nucleotide sequence of the 240 bp E/NS1 junction of 81 dengue viruses isolated from cases in Jeddah, Saudi Arabia was determined and used to serotype the viruses. The nucleotide sequences of the complete Envelope (E) genes of 19 isolates were used for a phylogenetic analysis of the dengue viruses circulating in Saudi Arabia from 1994 to 2006. Three of the four dengue serotypes (DENV‐1, DENV‐2 and DENV‐3) were found to circulate, often with more than one serotype in each outbreak. There was a major outbreak caused by DENV‐1 and DENV‐2 in 1994 while DENV‐3 emerged in 1997. In the summer of 2004, all three serotypes were isolated and this gave way to an extended outbreak of DENV‐1 that stretched from the summer of 2005 through early 2006. In the 1994 outbreak, the DENV‐1 circulating was from the America‐Africa genotype (lineage India‐2) while the most recent outbreak in 2005 and 2006 was caused by a different DENV‐1 strain from genotype Asia (lineage Asia‐2), suggesting a re‐introduction of DENV‐1 a decade after the first introduction in 1994. There has been no change in the genotypes of DENV‐2 (cosmopolitan genotype) and DENV‐3 (genotype III) circulating since introduction in 1994 and 1997, respectively.
Impact of seven rounds of mass administration of diethylcarbamazine and ivermectin on prevalence of chronic lymphatic filariasis in south India
Authors: Yuvaraj J. , Pani S. P. , Vanamail P. , Ramaiah K. D. , Das P. K. 
Published: August 2010

SummaryObjective  To evaluate the impact of seven rounds of mass administration of diethylcarbamazine (DEC) and ivermectin on the prevalence of chronic lymphatic filariasis and to compare it with that observed in a placebo arm in a community‐level trial.Methods  Cross‐sectional clinical surveys were carried out before and after seven rounds of mass drug administration (MDA). About 54–75% of the target population were treated at each round of MDA.Results  After seven rounds, the hydrocele prevalence had declined from the pre‐intervention level of 20.5–5.1% (P < 0.05) in the DEC arm, from 23.9% to 10.4% (P < 0.05) in the ivermectin arm and from 20.4% to 10.9% (P < 0.05) in the placebo arm, equivalent to reductions of 75.3%, 56.6% and 46.6%, respectively. The lymphoedema/elephantiasis prevalence declined only marginally and without statistical significance from 3.7% to 3.2%, 4.6% to 3.9% and 2.9% to 2.3% in the DEC, ivermectin and placebo arm. After the seventh MDA, none of the sampled people in the 0–20 age group was found with hydrocele and there was a statistically significant decline in hydrocele prevalence in all other age groups in the communities treated with DEC, the drug known to have macrofilaricidal effect. The impact was relatively less in ivermectin arm.Conclusion  Repeated DEC administration has the potential to prevent incidence of new hydrocele cases and may resolve the manifestation at least in a proportion of affected people. Apart from reducing the microfilaraemia prevalence and transmission of infection, MDA also results in significant public health benefits by reducing the burden of hydrocele in treated communities.
C‐reactive protein and procalcitonin in the evaluation of the efficacy of a pneumococcal conjugate vaccine in Gambian children
Authors: Cheung Yin‐Bun , Zaman Syed M. A. , Ruopuro Marja‐Leena , Enwere Godwin , Adegbola Richard A. , Greenwood Brian , Cutts Felicity T. 
Published: August 2010

SummaryObjective  To determine the value of C‐reactive protein (CRP) and procalcitonin in the evaluation of the efficacy of a pneumococcal conjugate vaccine in Gambian children.Methods  The investigation was done as a substudy of a phase III pneumococcal conjugate vaccine trial. A pilot study (n = 120) to compare CRP and procalcitonin concentrations in children with pneumonia was undertaken, followed by a larger study of CRP concentrations (n = 1868) obtained from a subsample of children with clinical pneumonia seen during the trial.Results  In the pilot study, CRP had a higher sensitivity and specificity for the detection of primary endpoint (radiographic) pneumonia than procalcitonin. In the subsequent study of 1868 episodes of clinical pneumonia, CRP showed moderate sensitivity but poor positive predictive value in identifying primary endpoint pneumonia or pneumococcal bacteraemia. Addition of CRP thresholds of 40, 60 or 120 mg/l to the diagnosis of clinical pneumonia did not give higher estimates of vaccine efficacy or vaccine attributable reduction in incidence than primary endpoint pneumonia.Conclusion  A combination of a raised CRP concentration with a clinical diagnosis of pneumonia is a more specific endpoint than clinical pneumonia alone but less appropriate than primary endpoint pneumonia as a measure of the impact of a pneumococcal vaccine in a Gambian setting.
Insecticide‐treated net ownership and usage in Niger after a nationwide integrated campaign
Authors: Thwing Julie , Hochberg Natasha , Eng Jodi Vanden , Issifi Sanouna , James Eliades M. , Minkoulou Etienne , Wolkon Adam , Gado Habi , Ibrahim Ousmane , Newman Robert D. , Lama Marcel 
Published: August 2010

SummaryObjectives  In December 2005 and March 2006, Niger conducted nationwide integrated campaigns to distribute polio vaccine and long lasting insecticide‐treated nets (LLINs) to children <5 years of age. We evaluated the campaign effectiveness, net retention, insecticide‐treated net (ITN) ownership, and usage.Methods  Two nationwide cross‐sectional surveys in January 2006 (dry season) and September 2006 (rainy season), using a stratified two‐stage cluster sampling design. We mapped selected communities, selected households by simple random sampling, and administered questionnaires by interviewers using personal digital assistants.Results  The first survey showed that ITN ownership in all households was 6.3% prior to the campaign, increasing to 65.1% after the campaign in the second survey. The second survey also showed that 73.4% of households with children <5 received an LLIN and that 97.7% of households that received ≥ one LLIN retained it. The wealth equity ratio for ITN ownership in households with children <5 increased from 0.17 prior to the campaign to 0.79 afterward. During the dry season, 15.4% of all children <5 and 11.3% of pregnant women slept under an ITN, while during rainy season, 55.5% of children <5 and 48.2% of pregnant women slept under an ITN.Conclusions  Free distribution during the integrated campaign rapidly increased ITN ownership and decreased inequities between those in the highest and lowest wealth quintiles. Retention of ITNs was very high, and usage was high during malaria transmission season. However, ITN ownership and usage by vulnerable groups continues to fall short of RBM targets, and additional strategies are needed to increase ownership and usage.
High HIV risk among Uigur minority ethnic drug users in northwestern China
Authors: Zhang Li , Zhu Junling , Rui Baoling , Zhang Yuanzhi , Zhang Lijiang , Yin Lu , Ruan Yuhua , Qian Han‐Zhu , Shao Yiming 
Published: August 2010

SummaryObjective  To assess differences of HIV risk between ethnicities in northwestern China.Method  Cross‐sectional serosurvey and structured questionnaire interview of 383 injection drug users of either Han or Uigur ethnicity in Urumqi, Xinjiang.Results  Both Uigur minority ethnicity and residence in a Uigur or mixed Uigur/Han community were independently associated with higher HIV risk.Conclusion  HIV prevention programs should give special focus on minority ethnic drug users and their communities.
Effects of revised diagnostic recommendations on malaria treatment practices across age groups in Kenya*
Authors: Zurovac D. , Njogu J. , Akhwale W. , Hamer D. H. , Larson B. A. , Snow R. W. 
Published: August 2010

SummaryObjective  The recent change of treatment policy for uncomplicated malaria from sulfadoxine‐pyrime‐thamine to artemether‐lumefantrine (AL) in Kenya was accompanied by revised malaria diagnosis recommendations promoting presumptive antimalarial treatment in young children and parasitological diagnosis in patients 5 years and older. We evaluated the impact of these age‐specific recommendations on routine malaria treatment practices 4–6 months after AL treatment was implemented.Methods  Cross‐sectional, cluster sample survey using quality‐of‐care assessment methods in all government facilities in four Kenyan districts. Analysis was restricted to the 64 facilities with malaria diagnostics and AL available on the survey day. Main outcome measures were antimalarial treatment practices for febrile patients stratified by age, use of malaria diagnostic tests, and test result.Results  Treatment practices for 706 febrile patients (401 young children and 305 patients ≥5 years) were evaluated. 43.0% of patients ≥5 years and 25.9% of children underwent parasitological malaria testing (87% by microscopy). AL was prescribed for 79.7% of patients ≥5 years with positive test results, for 9.7% with negative results and for 10.9% without a test. 84.6% of children with positive tests, 19.2% with negative tests, and 21.6% without tests were treated with AL. At least one antimalarial drug was prescribed for 75.0% of children and for 61.3% of patients ≥5 years with a negative test result.Conclusions  Despite different recommendations for patients below and above 5 years of age, malaria diagnosis and treatment practices were similar in the two age groups. Parasitological diagnosis was under‐used in older children and adults, and young children were still tested. Use of AL was low overall and alternative antimalarials were commonly prescribed; but AL prescribing largely followed the results of malaria tests. Malaria diagnosis recommendations differing between age groups appear complex to implement; further strengthening of diagnosis and treatment practices under AL policy is required.
Optimizing antibiotic usage in adults admitted with fever by a multifaceted intervention in an Indonesian governmental hospital
Authors: Hadi Usman , Keuter Monique , Van Asten Henri , Van Den Broek Peterhans ,   on behalf of the study group ‘Antimicrobial resistance in Indonesia: Prevalence and Prevention’ (AMRIN)
Published: August 2010

SummaryObjective  To optimize antimicrobial treatment of patients with fever upon admission to the department of internal medicine of Dr Soetomo Hospital in Surabaya, Indonesia.Method  Prospective intervention study. The intervention comprised development of a consensus guideline, an official declaration of the guideline by the head of department, distributing a guideline pocketbook, carrying out blood cultures free of charge, teaching sessions and refresher courses. The outcome was measured with reference to (i) percentage of patients with fever started on antibiotic therapy, (ii) amount of antibiotics used expressed as defined daily doses (DDD)/100 patient‐days, (iii) percentage of appropriate prescriptions and of prescriptions without indication as assessed by independent reviewers, (iv) percentage of treatments in accordance with guidelines, (v) percentage of patients in whom blood cultures were taken before starting antimicrobial therapy, (vi) percentage of treatments appropriately stopped on re‐evaluation of the patients at 72 h and (vii) mortality.Results  The study involved 501 patients, 95 residents and 60 specialists. After the intervention 17% patients less were treated with antibiotics upon admission and antibiotic use fell from 99.8 to 73 DDD/100 patient‐days. The percentage of patients with sepsis and dengue treated in accordance with the guideline increased by 23% and 30%. The percentage of appropriate therapies, therapies without indication and mortality did not change significantly. The percentage of patients for whom a blood culture was taken upon admission increased from 3% to 81%; however, almost all were taken after they commenced antibiotic therapy. Therapy was not adjusted after 72 h in any case. Interrupted time series analysis showed that the start of development of the guideline and the declaration of the guideline were the interventions with the greatest impact.Conclusion  The multifaceted intervention had limited success. A very important drawback to the prudent use of antibiotics was the absence of adequate microbiological diagnostics.
Accessibility and utilisation of delivery care within a Skilled Care Initiative in rural Burkina Faso
Authors: Hounton Sennen , Chapman Glyn , Menten Joris , De Brouwere Vincent , Ensor Tim , Sombié Issiaka , Meda Nicolas , Ronsmans Carine 
Published: August 2010

SummaryObjectives  The Skilled Care Initiative (SCI) was a comprehensive skilled attendance at delivery strategy implemented by the Ministry of Health and Family Care International in Ouargaye district (Burkina Faso) from 2002 to 2005. We aimed to evaluate the relationships between accessibility, functioning of health centres and utilisation of delivery care in the SCI intervention district (Ouargaye) and compare this with another district (Diapaga).Methods  Data were collected on staffing, equipment, water and energy supply for all health centres and a functionality index for health centres were constructed. A household census was carried out in 2006 to assess assets of all household members, and document pregnancies lasting more than 6 months between 2001 and 2005, with place of delivery and delivery attendant. Utilisation of delivery care was defined as birth in a health institution or birth by Caesarean section. Analyses included univariate and multivariate logistic regression.Results  Distance to health facility, education and asset ownership were major determinants of delivery care utilisation, but no association was found between the functioning of health centres (as measured by infrastructure, energy supply and equipment) and institutional birth rates or births by Caesarean section. The proportion of births in an institution increased more substantially in the SCI district over time but no changes were seen in Caesarean section rates.Conclusion  The SCI has increased uptake of institutional deliveries but there is little evidence that it has increased access to emergency obstetric care, at least in terms of uptake of Caesarean sections. Its success is contingent on large‐scale coverage and 24‐h availability of referral for life saving drugs, skilled personnel and surgery for pregnant women.
Assessing the costs and cost‐effectiveness of a Skilled Care Initiative in rural Burkina Faso
Authors: Newlands David , Yugbare‐Belemsaga Danielle , Ternent Laura , Hounton Sennen , Chapman Glyn 
Published: August 2010

SummaryObjectives The objectives of this study were to assess the cost‐effectiveness of a skilled attendance strategy (the Skilled Care Initiative, SCI) in enhancing maternal health care in a remote, rural district of Burkina Faso and to analyse more broadly the costs and cost patterns of maternal health provision in the intervention and comparison districts.Methods The approach used was to cost the standard provision of maternal care, to analyse the main cost structures, and to derive cost estimates per facility. The additional costs attributable to SCI were identified. Several measures of cost‐effectiveness or performance were calculated, including cost per delivery and utilisation.Results If the increase in deliveries in Ouargaye between 2004 and 2005 is attributed solely to the stimulus of demand for skilled care by the SCI community mobilisation and behavioural communication change activities, the incremental cost per delivery was $164 international dollars. This compares with an average cost per delivery in Health Centres across the two districts of $214 international dollars. However, if a broader measure of SCI costs is used, the incremental cost per delivery increases markedly, to $1306 international dollars. At the level of individual Health Centres, utilisation is a better measure of performance than cost per delivery and Health Centres in Ouargaye are utilised more than in Diapaga.Conclusions Demand side actions, such as community mobilisation and behavioural communication change activities, can be as important in improving skilled care at delivery as investment in health facilities, assuming there is some spare capacity, as has been the case in Burkina Faso. These conclusions have important potential implications for planning and resource allocation to achieve safer delivery for all women in Burkina Faso.
Treatment seeking for symptoms suggestive of TB: comparison between migrants and permanent urban residents in Chongqing, China
Authors: Wang Yang , Long Qian , Liu Qin , Tolhurst Rachel , Tang Shenglan 
Published: August 2010

Summaryobjectives To understand the health‐seeking behaviour of rural‐to‐urban migrants with chronic cough in Chongqing city, and compare this with the permanent urban population taking into account the socioeconomic factors influencing delays in access to healthcare in urban China.methods Patient survey in 23 health facilities from different levels of two urban districts in Chongqing: 1005 tuberculosis (TB) suspects (229 rural‐to‐urban migrants and 776 permanent urban residents) were interviewed about socioeconomic status and service‐seeking behaviours.results Migrants (67.7%) delayed treatment by more than 2 weeks, as did 54.0% of urban residents (P < 0.01). The reasons given by migrants for the delay in seeking care were lack of money and lack of perceived need for care. Female TB suspects, people without health insurance, those without sufficient knowledge of TB, without full‐time employment and people with low incomes also experienced longer patient delay (P < 0.01).conclusions To be more effective, TB control efforts need to be better accessible to the economically and socially vulnerable.
Predictive indicators for Ross River virus infection in the Darwin area of tropical northern Australia, using long‐term mosquito trapping data
Authors: Jacups Susan P. , Whelan Peter I. , Markey Peter G. , Cleland Sam J. , Williamson Grant J. , Currie Bart J. 
Published: August 2010

SummaryObjectives  To describe the epidemiology of Ross River virus (RRV) infection in the endemic Darwin region of tropical northern Australia and to develop a predictive model for RRV infections.Methods  Analysis of laboratory confirmed cases of RRV infection between 01 January 1991 and 30 June 2006, together with climate, tidal and mosquito data collected weekly over the study period from 11 trap sites around Darwin. The epidemiology was described, correlations with various lag times were performed, followed by Poisson modelling to determine the best main effects model to predict RRV infection.Results  Ross River virus infection was reported equally in males and females in 1256 people over the 15.5 years. Average annual incidence was 113/100 000 people. Infections peaked in the 30–34 age‐group for both sexes. Correlations revealed strong associations between monthly RRV infections and climatic variables and also each of the four implicated mosquito species populations. Three models were created to identify the best predictors of RRV infections for the Darwin area. The climate‐only model included total rainfall, average daily minimum temperature and maximum tide. This model explained 44.3% deviance. Using vector‐only variables, the best fit was obtained with average monthly trap numbers of Culex annulirostris, Aedes phaecasiatus, Aedes notoscriptus and Aedes vigilax. This model explained 59.5% deviance. The best global model included rainfall, minimum temperature and three mosquito species. This model explained 63.5% deviance, and predicted disease accurately.Conclusions  We have produced a model that accurately predicts RRV infections throughout the year, in the Darwin region. Our model also indicates that predicted anthropogenic global climatic changes may result in an increase in RRV infections. Further research needs to target other high‐risk areas elsewhere in tropical Australia to ascertain the best local climatic and vector predictive RRV infection models for each region. This methodology can also be tested for assessing utility of predictive models for other mosquito‐borne diseases endemic to locations outside Australia.