bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health education for community‐based malaria control: an intervention study in Ecuador, Colombia and Nicaragua
Authors: Kroeger Axel , Meyer Regine , Mancheno Manuel , González Martha 
Published: August 2010

SummaryA malaria study was undertaken in 98 rural communities of the Pacific coast of Ecuador (n=14), Colombia (n= 22) and Nicaragua (n= 62). In‐depth interviews on people's knowledge and practice regarding malaria aetiology, symptoms and treatment were conducted and complemented by formal household interviews. On the basis of this information, an educational programme was set up which included the training of village health promoters and community workshops organized by the health workers and used a set of methods of interactive learning. After the baseline survey the communities were paired and randomly allocated to the intervention and control groups. Malaria education took place only in the intervention communities.At the start of the project people's knowledge about malaria‐transmitting mosquitoes and malaria symptoms was correct and widespread in those areas where the community exposure to formal health services was pronounced. However, knowledge of the recommended dose of chloroquine was poor everywhere, and self‐treatment of malaria episodes deficient.The educational intervention achieved a high level of participant satisfaction which was expressed in a high and continuous attendance rate at the monthly workshops. The knowledge of malaria aetiology and symptoms was 33–61% better in the intervention group than in the control group. Knowledge of the recommended doses of chloroquine increased significantly (34% in Ecuador, 93% in Colombia but not in Nicaragua) and correct use of chloroquine in the treatment of malaria episodes also improved (26% in Ecuador, 85% in Colombia). In Nicaragua the results were less satisfactory due to the short period of promotional activities and the health services' policy of delivering only supervised treatment to the population. It is concluded that health education should play a major role in malaria control.
High acceptability of voluntary counselling and HIV‐testing but unacceptable loss to follow up in a prevention of mother‐to‐child HIV transmission programme in rural Malawi: scaling‐up requires a different way of acting
Authors: Manzi M. , Zachariah R. , Teck R. , Buhendwa L. , Kazima J. , Bakali E. , Firmenich P. , Humblet P. 
Published: August 2010

SummarySetting Thyolo District Hospital, rural Malawi.Objectives In a prevention of mother‐to‐child HIV transmission (PMTCT) programme, to determine: the acceptability of offering ‘opt‐out’ voluntary counselling and HIV‐testing (VCT); the progressive loss to follow up of HIV‐positive mothers during the antenatal period, at delivery and to the 6‐month postnatal visit; and the proportion of missed deliveries in the district.Design Cohort study.Methods Review of routine antenatal, VCT and PMTCT registers.Results Of 3136 new antenatal mothers, 2996 [96%, 95% confidence interval (CI): 95–97] were pre‐test counselled, 2965 (95%, CI: 94–96) underwent HIV‐testing, all of whom were post‐test counselled. Thirty‐one (1%) mothers refused HIV‐testing. A total of 646 (22%) individuals were HIV‐positive, and were included in the PMTCT programme. Two hundred and eighty‐eight (45%) mothers and 222 (34%) babies received nevirapine. The cumulative loss to follow up (n = 646) was 358 (55%, CI: 51–59) by the 36‐week antenatal visit, 440 (68%, CI: 64–71) by delivery, 450 (70%, CI: 66–73) by the first postnatal visit and 524 (81%, CI: 78–84) by the 6‐month postnatal visit. This left just 122 (19%, CI: 16–22) of the initial cohort still in the programme. The great majority (87%) of deliveries occurred at peripheral sites where PMTCT was not available.Conclusions  In a rural district hospital setting, at least 9 out of every 10 mothers attending antenatal services accepted VCT, of whom approximately one‐quarter were HIV‐positive and included in the PMTCT programme. The progressive loss to follow up of more than three‐quarters of this cohort by the 6‐month postnatal visit demands a ‘different way of acting’ if PMTCT is to be scaled up in our setting.
Trial participation and vaccine desirability for Vi polysaccharide typhoid fever vaccine in Hue City, Viet Nam
Authors: Kaljee Linda M. , Pham Van , Son Nguyen Dinh , Hoa Nguyen Thai , Thiem Vu Dinh , Canh Do Gia , Thoa Le Thi Kim , Ali Mohammad , Ochiai Rion Leon , Danovaro‐Holliday M. Carolina , Acosta Camilo J. , Stanton Bonita , Clemens John 
Published: August 2010

SummaryObjectives  To identify demand for Vi typhoid fever vaccine for school‐age children; obstacles and enabling factors for vaccine delivery; and socio‐behavioural factors associated with trial participation and possible predictors of future vaccine acceptance, in Hue City, Viet Nam.Methods  Pre‐ and post‐trial surveys of randomly selected households with children aged 6–17 years. Simple multinomial logistic analyses for ratios of relative risks (RRR) and significance on trial participation by demographics and variables related to typhoid fever, vaccination, and pre‐trial experiences with information and consents. Multiple logistic regressions to assess differences in participation based on child's characteristics.Results  As many as 62.6% of households let all school age children participate, 10.2% let some participate, and 26.8% let none of their children participate in the trial. Factors associated with all children participating included past use of healthcare facilities (RRR, 0.45; 95% CI, 0.24–0.83), knowledge of vaccines (RRR, 0.17; 95% CI, 0.03–0.86), and perceived causes of typhoid fever (RRR, 0.90; 95% CI, 0.81–0.99). Factors associated with some children participating included utilization of healthcare facilities (RRR, 0.08; 95% CI, 0.01–0.66) and perceived severity of typhoid fever (RRR, 0.64; 95% CI 0.46–0.88). Participation was associated with satisfaction regarding pre‐vaccination information and consent procedures. Children and adolescents were active decision‐makers. Only 14 of 461 (2.2%) respondents would not use the Vi vaccine in the future for their child(ren).Conclusions  Inter‐related factors contribute to participation in a clinical vaccine trial, which may differ from desire to participate in a public health campaign. Educational campaigns need to be targeted to children and adolescents, and consideration for assent procedures for minors. Obtaining informed consent may affect trial participation within a social and political system unaccustomed to these procedures.
Chloroquine prophylaxis against vivax malaria in pregnancy: a randomized, double‐blind, placebo‐controlled trial
Authors: Villegas Leopoldo , McGready Rose , Htway Mg , Paw Moo Kho , Pimanpanarak Mupawjay , Arunjerdja Ratree , Viladpai‐nguen Samuel Jacher , Greenwood Brian , White Nicholas J , Nosten François 
Published: August 2010

SummaryObjective  To assess the safety of chloroquine (CQ) as prophylaxis against Plasmodium vivax infection during pregnancy.Method  One thousand pregnant Karen women were enrolled in a randomized, double‐blind, placebo‐controlled trial of chemoprophylaxis with chloroquine (500 mg phosphate (or 300 mg base) weekly). Women received a median (range) chloroquine phosphate total dose of 9500 (1500–17 500) mg. The mothers were actively followed from inclusion to delivery and their infants until 12 months of age.Results  Chloroquine prophylaxis completely prevented P. vivax episodes; 10.1% (95%CI: 7.3–14.5) of women in the placebo group experienced at least one episode of vivax malaria but no episode occurred in women in the CQ group. By contrast, the numbers of P. falciparum episodes were similar in each group: 7.4% (95%CI: 3.7–11.1) and 5.6% (95%CI: 3.3–7.9) in the placebo and CQ groups respectively (P = 0.56). Chloroquine prophylaxis was well tolerated and there was no difference in the proportions of reported side effects between CQ treated and placebo groups except for the duration of palpitations and sleeping disorders which were more frequent in those who had received CQ. Chloroquine prophylaxis had no impact on maternal anaemia, birth weight, gestational age, development of newborns or on growth, neurological development or visual acuity in infants at 1 year of age.Conclusion  Chloroquine is safe and effective as prophylaxis against P. vivax during pregnancy in this population.
How much fat is necessary to optimize lumefantrine oral bioavailability?
Authors: Ashley Elizabeth A. , Stepniewska Kasia , Lindegårdh Niklas , Annerberg Anna , Kham Am , Brockman Al , Singhasivanon Pratap , White Nicholas J. , Nosten François 
Published: August 2010

SummaryBackground  Artemether–lumefantrine (AL) is the only fixed, artemisinin‐based combination antimalarial drug which is registered internationally and deployed on a large scale. Absorption of the hydrophobic lipophilic lumefantrine component varies widely between individuals and is greatly increased by fat coadministration; but patients with acute malaria are frequently nauseated and anorexic, making dietary advice difficult to comply with. The aim of this study was to describe the dose–response relationship between coadministration of fat and relative lumefantrine bioavailability, in order to determine the minimum amount of fat necessary to optimize absorption.Method  We conducted a multiple crossover pharmacokinetic study in 12 healthy volunteers. This compared the area under the plasma concentration–time curve (AUC) for lumefantrine after administration of a single dose of AL in the fasting state given with 0, 10, 40, 150 and 500 ml of soya milk corresponding to 0, 0.32, 1.28, 4.8 and 16 g of fat. All volumes of milk supplements were tested in all subjects with a 3‐ to 4‐week washout period in‐between.Results  A dose–response relationship was demonstrated between the volume of soya milk administered and lumefantrine bioavailability. AL administration with soya milk increased the lumefantrine AUC more than five fold. The population mean estimated volume of soya milk required to obtain 90% of maximum effect (in terms of lumefantrine AUC) was 36 ml (corresponding to 1.2 g of fat).Conclusions  Coadministration of artemether–lumefantrine with a relatively small amount of fat (as soya milk) was required to ensure maximum absorption of lumefantrine in healthy adult volunteers.
Pharmacokinetic study of artemether–lumefantrine given once daily for the treatment of uncomplicated multidrug‐resistant falciparum malaria
Authors: Ashley Elizabeth A. , Stepniewska Kasia , Lindegårdh Niklas , McGready Rose , Annerberg Anna , Hutagalung Robert , Singtoroj Thida , Hla Gilvary , Brockman Al , Proux Stephane , Wilahphaingern Jahser , Singhasivanon Pratap , White Nicholas J. , Nosten François 
Published: August 2010

SummaryBackground  Adherence to antimalarial drug regimens is improved by simple dosing. If the fixed antimalarial drug combination artemether–lumefantrine (AL) could be given once daily, this should improve adherence and thus effectiveness and lower the risk of selecting for resistance.Methods  In an open randomized study, 43 patients with uncomplicated falciparum malaria were given equivalent doses of AL with 200 ml flavoured milk either as the conventional twice‐daily regimen or as a single daily dose for 3 days. The primary end point was a comparison of the areas under the plasma lumefantrine concentration–time curves (AUC). Secondary end points were the day 42 polymerase chain reaction (PCR)‐adjusted cure rates and the tolerability profiles.Results  Lumefantrine pharmacokinetic profiles were obtained for 36 patients. The AUC(0→∞) of the once‐daily regimen was 30% lower than that in the conventional regimen (P = 0.011) with a median (range) value of 306 (114–5781) μg/ml h, compared with 432 (308–992) μg/ml h. There was no significant difference in the peak plasma concentrations reached. PCR‐adjusted cure rate estimates at day 42 of follow‐up were 94% (95% CI: 84–100) in the six‐dose arm and 85% (70–100) in the three‐dose arm (P = 0.3).Conclusion  Artemether–lumefantrine efficacy is reduced by once‐daily dosing, because absorption of lumefantrine is dose limited. At currently recommended doses, this antimalarial should be given twice daily in a 3‐day regimen, with food containing fat.
Effect of haematinic supplementation and malaria prevention on maternal anaemia and malaria in western Kenya
Authors: Van Eijk Anna M. , Ayisi John G. , Slutsker Laurence , Ter Kuile Feiko O. , Rosen Daniel H. , Otieno Juliana A. , Shi Ya‐Ping , Kager Piet A. , Steketee Richard W. , Nahlen Bernard L. 
Published: August 2010

SummaryObjective  To evaluate the effect of routine antenatal haematinic supplementation programmes and intermittent preventive treatment (IPT) with sulphadoxine–pyrimethamine (SP) in Kenya.Methods  Anaemia [haemoglobin (Hb) <11 g/dl), severe anaemia (Hb <8 g/dl) and placental malaria were compared among women with known HIV status who delivered at a provincial hospital after study enrolment in the third trimester during three consecutive periods: period 1, no routine intervention (reference); period 2, routine haematinic supplementation (60 mg elementary iron three times/day, folic acid 5 mg once daily) and period 3, haematinics and IPT with SP.Results  Among 3108 participants, prevalence of placental malaria, anaemia and severe anaemia postpartum was 16.7%, 53.6% and 12.7%, respectively. Compared with period 1, women in period 2 were less anaemic [adjusted odds ratio (AOR), 95% confidence interval anaemia: 0.56, 0.47–0.67; severe anaemia 0.37, 0.28–0.49] and shared a similar prevalence of placental malaria (AOR 1.07, 0.86–1.32). Women in period 3 were also less anaemic (AOR anaemia: 0.43, 0.35–0.53 and severe anaemia: 0.43, 0.31–0.59), and had less placental malaria (AOR 0.56, 0.42–0.73). The effect of intervention did not differ significantly by HIV status.Conclusion  The haematinic supplementation programme was associated with significant reductions in anaemia in HIV‐seropositive and HIV‐seronegative women. The subsequent introduction of IPT was associated with halving of malaria, but no additional haematological benefit over haematinics.
The role of imported cases in the epidemiology of urban Plasmodium falciparum malaria in Quibdó, Colombia
Authors: Osorio L. , Todd J. , Pearce R. , Bradley D. J. 
Published: August 2010

SummaryObjective  To assess the role of imported cases in the local epidemiology of malaria and population genetics of Plasmodium falciparum in an urban endemic area in Colombia.Method  A total of 679 P. falciparum cases presenting in the city were interviewed, mapped, and genotyped using msp1 and msp2 molecular markers.Results  Among the cases, 75% were classified as imported and harboured single‐clone infections. The P. falciparum parasite population had low genetic diversity with a preponderant haplotype (mean genetic diversity H = 0.36), even when microsatellite markers were used (H = 0.49), partly because of the small scale at which population movement was studied. Nevertheless, indigenous and potentially introduced cases were identified.Conclusion  Migration is a confounder in planning malaria control in this endemic urban area. Longitudinal studies which monitor the P. falciparum population in imported and autochthonous cases at larger spatial scales would be necessary to study the effect of population movement on malaria transmission and, with suitable molecular markers, on the spread of drug resistance.
What role do coagulation disorders play in the pathogenesis of leptospirosis?
Authors: Wagenaar J. F. P. , Goris M. G. A. , Sakundarno M. S. , Gasem M. H. , Mairuhu A. T. A. , De Kruif M. D. , Ten Cate H. , Hartskeerl R. , Brandjes D. P. M. , Van Gorp E. C. M. 
Published: August 2010

SummaryLeptospirosis is a zoonosis of worldwide distribution, spread by the urine of infected animals. It is a major public health problem, especially in developing countries, where circumstances for transmission are most favourable. The clinical picture varies from mild disease to a severe illness with haemostatic derangements and multiorgan failure eventually leading to death. Although the haemorrhagic complications of severe disease are serious, the pathophysiology is scarcely elucidated. The complex mechanisms involved in inflammation‐induced coagulation activation are extensively studied in various infectious diseases, i.e. Gram‐negative sepsis. Tissue factor‐mediated coagulation activation, impairment of anticoagulant and fibrinolytic pathways in close concert with the cytokine network are thought to be important. But for human leptospirosis, data are limited. Because of the growing interest in this field, the impact of leptospirosis, and the availability of new therapeutic strategies, we reviewed the evidence regarding the role of coagulation in leptospirosis and provide suggestions for future research.
Community‐based study on knowledge, attitude and practice on the mode of transmission, prevention and treatment of the Buruli ulcer in Ga West District, Ghana
Authors: Renzaho Andre M. N. , Woods Paul V. , Ackumey Mercy M. , Harvey Simon K. , Kotin Jacob 
Published: August 2010

SummaryBuruli ulcer disease (BUD), a devastating tropical disease caused by Mycobacterium ulcerans, occurs in more than 80% of the administrative districts of Ghana. To elucidate community perceptions and understanding of the aetiology of BUD, attitudes towards Buruli patients and treatment‐seeking behaviours, we conducted a survey with 504 heads of households and seven focus group discussions in Ga West District, Ghana. Although 67% of participants regarded BUD as a health problem, 53% did not know its cause. Sixteen per cent attributed the cause to drinking non‐potable water, 8.1% mentioned poor personal hygiene or dirty surroundings, and 5.5% identified swimming or wading in ponds as a risk factor. About 5.2% thought that witchcraft and curses cause BUD, and 71.8% indicated that BU sufferers first seek treatment from herbalists and only refer to the hospital as a last resort. The main reasons were prospects of prolonged hospital stay, cost of transport, loss of earnings and opportunity associated with parents attending their children's hospitalization over extended period, delays in being attended by medical staff, and not knowing the cause of the disease or required treatment. The level of acceptance of BUD sufferers was high in adults but less so in children. The challenge facing health workers is to break the vicious cycle of poor medical outcomes leading to poor attitudes to hospital treatment in the community. Because herbalists are often the first people consulted by those who contract the disease, they need to be trained in early recognition of the pre‐ulcerative stage of Buruli lesions.
Tuberculosis in intra‐urban settings: a Bayesian approach
Authors: Souza Wayner V. , Carvalho Marilia S. , Albuquerque Maria de Fátima P. M. , Barcellos Christovam C. , Ximenes Ricardo A. A. 
Published: August 2010

SummaryObjective To model the effect of socio‐economic deprivation and a few transmission‐related indicators of the tuberculosis (TB) incidence at small area level, to discuss the potential of each indicator in targeting places for developing preventive action.Methods Ecological spatial study of TB incidence in Olinda, a city in the north‐east of Brazil, during the period 1996–2000. Three socio‐economic indicators (mean number of inhabitants per household; percentage of heads of household with <1 year's formal education; percentage of heads of households with monthly income lower than the minimum wage) and two transmission‐related indicators (number of cases of retreatment; number of households with more than one case during the period under study), all calculated per census tract, were used. We adopted four different full hierarchical Bayesian models to estimate the relative risk of the occurrence of TB via Markov chain Monte Carlo.Results The best specified model includes all the selected covariates and the spatially structured random effect. The gain in goodness‐of‐fit statistic when the spatial structure was included confirms the clustered spatial pattern of disease and poverty. In this model, the covariates within the non‐zero credibility interval were the number of persons per house, the number of cases of retreatment and the number of households with more than one case (all with relative risk ≥1.8) in each census tract.Conclusions The possibility to estimate in the same framework both the contribution of covariates at ecological level and the spatial pattern should be encouraged in epidemiology, and may help with establishing Epidemiological Surveillance Systems on a territorial basis, that allows rational planning of interventions and improvement of the Control Programme effectiveness.
How to measure the prevalence of tuberculosis in a population
Authors: Van Der Werf Marieke J. , Borgdorff Martien W. 
Published: August 2010

SummaryThe World Health Assembly has defined targets for measuring performance of tuberculosis (TB) control programmes, which have been included in the framework of the Millennium Development Goals. To be able to measure progress towards these targets TB control programmes need epidemiological information. At the moment, surveillance data of countries with a high burden of TB are insufficient to assess performance of the TB control programme as a result of incompleteness or low quality. Several high‐burden countries have performed TB prevalence surveys to obtain epidemiological information. As a standardized method for TB prevalence surveys has not been defined, we discuss the different options for measuring prevalence and their advantages and disadvantages. Most surveys use comparable strategies. Alternatives strategies at lower cost need to be evaluated.
Assessment of a national monitoring and evaluation system for rapid expansion of antiretroviral treatment in Malawi
Authors: Lowrance David , Filler Scott , Makombe Simon , Harries Anthony , Aberle‐Grasse John , Hochgesang Mindy , Libamba Edwin 
Published: August 2010

SummaryObjectives  Monitoring and evaluation of national antiretroviral therapy (ART) programs is vital, but routine, standardized assessment of national ART patient monitoring systems has not been established. Malawi has undertaken an ambitious ART scale‐up effort, with over 57 000 patients initiated on ART by June 2006. We assessed the national ART monitoring and evaluation system in Malawi to ensure that the response to the epidemic was being monitored efficiently and effectively, and that data collected were useful.Methods  The evaluation, performed in August 2005, generally followed the Updated Guidelines for Evaluating Public Health Surveillance Systems (CDC) and Interim Patient Monitoring Guidelines for HIV Care and ART (WHO). Assessment was conducted with qualitative methods, including twelve ART site visits, with standardized key informant interviews with ART clinic coordinators, clinical staff, and data managers, at each site. Meetings were also held with key governmental stakeholders, including Ministry of Health and National AIDS Commission.Results  The national monitoring and evaluation system devised by the Ministry of Health HIV/AIDS Unit is successful in achieving its objectives, and facilitates important aspects of the national response to HIV. Several basic changes in the data collection tools and system would facilitate more effective long‐term assessment of the ART program and support improved patient care. As the number of ART sites and patients continues to expand, the current manual paper‐based system may be overwhelmed. Identification and implementation of a feasible electronic data system that would maintain and improve data quality and the efficiency of data recording and reporting and enhance patient care is a priority.Conclusions  The assessment of ART monitoring and evaluation systems can optimize the effectiveness of national ART programs, and should be considered in other resource‐constrained countries rapidly scaling up ART.