bluuebunny/crossref_metadata_2025_split huggingface dataset:
Drug policy for visceral leishmaniasis: a cost‐effectiveness analysis
Authors: Vanlerberghe V. , Diap G. , Guerin P. J. , Meheus F. , Gerstl S. , Stuyft P. Van der , Boelaert M. 
Published: August 2010

SummaryObjective  To facilitate the choice of the best visceral leishmaniasis (VL) treatment strategy for first‐line health services in (VL)‐endemic areas, we compared in a formal decision analysis the cost and the cost‐effectiveness of the different available options.Methods  We selected four drug regimens for VL on the basis of frequency of use, feasibility and reported efficacy studies. The point estimates and the range of plausible values of effectiveness and cost were retrieved from a literature review. A decision tree was constructed and the strategy minimizing the cost per death averted was selected.Results  Treatment with amphotericin B deoxycholate was the most effective approach in the baseline analysis and averted 87.2% of all deaths attributable to VL. The least expensive and the most cost‐effective treatment was the miltefosine regimen, and the most expensive and the least cost‐effective was AmBisome® treatment. The cost of drug and medical care are the main determinants of the cost‐effectiveness ranking of the alternative schemes. Sensitivity analysis showed that antimonial was competitive with miltefosine in the low‐resistance regions.Conclusion  In areas with >94% response rates to antimonials, generic sodium stibogluconate remains the most cost‐effective option for VL treatment, mainly due to low drug cost. In other regions, miltefosine is the most cost‐effective option of treatment, but its use as a first‐line drug is limited by its teratogenicity and rapid resistance development. AmBisome in mono‐ or combination therapy is too expensive to compete in cost‐effectiveness with the other regimens.
Costs and coverage of reproductive health interventions in three rural refugee‐affected districts, Uganda
Authors: Orach Christopher Garimoi , Dubourg Dominique , De Brouwere Vincent 
Published: August 2010

SummaryBackground  Uganda has hosted an estimated 200 000 refugees in post‐emergency phase settlements interspersed within host communities since 1990. However, refugee health service runs parallel to host in most refugee‐affected districts. The process of integration of health services began in 1999.Objective  To estimate and compare the costs and coverage of reproductive health (RH) interventions in refugee and host populations in three rural West Nile refugee‐affected districts of Uganda.Methods  Data on costs of RH interventions were collected through a survey in 38/116 (33%) health facilities (3 public hospitals and 35 health centres). Data on coverage of RH interventions were collected from all 116 health facilities in the three rural refugee‐affected districts for 2 years, 2003 and 2004.Results  The costs and coverage of RH interventions significantly varied between population categories and among levels of refugee and host health facilities. Per capita cost of health care is 2.7 times higher for the refugee than the host population (US$13.12 vs. US$4.85). The cost per RH intervention is higher in the refugee than in the host health system (US$3.02 vs. US$2.73). Significantly more refugees attend antenatal care [99.4% (95% CI, 97.5–100) vs. 53.5% (53.22–53.78); P < 0.0001]. The proportion of births in health facilities was significantly greater among refugees [37.3% (36.12–38.48) vs. 15.2% (15.01–15.39); P < 0.05]. Major obstetrical interventions for absolute maternal indications were significantly more frequent among refugees than the host population living in the same region [1.02% (0.79–1.25) vs. 0.85% (0.80–0.90); P < 0.05].Conclusions  Our study has shown higher costs and coverage in refugee than host health services. The findings suggest policy recommendations for improving the capacity, financing, organization and the performance of host health system in the refugee‐affected settings.
Feasibility of measuring compliance to annual ivermectin treatment in the African Programme for Onchocerciasis Control
Authors: Brieger William R. , Okeibunor Joseph C. , Abiose Adenike O. , Ndyomugyenyi Richard , Kisoka William , Wanji Samuel , Elhassan Elizabeth , Amazigo Uche V. 
Published: August 2010

SummaryThe African Programme for Onchocerciasis Control (APOC) sponsors annual distribution of ivermectin to control onchocerciasis. Ivermectin should be taken annually by 65% of community members for a number of years to eliminate the disease as a public health problem. While many community coverage surveys have been undertaken during project monitoring, individual compliance could not be studied until several annual rounds of distribution had occurred. This paper reports on the efforts to determine whether adequate records could be found to enable a compliance study. A step‐down process from project to district to community level was used to identify project sites where continuous ivermectin distribution up through 2004 had occurred. The first step consisted of selecting 17 of 25 projects by APOC. The second step determined adequacy of districts where distribution had occurred on a regular annual basis. Among 121 districts 58.6% undertook distribution in all 7 years. A total 852 villages were visited and community level records were found in all but three. Records showed that distribution had occurred for a minimum of five consecutive times in 429 villages, and ultimately 10 projects. While the feasibility study found an adequate number of villages to study compliance, the large number of projects, districts and villages that did not qualify for the follow‐on compliance study should lead National Onchocerciasis Control Programme managers to strengthen the overall coverage and consistency of their efforts.
Evaluation of pooled screening for anti‐HCV in two blood services set‐ups
Authors: Novack Lena , Shinar Eilat , Safi Jamal , Soliman Hassan , Yaari Arieh , Galai Noya , Pliskin Joseph S. , Sarov Batia 
Published: August 2010

SummaryObjective Screening blood donations for anti‐HCV is only partially performed in many developing countries due to the relatively high costs of testing. The screening expenditures can be reduced by testing donations in pools.This study evaluates the accuracy and feasibility of pooled screening procedure for anti‐HCV in blood banks in Israel and the Palestinian Authority.Methods The sensitivity and specificity of tests performed on pool sizes of 6–24 samples were compared to singleton immunoassay testing. All negative samples and those positive for anti‐HCV were obtained from the routine work of Magen David Adom Blood Services in Israel and Shifa Hospital blood bank in Palestinian Authority. The experiments were run in parallel with different technologies.Results  The sensitivity of pooled‐testing for anti‐HCV by Magen David Adom was 94–97% for verified samples. In the Shifa Hospital, the sensitivity was estimated as 96–97% for non‐verified samples. Cost‐analysis showed benefits up to $2 per donation screened for anti‐HCV in Shifa Hospital.Conclusions  We recommend using manually created pools of up to 6 samples when testing for anti‐HCV, but at the cost of 3% loss in sensitivity. Pooling can be considered, in countries which do not perform routine screening, due to their limited economic resources.
Rapid point‐of‐care HIV testing in pregnant women: a systematic review and meta‐analysis
Authors: Pai Nitika Pant , Tulsky Jacqueline Peterson , Cohan Deborah , Colford John M. , Reingold Arthur L. 
Published: August 2010

SummaryRapid, point‐of‐care human immunodeficiency virus (HIV) testing has the potential to enhance strategies to prevent mother‐to‐child transmission (MTCT) of HIV infection. Rapid tests need minimal laboratory infrastructure and can be performed by health workers with minimal training. In our systematic review and meta‐analysis, we aimed to summarize the overall diagnostic accuracy of rapid HIV tests in pregnancy, and outcomes such as acceptability, patient preference, feasibility and impact of rapid testing. We searched four major databases, identified and screened 1377 citations, and included 17 studies that met our eligibility criteria. Analyses of these studies suggested that the overall sensitivity and specificity of blood‐based rapid tests was high compared with oral rapid tests. A two‐step testing strategy, particularly parallel testing, was found to be superior to single‐test strategy in labour and delivery settings. Acceptability of rapid tests and patient preference was variable across studies. Overall, rapid HIV testing was highly accurate compared with conventional tests and offer a clear advantage of enabling the implementation of timely interventions to reduce MTCT of HIV. To improve diagnostic accuracy and to reduce false‐positive results, it may be necessary to use two rapid tests during labour and delivery.
Fracture treatment by bonesetters in central Ghana: patients explain their choices and experiences
Authors: Ariës Marcel J. H. , Joosten Hanneke , Wegdam Harry H. J. , Van Der Geest Sjaak 
Published: August 2010

SummaryObjective  To understand factors influencing patients’ decisions to choose either fracture treatment by a bonesetter or in the hospital and to explore patients’ experiences with bonesetter treatment.Method  In‐depth interviews with 46 patients with a radiological proven fracture in a district hospital in central Ghana.Results  Traditional healers, such as bonesetters, play a substantial role in the Ghanaian healthcare system. Over a period of 3 months, 14 patients with a proven fracture left hospital for treatment by a bonesetter. The hospital is considered the only institution where emergency care can be provided and reliable, extensive diagnostic and treatment facilities are available for fracture treatment. Patients opting for bonesetter treatment are guided by the severity of the fracture, availability of the service, their financial status and past experiences. The healing methods used by different bonesetters are based on mutual comparable principles.Conclusion  Fracture treatment can serve as a model for respectful and efficient co‐existence of traditional and biomedical medicine.
Malaria deaths as sentinel events to monitor healthcare delivery and antimalarial drug safety
Authors: Mehta U. , Durrheim D. N. , Blumberg L. , Donohue S. , Hansford F. , Mabuza A. , Kruger P. , Gumede J. K. , Immelman E. , Sánchez Canal A. , Hugo J. J. , Swart G. , Barnes K. I. 
Published: August 2010

SummaryObjectives  To identify case management, health system and antimalarial drug factors contributing to malaria deaths.Method  We investigated malaria‐related deaths in South Africa's three malaria endemic provinces from January 2002 to July 2004. Data from healthcare facility records and a semi‐structured interview with patients’ contacts were reviewed by an expert panel, which sought to reach consensus on factors contributing to the death. This included possible health system failures, adverse reactions to antimalarials, inappropriate medicine use and failing to respond to treatment.Results  Approximately 177 of 197 cases met inclusion criteria for the study. Delay in seeking formal health care was significantly longer for patients who sought traditional health care [median 4; inter‐quartile range (IQR) 3–7 days] than for patients who did not (median 3; IQR 1–5 days; P = 0.033). Patients with confirmed or suspected HIV/AIDS were significantly more likely to use traditional approaches (25%) than those with other comorbidities (0%; P = 0.002). Malaria was neither suspected nor tested for at a primary care facility in 23% of cases with adequate records. Initial hospital assessment was considered inadequate in 74% of cases admitted to hospital and in‐patient monitoring and management was adequate in only 27%. There were 32 suspected adverse reactions to antimalarial therapy.Conclusion  A confidential enquiry into malaria‐related deaths is a useful tool for identifying preventable factors, health system failures and adverse events affecting malaria case management.
A correlative study of ultrasound with serology in an area in China co‐endemic for human alveolar and cystic echinococcosis
Authors: Yang Y. R. , Craig P. S. , Ito A. , Vuitton D. A. , Giraudoux P. , Sun T. , Williams G. M. , Huang Z. , Li Z. , Wang Y. , Teng J. , Li Y. , Huang L. , Wen H. , Jones M. K. , McManus D. P. 
Published: August 2010

SummaryWe correlated ultrasound (US) imaging classifications for human alveolar echinococcosis (AE) and cystic echinococcosis (CE) with serology (ELISA and immunoblotting (IB) incorporating native and recombinant/purified echinococcal antigens) in community surveys (2001–2003) and follow‐up (2002 and 2003) of US‐confirmed cases in Ningxia, China. One hundred and seventy‐one cases (96 with AE, 75 with CE) were identified; of these, US classification and serological data were obtained for 142 and 112 cases, respectively. Seropositive‐rates increased in CE patients with highly viable unilocular cyst lesions (Types CL, CE 1 or CE 2) to degenerating primary lesions (CE 3), but then decreased in subjects with inactive (CE 4) or dead (CE 5) cysts. In contrast, there was a constant increase in seropositivity from the early (P1, P2) to the advanced stages (P3, P4) with AE cases. For US‐confirmed cases, follow‐up by US combined with serology is invaluable for studying the clinical progression of echinococcosis and for detecting recurrent cysts or reinfection post‐treatment.
A multiplex PCR assay that separates Rhodnius prolixus from members of the Rhodnius robustus cryptic species complex (Hemiptera: Reduviidae)
Authors: Pavan M. G. , Monteiro F. A. 
Published: August 2010

Summary Rhodnius prolixus is one of the most important primary vectors of human Chagas disease in Latin America. Its morphology is, however, identical to that of the members of the Rhodnius robustus cryptic species complex, which includes secondary vectors. The correct identification of these taxa with differential vector competence is, therefore, of great epidemiological relevance. We used the alignment of 26 mitochondrial cytochrome b haplotypes (663 bp) to select for PCR‐amplifiable species‐specific regions. We designed one forward primer on a region conserved across all haplotypes, and three reverse primers that anneal to species‐specific regions and amplify fragments of different lengths for R. prolixus (285 bp) and for members of the two major R. robustus lineages: group I (349 bp) and groups II–IV (239 bp). These fragments were easily identifiable on regular 1.5% agarose gels. This multiplex PCR assay was successfully tested on 81 specimens from six Latin American countries, and used to determine the phylogeographic boundaries for each species. It is a simple, objective, and cost‐effective assay. Its PCR‐based nature makes it applicable to any insect developmental stage, as well as to dried specimens, and insect remains. It should be particularly useful in areas where representatives of these Rhodnius species occur in sympatry.
Field trial of a low cost method to evaluate hand cleanliness
Authors: Luby Stephen P. , Agboatwalla Mubina , Billhimer Ward , Hoekstra Robert M. 
Published: August 2010

SummaryObjective  To evaluate a simple low cost method for measuring hand contamination as an objective assessment of handwashing practices.Method  As part of a larger randomized controlled trial of handwashing promotion with soap conducted in squatter settlements of Karachi, Pakistan, a randomly selected subset of 52 mothers in households receiving soap and handwashing promotion and 28 mothers in control households directly pressed three fingers of their right hand onto MacConkey agar plates on weekly unannounced visits from April to September 2002, and monthly from October 2002 to March 2003. The MacConkey plates were incubated at 44 °C for 24 h, and evaluated for growth of thermotolerant coliform bacteria.Results  The proportion of samples that had detectable thermotolerant coliforms (50%) was similar in households that received soap and control households (52%, P = 0.40). In the week after evaluation of the mothers’ hands, the proportion of households that reported diarrhoea was similar regardless of whether or not the mother had thermotolerant coliforms detected by direct finger imprint (18.6%vs. 19.1%, Relative Risk 0.99, 95% CI 0.96, 1.03).Conclusions  A three finger direct imprint test using MacConkey agar for thermotolerant coliforms was not a useful method to assess regular handwashing practices with soap in Karachi. Developing better measures of handwashing behaviour remains an important research priority.
Factors determining use of pre‐travel preventive health services by West African immigrants in The Netherlands
Authors: Schilthuis Herbert J. , Goossens Ingrid , Ligthelm Robert J. , De Vlas Sake J. , Varkevisser Corlien , Richardus Jan H. 
Published: August 2010

SummaryObjective  To determine for what reasons West African immigrants, who contribute the largest single group of malaria cases in the Netherlands, visit pre‐travel preventive health services and whether use of such services is likely to improve use of preventive measures.Methods  Semi‐structured interviews with eligible participants recruited through West African churches and societies and at a large festival.Results  A total of 70% of the total non‐random sample of 292 participants said that they always use pre‐travel preventive health services before travelling. Being from Ghana (OR = 2.5), having legal residency status (OR = 2.5), visiting friends and relatives rather than going for business or funeral (OR = 6.7), and living in Amsterdam (OR = 5.1) were all independently associated with using pre‐travel preventive health services, as were taking general preventive measures (OR = 3.0), and self‐reported use of malaria prophylaxis. Higher use of pre‐travel preventive health services was not associated with better knowledge of malaria as such.Conclusions  West Africans, in particular non‐Ghanaians, illegal immigrants and West African immigrants leaving at short notice should be encouraged to use pre‐travel preventive health services. Adequate methods to reach these groups need to be developed, including health education on the importance of prevention in general.
Predictors of death from severe pneumonia among children 2–59 months old hospitalized in Bohol, Philippines: implications for referral criteria at a first‐level health facility
Authors: Lupisan S. P. , Ruutu P. , Erma Abucejo‐Ladesma P. , Quiambao B. P. , Gozum L. , Sombrero L. T. , Romano V. , Herva E. , Riley I. , Simoes E. A. F. ,   ARIVAC Consortium
Published: August 2010

SummaryObjective  To determine predictors of death among children 2–59 months old admitted to hospital with severe pneumonia.Methods  Prospective observational study from April 1994 to May 2000 to investigate serious infections in children less than 5 years old admitted to a tertiary care government hospital in a rural province in central Philippines. The quality of clinical and laboratory work was monitored. The WHO classification for severe pneumonia was used for patient enrolment.Results  There were 1249 children with severe pneumonia and no CNS infection. Thirty children died. Using univariate analysis, the following factors were significantly associated with death: age 2–5 months, dense infiltrates on chest radiography and presence of definite bacterial pathogens in the blood. Stepwise logistic regression analysis revealed the following independent predictors of death: age 2–5 months, weight for age z‐score less than −2 SD, dense infiltrates on chest radiography and definite pathogens isolated in the blood. When the results of chest radiographs and blood cultures were not included to mimic facilities available at first‐level facilities, age 2–5 months and weight for age z‐score less than −2 SD remained independent predictors of death.Conclusion  When resources are limited, children with lower chest wall indrawing (severe pneumonia) who are 2–5 months old or moderately to severely malnourished should be referred for immediate higher‐level care.
Migrants’ access to antiretroviral therapy in Thailand
Authors: Saether Simen Tellemann , Chawphrae Usawadee , Zaw Maw Maw , Keizer Cornelieke , Wolffers Ivan 
Published: August 2010

SummaryObjective  To investigate migrants’ access to antiretroviral therapy (ART) and assess the applicability of ART guidelines to migrants.Methods  Six focus group discussions (FGD) were conducted in Thailand with 74 Burmese migrants: factory workers in Mae Sot and Bangkok, construction site workers in Chiang Mai and unemployed and undocumented HIV‐positive migrants in Mae Sot. Thirteen key stakeholders and migrants were interviewed for triangulation.Results  (1) Present criteria for in‐/exclusion restrict migrants’ access to ART. (2) Leading ART guidelines are not applicable for migrants in general. (3) Migrants are likely to experience more problems with adherence to ART than local patients, which increases the importance of ART guidelines.Conclusions  Without ART guidelines that take into consideration the specific circumstances that limit migrants’ access to ART, health care providers will continue to render HIV‐positive migrants ineligible. Interventions are needed to both make the ART guidelines applicable to migrants and to overcome obstacles restricting migrants’ access to ART. This will greatly improve migrants’ access to ART and help to save the lives of thousands of HIV‐positive migrants.
Risk factors for HIV/AIDS in a low HIV prevalence site of sub‐Saharan Africa
Authors: Croce Francesco , Fedeli Paolo , Dahoma Mohamed , Dehò Lorenzo , Ramsan Mahdi , Adorni Fulvio , Corvasce Stefano , Galli Massimo 
Published: August 2010

SummaryWe conducted a hospital‐based survey on prevalence and risk factors of HIV‐1/2 and other viral infections in Zanzibar archipelago. Blood samples, socio‐demographic and behavioural data were collected from 2697 patients. The overall HIV prevalence was 2.9%. About 1.4%, 2.1%, 4.2% of antenatal clinic (ANC) attendees and 2.1%, 3.7%, 5.3% of blood donors were, respectively, HIV‐Abs‐, HTLV‐Abs‐ and HBs‐Ag‐positive; 5.5% of blood donors were HCV‐affected. Co‐infections were rare. Exactly 3.4% of the children aged 6–10 years were HIV‐positive. People aged 26–35 years [adjusted odds ratio (AOR) 4.4, 95% CI (confidence interval) 1.72–11.22; P = 0.002], illiterate subjects (AOR 3.6, 95% CI 1.65–7.98; P = 0.001) mobile workers (AOR 7.0, 95% CI 1.41–34.62; P = 0.02) and previously operated patients (AOR 1.9, 95% CI 1.02–3.66; P = 0.04) were at higher risk for HIV/AIDS. Any of the examined factors were associated with hepatitis B virus, hepatitis C virus and human T lymphotropic virus type 1/2 transmission. HIV/AIDS prevention strategies must primarily be addressed to traditional high‐risk groups and secondarily to unsafe health care procedures in relatively preserved sub‐Saharan areas.