bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology of meningococcal disease in southern Brazil from 1995 to 2003, and molecular characterization of Neisseria meningitidis using multilocus sequence typing
Authors: Baethgen L. F. , Weidlich L. , Moraes C. , Klein C. , Nunes L. S. , Cafrune P. I. , Lemos A. P. , Rios S. S. , Abreu M. F. , Kmetzsch C. , Sperb A. F. , Riley L. W. , Rossetti M. L. R. , Zaha A. 
Published: August 2010

SummaryObjective  To describe the epidemiology of meningococcal disease (MD) in southern Brazil.Methods  Retrospective cohort study among 2215 MD cases reported from 1995 to 2003 in Rio Grande do Sul (RS) State.Results  The overall incidence fell by 50%; the case‐fatality rate during this period was 22%. Even so, the incidence of MD remained high after the epidemic period ended in 1999. Together, the age groups of 1–4 years and infants accounted for 54.1% of reported cases with incidences of 11.3/100 000 and 31.3/100 000, respectively; 69.8% of cases were caused by Neisseria meningitidis serogroup B, which increased significantly. There was a significant decrease in serogroup C cases in the whole period. The phenotypes B:4,7:P1.19,15, B:15:P1.7,16 and B:NT:P1.3 caused almost 50% of all serotyped cases. Fifty‐six isolates obtained from RS patients during the first non‐epidemic year 2000 plus 20 isolates from other southern Brazilian states (Santa Catarina and Paraná), Denmark and France were typed by multilocus sequence typing. Twenty sequence types (STs) were identified, eight of them found only in RS. ST‐33 (27%) and ST‐259 (18%) were the most frequent; both belong to the ST‐32/ET‐5 complex. ST‐259 cases showed a trend towards higher risk of fatal outcome. ST‐259 isolates were not detected among geographic controls or in other studies in Brazil.Conclusion  Our data suggest that ST‐33 and ST‐259 clones and the emergence of the ST‐103 isolates contributed to the continued high incidence of MD in RS.
Ascertainment of childhood vaccination histories in northern Malawi
Authors: Jahn A. , Floyd S. , Mwinuka V. , Mwafilaso J. , Mwagomba D. , Mkisi R. E. , Katsulukuta A. , Khunga A. , Crampin A. C. , Branson K. , McGrath N. , Fine P. E. M. 
Published: August 2010

SummaryObjective  To assess factors related to recorded vaccine uptake, which may confound the evaluation of vaccine impact.Methods  Analysis of documented vaccination histories of children under 5 years and demographic and socio‐economic characteristics collected by a demographic surveillance system in Karonga District, Malawi. Associations between deviations from the standard vaccination schedule and characteristics that are likely to be associated with increased mortality were determined by multivariate logistic regression.Results  Approximately 78% of children aged 6–23 months had a vaccination document, declining to <50% by 5 years of age. Living closer to an under‐5 clinic, having a better educated father, and both parents being alive were associated with having a vaccination document. For a small percentage of children, vaccination records were incomplete and/or faulty. Vaccination uptake was high overall, but delayed among children living further from the nearest under‐5 clinic or from poorer socio‐economic backgrounds. Approximately 9% of children had received their last dose of DPT with or after measles vaccine. These children were from relatively less educated parents, and were more likely to have been born outside the health services.Conclusions  Though overall coverage in this community was high and variation in coverage according to child or parental characteristics small, there was strong evidence of more timely coverage among children from better socio‐economic conditions and among those who lived closer to health facilities. These factors are likely to be strong confounders in the association of vaccinations with mortality, and may offer an alternative explanation for the non‐specific mortality impact of vaccines described by other studies.
The role of context: neighbourhood characteristics strongly influence HIV risk in young women in Ndola, Zambia
Authors: Gabrysch Sabine , Edwards Tansy , Glynn Judith R. ,   for the Study Group on heterogeneity of HIV epidemics in African cities
Published: August 2010

SummaryObjectives  To examine the effect of neighbourhood socioeconomic factors on human immunodeficiency virus (HIV) prevalence in young women (aged 15–24 years) in Zambia.Methods  Re‐analysis of a cross‐sectional, population‐based sero‐survey of nearly 2000 adults conducted in 1997/1998 in Ndola, Zambia. Neighbourhood‐level socioeconomic status (SES) was defined using the availability of running water and electricity in addition to educational, employment and occupational characteristics of adults older than 24 years. Neighbourhood‐level and individual‐level risk factors were analysed with a multivariate multilevel logistic regression model using a hierarchical conceptual framework.Results  Young women living in neighbourhoods of lower or middle SES had higher HIV prevalences than those from higher SES neighbourhoods [lower SES: adjusted odds ratio (OR) 2.4, 95% confidence interval (CI) 1.3–4.5, middle SES: adjusted OR 2.4, 95% CI 1.3–4.7]. Young women living near a market were at increased risk of HIV infection (OR 2.9, 95% CI 1.4–5.9), while proximity to a health centre seemed protective (OR 0.4, 95% CI 0.2–1.0). When controlling for neighbourhood factors, better education was a risk factor for HIV infection (OR 1.5, 95% CI 1.0–2.1), although it was not significant in individual‐level analysis.Conclusions  Community‐level factors are as important as individual‐level factors in determining HIV infection in young women. Confining analyses to individual‐level factors ignores the underlying causes and the modifying effect of context on individual behaviour and may even lead to different conclusions concerning the role of individual‐level factors.
Eflornithine is a cost‐effective alternative to melarsoprol for the treatment of second‐stage human West African trypanosomiasis in Caxito, Angola
Authors: Robays J. , Raguenaud M. E. , Josenando T. , Boelaert M. 
Published: August 2010

SummaryObjective  To compare the cost‐effectiveness of eflornithine and melarsoprol in the treatment of human African trypanosomiasis.Method  We used data from a Médecins Sans Frontières treatment project in Caxito, Angola to do a formal cost‐effectiveness analysis, comparing the efficiency of an eflornithine‐based approach with melarsoprol. Endpoints calculated were: cost per death avoided; incremental cost per additional life saved; cost per years of life lost (YLL) averted; incremental cost per YLL averted. Sensitivity analysis was done for all parameters for which uncertainty existed over the plausible range. We did an analysis with and without cost of trypanocidal drugs included.Results  Effectiveness was 95.6% for melarsoprol and 98.7% for eflornithine. Cost/patient was 504.6 for melarsoprol and 552.3 for eflornithine, cost per life saved was 527.5 USD for melarsoprol and 559.8 USD for eflornithine without cost of trypanocidal drugs but it increases to 600.4 USD and 844.6 USD per patient saved and 627.6 USD and 856.1 USD per life saved when cost of trypanocidal drugs are included. Incremental cost‐effectiveness ratio is 1596 USD per additional life saved and 58 USD per additional life year saved in the baseline scenario without cost of trypanocidal drugs but it increases to 8169 USD per additional life saved and 299 USD per additional life year saved if costs of trypanocidal drugs are included.Conclusion  Eflornithine saves more lives than melarsoprol, but melarsoprol is slightly more cost‐effective. Switching from melarsoprol to eflornithine can be considered as a cost‐effective option according to the WHO choice criteria.
Knockdown resistance mutations (kdr) and insecticide susceptibility to DDT and pyrethroids in Anopheles gambiae from Equatorial Guinea
Authors: Moreno M. , Vicente J. L. , Cano J. , Berzosa P. J. , De Lucio A. , Nzambo S. , Bobuakasi L. , Buatiche J. N. , Ondo M. , Micha F. , Do Rosario V. E. , Pinto J. , Benito A. 
Published: August 2010

SummaryObjectives  To determine the frequency of knockdown resistance (kdr) mutations in the malaria vector Anopheles gambiae s.s. from continental Equatorial Guinea; and to relate kdr genotypes with susceptibility to DDT and pyrethroid insecticides in this vector.Methods  Female mosquitoes were collected in two villages, Miyobo and Ngonamanga, of mainland Equatorial Guinea. Insecticide susceptibility tests were performed following WHO procedures. Anopheles gambiae complex specimens were identified to species and molecular form by PCR. Genotyping of the kdr locus was performed by allele‐specific PCR and direct sequencing in a subset of samples.Results  Both M and S molecular forms of A. gambiae were found in Ngonamanga whereas only the S‐form was identified in Miyobo. The two kdr mutations were detected in S‐form samples of both villages, with a higher frequency of the kdr‐e (Leu‐1014‐Ser) allele (Miyobo: 16%; Ngonamanga: 40%). The kdr‐w (Leu‐1014‐Phe) mutation was also detected in 3% of the M‐form. All individuals tested for pyrethroids were susceptible. A mortality rate of 86% was obtained for DDT. An overall kdr allele frequency (i.e. kdr‐e + kdr‐w) of 22% was detected in DDT resistant individuals, whereas susceptible individuals had a kdr frequency of 6%.Conclusion  The co‐occurrence of both kdr mutations and reduced susceptibility to DDT found in A. gambiae highlights the importance of implementing efficient surveillance of insecticide resistance in Equatorial Guinea.
Urban living and obesity: is it independent of its population and lifestyle characteristics?
Authors: Arambepola Carukshi , Allender Steven , Ekanayake Ruvan , Fernando Dulitha 
Published: August 2010

SummaryObjectives  Living in an urban area influences obesity. However, little is known about whether this relationship is truly independent of, or merely mediated through, the demographic, socio‐economic and lifestyle characteristics of urban populations. We aimed to identify and quantify the magnitude of this relationship in a Sri Lankan population.Methods  Cross‐sectional study of adults aged 20–64 years representing the urban (n = 770) and rural (n = 630) populations, in the district of Colombo in 2004. Obesity was measured as a continuous variable using body mass index (BMI). Demographic, socio‐economic and lifestyle factors were assessed. Gender‐specific multivariable regression models were developed to quantify the independent effect of urban/ rural living and other variables on increased BMI.Results  The BMI (mean; 95% confidence interval) differed significantly between urban (men: 23.3; 22.8–23.8; women: 24.2; 23.7–24.7) and rural (men: 22.3; 21.9–22.7; women: 23.2; 22.7–23.7) sectors (P < 0.01). The observed association remained stable independently of all other variables in the regression models among both men (coefficient = 0.64) and women (coefficient = 0.95). These coefficients equated to 2.2 kg weight for the average man and 1.7 kg for the average woman. Other independent associations of BMI were with income (coefficient = 1.74), marital status (1.48), meal size (1.53) and religion (1.20) among men, and with age (0.87), marital status (2.25) and physical activity (0.96) among women.Conclusions  Urban living is associated with obesity independently of most other demographic, socio‐economic and lifestyle characteristics of the population. Targeting urban populations may be useful for consideration when developing strategies to reduce the prevalence of obesity.
Dynamics of insecticide resistance in the malaria vector Anopheles gambiae s.l. from an area of extensive cotton cultivation in Northern Cameroon
Authors: Chouaïbou M. , Etang J. , Brévault T. , Nwane P. , Hinzoumbé C. K. , Mimpfoundi R. , Simard F. 
Published: August 2010

SummaryObjective  To explore temporal variation in insecticide susceptibility of Anopheles gambiae s.l. populations to the four chemical groups of insecticides used in public health and agriculture, in close match with the large‐scale cotton spraying programme implemented in the cotton‐growing area of North Cameroon.Methods  Mosquito larvae were collected in 2005 before (mid June), during (mid August) and at the end (early October) of the cotton spraying programme. Larvae were sampled in breeding sites located within the cotton fields in Gaschiga and Pitoa, and in Garoua, an urban cotton‐free area that served as a control. Insecticide susceptibility tests were carried out with 4% DDT (organochlorine), 0.4% chlorpyrifos methyl (organophosphate), 0.1% propoxur (carbamate), 0.05% deltamethrin and 0.75% permethrin (pyrethroids).Results  Throughout the survey, An. gambiae s.l. populations were completely susceptible to carbamate and organophosphate, whereas a significant decrease of susceptibility to organochlorine and pyrethroids was observed during spraying in cotton‐growing areas. Tolerance to these insecticides was associated with a slight increase of knockdown times compared to the reference strain. Among survivor mosquitoes, the East and West African Kdr mutations were detected only in two specimens of An. gambiae s.s. (n = 45) and not in Anopheles arabiensis (n = 150), suggesting metabolic‐based resistance mechanisms.Conclusions  Environmental disturbance due to the use of insecticides in agriculture may provide local mosquito populations with the enzymatic arsenal selecting tolerance to insecticides.
The neglected ‘m’ in MCH programmes – why mental health of mothers is important for child nutrition
Authors: Rahman Atif , Patel Vikram , Maselko Joanna , Kirkwood Betty 
Published: August 2010

SummaryIn most societies, mothers are the primary providers of nutrition and care to young children. This is a demanding task, and poor physical or mental health in mothers might be expected to have adverse consequences on their children’s health, nutrition and psychological well‐being. Child nutrition programmes do not adequately address maternal mental health. In this article, we consider the evidence from less developed countries on whether maternal mental health influences child growth, with respect to evidence from both observational studies and from clinical trials. We estimate how much of the burden of undernutrition might be averted in one setting, and propose that promoting maternal mental health and treating maternal mental illness offer important new opportunities to tackle the twin scourges of maternal ill‐health and child undernutrition.
High efficacy of two artemisinin‐based combinations (artemether–lumefantrine and artesunate plus amodiaquine) for acute uncomplicated malaria in Ibadan, Nigeria
Authors: Falade C. O. , Ogundele A. O. , Yusuf B. O. , Ademowo O. G. , Ladipo S. M. 
Published: August 2010

SummaryObjective  To test the hypothesis that artesunate plus amodiaquine (ASAQ) is as effective as artemether–lumefantrine (AL) in the treatment of acute uncomplicated malaria in Nigerian children.Methods  In an open label, randomized controlled clinical trial, children aged 6 months to 10 years were randomized to receive artesunate (4 mg/kg daily) plus amodiaquine (10 mg/kg daily) or AL (5–14 kg, one tablet; 15–24 kg, two tablets and 25–34 kg, three tablets twice daily). Both drug regimens were given for 3 days and follow‐up was for 28 days.Results  A total of 132 children (66 in each group) were randomized to receive either ASAQ or AL. Day 28 cure rates in the per protocol (PP) population were 93% for ASAQ and 95% for AL (OR = 0.71, 95% CI = 0.12–3.99, ρ = 0.66). Using Kaplan–Meier product‐limit estimates of failure, the median survival time for ASAQ was 21 days and for AL 28 days (P = 0.294). PCR corrected day 28 cure rate for PP populations were 98.4% for ASAQ and 100% for AL. Both drugs were well‐tolerated.Conclusion  ASAQ is as effective as AL and both combinations were efficacious and safe.
Invasive Haemophilus influenzae disease in children less than 5 years of age in Manhiça, a rural area of southern Mozambique
Authors: Roca Anna , Quintó Llorenç , Abacassamo Fatima , Morais Luis , Vallès Xavi , Espasa Mateu , Sigaúque Betuel , Sacarlal Jahit , Macete Eusebio , Nhacolo Ariel , Mandomando Inacio , Levine Myron M. , Alonso Pedro L. 
Published: August 2010

SummaryObjective  To measure the disease burden and epidemiological characteristics of invasive Haemophilus influenzae in rural Mozambican children.Methods  As part of the clinical management of children admitted to Manhiça District Hospital, blood and cerebrospinal fluid samples were collected between May 2001 and April 2005 for children aged <5 years. The level of antibiotic resistance of the isolates was analysed.Results  During the surveillance period, there were 106 episodes of invasive H. influenzae disease. The estimated minimum incidence rate of invasive disease among children <5 years of age was 125/100 000 per child‐year‐at‐risk. Fifty‐six (59/106) per cent of cases were infants aged 3 to <12 months. Confirmed meningitis explained 16% of the episodes (n = 17) but was probably underestimated, as meningitis surveillance was not well implemented in the setting during the study. The case‐fatality‐rate was 21%, being highest among children with meningitis (odds ratio = 4.38, P = 0.011). Resistance to the antibiotics most commonly used in Mozambique was high – chloramphenicol 39%, ampicillin 35% and cotrimoxazol 74%– and had increased over the years (P < 0.001 for chloramphenicol).Conclusion  Invasive H. influenzae disease is of considerable public health importance in Mozambique; implementing H. influenzae type b vaccination in sub‐Saharan Africa has the potential to increase child survival.
Cutaneous leishmaniasis in the Jordanian side of the Jordan Valley: severe under‐reporting and consequences on public health management
Authors: Mosleh Ibrahim M. , Geith Eid , Natsheh Lina , Abdul‐Dayem Muna , Abotteen Nabil 
Published: August 2010

SummaryObjective  To test if cutaneous leishmaniasis (CL) is under‐reported in the Jordanian Mid Jordan Valley, with resultant serious consequences for drug supply.Methods  For 2001–2003, prescribed amounts of drug and laboratory log‐books were investigated to estimate CL cases reported in Jordanian Mid Jordan Valley. From April 2004 to May 2005, passive detection and focused active ‘index case cluster’‐directed detection were used.Results  An average of 75/100 000 cases per year was estimated to have occurred 2001–2003, resulting in under‐reporting by a factor of 47. In 2004/2005, 313/100 000 cases per year were passively detected. Active case‐finding detected additional cases.Conclusion  Cutaneous leishmaniasis is severely under‐reported in Jordanian Mid Jordan Valley, which impacts its eradication.
Clonal heterogeneity of clinical isolates of vancomycin‐resistant Enterococcus faecium with unique vanS
Authors: Pourshafie Mohammad R. , Talebi Malihe , Saifi Mahnaz , Katouli Mohammad , Eshraghi Saeed , Kühn Inger , Möllby Roland 
Published: August 2010

SummaryObjective  To examine the clonal diversity of vancomycin‐resistant enterococci (VRE).Methods  A total of 900 clinical isolates of enterococci were obtained, and VRE isolates were subjected to antimicrobial susceptibility tests, biochemical fingerprinting with the PhPlate system (PhP), ribotyping and pulsed‐field gel electrophoresis (PFGE) typing.Results  Forty‐nine of all enterococcal isolates were resistant to high levels of vancomycin (MIC ≥ 128) and identified as Enterococcus faecium. Biochemical fingerprinting with PhP showed that the VRE isolates were highly diverse (diversity index, Di = 0.93) and belonged to 24 PhP‐types. The VRE could be separated into 34 and 27 types with PFGE and ribotyping, giving diversity indices of 0.98 and 0.97, respectively. The PFGE method was more discriminatory than ribotyping and PhP system for E. faecium isolates. A combination of either of the two typing methods resulted in at least 44 types. Furthermore, sequencing analysis of vanS of Tn1546 showed one nucleotide mutation (C→A) at position 5727 in comparison with the prototype BM4147, which was found to be unique in all Iranian VRE isolates.Conclusion  The isolated clinical VRE strains were highly diverse in Tehran.
Case–control study of risk factors associated with hepatitis C virus infection among pregnant women in hospitals of Karachi‐Pakistan
Authors: Khan Uzma R. , Janjua Naveed Z. , Akhtar Saeed , Hatcher Juanita 
Published: August 2010

SummaryObjective  To identify risk factors for hepatitis C virus (HCV) infection among pregnant women seeking antenatal care in tertiary care hospitals of Karachi, Pakistan.Methods  We enrolled 119 cases and 238 controls. Cases were enzyme‐linked immunosorbent assay (ELISA III) positive pregnant women for antibodies to HCV; controls were anti‐HCV ELISA negative pregnant women.Results  The mean age of study subjects was 26 years (SD 5) ranging from 15 to 50 years. The mean number of pregnancies for cases was 4 (SD 3) and for controls was 3 (SD 2). Among cases an average number of injections in any month was 40%, history of hospitalization was 61% and household contact with jaundice or hepatitis was 35%. In the final multivariable logistic regression model, five or more gestations (aOR = 1.99; 95% CI = 1.08–3.33), ≥1 injection (aOR = 2.33; 95% CI = 1.38–3.91) per month, hospitalization (aOR = 1.78; 95% CI = 1.01–2.99) and household contact with jaundice/hepatitis (aOR = 3.32; 95% CI = 1.89–5.83) were independently associated with HCV.Conclusion  Iatrogenic exposure (health care injections, hospitalizations and gestations) is the major risk factor for transmission of HCV among pregnant women.
Undertaking a complex evaluation of safe motherhood in rural Burkina Faso
Authors: Graham Wendy J. , Conombo S. Ghislaine , Zombré D. Sosthène , Meda Nicolas , Byass Peter , De Brouwere Vincent 
Published: August 2010

SummaryEvaluations of composite health interventions, such as those attempting to make motherhood safer, are by definition complex, but nevertheless regarded as essential to informing progress in global health. This paper introduces a series of reports which set out the basis of Family Care International’s Skilled Care Initiative in rural Burkina Faso, go on to describe strategies and methods for evaluating it, and present evaluation findings in terms of pregnancy outcomes, utilisation and effects of the intervention and economics. Although there were encouraging findings, no ‘magic bullets’ emerged from these studies, illustrating the reality that sustained and increasing resources are needed to achieve safe motherhood for all. There is no cheap or short‐cut solution.