bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk factors for active trachoma and Chlamydia trachomatis infection in rural Ethiopia after mass treatment with azithromycin
Authors: Edwards Tansy , Harding‐Esch Emma M. , Hailu Girum , Andreason Aura , Mabey David C. , Todd Jim , Cumberland Phillippa 
Published: August 2010

SummaryObjectives  To investigate risk factors for ocular Chlamydia trachomatis infection and active trachoma, comparing communities receiving or not receiving an intervention programme of community‐wide azithromycin treatment and health education.Methods  In a 3‐year post‐intervention follow‐up survey, 1722 children aged 3–9 years, from randomly selected households in 37 communities, were examined for signs of active trachoma and had samples taken to test for ocular C. trachomatis by polymerase chain reaction. Multivariate random effects logistic regression analyses considered interventions at community level, adjusting for other independent risk factors as appropriate.Results  Younger age, ocular discharge and flies on eyes were risk factors for active trachoma in communities with and without antibiotic treatment. After azithromycin treatment, odds of active trachoma were lower in children aged 6–9 years than in children aged 3–5 years (OR 0.48, 95% CI: 0.36–0.66) and higher for children with ocular discharge (OR 4.5, 95% CI: 2.6–7.7) or flies on their eyes (OR 2.5, 95% CI: 1.6–3.7). Odds of C. trachomatis infection were lower in children aged 6–9 years than in younger children (OR 0.47, 95% CI: 0.23–0.96); and in children who received 2 or 3 doses rather than 1 (OR 0.26, 95% CI: 0.08–0.88).Conclusions  In communities that received or did not receive the mass antibiotic treatment, the same risk factors for C. trachomatis and active trachoma were identified. Education and environmental improvements need to supplement antibiotic campaigns in order to positively impact on these remaining child level risk factors.
International open trial of uniform multi‐drug therapy regimen for 6 months for all types of leprosy patients: rationale, design and preliminary results
Authors: Kroger Axel , Pannikar V. , Htoon M. T. , Jamesh A. , Katoch K. , Krishnamurthy P. , Ramalingam K. , Jianping Shen , Jadhav Vitthal , Gupte M. D. , Manickam P. 
Published: August 2010

SummaryObjective  To describe the rationale, design and preliminary results of an open trial of 6 months uniform multi‐drug therapy (U‐MDT) for all types of leprosy patients assuming a cumulative relapse rate not exceeding 5% over 5 years of follow‐up.Methods  We intended to recruit 2500 patients each in multi‐bacillary (MB) and pauci‐bacillary (PB) groups from India (five centres) and China (two centres). Standardized clinical criteria were used to assess skin lesions in the field.Results  A total of 2912 patients enrolled from November 2003 to May 2007 (India, 2746; China, 166). MB patients constituted 39% and 3% had grade 2 disability. During follow‐up, 27 patients (0.9%) developed new lesions. Of these, 78% were on account of reactions. Six patients had clinically confirmed relapse. Clofazimine‐related skin pigmentation was short‐lived and was acceptable to patients. We analysed data for clinical status of skin lesions. About 2.9% of patients were lost to follow‐up; 85.9% completed treatment, of whom 19% had inactive skin lesions. PB patients responded better than MB patients (27%vs. 6%; P < 0.001). At the end of the first (n = 2013) and second year (n = 807) of follow‐up post‐U‐MDT, in 49% and 46% patients, lesions were inactive, respectively (59% and 57% in PB, 37% and 28% in MB; P < 0.001).Conclusion  U‐MDT appears to be promising with respect to clinical status of skin lesions.
The unbearable lightness of technocratic efforts at dengue control
Authors: Toledo Maria E. , Baly Alberto , Vanlerberghe Veerle , Rodríguez Maritza , Benitez Juan R. , Duvergel Jacinto , Van der Stuyft Patrick 
Published: August 2010

SummaryObjective  To identify key elements that should provide an added value and assure sustainable effects of the deployment of technical tools for Aedes aegypti control.Methods  An observational study was conducted between April 2001 and March 2002 in 30 blocks (1574 houses) in the central zone of Guantanamo city. A trial that combined two complementary technical interventions, the distribution of new ground level water tanks and the intensive use of insecticide, was nested in May 2001. Another 30 blocks (1535 houses) were selected as control area. We assessed community perceptions and household risk behaviour at baseline and after 9  months, and measured the trial’s impact through entomological indices.Results  Perceived self efficacy to solve A. aegypti infestation and prevent dengue was not modified. We found no changes in behaviour. In the study area the container indices decreased significantly from 0.7% before to 0.1% 1 month after the intervention. Six months later, they had increased to 2.7% and uncovered new water tanks constituted 75.9% of all breeding sites. Over the 9 months after the trial the average monthly house indices were similar in the study and control areas. A technical approach and lack of community involvement in the trial’s implementation were the main causes of these short‐lived results.Conclusions  Top–down deployment of technical tools without active involvement of the community has a temporary effect and does not lead to the behavioural changes necessary for sustainable A. aegypti control.
Laboratory reference values for healthy adults from southern Tanzania
Authors: Saathoff Elmar , Schneider Philine , Kleinfeldt Vera , Geis Steffen , Haule Dennis , Maboko Leonard , Samky Eleuter , Souza Mark de , Robb Merlin , Hoelscher Michael 
Published: August 2010

SummaryObjectives  To define and discuss reference ranges for commonly determined laboratory parameters in healthy adults from southern Tanzania.Methods  A population‐based sample of adult volunteers from Mbeya, Tanzania, who were not HIV positive or showing signs and symptoms of other diseases, participated in this study. We enrolled 145 women and 156 men between 19 and 48 years of age to determine clinical chemistry (CC), haematology and lymphocyte immunophenotyping (LIP) parameters using standard laboratory methods. Medians and nonparametric 95% reference ranges for each parameter were determined and compared with reference ranges from the USA, Europe and from other African countries.Results  Agreement with ranges from developed countries was poor: for CC values the average concordance was 80.9% and 86.7% with values from two developed countries. Haematology ranges from the USA classified 86.3% of values correctly, whereas ranges from three different sub‐Saharan Africa (SSA) sites classified between 82.5% and 94.5% of values correctly. The agreement of LIP reference ranges was 87.5% with values determined in Germany but between 91.7% and 95.8% compared with values determined at other sites in SSA.Conclusion  Clinical reference ranges determined in developed countries are inadequate for use in SSA. Laboratories in this region should either define their own or use values determined under similar conditions. The ranges reported here are more appropriate for use in SSA than ranges determined in developed countries.
Is HIV infection associated with an increased risk for cholera? Findings from a case–control study in Mozambique
Authors: Von Seidlein Lorenz , Wang Xuan‐Yi , Macuamule Arminda , Mondlane Catarina , Puri Mahesh , Hendriksen Ilse , Deen Jacqueline L. , Chaignat Claire‐Lise , Clemens John D. , Ansaruzzaman M. , Barreto Avertino , Songane Francisco F. , Lucas Marcelino 
Published: August 2010

SummaryObjective  As residents of sub‐Saharan Africa are at high risk for HIV and cholera, it is biologically plausible that immune suppression caused by HIV infection predisposes to cholera. Our aim was to assess the potential association between both diseases.Methods  We conducted a case–control study in Beira, Mozambique, a high‐risk area for HIV and cholera. Between 1 January 2005 and 30 June 2006, experienced counsellors invited 132 suspected cholera cases and 528 age‐ and sex‐matched controls to an HIV counselling and testing centre.Results  Forty (30%) of the invited cases and 127 (24%) of the invited controls came for HIV testing. No significant differences in demographic and socio‐economic baseline characteristics were detected between participants and non‐participants. Twentyfive of 167 (15%) individuals who underwent testing were found HIV‐positive. The probability of a positive HIV‐test was highest in participants between 40 and 49 years; 6 of 14 (43%) tested HIV‐positive. Nine of 40 (23%) cholera cases were found to be HIV‐infected compared with 16 of 127 (13%) controls (adjusted odds ratio 2.6; 95% CI 0.9–7.5; P = 0.08).Discussion  The findings suggest that in a cholera‐endemic area, HIV infection is associated with an increased risk for cholera. More research in HIV endemic settings is needed to confirm the findings and to explore the effect of HIV‐related immunosuppression on the transmission of cholera.
Uptake of HIV and syphilis testing of pregnant women and their male partners in a programme for prevention of mother‐to‐child HIV transmission in Uganda
Authors: Kizito Dennison , Woodburn Patrick W. , Kesande Beleth , Ameke Christine , Nabulime Juliet , Muwanga Moses , Grosskurth Heiner , Elliott Alison M. 
Published: August 2010

SummaryObjective  To describe uptake of HIV and syphilis testing in a prevention of mother‐to‐child HIV transmission programme in Uganda.Methods  Analysis of data from routine HIV and syphilis testing at Entebbe Hospital antenatal services.Results  A total of 20 738 women attended antenatal services. Exactly 62.8% of women, but only 1.8% of their male partners, accepted testing for HIV; 82.2% of women, but only 1.1% of their male partners accepted syphilis testing. Partners of women with positive HIV results were more likely to come for subsequent testing. Of 200 couples whose partners accepted HIV‐testing within 30 days of one another, 19 (9.5%) were HIV‐discordant, representing 65.5% of couples with at least one partner HIV‐positive. HIV prevalence was 12.6% for women and 10.8% for men; syphilis prevalence was 4.0% for women and 6.2% for men.Conclusion  Uptake of HIV and syphilis testing was fairly good among pregnant women attending antenatal clinics at Entebbe Hospital, but very low among their male partners. The level of HIV‐discordant couples was high. These clinics should be made more couples‐friendly to identify both HIV‐positive men for treatment and discordant couples for HIV prevention.
Interpretation of mycobacterial antibodies in the cerebrospinal fluid of adults with tuberculous meningitis
Authors: Restrepo Blanca I. , Pino Paula A. , Volcy Michel , Franco Andrés F. , Kanaujia Ganga V. , Robledo Jaime 
Published: August 2010

SummaryObjective  Microbiological identification of Mycobacterium tuberculosis is insensitive and slow, and clinical distinction of tuberculous meningitis (TBM) from other subacute or chronic meningoenchephalitides (SACM) is difficult. Successful use of highly specific M. tuberculosis serological assays on cerebrospinal fluid has been reported, but their performance for diagnosis in a tuberculosis endemic country where they would be of most value is unclear. We sought to determine the biological basis for the uncertainty in interpretation of antibody detection in the CSF of TBM patients.Methods  We identified prospectively 46 adults with SACM and explored the concordance between TBM diagnosis and detection of highly specific M. tuberculosis antibodies in CSF. The source of antibodies in CSF was explored by evaluating the correlation between antibody titres in CSF with those in serum, or with the albumin quotient. Intrathecal IgG synthesis was assessed by the IgG index.Results  Positive antibody titres were more frequent among TBM patients (76%), but were also present in individuals with other SACM (59%). A positive correlation between antibody titres in CSF with those in serum, or with the albumin quotient, supported the leakage of antibodies from plasma to CSF through an increased blood–brain barrier permeability. Intrathecal IgG synthesis was only detected in 35% of the TBM cases.Conclusion  Plasma antibodies likely synthesized in response to previous tuberculosis infections were a major source of mycobacterial antibodies in CSF due to leakage through an impaired blood–brain barrier. Interpretation of mycobacterial antibodies in CSF of adults for TBM, however specific, must take into account the contribution of antibodies from plasma, and hence, has questionable use for diagnosis.
ST2859 serogroup A meningococcal meningitis outbreak in Nouna Health District, Burkina Faso: a prospective study
Authors: Sié A. , Pflüger V. , Coulibaly B. , Dangy J. P. , Kapaun A. , Junghanss T. , Pluschke G. , Leimkugel J. 
Published: August 2010

SummaryWe analysed cerebrospinal fluid samples from suspected meningitis cases in Nouna Health District, Burkina Faso, during the meningitis seasons of 2004–2006. Serogroup A ST2859 meningococci belonging to the ST5 clonal complex of subgroup III meningococci were the predominant causative agent. ST2859 bacteria were associated with focal outbreaks in the north of the district. While >10% of the population of an outbreak village carried ST2859, the population in the south of the district was predominantly colonised by serogroup Y ST4375 meningococci, which were associated with only sporadic cases of meningitis. Colonisation with the less virulent Y meningococci may interfere with the spread of the ST2859 to the south of the district, but there are concerns that this serogroup A clone may cause a third wave of subgroup III meningococcal disease in the African Meningitis Belt.
Experimental hut evaluation of the pyrrole insecticide chlorfenapyr on bed nets for the control of Anopheles arabiensis and Culex quinquefasciatus
Authors: Mosha F. W. , Lyimo I. N. , Oxborough R. M. , Malima R. , Tenu F. , Matowo J. , Feston E. , Mndeme R. , Magesa S. M. , Rowland M. 
Published: August 2010

SummaryObjective  To determine the efficacy of chlorfenapyr against Anopheles arabiensis and Culex quinquefasciatus in East Africa and to identify effective dosages for net treatment in comparison with the commonly used pyrethroid deltamethrin.Methods  Chlorfenapyr was evaluated on bed nets in experimental huts against A. arabiensis and C. quinquefasciatus in Northern Tanzania, at application rates of 100–500 mg/m2.Results  In experimental huts, mortality rates in A. arabiensis were high (46.0–63.9%) for all dosages of chlorfenapyr and were similar to that of deltamethrin‐treated nets. Mortality rates in C. quinquefasciatus were higher for chlorfenapyr than for deltamethrin. Despite a reputation for being slow acting, >90% of insecticide‐induced mortality in laboratory tunnel tests and experimental huts occurred within 24 h, and the speed of killing was no slower than for deltamethrin‐treated nets.Conclusions  Chlorfenapyr induced low irritability and knockdown, which explains the relatively small reduction in blood‐feeding rate. Combining chlorfenapyr with a more excito‐repellent pyrethroid on bed nets for improved personal protection, control of pyrethroid‐resistant mosquitoes and pyrethroid resistance management would be advantageous.
Very young children with uncomplicated falciparum malaria have higher risk of hypoglycaemia: a study from Suriname
Authors: Zijlmans Wilco C. W. R. , Van Kempen Anne A. M. W. , Ackermans Mariëtte T. , De Metz Jesse , Kager Piet A. , Sauerwein Hans P. 
Published: August 2010

SummaryObjective  To measure glucose kinetics and the influence of age, nutritional status and fasting duration in children with uncomplicated falciparum malaria (UFM) under the age of 5 years.Methods  Plasma glucose concentration, endogenous glucose production (EGP) and gluconeogenesis (GNG) were measured using [6,6‐2H2]glucose and 2H2O in 17 very young (<3 years) and 7 older (3–5 years) Surinamese children with UFM admitted to the Distrikt Hospital Stoelmanseiland and Diakonessen Hospital Paramaribo over 17 months.Results  Plasma glucose concentration was lower in the group of very young children than in the older children (P = 0.028). There were no differences in EGP and GNG between the groups. Overall GNG contributed 56% (median, range 17–87%) to EGP, with no differences between the groups (P = 0.240). Glucose clearance was lower in the older children (P = 0.026). Glucose concentration did not differ between children with weight for length/height less than −1.3 SD and children with weight for length/height greater than −1.3 SD (P = 0.266). Plasma glucose concentration was not predicted by fasting duration (P = 0.762).Conclusions  Our data suggest a higher risk of hypoglycaemia in very young children with uncomplicated malaria as plasma glucose concentration was lower in this study group. Since this could not be attributed to an impaired EGP, and because glucose clearance was lower in the older children, we presume that older children were better capable of reducing glucose utilization during fasting. Studies on glucose kinetics are feasible in very young children with malaria and give more insight in the pathophysiology of hypoglycaemia.
Anaemia in a rural Ugandan HIV cohort: prevalence at enrolment, incidence, diagnosis and associated factors
Authors: Mugisha Joseph O. , Shafer Leigh Anne , Der Paal Lieve Van , Mayanja Billy N. , Eotu Henry , Hughes Peter , Whitworth Jimmy A. G. , Grosskurth Heiner 
Published: August 2010

SummaryObjectives  To determine the prevalence and incidence of anaemia in HIV‐positive and negative individuals; to identify risk factors for anaemia, prior to the introduction of HAART; and to determine the validity of the clinical diagnosis of anaemia.Methods  Between 1990 and 2003, we followed a rural population based cohort of HIV‐infected and uninfected participants. Prevalence and incidence of anaemia were determined clinically and by laboratory measurements. The sensitivity, specificity and predictive values of clinical diagnosis were calculated.Results  The prevalence of anaemia at enrolment was 18.9% among HIV‐positive and 12.9% among HIV‐negative participants (P = 0.065). Incidence of anaemia increased with HIV disease progression, from 103 per 1000 person‐years of observation among those with CD4 counts >500 to 289 per 1000 person‐years of observation among those with CD4 counts <200. Compared to laboratory diagnosis, the clinical diagnosis of anaemia had a sensitivity of 17.8%, specificity of 96.8%, a positive predictive value of 50.6% and a negative predictive value of 86.4%. Being female, low CD4 cell counts, HIV‐positive, wasting syndrome, WHO stage 3 or 4, malaria, fever, pneumonia and oral candidiasis were associated with prevalent anaemia.Conclusions  Anaemia prevalence and incidence were higher among HIV‐positive than negative participants. Compared to laboratory diagnosis, clinical detection of anaemia had a low sensitivity. Clinicians working in settings with limited laboratory support must be conscious of the risk of anaemia when managing HIV/AIDS patients, particularly when using antiretroviral drugs which by themselves may cause anaemia as a side effect. We recommend that haemoglobin should be measured before starting ART and monthly for the first three months.
Estimates of the burden of malaria morbidity in Africa in children under the age of 5 years
Authors: Roca‐Feltrer Arantxa , Carneiro Ilona , Armstrong Schellenberg Joanna R. M. 
Published: August 2010

SummaryObjective  To estimate the direct burden of malaria among children younger than 5 years in sub‐Saharan Africa (SSA) for the year 2000, as part of a wider initiative on burden estimates.Methods  A systematic literature review was undertaken in June 2003. Severe malaria outcomes (cerebral malaria, severe malarial anaemia and respiratory distress) and non‐severe malaria data were abstracted separately, together with information on the characteristics of each study and its population. Population characteristics were also collated at a national level. A meta‐regression model was used to predict the incidence of malaria fevers at a national level. For severe outcomes, results were presented as median rates as data were too sparse for modelling.Results  For the year 2000, an estimated 545 000 (uncertainty interval: 105 000–1 750 000) children under the age of 5 in SSA experienced an episode of severe malaria for which they were admitted to hospital. A total of 24 000 (interquartile range: 12 000–37 000) suffered from persistent neurological deficits as a result of cerebral malaria. The number of malaria fevers associated with high parasite density in under‐5s in SSA in 2000 was estimated as 115 750 000 (uncertainty interval: 91 243 000–257 957 000).Conclusion  Our study predicts a lower burden than previous estimates of under‐5 malaria morbidity in SSA. As there is a lack of suitable data to enable comprehensive estimates of annual malaria incidence, we describe the information needed to improve the validity of future estimates.
Antiretroviral therapy in resource‐limited settings 1996 to 2006: patient characteristics, treatment regimens and monitoring in sub‐Saharan Africa, Asia and Latin America
Authors:   The ART‐LINC Collaboration of the International Databases to Evaluate AIDS (IeDEA)
Published: August 2010

SummaryObjectives  To describe temporal trends in baseline clinical characteristics, initial treatment regimens and monitoring of patients starting antiretroviral therapy (ART) in resource‐limited settings.Methods  We analysed data from 17 ART programmes in 12 countries in sub‐Saharan Africa, South America and Asia. Patients aged 16 years or older with documented date of start of highly active ART (HAART) were included. Data were analysed by calculating medians, interquartile ranges (IQR) and percentages by regions and time periods. Not all centres provided data for 2006 and 2005 and 2006 were therefore combined.Results  A total of 36 715 patients who started ART 1996–2006 were included in the analysis. Patient numbers increased substantially in sub‐Saharan Africa and Asia, and the number of initial regimens declined, to four and five, respectively, in 2005–2006. In South America 20 regimes were used in 2005–2006. A combination of 3TC/D4T/NVP was used for 56% of African patients and 42% of Asian patients; AZT/3TC/EFV was used in 33% of patients in South America. The median baseline CD4 count increased in recent years, to 122 cells/μl (IQR 53–194) in 2005–2006 in Africa, 134 cells/μl (IQR 72–191) in Asia, and 197 cells/μl (IQR 61–277) in South America, but 77%, 78% and 51%, respectively, started with <200 cells/μl in 2005–2006. In all regions baseline CD4 cell counts were higher in women than men: differences were 22cells/μl in Africa, 65 cells/μl in Asia and 10 cells/μl in South America. In 2005–2006 a viral load at 6 months was available in 21% of patients Africa, 8% of Asian patients and 73% of patients in South America. Corresponding figures for 6‐month CD4 cell counts were 74%, 77% and 81%.Conclusions  The public health approach to providing ART proposed by the World Health Organization has been implemented in sub‐Saharan Africa and Asia. Although CD4 cell counts at the start of ART have increased in recent years, most patients continue to start with counts well below the recommended threshold. Particular attention should be paid to more timely initiation of ART in HIV‐infected men.