bluuebunny/crossref_metadata_2025_split huggingface dataset:
Associations between specific antibody responses and resistance to reinfection in a Senegalese population recently exposed to Schistosoma mansoni
Authors: Vereecken Kim , Naus Cynthia W. A. , Polman Katja , Scott Janet T. , Diop Mamadou , Gryseels Bruno , Kestens Luc 
Published: August 2010

SummaryWe examined associations between schistosome‐specific antibody responses and reinfection in Senegalese individuals recently exposed to Schistosoma mansoni. The effects of treatment, age, intensity of infection and duration of exposure on schistosome‐specific antibody responses were also investigated by comparing immune responses in individuals exposed for less than 3 years with responses in people exposed for more than 8 years. All individuals were bled before treatment as well as 6 and 12 weeks after. We used a statistical model that included interaction terms between time, age, infection intensity and duration of exposure. The overall patterns of most specific antibody responses by age were similar to those previously published for S. mansoni, Schistosoma japonicum and Schistosoma haematobium infections in different endemic areas. In general, a boost in specific antibody responses against adult worm antigen (SWA) was observed at 6 weeks after treatment whereas the majority of isotype responses against egg antigen (SEA) were not affected by treatment. Our analysis showed that the effect of treatment on schistosome‐specific antibody responses is influenced by age, infection intensity and duration of exposure. We found no evidence that treatment matures the specific antibody response of children recently infected with S. mansoni. Our results indicate that the build‐up of potentially protective immunoglobulin E (IgE) responses was associated with duration of exposure, or, in other words, experience of infection. Interestingly, in recently exposed individuals there was a significant association between IgA responses to SWA and resistance to reinfection. Resistance to reinfection and production of IgA‐SWA was associated with adulthood independently of exposure patterns, suggesting that susceptibility to S. mansoni and the development of protective immune responses is age‐dependent.
Diagnosis and management of malaria by rural community health providers in the Lao People's Democratic Republic (Laos)
Authors: Mayxay Mayfong , Pongvongsa Tiengkham , Phompida Samlane , Phetsouvanh Rattanaxay , White Nicholas J. , Newton Paul N. 
Published: August 2010

SummaryWe assessed the knowledge of malaria diagnosis and management by community health providers in rural Vientiane and Savannakhet Provinces, Lao PDR. Sixty health providers (17 pharmacy owners/drug sellers and 43 village health volunteers) were interviewed. All diagnosed malaria using symptoms and signs only; 14% were aware of >2 criteria for the diagnosis of severe malaria. Although chloroquine and quinine, the then recommended Lao national policy for uncomplicated malaria treatment, were the most common antimalarials prescribed – 65% gave incorrect doses and 70% did not know the side effects. Although not recommended by the then national policy, 27% of the health providers used combinations of antimalarials as they considered monotherapy ineffective. This study strongly suggests that further training of Lao rural health providers in malaria diagnosis and management is needed to improve the quality of health services in areas remote from district hospitals.
Longitudinal analysis of community health workers’ adherence to treatment guidelines, Siaya, Kenya, 1997–2002
Authors: Rowe S. Y. , Olewe M. A. , Kleinbaum D. G. , McGowan J. E. , McFarland D. A. , Rochat R. , Deming M. S. 
Published: August 2010

SummaryObjectives  To investigate community health workers’ (CHW) adherence over time to guidelines for treating ill children and to assess the effect of refresher training on adherence.Methods  Analysis of 7151 ill‐child consultations performed by 114 CHWs in their communities from March 1997–May 2002. Adherence was assessed with a score (percentage of recommended treatments that were prescribed), calculated for each consultation. Recommended treatments were those that were indicated based on CHW assessments. We used piecewise regression models to evaluate adherence before and after training.Results  The average adherence score was 79.4%. Multivariable analyses indicate that immediately after the first refresher training, the mean adherence level improved for patients with a severe illness, but worsened for patients without severe illness. Adherence scores declined rapidly during the 6 months after the second refresher training.Conclusions  The first refresher was partially effective, the second refresher had an effect contrary to that intended, and patient characteristics had a strong influence on adherence patterns. Longitudinal studies are useful for monitoring the dynamics of CHW performance and evaluating effects of quality improvement interventions.
Treatment‐seeking behaviour, cost burdens and coping strategies among rural and urban households in Coastal Kenya: an equity analysis
Authors: Chuma Jane , Gilson Lucy , Molyneux Catherine 
Published: August 2010

SummaryIll‐health can inflict costs on households directly through spending on treatment and indirectly through impacting on labour productivity. The financial burden can be high and, for poor households, contributes significantly to declining welfare. We investigated socio‐economic inequities in self‐reported illnesses, treatment‐seeking behaviour, cost burdens and coping strategies in a rural and urban setting along the Kenyan coast. We conducted a survey of 294 rural and 576 urban households, 9 FGDs and 9 in‐depth interviews in each setting. Key findings were significantly higher levels of reported chronic and acute conditions in the rural setting, differences in treatment‐seeking patterns by socio‐economic status (SES) and by setting, and regressive cost burdens in both areas. These data suggest the need for greater governmental and non‐governmental efforts towards protecting the poor from catastrophic illness cost burdens. Promising health sector options are elimination of user fees, at least in targeted hardship areas, developing more flexible charging systems, and improving quality of care in all facilities. The data also strongly support the need for a multi‐sectoral approach to protecting households. Potential interventions beyond the health sector include supporting the social networks that are key to household livelihood strategies and promoting micro‐finance schemes that enable small amounts of credit to be accessed with minimal interest rates.
Rapid achievement of the child survival millennium development goal: evidence from the Navrongo experiment in Northern Ghana
Authors: Binka Fred N. , Bawah Ayaga A. , Phillips James F. , Hodgson Abraham , Adjuik Martin , MacLeod Bruce 
Published: August 2010

SummaryObjective  To determine the impact of deploying nurses and volunteers to village locations on demographic and health outcomes.Method  We implemented an experimental design that emphasizes the value of aligning community health services with traditional social institutions that organize village life. Data for this analysis come from the Navrongo demographic surveillance system, a longitudinal database that tracks fertility, mortality, and migration events over time. The experiment uses conventional demographic methods for estimating mortality rates from longitudinal demographic surveillance registers.Results  Posting nurses to community locations reduced childhood mortality rates by over half in 3 years and accelerated attainment of the childhood‐survival millennium development goal (MDG) in the study areas relative to trends observed in comparison areas.Conclusion  Results from the Navrongo experiment demonstrate that community health and family planning programmes can have an impact on childhood mortality. Posting nurses to communities can dramatically accelerate the pace of progress in achieving the childhood‐survival MDGs. Community‐volunteer approaches, however, have no additional impact, a finding that challenges the child survival value of international investment in volunteer‐based health programmes. The total cost of the intensive arm of the project is less than $10 per capita per year. Navrongo research thus demonstrates affordable means of attaining the child survival MDG agenda with existing technologies.
Trend of case detection and leprosy elimination in Brazil
Authors: Penna Maria L. F. , Penna Gerson O. 
Published: August 2010

SummaryOnly six countries did not meet the leprosy elimination target during 2005, amongst them Brazil. In 2006, the Brazilian Ministry of Health announced a reduction of the detection rate of 24% or 10 900 cases from 2004 to 2005. A negative binomial parabolic regression model was adjusted to the detection rate historical series from 1980 to 2004, in order to predict the 2005 detection rate and its 95% confidence interval. This analysis showed that the number of new leprosy cases for 2005 could not be predicted from the previous behaviour of the data what calls for an epidemiological or operational explanation hypothesis. The hypothesis that this drop in detected case number is due to operational change, as a reduction in diagnosis or a modification in the reporting routine, is more likely. Recent change in prevalence case definition turned the prevalence ratio a function of only one variable, the detection rate, as the duration of the diagnosed disease became fixed. In the early nineties, based on epidemiological data evaluation, the BMoH recognized the impossibility of reaching the elimination goal, but it committed to seek leprosy control. This position changed after some years. Leprosy Elimination is a strategy supported by the national and international public opinion. As a one for all recipe, it may cause unwanted effects for it is not flexible enough to deal with different epidemiological behaviours and public health traditions.
The role of pfmdr1 in Plasmodium falciparum tolerance to artemether‐lumefantrine in Africa
Authors: Sisowath Christin , Ferreira Pedro E. , Bustamante Leyla Y. , Dahlström Sabina , Mårtensson Andreas , Björkman Anders , Krishna Sanjeev , Gil José P. 
Published: August 2010

SummaryObjective  Artemether‐lumefantrine (AL), presently the most favoured combination therapy against uncomplicated Plasmodium falciparum malaria in Africa, has recently shown to select for the pfmdr1 86N allele. The objective of this study was to search for the selection of other mutations potentially involved in artemether‐lumefantrine tolerance and/or resistance, i.e. pfmdr1 gene amplification, pfmdr1 Y184F, S1034C, N1042D, D1246Y, pfcrt S163R and PfATP6 S769N.Methods  The above mentioned SNPs were analysed by PCR–restriction fragment length polymorphism and pfmdr1 gene amplification by real‐time PCR based protocols in parasites from 200 children treated with AL for uncomplicated P. falciparum malaria in Zanzibar.Results  A statistically significant selection of pfmdr1 184F mostly in combination with 86N was seen in reinfections after treatment. No pfmdr1 gene amplification was found.Conclusion  The results suggest that different pfmdr1 alleles are involved in the development of tolerance/resistance to lumefantrine.
Is the Expanded Programme on Immunisation the most appropriate delivery system for intermittent preventive treatment of malaria in West Africa?
Authors: Chandramohan Daniel , Webster Jayne , Smith Lucy , Awine Timothy , Owusu‐Agyei Seth , Carneiro Ilona 
Published: August 2010

SummaryObjective  To investigate the coverage and equity of the Expanded Programme on Immunisation (EPI) and its effect on age schedule, seasonality of malaria risk, and linked intermittent preventive treatment (IPT) in West Africa.Method  Secondary analyses of data from a trial of IPT in Ghana. The potential effectiveness and impact of EPI‐linked IPT in West Africa was calculated using the coverage of Diptheria Pertussis Tetanus vaccination obtained from national surveys and the reported protective efficacies of IPT.Results  In West Africa, where the transmission of malaria is highly seasonal, only 10% of malaria episodes in infants would be averted with the current coverage of EPI.Conclusion  In this setting, the EPI‐linked IPT is not necessarily the most appropriate approach and alternative IPT schedules and delivery systems are needed.
Patterns of maternal care seeking behaviours in rural Bangladesh
Authors: Moran Allisyn C. , Winch Peter J. , Sultana Nighat , Kalim Nahid , Afzal Kazi M. , Koblinsky Marge , Arifeen Shams E. , Seraji M. Habibur R. , Mannan Ishtiaq , Darmstadt Gary L. , Baqui Abdullah H. ,   The Bangladesh PROJAHNMO Maternal Morbidity Study Group
Published: August 2010

SummaryObjective  Seeking care from a basic or comprehensive facility in response to obstetric complications is a key behaviour promoted in safe motherhood programmes. This study examined definitions of care seeking for maternal health complications used by families in rural Bangladesh, and the frequency and determinants of locally‐defined care seeking practices.Methods  We conducted 24 semi‐structured qualitative interviews with women who had recently given birth to characterize care seeking behaviours in response to perceived complications. Based on these findings, a quantitative household questionnaire was developed and administered to 1490 women, half of whom reported a ‘serious or very serious’ complication during their last pregnancy and/or delivery (n = 769; 52%), and were included in the quantitative analysis.Results  Informants described three care seeking patterns in qualitative interviews: (i) sending a family member to purchase treatment to administer in the home; (ii) sending for a provider to treat the woman in the home and (iii) taking the woman outside the home to a facility or provider's office. The quantitative survey revealed that most women sought care for ‘serious’ complications (86%), with 42% seeking multiple sources of care. The majority of women purchased a treatment to administer at home (68%), while 20% brought a provider to the home. Thirty per cent of women were taken to a provider or facility.Conclusions  Families generally seek care for complications, but care seeking does not correspond to definitions used by maternal health programmes. Local definitions of care seeking must be considered in intervention design so that promotion of care seeking increases for facility‐based care for life‐threatening emergencies rather than unintentionally increasing the use of home‐based treatments of little medical value for prevention of mortality.
Epidemiology and risk factors for endemic typhoid fever in Uzbekistan
Authors: Srikantiah Padmini , Vafokulov Sagdullo , Luby Stephen P. , Ishmail Tharwat , Earhart Kenneth , Khodjaev Ne'mat , Jennings Gregory , Crump John A. , Mahoney Frank J. 
Published: August 2010

SummaryBackground  To investigate the risk factors for infection with endemic typhoid fever in the Samarkand region of Uzbekistan.Methods  Case–control study of culture‐confirmed bloodstream infection with Salmonella Typhi. Patients were compared to age‐matched community controls. Salmonella Typhi isolates were tested for antimicrobial susceptibility.Results  We enrolled 97 patients and 192 controls. The median age of patients was 19 years. In a conditional regression model, consumption of unboiled surface water outside the home [adjusted odds ratio (aOR) = 3.0, 95% confidence interval (CI) = 1.1–8.2], use of antimicrobials in the 2 weeks preceding onset of symptoms (aOR = 12.2, 95% CI 4.0–37.0), and being a student (aOR = 4.0, 95% CI 1.4–11.3) were independently associated with typhoid fever. Routinely washing vegetables (aOR 0.06, 95% CI 0.02–0.2) and dining at a tea‐house (aOR 0.4, 95% CI 0.2–1.0) were associated with protection against illness. Salmonella Typhi resistant to ampicillin, chloramphenicol, and trimethoprim‐sulfamethoxazole was identified in 6 (15%) of 41 isolates tested.Conclusions  Endemic typhoid fever in Uzbekistan is transmitted by contaminated water. Recent use of antimicrobials also increased risk of infection. Targeted efforts at improving drinking water quality, especially for students and young adults, are likely to decrease transmission of typhoid fever. Measures to decrease the unnecessary use of antimicrobials would be expected to reduce the risk of typhoid fever and decrease the spread of multiple drug‐resistant Salmonella Typhi.
Influence of body mass index on pregnancy outcomes among HIV‐infected and HIV‐uninfected Zambian women
Authors: Banda Yolan , Chapman Victoria , Goldenberg Robert L. , Chi Benjamin H. , Vermund Sten H. , Stringer Jeffrey S. A. 
Published: August 2010

SummaryObjectives  To determine the influence of body mass index (BMI) on pregnancy outcomes of HIV‐infected and HIV‐uninfected Zambian women and to assess the possible role of BMI on mother‐to‐child transmission rate of HIV.Methods  We analysed data from a clinical trial on nevirapine administration for the prevention of mother‐to‐child transmission of HIV in Lusaka, Zambia. Demographic characteristics, medical information and pregnancy outcomes were used in this secondary analysis.Results  A total of 1211 women were included in this analysis and 36% were HIV‐infected. Among HIV‐infected women, maternal parity and prior stillbirths increased with increasing BMI in univariate analysis. Mean birth weight rose as well at 28.3 g [95% confidence interval (CI) = 14.0–42.6] of infant weight per BMI unit. Transmission of HIV from mother to child appeared inversely related to BMI when compared according to BMI quartile (P for trend = 0.07). In the HIV‐uninfected group, infant birth weight increased with increasing BMI, at 32.7 g (95% CI = 23.5–41.9) of infant weight per BMI unit.Conclusion  Birth weight increased alongside BMI in both HIV‐infected and HIV‐uninfected women. There is a suggestion that women with lower BMI have a greater risk of perinatal HIV transmission, even after adjustments for HIV viral load and CD4 count.
Sex differences in under and over nutrition among school‐going Black teenagers in South Africa: an uneven nutrition trajectory
Authors: Jinabhai C. C. , Reddy P. , Taylor M. , Monyeki D. , Kamabaran N. , Omardien R. , Sullivan K. R. 
Published: August 2010

SummaryObjectives  To investigate the nutritional status of Black South African teenagers by sex and compare it with nutritional profiles of teenagers from other countries.Methods  The first South African Youth Risk Behaviour Survey (2002) was adapted to include anthropometric data and this paper reports on the prevalence of under and over nutrition among 5322 Black teenagers, aged 13.0–17.9 years, grades 8–11. Prevalence of over nutrition in this study was compared with other countries using a World Bank country economic classification.Results  Significant sex differences were observed for under and over nutrition. Boys (18.4%) had a higher prevalence of underweight than girls (2.6%) (P < 0.005), who were more at risk of overweight than boys (20.9%vs. 4.2%) (P < 0.005). Boys (21.9%) were more stunted than girls (9.4%) (P < 0.05), but stunted girls were at greater risk of overweight than boys across all levels of stunting. The prevalence of overweight among boys (4.2%) was lower than in other countries while for girls (20.9%) was similar to several upper middle and high income countries.Conclusion  Gender sensitive strategies are required to address both under and over nutrition among South African teenagers to reduce stunting and future chronic disease epidemics in adulthood. This paper suggests that Black South African teenagers are experiencing an uneven nutritional transition across sex, from under nutrition to over nutrition.
Short communication: Antituberculosis drug‐induced hepatotoxicity is unexpectedly low in HIV‐infected pulmonary tuberculosis patients in Malawi
Authors: Tostmann A. , Boeree M. J. , Harries A. D. , Sauvageot D. , Banda H. T. , Zijlstra E. E. 
Published: August 2010

SummaryThe proportion of patients with antituberculosis drug‐induced hepatotoxicity (ATDH) was unexpectedly low during a trial on cotrimoxazole prophylaxis in Malawian HIV‐positive pulmonary tuberculosis patients. About 2% of the patients developed grade 2 or 3 hepatotoxicity during tuberculosis (TB) treatment, according to WHO definitions. Data on ATDH in sub‐Saharan Africa are limited. Although the numbers are not very strong, our trial and other papers suggest that ATDH is uncommon in this region. These findings are encouraging in that hepatotoxicity may cause less problem than expected, especially in the light of combined HIV/TB treatment, where drug toxicity is a major cause of treatment interruption.
Spatial distribution of Burkitt’s lymphoma in Kenya and association with malaria risk
Authors: Rainey Jeanette J. , Mwanda Walter O. , Wairiumu Priscilla , Moormann Ann M. , Wilson Mark L. , Rochford Rosemary 
Published: August 2010

SummaryEndemic Burkitt’s lymphoma (BL) is the most common paediatric malignancy in equatorial Africa and was originally shown to occur at high‐incidence rates in regions where malaria transmission is holoendemic. New ecological models of malaria that are based on both parasite prevalence and disease have been described. In this study, we examined district level data collected from paediatric BL cases in Kenya from 1988 through 1997 and assessed whether the distribution of district level incidence rates could be explained by new ecologic estimates of malaria risk. Chi‐square tests and log‐linear regression models were used to evaluate these associations. An association with tribe of origin as a factor also was examined. The 10‐year average annual incidence rate (IR) for Kenya was 0.61 per 100 000 children. Incidence rates varied by malaria transmission intensity as follows: low malaria risk (BL IR = 0.39), arid/seasonal (0.25), highland (0.66), endemic coast (0.68), and endemic lake (1.23) (χ2 = 11.32, P = 0.002). In a log‐linear model, BL rates were 3.5 times greater in regions with chronic and intense malaria transmission intensity than in regions with no or sporadic malaria transmission (odds ratio = 3.47, 95% confidence interval = 1.30–9.30), regardless of tribe. Although crude tribe‐specific incidence rates ranged between 0.0 and 3.26, tribe was not associated with BL after controlling for malaria. These findings support the aetiologic role of intense malaria transmission intensity in BL.