bluuebunny/crossref_metadata_2025_split huggingface dataset:
The 5‐year outcome of multidrug resistant tuberculosis patients in the Cape Province of South Africa
Authors: Schaaf H. S. , Botha P. , Beyers N. , Gie R. P. , Vermeulen H. A. S. , Groenewald P. , Coetzee G. J. , Donald P. R. 
Published: August 2010

SummaryLittle is known about the outcome of multidrug resistant (MDR) tuberculosis (TB) in developing countries. In this study, 443 patients with MDR‐TB, defined as resistance to two or more antituberculosis drugs, were identified over the 2‐year period 1987 and 1988 in the Cape Province of South Africa. The 5‐year outcome of the 343 (77%) patients that could be traced by questionnaire was evaluated retrospectively during 1992 and 1993. Of these, 240 (70%) were resistant to both isoniazid (H) and rifampicin (R) with or without resistance to other first‐line antituberculosis drugs and 103 (30%) were resistant to H or R and/or other antituberculosis drugs. Mortality was 116 (48%) and 28 (27%) in these groups respectively with a significantly greater risk of death in the first group. Only 114 (33%) of all the MDR‐TB patients were cured after 5 years, 50 (15%) were respiratory disabled and 44 (13%) were still bacteriology positive. Twenty‐four (7%) patients were lost during follow‐up. Taking into account the high costs involved in treating MDR‐TB patients and the scarce resources available in developing countries, more emphasis should be placed on direct observed therapy to cure newly diagnosed infectious drug sensitive tuberculosis patients, thus preventing MDR‐TB rather than treating it.
Clinical and parasitological responses after up to 6.5 years of ivermectin treatment for onchocerciasis
Authors: Whitworth J. A. G. , Maude G. H. , Downham M. D. 
Published: August 2010

SummaryThere are plans to use mass treatment with ivermectin to clear all Africa of the worst ocular and cutaneous effects of onchocerciasis. However, there remains uncertainty about the most suitable treatment regimen and the likely effects of ivermectin on onchocercal skin disease. We have followed 948 subjects for over 6 years in a double‐blind, randomized, controlled study of ivermectin for onchocerciasis in a hyperendemic focus in Sierra Leone. Using an intention‐to‐treat analysis we found a microfilarial prevalence of 16% 6 months after up to 4 annual doses of ivermectin, and 13% prevalence in the group receiving up to 10 doses of ivermectin at 6‐monthly intervals. Microfilarial loads were well suppressed in both groups, but repopulation data suggest that adult female worms are still alive and fecund, strongly underlining the need to continue treatment. A clear effect of ivermectin was demonstrated on itching, with about one‐third of cases being alleviated. Significant reductions in the prevalence of serious hyperkeratosis, and possibly dyspigmentation (leopard skin), were noted, but not for any other onchocercal skin lesion. Six‐monthly and annual treatment regimens with ivermectin were equally effective in terms of dermatological and parasitological impact.
In vitro susceptibility of Plasmodium falciparum to quinine: relation to parasite density and drug distribution in culture fractions
Authors: Mapaba Erasto , Ericsson Örjan , Hellgren Urban , Rombo Lars 
Published: August 2010

SummaryWe have studied the importance of parasite density (2, 0·2, 0·02 and 0·002%) for the in vitro susceptibility of Plasmodium falciparum (F32 strain) to quinine. Shorter exposures (48 hours) only briefly inhibited parasites in wells with the highest initial density. Parasites reappeared after 3–5.5 days in wells with intermediate (0·2 and 0·02%) and lowest density (0·002%). Longer exposures (72 hours), however, inhibited them for much longer periods and parasites did not reappear in most of the wells with the lowest density during the 28 days of follow‐up. The mean multiplication rate following reappearance was tenfold per parasite schizogony cycle. The mean elimination rate per schizogony cycle was calculated to be 99·91%. The elimination and multiplication rates were not correlated to initial parasite density. The mean ratio between quinine concentrations in erythrocytes and medium was 3·6 regardless of quinine concentrations and presence of parasites. Mean quinine‐free fractions of 36 and 67% were found from total concentrations of 0·33 and 10·4 µmol/1.We conclude that initial parasite density determines the time to reappearance of parasites following quinine exposure while the elimination and multiplication rates are independent of the initial parasite density, and that quinine protein binding is concentration‐dependent in vitro and lower than during treatment.
Deltamethrin‐impregnated bednets as an operational tool for malaria control in a hyper‐endemic region of Burundi: impact on vector population and malaria morbidity
Authors: Bortel W. Van , Delacollette C. , Barutwanayo M. , Coosemans M. 
Published: August 2010

SummaryWithin the framework of the National Malaria Control Programme Burundi, impregnated bednets were promoted through health care facilities, schools and local administration in Nyanza Lac district. The decision to buy a bednet was left to the inhabitants and, as a result, coverage rates between 6 and 65% were observed at sub‐district level. Three intervention regions were specified based on the intervention start date. From November 1992 until March 1995, bi‐monthly parasitological and entomological surveys were carried out in two areas each of Region 1 and Region 2. After introduction of impregnated bednets in Region 1 the proportions of children under 5 with high parasitaemia were reduced by 42 and 53% in the 2 parasitological survey areas, where the average bednet coverages were 55 and 44% respectively. In the survey areas of Region 2 (control) no significant change occurred during the same period. During the second part of the intervention from September 1994, when intervention was also operational in Region 2, significant decreases in the proportion of high parasitaemia (63 and 42%) among children under 5 years were obtained in both parasitological survey areas of Region 2 (average coverages of 51 and 29%). The positive output of the intervention was maintained and even reinforced in the survey areas of Region 1. Bednets as a tool for malaria control entail specific problems such as coverage, daily use, reimpregnation, and renewal of old and torn nets. Further evaluation has to point out the possible shift of the clinical spectrum and the age‐specific admission of malaria cases to assess the long‐term benefit of this control method.
Assessment of mouth‐to‐mask ventilation in resuscitation of asphyxic newborn babies. A pilot study
Authors: Massawe August , Kilewo Charles , Irani Simin , Verma Rahul J. , Chakrapam Anupam B. , Ribbe Tommy , Tunell Ragnar , Fischler BjÖrn 
Published: August 2010

SummaryThe aim of the study was to compare the effectiveness of mouth‐to‐mask ventilation (MM) in neonatal asphyxia with bag‐and‐mask ventilation (BM). A new mouth‐to‐mask infant resuscitation system was constructed. The study was performed in two university clinics with different resources. The KEM Hospital in Bombay was well equipped and neonatologists took part in all resuscitations; Muhimbili Medical Centre in Dar es Salaam was understaffed and had no physicians available at resuscitation. Therefore, different protocols had to be used. In Bombay, the study period was limited to 5 minutes. If needed, mask ventilation was then replaced by intubation. In Dar es Salaam, MM ventilation was continued for up to 10 minutes, the inspiratory pressure was adjusted to 30 cmH2O and the ventilation was slow (8–10 breaths/min). In Bombay, 30 babies were allocated to the BM and 24 to the MM groups. In Dar es Salaam 56 were in the BM and 64 in the MM groups.The results for term babies in Bombay and both term and pre‐term babies in Dar es Salaam showed no significant differences between the two groups of treatment, as determined by Apgar score 4 at 5 and 10 minutes, number of babies with their first gasp, heart rate >130 beats/min or pulse oximeter values above 75%, all at 5 minutes. An Apgar score 4 at 5 minutes was achieved in more than 75% of all infants, irrespective of treatment. The rates of early neonatal mortality and neonatal convulsions did not differ between the two methods of resuscitation.In Dar es Salaam, the low respiratory frequency used in both groups was associated with a slow increase in heart rate above 130 beats per min. This result indicates that further studies will be needed before such slow respiratory frequencies are used. We conclude that, if adequate training is provided and the respiratory frequency is kept within the normal range, MM ventilation is an alternative to assisted ventilation when no bag and mask is available. However, further studies are necessary, since this method has proved to be tiring and uncomfortable for the resuscitating health personnel.
Maternal vitamin A supplementation and immunity to malaria in pregnancy in Ghanaian primigravids
Authors: Cox Sharon E. , Staalsoe Trine , Arthur Paul , Bulmer Judith N. , Tagbor Harry , Hviid Lars , Frost Chris , Riley Eleanor M. , Kirkwood Betty R. 
Published: August 2010

SummaryBackground  Vitamin A supplementation is believed to enhance immune responses to infection but few studies have assessed its effects on anti‐malarial immunity, especially during pregnancy when women are at increased risk from both vitamin A deficiency and pregnancy‐associated malaria. The pathological effects of malaria in pregnancy are believed to be due to the sequestration of parasites in the placenta mediated via binding of variant surface antigens (VSA) expressed on the surface of P. falciparum infected red blood cells to placental chondroitin sulphate A (CSA).Methods  We conducted a randomized double‐blind controlled trial of vitamin A supplementation in 98 primigravid Ghanaian women to investigate the effects of vitamin A supplementation on levels of IgG antibodies binding to VSA of a clinical, P. falciparum placental isolate and to two isolates selected (or not) for adherence to CSA in vitro (anti‐VSACSA IgG or anti‐VSA IgG). Placental malarial infection was determined by placental blood smear and histology.Results  Vitamin A supplementation was non‐significantly associated with a decreased risk of active or chronic‐active placental malarial infection compared to past, resolved infection at delivery, as determined by histology (OR = 0.42, P = 0.13 – adjusted for level of education). After adjustment for differences in baseline values, levels of anti‐VSACSA IgG to a placental, CSA‐adherent isolate (EJ‐24) but not to two isolates selected for CSA‐adhesion in vitro (FCR3CSA and BusuaCSA), were significantly lower in women receiving vitamin A supplementation than in women receiving placebo (P = 0.002). There was no apparent effect of vitamin A supplementation to levels of Ab to non‐CSA‐adherent parasite isolates.Conclusions  The data suggest that the reduction in the levels of anti‐VSACSA antibodies to the known placental malaria isolate may reflect reduced intensity or duration of placental parasitaemia in women receiving vitamin A supplementation. These observations are of potential public health significance and deserve further investigation.
Review editorial: Prevention of tuberculosis in resource‐poor countries with increasing access to highly active antiretroviral treatment
Authors: Apers Ludwig , Lynen Lut , Worodria William , Colebunders Robert 
Published: August 2010

SummaryThe administration of isoniazid (INH) has been proposed, evaluated and implemented to prevent tuberculosis (TB) disease among patients who are infected with the human immunodeficiency virus (HIV). This strategy has been developed in communities where TB is highly endemic and at a time when antiretroviral (ARV) treatment was not, or was rarely available. Although INH prevention programmes were somewhat pushed to the background due to the worldwide advocacy for ARV drugs, prevention of TB remains of paramount importance. The dual HIV–TB infection poses problems, not only for the individual and his/her clinician but also for the programme manager. We review various aspects of TB preventive treatment in countries with a high prevalence of HIV–TB co‐infection and limited resources but with increasing access to ARV treatment.
High frequency of multidrug‐resistant Mycobacterium tuberculosis isolates in Georgetown, Guyana
Authors: Menner Nikolai , Günther Ingo , Orawa Helmut , Roth Andreas , Rambajan Indal , Wagner Jutta , Hahn Helmut , Persaud Shamdeo , Ignatius Ralf 
Published: August 2010

SummaryEmergence of multidrug‐resistant (MDR) Mycobacterium tuberculosis isolates constitutes a threat to public health worldwide. This study aimed at acquiring first epidemiological data for Guyana. Thirty‐six M. tuberculosis isolates from patients of the Georgetown Chest Clinic were subjected to susceptibility testing on solid agar and in broth media. Resistance to at least one first‐line drug was observed in 8 (22.2%, 95% confidence interval 8.3–36.1%) and simultaneous resistance to rifampicin and isoniazid (MDR) in 4 (11.1%, 95% confidence interval 0.6–21.6%) of the 36 isolates. The risk of infection with resistant isolates was significantly related to earlier antituberculosis therapy (P = 0.040). These data indicate a high proportion of resistant M. tuberculosis isolates in Guyana and call for the implementation of control strategies based on an improved laboratory diagnosis of TB.
Prevalence of enzootic simian viruses among urban performance monkeys in Indonesia
Authors: Schillaci Michael A. , Jones‐Engel Lisa , Engel Gregory A. , Paramastri Yasmina , Iskandar Entang , Wilson Brenda , Allan Jonathan S. , Kyes Randall C. , Watanabe Robin , Grant Richard 
Published: August 2010

SummaryAnimal reservoirs are the most important sources of emerging infectious diseases that threaten human populations. Global travel and tourism bring ever‐increasing numbers of humans into contact with animals, increasing the likelihood of cross species transmission of infectious agents. Non‐human primates come into contact with humans in a variety of contexts and may harbor infectious agents with zoonotic potential. We investigated the prevalence of infection with enzootic simian viruses among 20 urban performance monkeys (Macaca fascicularis) in Jakarta, Indonesia. This report documents for the first time evidence of infection with four simian viruses in urban performance monkeys. Simian foamy virus was detected by PCR in 52.9% of the macaques. Antibodies to simian retrovirus were detected in 10.5% of the macaques. Antibodies to Cercopithecine Herpesvirus 1, were detected in 5.3% of the macaques. Similarly, antibodies to simian T‐cell lymphotropic virus were detected in 5.3% of the macaques. No evidence of infection with simian immunodeficiency virus was detected in these macaques. These results suggest that urban performance monkeys are a reservoir for enzootic simian viruses known to be capable of infecting humans.
Adoption of safer infant feeding and postpartum sexual practices and their relationship to maternal HIV status and risk of acquiring HIV in Zimbabwe
Authors: Tavengwa N. V. , Piwoz E. G. , Iliff P. J. , Moulton L. H. , Zunguza C. D. , Nathoo K. J. , Hargrove J. W. ,   the ZVITAMBO Study Group, Humphrey J. H. 
Published: August 2010

SummaryObjective  To examine the relationships between maternal knowledge and concern about HIV status, adoption of preventive practices and risk of acquiring HIV in Zimbabwe.Methods  Knowledge and behavioural data were collected via interview from 2595 mothers enrolled in ZVITAMBO, a randomized trial of postpartum vitamin A supplementation that also offered education on safer infant feeding and sexual practices. Mothers were tested for HIV at delivery; those uninfected at baseline were retested during study follow‐up. Logistic regression methods were used to identify variables associated with adoption of preventive behaviours and, for HIV‐negative mothers, their relationship to risk of acquiring HIV post‐delivery.Results  A total of 518 mothers (20%) reported practicing safer sex and 289 mothers (11%) reported modifying their feeding behaviour because of HIV. Fear of transmitting HIV (50.4%) and protecting the baby's health (30.9%) were the most frequently cited reasons for behaviour change. Forty‐nine HIV‐negative mothers acquired HIV during the first postpartum year. After taking into account other significant covariates, mothers who were concerned about their own HIV status were 1.9 times more likely (95% CI: 1.05–3.52; P = 0.03), and those reporting safer sex practices were 58% less likely to become infected (adjusted odds ratio: 0.42; 95% CI: 0.17–1.04; P = 0.06). Married women who reported practicing abstinence to prevent HIV were 3.2 times more likely to become infected than non‐abstaining mothers (P = 0.01), while there were no new HIV infections among abstaining single mothers.Conclusions  Greater emphasis should be given to safer sex practices among women who test negative in mother‐to‐child HIV prevention programmes.
Drug toxicity and cost as barriers to community participation in HAT control in the Democratic Republic of Congo
Authors: Robays J. , Lefèvre P. , Lutumba P. , Lubanza S. , Kande Betu Ku Mesu V. , Van der Stuyft P. , Boelaert M. 
Published: August 2010

SummaryIntroduction  Active case‐finding programmes by mobile teams are the cornerstone of West African Human African Trypanosomiasis (HAT) control. Low attendance rates of screening and low uptake of treatment after diagnosis are major problems. The objectives of this survey were to explore community perception of HAT, to assess acceptability of control activities and to identify barriers amenable to intervention.Methods  In September 2004, we conducted 33 focus group discussions with beneficiaries of the HAT control programme among various ethnic groups in two ecological settings (savannah and fluvial) of the Democratic Republic of Congo.Results  The population had a very detailed knowledge and understanding of HAT transmission, utility of screening, symptoms and treatment. Melarsoprol treatment was feared for its side effects. The sudden death of previously asymptomatic people during treatment was attributed to witchcraft, to which one becomes more vulnerable when the diagnosis is disclosed in public. Lack of confidentiality was also a problem because HAT carries a stigma as a mental disease. Lumbar punctures, especially when performed in public, were disliked but less feared. Financial barriers were a major obstacle for many patients.Conclusion  Less toxic drugs, lowering financial barriers and improving confidentiality would have considerable impact on the participation in population screening for HAT.
Viewpoint: do we have enough data to estimate the current burden of tuberculosis? The example of Bangladesh
Authors: Begum Vikarunnessa , Van Der Werf Marieke J. , Becx‐Bleumink Marijke , Borgdorff Martien W. 
Published: August 2010

SummaryObjective  National tuberculosis (TB) programmes need accurate estimates of the burden of TB in order to assess case detection, and progress towards the millennium development goals (MDGs). We reviewed nationwide epidemiological data on TB burden in Bangladesh to decide whether additional information is needed, in order to assess the current burden of TB.Method  We collected all nationwide epidemiological information: notification data for the period 1995–2004; reports of TB prevalence surveys in 1964–1966 and 1987–1988 and a tuberculin survey in 1964–1966. Data were evaluated for usefulness to provide information about the current burden of TB.Results  The TB prevalence surveys from 1964 to 1966 and 1987 to 1988 provide very different results, respectively, 127/100 000 and 471/100 000 smear positives. In 1964–1966, the annual risk of infection was 0.6% in the 5‐ to 9‐year age group and 1.2% in those aged between 10 and 14 years. The notification data show an increase from 18/100 000 in 1995 to 46/100 000 smear positives in 2004.Conclusion  Interpretation and extrapolation of the existing epidemiological data of Bangladesh to estimate the current burden of TB is difficult. Many of the 22 high‐burden countries have as few or even less survey data than Bangladesh. To enable the evaluation of progress towards the MDGs and to be able to assess the global burden of TB, epidemiological surveys are needed.
Improved injection safety after targeted interventions in the Syrian Arab Republic
Authors: Mantel Carsten , Khamassi Selma , Baradei Khaled , Nasri Haifa , Mohsni Ezzedine , Duclos Philippe 
Published: August 2010

SummaryObjectives  Concerns about unsafe injection practices and possible infections with blood‐borne pathogens in the Syrian Arab Republic motivated an assessment of the injection safety situation in the country in July 2001. In light of the recommendations from this assessment, the Ministry of Health of Syria, with the assistance of WHO, implemented a set of activities under the ‘Focus Project’, which aims to ensure immunization safety. The first phase of the project ran from May 2002 to February 2004, and consisted of the improved provision of injection safety equipment and supplies, the elaboration and wide distribution of national guidelines on injection safety and safe waste management, a behaviour change and communication campaign targeting the general public, and comprehensive training of healthcare workers. A follow‐up survey was carried out in February 2004, 2 years after initiation of the project.Methods  Two representative surveys were conducted using a standardized assessment tool. A cluster sampling strategy, with probability proportionate to the population size, led to the inclusion of 80 health facilities in eight districts in 2001 and of 120 health facilities in 12 districts in 2004.Results  Injection practices had significantly improved 2 years after the start of the project. The 2001 study had pointed to a low, but non‐negligible risk to patients (2% unsafe injections), coupled with a high risk to healthcare workers (61% reported needle‐stick injuries in the last 12 months) and to the communities owing to unsafe waste disposal (sharps waste found outside 37% of health facilities, waste disposal considered unsafe in 48% of them). The 2004 survey showed that 90% of Syrian healthcare workers had received training in injection safety. All injections observed were given safely (difference to 2001 not significant), although some problems in preparation and reconstitution prevailed. The risk to healthcare workers was significantly reduced as only 14% of the staff reported needle‐stick injuries (p < 0.001). The risk to the communities was notably decreased following improvements in sharps waste management (sharps were found in the surroundings of only 13% of health facilities, p < 0.001).Conclusions  The example of Syria shows that rapid improvement in injection safety is possible and that the necessary tools and methods to monitor and evaluate progress are at our disposal. Challenges remain in transferring this successful programme from the well‐structured immunization programme to the more diverse curative health services.