bluuebunny/crossref_metadata_2025_split huggingface dataset:
Access and barriers to measures targeted to prevent malaria in pregnancy in rural Kenya*
Authors: Gikandi Priscilla W. , Noor Abdisalan M. , Gitonga Carol W. , Ajanga Antony A. , Snow Robert W. 
Published: August 2010

SummaryObjectives  To evaluate barriers preventing pregnant women from using insecticide‐treated nets (ITN) and intermittent presumptive treatment (IPT) with sulphadoxine‐pyrimethamine (SP) 5 years after the launch of the national malaria strategy promoting these measures in Kenya.Methods  All women aged 15–49 years were interviewed during a community survey in four districts between December 2006 and January 2007. Women pregnant in the last 12 months were asked about their age, parity, education, use of nets, ITN, antenatal care (ANC) services and sulphadoxine‐pyrimethamine (SP) (overall and for IPT) during pregnancy. Homestead assets were recorded and used to develop a wealth index. Travel time to ANC clinics was computed using a geographic information system algorithm. Predictors of net and IPT use were defined using multivariate logistic regression.Results  Overall 68% of pregnant women used a net; 52% used an ITN; 84% attended an ANC clinic at least once and 74% at least twice. Fifty‐three percent of women took at least one dose of IPT‐SP, however only 22% took two or more doses. Women from the least poor homesteads (OR = 2.53, 1.36–4.68) and those who used IPT services (OR = 1.73, 1.24–2.42) were more likely to sleep under any net. Women who used IPT were more likely to use ITNs (OR = 1.35, 1.03–1.77), while those who lived more than an hour from an ANC clinic were less likely (OR = 0.61, 0.46–0.81) to use ITN. Women with formal education (1.47, 1.01–2.17) and those who used ITN (OR: 1.68, 1.20–2.36) were more likely to have received at least one dose of IPT‐SP.Conclusion  Although the use of ITN had increased 10‐fold and the use of IPT fourfold since last measured in 2001, coverage remains low. Provider practices in the delivery of protective measures against malaria must change, supported by community awareness campaigns on the importance of mothers’ use of IPT.
The northward spread of leishmaniasis in Italy: evidence from retrospective and ongoing studies on the canine reservoir and phlebotomine vectors
Authors: Maroli Michele , Rossi Luca , Baldelli Raffaella , Capelli Gioia , Ferroglio Ezio , Genchi Claudio , Gramiccia Marina , Mortarino Michele , Pietrobelli Mario , Gradoni Luigi 
Published: August 2010

SummaryVisceral leishmaniasis (VL) incidence has been increased in Italy in humans and dogs since the 1990s, with new foci being detected within traditional boundaries of endemic transmission but also in northern regions previously regarded as non‐endemic. To monitor the putative VL spreading, surveillance was implemented in northern continental Italy comprising: analysis of human cases recorded from 1990 through 2005; retrospective literature analysis of canine leishmaniasis (CanL) and phlebotomine sandfly records through 2002; prospective investigations in dogs from 2003 through 2005 and surveys on sandflies in 2003 and 2004. Two‐hundred‐thirty human cases (11% of Italian cases) were recorded. Their stratification by age and HIV status disclosed a sharp decrease of HIV/VL co‐infections paralleled by concomitant increase of paediatric and HIV‐negative adult patients during the study period. Four patients had no travel history. Seven leishmaniasis foci were retrospectively identified since 1990, whereas prospective investigations in dogs disclosed 47 autochthonous clinical cases and 106 autochthonous seropositives among 5442 dogs (2.1%) from 16 foci of six regions. Parasites were typed asLeishmania infantumMON‐1. Four vector species were identified among 1696Phlebotomus(Larroussius) collected specimens. Comparisons with historical data showed thatP. perniciosusandP. neglectushave increased in density and expanded their geographic range in the study area. Northern continental Italy is now focally endemic for VL and a moderate risk for human disease does exist, although the intensity of transmission seems to be lower than in traditional settings of Mediterranean VL.
Comparing the performance of indicators of hand‐washing practices in rural Indian households
Authors: Biran A. , Rabie T. , Schmidt W. , Juvekar S. , Hirve S. , Curtis V. 
Published: August 2010

SummaryObjective  To compare the results obtained from 26 proxy indicators of domestic hand‐washing practices with those obtained from direct, ‘structured’ observation of hand‐washing in a sample of 387 households and to assess the potential of these indicators for use in the evaluation of hygiene promotion campaigns.Methods  Fieldwork in rural India between February 2005 and April 2006. Household‐level data on hand‐washing practices and the availability of soap and water were collected by structured observation, questionnaire survey, pocket voting, hand‐wash demonstration and environmental check. Between them these techniques produced 27 binary indicators of hand‐washing practices, each of which was used to classify households as ‘hand‐washing’ or ‘non‐hand‐washing. To assess the extent to which household classification based on each of 26 proxy indicators concurred with classification based on observation, we used the kappa statistic. The prevalence of households defined as ‘hand‐washing’ according to each indicator was compared statistically with the prevalence according to structured observations by testing for a significant difference between two proportions.Results  Agreement between all the proxy indicators and the observation data was poor and all but two of the indicators produced estimates of hand‐washing prevalence that were significantly different from that resulting from observation.Conclusion  Although some interventions may be able to use proxy indicators as a guide to the magnitude and direction of their impact, these indicators do not provide an accurate guide to the actual practice or prevalence of hand‐washing. Structured observation remains the best indicator of those tested.
Uptake of HIV voluntary counselling and testing services in rural Tanzania: implications for effective HIV prevention and equitable access to treatment
Authors: Wringe Alison , Isingo Raphael , Urassa Mark , Maiseli Griter , Manyalla Rose , Changalucha John , Mngara Julius , Kalluvya Samuel , Zaba Basia 
Published: August 2010

SummaryObjective  To describe the associations between socio‐demographic, behavioural and clinical characteristics and the use of HIV voluntary counselling and testing (VCT) services among residents in a rural ward in Tanzania.Methods  Eight thousand nine hundred and seventy participants from a community‐based cohort were interviewed, provided blood for research HIV testing, and were offered VCT. Univariate and multivariate logistic regression was used to identify socio‐demographic, clinical and behavioural factors associated with VCT use.Results  Although 31% (1246/3980) of men and 24% (1195/4990) of women expressed an interest in the service, only 12% of men and 7% of women subsequently completed VCT. Socio‐demographic factors, such as marital status, area of residence, religion and ethnicity influenced VCT completion among males and females in different ways, while self‐perceived risk of HIV, prior knowledge of VCT, and sex with a high‐risk partner emerged as important predictors of VCT completion among both sexes. Among males only, those infected with HIV for 5 years or less tended to self‐select for VCT compared to HIV‐negatives (adjusted odds ratio = 1.43; 95% CI: 0.99–2.14). This contributed to a higher proportion of HIV‐positive males knowing their status compared to HIV‐positive females.Conclusions  In this setting, a disproportionate number of HIV‐positive women are failing to learn their status, which has implications for equitable access to onward referral for care and treatment services. Evidence that some high‐risk behaviours may prompt VCT use is encouraging, although further interventions are required to improve knowledge about HIV risk and the benefits of VCT. Targeted interventions are also needed to promote VCT uptake among married women and rural residents.
Defaulters from antiretroviral treatment in Jimma University Specialized Hospital, Southwest Ethiopia
Authors: Deribe Kebede , Hailekiros Fikre , Biadgilign Sibhatu , Amberbir Alemayehu , Beyene Biruk Kebede 
Published: August 2010

SummaryObjective  To determine the prevalence of and factors associated with defaulting from antiretroviral treatment (ART) in Jimma, Ethiopia.Methods  Unmatched case control study: cases were individuals who had missed two or more clinical appointments (i.e. had not been seen for the last 2 months) between January 2005 and February 2007; controls were individuals who had been on ART at least for 1 year and were rated as excellent adherers by the providers. Data were collected from patient records, and by telephone call and home visit to identify the reason for defaulting.Results  Of 1270 patients who started ART, 915 (72.0%) were active ART users and 355 (28.0%) had missed two or more clinical appointments. The latter comprised 173 (13.6%) defaulters, 101 (8.0%) who transferred out, 75 (5.9%) who died, and 6 (0.5%) who restarted ART. Reasons for defaulting were unclear in most cases. Reasons given were loss of hope in medication, lack of food, mental illness, holy water, no money for transport, and other illnesses. Tracing was not successful because of incorrect address on the register in 61.6% of the cases. Taking hard drugs (cocaine, cannabis and IV drugs), excessive alcohol consumption, being bedridden, living outside Jimma town and having an HIV negative or unknown HIV status partner were associated with defaulting ART.Conclusion  A significant proportion of patients defaulted from ART treatment. ART clinics should ensure that patients’ addresses are correct and complete. Programmatic and counseling efforts to decrease ART defaulting should address illicit drug and excessive alcohol use, decentralise ART services, institute home‐based treatment options for seriously ill and bedridden patients, and address patients concerns.
Use of proxy measures in estimating socioeconomic inequalities in malaria prevalence
Authors: Somi Masha F , Butler James R , Vahid Farshid , Njau Joseph D , Kachur S P , Abdulla Salim 
Published: August 2010

SummaryObjectives  To present and compare socioeconomic status (SES) rankings of households using consumption and an asset‐based index as two alternative measures of SES; and to compare and evaluate the performance of these two measures in multivariate analyses of the socioeconomic gradient in malaria prevalence.Methods  Data for the study come from a survey of 557 households in 25 study villages in Tanzania in 2004. Household SES was determined using consumption and an asset‐based index calculated using Principal Components Analysis on a set of household variables. In multivariate analyses of malaria prevalence, we also used two other measures of disease prevalence: parasitaemia and self‐report of malaria or fever in the 2 weeks before interview.Results  Household rankings based on the two measures of SES differ substantially. In multivariate analyses, there was a statistically significant negative association between both measures of SES and parasitaemia but not between either measure of SES and self‐reported malaria. Age of individual, use of a mosquito net, and wall construction were negatively and significantly associated with parasitaemia, whilst roof construction was positively associated with parasitaemia. Only age remained significant when malaria self‐report was used as the measure of disease prevalence.Conclusions  An asset index is an effective alternative to consumption in measuring the socioeconomic gradient in malaria parasitaemia, but self‐report may be an unreliable measure of malaria prevalence for this purpose.
Primary health care supervision in developing countries
Authors: Bosch‐Capblanch Xavier , Garner Paul 
Published: August 2010

SummaryObjectives  To (a) summarise opinion about what supervision of primary health care is by those advocating it; (b) compare these features with reports describing supervision in practice; and (c) to appraise the evidence of the effects of sector performance.Methods  Systematic review. Reports were classified into three groups and summarised using appropriate methods: policy and opinion papers (narrative summary), descriptive studies (systematically summarised) and experimental or quasi‐experimental studies (design and outcomes systematically summarised). Data presented as narrative summaries and tables.Results  74 reports were included. In eight policy and opinion papers, supervision was conceptualised as the link between the district and the peripheral health staff; it is important in performance and staff motivation; it often includes problem solving, reviewing records, and observing clinical practice; and is usually undertaken by visiting the supervisees place of work. In 54 descriptive studies, the setting was the primary health care (PHC) or specific services and programmes. Supervisor‐supervisee dyads were generally district personnel supervising health facilities or lay health workers. Supervision mostly meant visiting supervisees, but also included meetings in the centre; it appeared to focus on administration and checking, sometimes with checklists. Problem solving, feedback and clinical supervision, training and consultation with the community were less commonly described in the descriptive studies. Supervision appears expensive from studies that have reported costs. In 12 quasi‐experimental trials, supervision interventions generally showed small positive effects in some of the outcomes assessed. However, trial quality was mixed, and outcomes varied greatly between studies.Conclusions  Supervision is widely recommended, but is a complex intervention and implemented in different ways. There is some evidence of benefit on health care performance, but the studies are generally limited in the rigor and follow up is limited. Further research delineating what supervision consists of and evaluating it in the context of unbiased comparisons would guide the implementation of effective supervision as part of the management of PHC.
Socio‐cultural, psychosexual and biomedical factors associated with genital symptoms experienced by men in rural India
Authors: Gautham Meenakshi , Singh Rajesh , Weiss Helen , Brugha Ruairi , Patel Vikram , Desai Nimesh G , Nandan Deoki , Kielmann Karina , Grosskurth Heiner 
Published: August 2010

SummaryBiomedical, anthropological and psychiatric frameworks have been used to research different elements of men’s sexual health – sexually transmitted infections, psychosexual concerns and psychological distress – but rarely within the same study. We combined these in a study in rural north India. In Tehri Garhwal and Agra districts, we explored male perceptions of genital and sexual symptoms through focus group discussions and then conducted a clinic‐based survey of 366 symptomatic men who presented at rural private provider clinics. Men’s urine specimens were tested for gonorrhoea and chlamydia infection using polymerase chain reaction techniques. Researchers screened them for probable psychological distress by administering the General Health Questionnaire (12‐ items). Results revealed that local and traditional notions of health influenced men’s symptom perceptions, with semen loss their predominant concern. Dhat, commonly perceived as an involuntary semen loss, corresponded most closely with the symptom of urethral discharge, but was attributed mainly to non‐infectious causes. It could also manifest as a syndrome with physical weakness and mental lethargy. FGD participants lacked correct and complete information on reproductive health. Around 75% of the symptomatic men presented with dhat, but only 5.5% tested positive for gonorrhoea or chlamydia. Application of syndromic sexually transmitted infection (STI) guidelines in these settings could result in over diagnosis and over treatment with antibiotics. In contrast, there was a significant association between dhat and probable psychological distress as detected by the GHQ (Adjusted OR, GHQ case positive: 2.66, 95% CI: 1.51–4.68). Our study confirms the existence of a dhat syndrome in rural India, which is culturally influenced and reflects heightened psychosexual concerns as well as mental distress states. Comprehensive health services for men should include assessments of their psychosexual needs and be supported by reproductive/sexual health education. STI treatment guidelines for urethral symptoms should be revised and be based on epidemiological data.
Changing pattern of malaria in Bissau, Guinea Bissau
Authors: Rodrigues Amabelia , Schellenberg Joanna Armstrong , Kofoed Poul‐Erik , Aaby Peter , Greenwood Brian 
Published: August 2010

SummaryObjective  To describe the epidemiology of malaria in Guinea‐Bissau, in view of the fact that more funds are available now for malaria control in the country.Methods  From May 2003 to May 2004, surveillance for malaria was conducted among children less than 5 years of age at three health centres covering the study area of the Bandim Health Project (BHP) and at the outpatient clinic of the national hospital in Bissau. Cross‐sectional surveys were conducted in the community in different malaria seasons.Results  Malaria was overdiagnosed in both health centres and hospital. Sixty‐four per cent of the children who presented at a health centre were clinically diagnosed with malaria, but only 13% of outpatient children who tested for malaria had malaria parasitaemia. Only 44% (963/2193) of children admitted to hospital with a diagnosis of malaria had parasitaemia. The proportion of positive cases increased with age. Among hospitalized children with malaria parasitaemia, those less than 2 years old were more likely to have moderate anaemia (RR = 1.27; 95% CI: 1.02–1.56) (P = 0.03) or severe anaemia (RR = 1.67; 95% CI: 1.25–2.24) (P = 0.0005) than older children. The prevalence of malaria parasitaemia in the community was low (3%, 53/1926).Conclusion  In Bissau, the prevalence of malaria parasitaemia in the community is now low and malaria is over‐diagnosed in health facilities. Laboratory support will be essential to avoid unnecessary use of the artemisinin combination therapy which is now being introduced as first‐line treatment in Bissau with support from the Global Fund.
Low carriage rate of group B streptococcus in pregnant women in Maputo, Mozambique
Authors: De Steenwinkel Florentien D. O. , Tak Henrike V. , Muller Anouk E. , Nouwen Jan L. , Oostvogel Paul M. , Mocumbi Sibone M. 
Published: August 2010

SummaryThe prevalence of group B streptococcus (GBS) carriage varies strongly with geographical region. A study was done to determine the prevalence of GBS in women in Maputo, Mozambique. The method used was a rectovaginal swab which was taken from women between 35 and 37 weeks of pregnancy who visited the clinic for antenatal consultation. GBS was cultured from 2 out of 113 samples, yielding a prevalence of 1.8% (95% Cl: 0.0–4.0). In conclusion, the prevalence of GBS carriage among pregnant women in Maputo, Mozambique was low.
Distribution and antibiotic susceptibility of Shigella isolates in Bangui, Central African Republic
Authors: Bercion Raymond , Njuimo Siméon P. , Boudjeka Prisca Megne , Manirakiza Alexandre 
Published: August 2010

SummaryWe conducted a prospective study in four urban health care centres between January 2004 and November 2005 to determine the distribution and susceptibility patterns of Shigella strains causing invasive diarrhoea in Bangui, Central African Republic. Of the 155 Shigella isolated, Shigella flexneri (51%) and Shigella dysenteriae (30%) were the most common and the most resistant to usual antibiotics, including amoxicillin, sulphamethoxazole–trimethoprim and chloramphenicol. Though multi‐drug resistance was common, no strains were resistant to quinolone and fluoroquinolones. We conclude that short‐course treatments with ciprofloxacin can be recommended in Bangui for treatment of invasive diarrhoea.
Cryptosporidium and Giardia infection and drinking water sources among children in Lege Dini, Ethiopia
Authors: Ayalew D. , Boelee E. , Endeshaw T. , Petros B. 
Published: August 2010

SummaryWe assessed the prevalence of Cryptosporidium and Giardia infections among children using protected and unprotected water sources in the Lege Dini watershed, Eastern Ethiopia, in November 2005 and May 2006. Of 655 children examined, 80 (12.2%) were infected with Cryptosporidium and 231 (35.3%) with Giardia. No difference was observed in the prevalence of cryptosporidiosis and giardiasis (P > 0.05) between children drinking water from protected and unprotected sources.
Increased mortality of male adults with AIDS related to poor compliance to antiretroviral therapy in Malawi
Authors: Chen Solomon Chih‐Cheng , Yu Joseph Kwong‐Leung , Harries Anthony David , Bong Chin‐Nam , Kolola‐Dzimadzi Rose , Tok Teck‐Siang , King Chwan‐Chuen , Wang Jung‐Der 
Published: August 2010

SummaryObjective  To investigate the effect of gender on mortality of HIV‐infected adults receiving antiretroviral therapy (ART) and its possible reasons.Methods  A retrospective study to review the records for outcomes of adult cases receiving ART at Mzuzu Central Hospital, Malawi, between July 2004 and December 2006.Results  Over the study period, 2838 adult AIDS patients received ART. Of these, 2029 (71.5%) were alive and still on ART, 376 (13.2%) were dead and 433 (15.3%) were lost to follow‐up. Survival analysis with Kaplan–Meier estimator showed significantly higher survival rates among females than males in WHO stage 1, 2 and 3 (both P < 0.0001) and borderline in stage 4 (P = 0.076). The Cox model revealed a death hazard ratio (males vs. females) of 1.70 (95% confidence interval 1.35–2.15) after controlling for WHO clinical stages, body mass index and age. More men than women were lost to follow‐up in all occupations except health workers.Conclusions  The most important reasons for a higher mortality in male patients starting ART may relate to their seeking medical care at a more advanced stage of immunodeficiency and poorer compliance with therapy. The issue needs to be addressed in scaling up ART programmes in Africa.
Characterization of knockdown resistance in DDT‐ and pyrethroid‐resistant Culex quinquefasciatus populations from Sri Lanka
Authors: Wondji Charles S. , Priyanka De Silva W. A. P. , Hemingway Janet , Ranson Hilary , Parakrama Karunaratne S. H. P. 
Published: August 2010

SummaryDDT and pyrethroid resistance in Culex quinquefasciatus have been previously reported in Sri Lanka, but the mechanisms involved have yet to be characterized. We report the presence of two mutant alleles of the sodium channel gene, the target site for both DDT and pyrethroid insecticides. Both mutations resulted in classic knockdown resistance (kdr) L1014F mutation because of either an A‐to‐T substitution or an A‐to‐C substitution. We developed two alternative assays to distinguish between the two mutations and used these to screen 214 individuals from nine geographic locations throughout Sri Lanka. Very high levels of kdr mutations were found throughout the country. A predominance of the A‐to‐C mutation was observed over the A‐to‐T with an average allele frequency of 50% and 2%, respectively. In addition to these non‐synonymous kdr substitutions, we also found an indel (TCACA) in the intron downstream of the kdr mutation. After genotyping this indel in 136 individuals, we found no evident correlation between kdr genotypes and intronic indel. The presence of two alternative kdr mutations has implications for the reliance on single molecular diagnostics for detection of resistance in field populations. Furthermore, the high levels of these kdr mutations in C. quinquefasciatus populations throughout Sri Lanka are of concern for the future of pyrethroid‐based control programmes on this island.