bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reducing financial barriers to emergency obstetric care: experience of cost‐sharing mechanism in a district hospital in Burkina Faso
Authors: Richard F. , Ouédraogo C. , Compaoré J. , Dubourg D. , De Brouwere V. 
Published: August 2010

SummaryObjective  To describe the implementation of a cost‐sharing system for emergency obstetric care in an urban health district of Ouagadougou, Burkina Faso and analyse its results after 1 year of activity.Methods  Service availability and use, service quality, knowledge of the cost‐sharing system in the community and financial viability of the system were measured before and after the system was implemented. Different sources of data were used: community survey, anthropological study, routine data from hospital files and registers and specific data collected on major obstetric interventions (MOI) in all the hospitals utilized by the district population. Direct costs of MOI were collected for each patient through an individual form and monitored during the year 2005. Rates of MOI for absolute maternal indications (AMI) were calculated for the period 2003–2005.Results  The direct cost of a MOI was on average 136US$, including referral cost. Through the cost‐sharing system this amount was shared between families (46US$), health centres (15US$), Ministry of Health (38US$) and local authority (37US$). The scheme was started in January 2005. The rate of cost recovery was 91.3% and the balance at the end of 2005 was slightly positive (4.7% of the total contribution). The number of emergency referrals by health centres increased from 84 in 2004 to 683 in 2005. MOI per 100 expected births increased from 1.95% in 2003 to 3.56% in 2005 and MOI for AMI increased from 0.75% to 1.42%.Conclusions  The dramatic increase in MOI suggests that the cost‐sharing scheme decreased financial and geographical barriers to emergency obstetric care. Other positive effects on quality of care were documented but the sustainability of such a system remains uncertain in the dynamic context of Burkina Faso (decentralization).
Molecular analysis of chloroquine resistance in Plasmodium falciparum in Yunnan Province, China
Authors: Yang Zhaoqing , Zhang Zaixin , Sun Xiaodong , Wan Wenlin , Cui Long , Zhang Xiang , Zhong Daibin , Yan Guiyun , Cui Liwang 
Published: August 2010

SummaryResistance of Plasmodium falciparum to chloroquine (CQ) is determined by the mutation at K76T of the P. falciparum chloroquine resistance transporter (pfcrt) gene and modified by other mutations in this gene and in the P. falciparum multidrug resistance 1 (pfmdr1) gene. To determine the extent of polymorphisms in these genes in field P. falciparum isolates from Yunnan province of China, we genotyped the pfcrt codon 76, pfmdr1 codons 86 and 1246. Our results showed that although CQ has been withdrawn from treating falciparum malaria for over two decades, 90.3% of the parasites still carried the pfcrt K76T mutation. In contrast, mutations at pfmdr1 codons 86 and 1246 were rare. Sequencing analysis of the pfcrt gene in 34 parasite field isolates revealed CVIET at positions 72–76 as the major type, consistent with the theory of Southeast Asian origin of CQ resistance in the parasite. In addition, two novel pfcrt haplotypes (75D/144Y/220A and 75E/144Y/220A) were identified. Real‐time polymerase chain reaction was used to determine pfmdr1 gene amplification, which is associated with mefloquine resistance. Our result indicated that in agreement with that mefloquine has not been used in this area, most (>90%) of the parasites had one pfmdr1 copy. Genotyping at two hypervariable loci showed relatively low levels of genetic diversity of the parasite population. Meanwhile, 28.4% of cases were found to contain mixed clones, which favour genetic recombination. Furthermore, despite a unique history of antimalarial drugs in Yunnan, its geographical connections with three malarious countries facilitate gene flow among parasite populations and evolution of novel drug‐resistant genotypes. Therefore, continuous surveillance of drug resistance in this area is necessary for timely adjustment of local drug policies and more effective malaria control.
Preserving breastfeeding practice through the HIV pandemic
Authors: Coovadia H. M. , Bland R. M. 
Published: August 2010

SummaryBreastfeeding, particularly for the first 6 months of life, is unquestionably the ideal way to feed most infants. However, the human immunodeficiency virus (HIV) pandemic has caused debate and confusion about the best way for HIV‐positive mothers to feed their children. This review provides recent key findings and opinions around making breastfeeding safer for HIV‐positive women, and argues for preservation of breastfeeding, as opposed to complete avoidance of breastfeeding for all HIV‐positive women.
Economic costs of epidemic malaria to households in rural Ethiopia
Authors: Deressa Wakgari , Hailemariam Damen , Ali Ahmed 
Published: August 2010

SummaryObjective  To estimate the direct and indirect costs of malaria morbidity among communities in an epidemic area in rural Southcentral Ethiopia.Methods  Community‐based cross‐sectional study of 2195 households in Adami Tulu district from October to November 2003. Treatment‐seeking behaviour, expenditure on treatment and transportation, interruption of normal activities, time lost from working and household expenditure on preventive methods were ascertained through interview.Results  Of 12 225 surveyed individuals, 1748 (14.3%) reported perceived malaria during the preceding 2 weeks. 77.1% sought any form of care and 70% had recovered at the time of interview. The average treatment cost per patient at private clinics was Birr 24.00 ($2.76) and Birr 12.50 ($1.44) at public facilities. The average estimated direct cost of malaria per patient was Birr 14.00 ($1.60); the average indirect cost, Birr 35.26 ($4.08). Only 5% of all households reported any preventive expenditure in the preceding month, with a mean of Birr 0.76 ($0.09).Conclusion  Malaria poses a significant economic burden on rural households and individuals both through out‐of‐pocket payment and person‐days lost. The promotion and implementation of insecticide‐treated nets would alleviate the economic consequences of the disease.
Viewpoint: A framework for decision‐making in integrated vector management to prevent disease
Authors: Van Den Berg Henk , Takken Willem 
Published: August 2010

SummaryIntegrated vector management (IVM) aims to extend the basis of disease control by involving other sectors and local communities in control action. It is vital that decisions on IVM are made locally for two reasons: first, the epidemiology of disease can vary at a small spatial scale, suggesting the need for precise targeting and second, a number of disease determinants relate to the actions and conditions of local communities, suggesting the need for their increased participation. This requires a shift from centrally managed, sector‐specific operations to the facilitation of multi‐partner programmes at the district and local level. We propose a methodology for involving local partners outside the health sector in describing and mapping the local determinants and conditions of disease, analysing control options, and consolidating a joint strategy of control. Thus determinants that often lie outside the domain of the health sector are tackled.
Short communication: Detecting depression after pregnancy: the validity of the K10 and K6 in Burkina Faso
Authors: Baggaley R. F. , Ganaba R. , Filippi V. , Kere M. , Marshall T. , Sombié I. , Storeng K. T. , Patel V. 
Published: August 2010

SummaryObjective  The K10 and K6 are short rating scales designed to detect individuals at risk for depressive disorder, with or without anxiety. Despite being widely used, they have not yet been validated for detecting postnatal depression. We describe the validity of these scales for the detection of postnatal depression in Burkina Faso.Method  The English language version of the K10 questionnaire was translated into West African French and local languages for use in Burkina Faso. Scores for 61 women were compared with the diagnostic interview made by a local psychiatrist within 3 days of administering the K10.Results  Clinical assessment found that 27 (44%) women were probable cases of depression. Internal consistency of K10 and K6 scores, defined by Cronbach’s alpha coefficient, was 0.87 and 0.78, respectively, indicating satisfactory reliability. The performance of the scores was not significantly different, with areas under the curve of 0.77 and 0.75 for the K10 and K6, respectively. To estimate prevalence of depression, we suggest cut‐offs of ≥14 for the K10 and between ≥9 and ≥11 for the K6 for identifying women at high risk of depression. At ≥14, the K10 has 59% sensitivity, 91% specificity; at ≥10, the K6 has 59% sensitivity and 85% specificity.Conclusion  This study suggests that K10 and K6 are reasonably valid measures of depression among postpartum women in Burkina Faso and can be used as relatively cheap tools for estimating prevalence of postnatal depression in developing countries.
A 84‐month follow up of adherence to HAART in a cohort of adult Senegalese patients
Authors: Etard Jean‐François , Lanièce Isabelle , Fall Mame Basty Koita , Cilote Vannina , Blazejewski Laure , Diop Karim , Desclaux Alice , Ecochard René , Ndoye Ibra , Delaporte Eric ,   ANRS 1215/1290 Study Group
Published: August 2010

SummaryObjectives  To assess long‐term adherence of the first HIV‐1 patients receiving highly active antiretroviral therapy (HAART) in Senegal, and to identify the main determinants of adherence.Methods  The first 180 patients enrolled in the Senegalese HAART initiative between August 1998 and April 2001 followed up for at least 30 days were eligible. Adherence was assessed monthly at each drug dispensation between November 1999 and November 2006 by a pharmacist using a pill count completed by a questionnaire. Adherence was expressed as the proportion of tablets taken to prescribed tablets. An adherence of 95% was considered to be good. A random‐intercept logit model was fitted to identify the main determinants of adherence.Results  Adherence data were available for 158 of 167 eligible patients. Twenty‐nine patients died during the study period and 10 were lost to follow‐up. Median treatment duration was 78 months, accruing to 6657 person‐months of observation. Overall, mean adherence reached 91% [median: 100%, interquartile range (IQR) 96‐100%] and adherence exceeded 95% in 78% [95% CI 77‐79%] of observations. After 4 years of treatment mean adherence stabilized around 90% and adherence 95% stabilized around 70%. Treatment duration and protease inhibitor (PI)‐based regimen (indinavir) had a negative effect on adherence, but adherence tended to improve with time for patients receiving a PI. Patient‐level variance was highly significant and accounted for a third of total variance.Conclusions  This work demonstrates that good long‐term adherence can be achieved in the sub‐Saharan context given close monitoring and adherence support measures, confirms the worse adherence for indinavir and underlines the importance of patient heterogeneity.
Assessment of antigenic fractions of varying hydrophobicity from Taenia solium metacestodes for the diagnosis of human neurocysticercosis
Authors: Machado Gleyce Alves , Santiago Fernanda Maria , Mineo José Roberto , Costa‐Cruz Julia Maria 
Published: August 2010

SummaryObjective  To evaluate the detergent and aqueous phases of crude saline extract (crude) of Taenia solium metacestodes extracted with Triton X‐114, for the detection of immunoglobulin G (IgG) antibodies by enzyme‐linked immunosorbent assay (ELISA) and immunoblot for the laboratory diagnosis of human neurocysticercosis.Method  Serum samples were collected from 138 individuals and tested; 40 were diagnosed with neurocysticercosis (NC; group 1), 58 presented other parasitic diseases (group 2) and 40 were apparently healthy (group 3).Results  The detergent phase showed only one dominant component (70–50 kDa), while the aqueous phase showed four (116, 110, 97 and 77 kDa) by silver staining. ELISA sensitivity and specificity were 92.5% and 84.5% for crude phase, 92.5% and 93.3% for detergent phase and 72.5% and 72.6% for aqueous phase.Conclusions  The immunoblot of the antigens confirmed the results obtained by ELISA. Detergent phase purified from T. solium metacestodes was an important source of specific peptides and was efficient in detecting T. solium metacestodes antibodies in serum samples. This phase can be used for detecting IgG antibodies to T. solium metacestodes in seroepidemiological investigations and in the diagnostic screening of NC patients.
Epidemiology and clinical features of pneumonia according to radiographic findings in Gambian children
Authors: Enwere Godwin , Cheung Yin Bun , Zaman Syed M. A. , Akano Alieu , Oluwalana Claire , Brown Okoko , Vaughan Adeola , Adegbola Richard , Greenwood Brian , Cutts Felicity 
Published: August 2010

SummaryObjective  To assess the effect of vaccines against pneumonia in Gambian children.Methods  Data from a randomized, controlled trial of a 9‐valent pneumococcal conjugate vaccine (PCV) were used. Radiographic findings, interpreted using WHO definitions, were classified as primary end point pneumonia, ‘other infiltrates/abnormalities’ pneumonia and pneumonia with no abnormality. We calculated the incidence of the different types of radiological pneumonia, and compared clinical and laboratory features between these groups.Results  Among children who did not receive PCV, the incidence of pneumonia with no radiographic abnormality was about twice that of ‘other infiltrates’ pneumonia and three times that of primary endpoint pneumonia. Most respiratory symptoms, reduced feeding and vomiting occurred most frequently in children with primary endpoint pneumonia. These children were more likely to be malnourished, to have bronchial breath sounds or invasive bacterial diseases, and to die within 28 days of consultation than children in the other groups. Conversely, a history of convulsion, diarrhoea or fast breathing, malaria parasitaemia and isolation of salmonellae were commoner in children with pneumonia with no radiographic abnormality. Lower chest wall indrawing and rhonchi on auscultation were seen most frequently in children with ‘other infiltrates/abnormalities’ pneumonia.Conclusion  Primary endpoint pneumonia is strongly associated with bacterial aetiology and severe pneumonia. Since this category of pneumonia is significantly reduced after vaccination with Hib and pneumococcal vaccines, the risk‐benefit of antimicrobial prescription for clinical pneumonia for children with increased respiratory rate may warrant re‐examination once these vaccines are in widespread use.
Expanding access to voluntary HIV counselling and testing in sub‐Saharan Africa: alternative approaches for improving uptake, 2001–2007
Authors: Matovu Joseph K.B. , Makumbi Fredrick E. 
Published: August 2010

SummaryThe changing face of the HIV/AIDS epidemic has resulted in new opportunities to increase access to voluntary HIV counselling and testing (VCT), especially during the past 7 years (2001–2007). As access to HIV treatment becomes more widely available in sub‐Saharan Africa, the need for enhanced access to VCT would become even greater. When given the opportunity, many more adults in sub‐Saharan African would accept VCT, and many clearly express the desire to learn their HIV sero‐status. However, in most parts of sub‐Saharan Africa, fewer than one in 10 people know their HIV status. Stigma, fear of receiving an HIV‐positive status, lack of confidentiality, long distances to VCT sites, and long delays in returning HIV test results limit people’s access to traditional VCT systems. Alternative VCT delivery models, such as mobile VCT, routine offer of VCT and home‐based VCT increase access to and uptake of VCT. We recommend that these alternative models be implemented in more settings and on a much larger scale in sub‐Saharan Africa, where VCT uptake rates remain low.
Short communication: Patterns of chronic and acute diseases after natural disasters – a study from the International Committee of the Red Cross field hospital in Banda Aceh after the 2004 Indian Ocean tsunami
Authors: Guha‐Sapir Debarati , Van Panhuis Willem Gijsbert , Lagoutte Joel 
Published: August 2010

SummaryObjective  To assess the pattern of diseases in a natural disaster, which are not necessarily a direct consequence of the event but can impact on the way health assistance is to be provided.Methods  Cross‐sectional, record‐based study in the International Committee of the Red Cross field hospital in Aceh, Indonesia, established immediately after the tsunami in 2004. Patients who presented to hospital from January 15 to 31, and whose diagnoses were available, were included in the study.Results  One thousand one hundred and eighty‐eight residents of Aceh participated. 43.5% of the diagnoses was chronic diseases. The odds of chronic vs. acute diseases increased by 16.4% per day up to January 23 [95% confidence interval (CI): 7.8–25.6%] and decreased thereafter by 13.1% (95% CI: 6.6–19.1%) per day. The odds of acute diseases were 34% lower among females than males (95% CI: 16–49%) and 4.3 times higher among children than the rest of the population (95% CI: 2.4–7.6). There were relatively few trauma cases among females and children.Conclusions  Medical teams providing relief after acute disasters should be prepared to provide healthcare for chronic diseases too. A delay in the presentation of many acute conditions has implications for long‐term health consequences of disasters, such as disability.
How affordable are tuberculosis diagnosis and treatment in rural China? An analysis from community and tuberculosis patient perspectives
Authors: Liu Xiaoyun , Thomson Rachael , Gong Youlong , Zhao Fengzeng , Squire S. Bertel , Tolhurst Rachel , Zhao Xinping , Yan Fei , Tang Shenglan 
Published: August 2010

SummaryObjectives  To assess equity in access to tuberculosis (TB) care by estimating and comparing the direct household costs perceived by community residents with actual costs experienced by TB patients and to identify the factors influencing the financial burden of TB patients.Methods  Economic study in four provinces of China by means of a survey of 889 TB patients and 2560 community residents and in‐depth interviews with key informants.Results  The direct household costs for using TB health services perceived by the communities were two to five times higher than the actual costs incurred by the TB patients. Patients had to pay a substantial proportion of their annual income for TB services (12–40%), despite the fact that smear‐positive and some severe smear‐negative patients received free drugs. Repeated outpatient visits before diagnosis, over‐prescription of drugs and prolonged treatments were common.Conclusions  The heavy financial burden (both perceived and real) on these patients is one of the main reasons that some TB patients fail to access and complete treatment. Pressure to generate revenue through current incentives in health‐care financing and poor competence of health workers at the village and township levels cause delay and high expenses to TB patients and ultimately impede effective TB control in China.
Risk factors and consequences of congenital Chagas disease in Yacuiba, south Bolivia
Authors: Salas N. A. , Cot M. , Schneider D. , Mendoza B. , Santalla J. A. , Postigo J. , Chippaux J. P. , Brutus L. 
Published: August 2010

SummaryObjective To determine the risk factors of congenital Chagas disease and the consequences of the disease in newborns.Methods Study of 2712 pregnant women and 2742 newborns in Yacuiba, south Bolivia. Chagas infection was determined serologically in mothers and parasitologically in newborns. Consequences of congenital Chagas disease were assessed clinically.Results The prevalence of Chagas disease in pregnant women was 42.2%. Congenital transmission was estimated at 6% of infected mothers leading to an incidence rate of 2.6% among newborns. Main risk factors of congenital transmission were mothers’ seropositivity and maternalTrypanosoma cruziparasitaemia. Parity was higher in infected than in non‐infected mothers, but it was not associated with the risk of congenital transmission. The rate of congenital infection was significantly higher in newborns from multiple pregnancies than in singletons. However, we did not observe statistically significant consequences of Chagas disease in newborns from single pregnancies or among twins.Conclusions The main risk factors for congenital transmission were infection and parasitaemia of mothers. Consequences of the disease seemed mild in newborns from single pregnancies and perhaps more important in multiple births.
Malaria and anaemia among pregnant women at first antenatal clinic visit in Kisumu, western Kenya
Authors: Ouma Peter , Van Eijk Anna M. , Hamel Mary J. , Parise Monica , Ayisi John G. , Otieno Kephas , Kager Piet A. , Slutsker Laurence 
Published: August 2010

SummaryObjective  To determine the prevalence of malaria and anaemia among urban and peri‐urban women attending their first antenatal clinic (ANC) in an area of perennial malaria transmission.Methods  Between November 2003 and May 2004 we screened first ANC attenders for malaria and anaemia in a large urban hospital in Kisumu (western Kenya) and interviewed them to obtain demographic and medical information.Results  Among the 685 study participants, prevalence of malaria parasitaemia was 18.0%, prevalence of any anaemia (haemoglobin < 11 g/dl) was 69.1% and prevalence of moderate anaemia was (haemoglobin < 8 g/dl) 11.8%. Sixteen women were hospitalized during pregnancy, eight because of malaria. In multivariate analysis, young age, living in a house with mud walls, a visit to rural area, peri‐urban residence, second trimester of pregnancy and Luo ethnicity were significant risk factors for malaria parasitaemia. Malaria was an important risk factor for any and moderate anaemia; use of an insecticide‐treated net (ITN) was a protective factor for any anaemia. Married women with a higher level of education, better‐quality housing and full‐time employment were more likely to use an ITN.Conclusion  Malaria and anaemia are established problems by the time of the first ANC visit. Mechanisms to deliver ITNs to women of child‐bearing age before they become pregnant need to be explored. Early ANC visits are warranted in order for women to benefit from policies aimed at reducing the burden of malaria and anaemia.
Antimicrobial resistance surveillance among commensal Escherichia coli in rural and urban areas in Southern India
Authors: Mathai Elizabeth , Chandy Sujith , Thomas Kurien , Antoniswamy Belavendra , Joseph Inbakumar , Mathai Matthews , Sorensen Thomas L. , Holloway Kathleen 
Published: August 2010

SummaryObjective  To assess antimicrobial resistance (AMR) in Tamil Nadu, India.Methods  Data on AMR of commensal and uropathogenic Escherichia coli were collected from one urban (Christian Medical College Hospital, Vellore) and one rural (CMCH Rural Unit for Health and Social Affairs) centre in Tamil Nadu at monthly intervals for 1 year.Results  Forty‐two per cent of commensal E. coli was resistant to one or more of the tested antimicrobials. 8.4% were resistant to three drugs commonly used for the treatment of urinary tract infections, namely ampicillin, co‐trimoxazole and nalidixic acid. 1.5% of isolates were resistant to nitrofurantoin. There was no significant difference between resistance rates in commensal E. coli collected in rural and urban areas. Resistance was more common in infecting than commensal strains.Discussion  Resistance to most antimicrobials is high both in urban and rural areas. Higher resistance to antimicrobials used widely for the treatment suggests that drug use contributes to it. Hence unnecessary use of antimicrobials must be avoided. Surveillance among commensal E. coli can be used to monitor changes in AMR over time.