bluuebunny/crossref_metadata_2025_split huggingface dataset:
Are intestinal helminths risk factors for developing active tuberculosis?
Authors: Elias Daniel , Mengistu Getahun , Akuffo Hannah , Britton Sven 
Published: March 2006

SummaryObjectives  To determine the prevalence of intestinal helminth infections in active tuberculosis patients and their healthy household contacts and to assess its association with active TB in an area endemic for both types of infections.Methods  Smear‐positive pulmonary TB patients and healthy household contacts were tested for intestinal helminths using direct microscopy and the formol‐ether concentration techniques. Three consecutive stool samples were examined before the start of TB chemotherapy. Sputum microscopy was done using the sodium hypochlorite concentration techniques. Participants were also tested for HIV by commercial sandwich enzyme linked immunosorbent assay.Results  The study population consisted of 230 smear‐positive TB patients and 510 healthy household contacts. The prevalence of intestinal helminths was 71% in patients and 36% in controls. HIV seroprevalence was significantly higher in patients than in controls (46.7%vs. 11.6%, P < 0.001). Conditional logistic regression analysis showed a strong association between TB and intestinal helminth infection (OR = 4.2, 95% CI 2.7–5.9, P < 0.001), and between TB and HIV infection (OR = 7.8, 95% CI 4.8–12.6, P < 0.0001). The odds of being a TB patient increased with the number of helminth species per person: in individuals with mono‐infection it was 4.3 (95% CI 2.8–6.8); in people infected with two species was 4.7 (95% CI 2.5–8.7), and in patients infected with three or more helminths was 12.2 (3.9–52.6).Conclusion  Intestinal helminth infection may be one of the risk factors for the development of active pulmonary TB in addition to HIV infection. This finding may have important implications in the control of TB in helminth endemic areas of the world.
The effect of Plasmodium falciparum on cognition: a systematic review
Authors: Kihara Michael , Carter Julie A. , Newton Charles R. J. C. 
Published: March 2006

SummaryObjective  Systematic review to investigate the relationship between Plasmodium falciparum infection and cognitive function.Method  We searched MEDLINE, EMBASE and PsycINFO, and hand‐searched journals and PhD theses. The inclusion criteria were (1) use of standardized tests for the specific populations and/or appropriate controls; (2) clear differentiation between children and adults. Eighteen studies were eligible, of which three gave information on all cognitive domains considered in the review.Results  Deficits in attention, memory, visuo‐spatial skills, language and executive functions may occur after malaria infection. These deficits are not only caused by cerebral falciparum malaria, but also appear to occur in less severe infections. P. falciparum seems to affect the brain globally, not in a localised fashion. Outcome depends on both biological and social risk factors.Conclusion  Future research should seek to establish the extent of these cognitive deficits using culturally appropriate techniques and well‐defined criteria of disease.
Operational response to malaria epidemics: are rapid diagnostic tests cost‐effective?
Authors: Rolland Estelle , Checchi Francesco , Pinoges Loretxu , Balkan Suna , Guthmann Jean‐Paul , Guerin Philippe J 
Published: March 2006

SummaryObjective  To compare the cost‐effectiveness of malaria treatment based on presumptive diagnosis with that of malaria treatment based on rapid diagnostic tests (RDTs).Methods  We calculated direct costs (based on experience from Ethiopia and southern Sudan) and effectiveness (in terms of reduced over‐treatment) of a free, decentralised treatment programme using artesunate plus amodiaquine (AS + AQ) or artemether‐lumefantrine (ART‐LUM) in a Plasmodium falciparum epidemic. Our main cost‐effectiveness measure was the incremental cost per false positive treatment averted by RDTs.Results  As malaria prevalence increases, the difference in cost between presumptive and RDT‐based treatment rises. The threshold prevalence above which the RDT‐based strategy becomes more expensive is 21% in the AS + AQ scenario and 55% in the ART‐LUM scenario, but these thresholds increase to 58 and 70%, respectively, if the financing body tolerates an incremental cost of 1 € per false positive averted. However, even at a high (90%) prevalence of malaria consistent with an epidemic peak, an RDT‐based strategy would only cost moderately more than the presumptive strategy: +29.9% in the AS + AQ scenario and +19.4% in the ART‐LUM scenario. The treatment comparison is insensitive to the age and pregnancy distribution of febrile cases, but is strongly affected by variation in non‐biomedical costs. If their unit price were halved, RDTs would be more cost‐effective at a malaria prevalence up to 45% in case of AS + AQ treatment and at a prevalence up to 68% in case of ART‐LUM treatment.Conclusion  In most epidemic prevalence scenarios, RDTs would considerably reduce over‐treatment for only a moderate increase in costs over presumptive diagnosis. A substantial decrease in RDT unit price would greatly increase their cost‐effectiveness, and should thus be advocated. A tolerated incremental cost of 1 € is probably justified given overall public health and financial benefits. The RDTs should be considered for malaria epidemics if logistics and human resources allow.
Trend and causes of neonatal mortality in the Kassena–Nankana district of northern Ghana, 1995–2002
Authors: Baiden F. , Hodgson A. , Adjuik M. , Adongo P. , Ayaga B. , Binka F. 
Published: March 2006

SummaryObjectives  To describe the trend and causes of neonatal deaths in a rural district in northern Ghana.Methods  Descriptive analysis of data collected from the Navrongo Demographic Surveillance System and verbal autopsies conducted on all neonatal deaths from 1995–2002.Results  Of 1118 recorded neonatal deaths 1068 (95.5%) could be analysed. Only 13.2% of deaths occurred at the health facility; 62.7% occurred in the early neonatal period, with prematurity (38%) and birth injuries (19%) as leading causes. Infectious causes (66%) were the major contributors to late neonatal deaths. Infanticide accounted for 4.9% of all neonatal deaths. The cause‐specific mortality rate for neonatal tetanus remained under 2.5% throughout the 8‐year period. Overall, the neonatal mortality rate declined at an average of 2.5 per 1000 live births per year: Down by nearly 50% from 40.9 (95%C.I. 34.1–46.8) in 1995 to 20.5 (95%C.I.17.3–22.7) in 2002.Conclusion  The various health interventions undertaken in this district have had the collateral effect of causing decline in neonatal mortality. Neonatal mortality could be further reduced by preventing and treating neonatal infections, having skilled attendance at delivery and the elimination of infanticide. Data from demographic surveillance sites may be useful in monitoring trends in child mortality.
Relationship between expressed HIV/AIDS‐related stigma and HIV‐beliefs/knowledge and behaviour in families of HIV infected children in Kenya
Authors: Hamra Mary , Ross Michael W. , Orrs Mark , D'Agostino Angelo 
Published: March 2006

SummaryObjectives To quantify expressed stigma in clients of the Kangemi program for HIV+ children, and to characterize the association between stigma and other population characteristics.Methods By means of a household survey we created a stigma index and indices for other social and knowledge domains that influence HIV‐related healthcare. We usedχ2, anova, and correlation to identify associations between domains.Results The mean (±SD) expressed stigma on a six points scale (6 = least stigma) was 3.65 ± 1.64. Composite scores on knowledge about AIDS were skewed toward more knowledge; and analysis of individual knowledge items indicates that most respondents reject erroneous traditional beliefs and myths about the causes and transmission routes of AIDS. Respondents who were younger, had never married, and had less education expressed greater stigma. Differences in stigma were associated with poor knowledge about AIDS and negative attitudes toward testing, but not with gender or tribal affiliation. Condom use at last intercourse, unrelated to stigma, was only 40% (n = 218).Conclusions While this population has good knowledge about AIDS and appraises risks realistically, it fails to reduce these risks. Associations between stigma and other domains can inform interventions that improve HIV care and mitigate spread of HIV.
Reaching the Abuja target for intermittent preventive treatment of malaria in pregnancy in African women: a review of progress and operational challenges
Authors: Hill Jenny , Kazembe Peter 
Published: March 2006

SummaryObjective  To review progress with the implementation of intermittent preventive treatment (IPT) for the control of malaria in pregnancy in sub‐Saharan Africa (SSA), in order to identify facilitating factors and operational challenges for scaling up IPT delivery.Methods  Information on the status of IPT policy, programme and coverage indicators was extracted from published sources. Information on country experiences from both published and unpublished literature was supplemented with semi‐structured interviews with malaria programme managers.Results  Whilst countries in SSA have made important progress with IPT implementation, coverage levels remain low. High antenatal clinic (ANC) attendance alone is not sufficient to ensure high IPT coverage. Staff shortages, poor drug supply, poor ANC access and poor health worker practices are some of the operational challenges in delivering IPT.Conclusion  Country experiences show that IPT can be introduced and scaled up relatively quickly and effectively where there is political will, effective integration between malaria and reproductive health programmes, adequate funding and drug supply, high ANC attendance and community receptiveness. There is however urgent need to better document best practices and lessons as a basis for developing simplified guidelines for dissemination to countries embarking on IPT implementation.
Prevalence of malaria parasitemia among clients seeking treatment for fever or malaria at drug stores in rural Tanzania 2004
Authors: Patrick Kachur S. , Schulden Jeffrey , Goodman Catherine A. , Kassala Herry , Elling Berty Farida , Khatib Rashid A. , Causer Louise M. , Mkikima Saidi , Abdulla Salim , Bloland Peter B. 
Published: March 2006

SummaryObjective  To determine the prevalence of malaria parasitemia and other common illnesses among drug store clients in one rural community, with a view to the potential role of specialist drug stores in expanding coverage of effective malaria treatment to households in highly endemic areas.Method  Follow‐back study of 2466 client visits selected from all 10 drug stores operating in the town of Ikwiriri between May 30 and August 31 2004. Of these, 521 (21.2%) were made by or on behalf of persons ill with fever or malaria. Two hundred and ninety three were eligible as residents of the surrounding nine villages and all agreed to participate in the study. Each patient was evaluated by a clinical officer and provided a blood sample for malaria on the day of the shop visit, either at the shop or at home.Results  Only 50 (17.1%) visits by or on behalf of febrile patients resulted in the purchase of an antimalarial drug, while an antipyretic medication was obtained at 226 visits (77.1%). Clinicians diagnosed malaria in 63.8% of patients. Malaria parasites were identified in blood film samples from 24.2% (95% CI: 19.6, 29.5). This is double the parasite prevalence rate of 10.7% (95% CI: 8.6, 13.1) obtained from a household survey of 1004 healthy individuals selected from these villages at the same time. It is not significantly lower than the prevalence observed among 880 clients presenting with fever at health facilities in the district: 29.7% (95% CI: 23.0, 37.3). The prevalence of malaria parasitemia among children younger than 5 years whose families sought fever treatment from drug stores (42.1%; 95% CI: 31.4, 53.5) was equal to that of children presenting with fever at health facilities (42.5%; 95% CI: 25.0, 62.2).Conclusions  Currently, drug store clients do not obtain malaria‐specific treatment in the majority of cases where it might be warranted. Parasitological findings indicate that drug store clients, especially children, are as likely to be infected with malaria as patients seeking care for similar illnesses at health facilities. Drug stores may be attractive partners for policy makers eager to engage the private retail sector in expanding coverage of malaria treatment.
Validité, coût et faisabilité de la mAECT et CTC comme tests de confirmation dans la détection de la Trypanosomiase Humaine Africaine
Authors: Lutumba P. , Robays J. , Miaka C. , Kande V. , Mumba D. , Büscher P. , Dujardin B. , Boelaert M. 
Published: March 2006

ResumeObjectifs  Evaluer la validité, le coût et la faisabilité de deux tests parasitologiques pour la confirmation de la maladie du sommeil; la mini Anion Exchange Centrifugation Technique (mAECT) et la Capillary Tube Centrifugation (CTC).Méthodes Au cours d'une campagne de dépistage de la maladie du sommeil en 2004 nous avons examiné 6502 personnes à Kwamouth en République Démocratique du Congo (RDC). Les personnes testées positives au Card Agglutination Test for Trypanosomiasis sur sang total (CATT) ont reçu une ponction ganglionnaire, un examen de sang frais, une goutte épaisse colorée, un examen de mAECT, un examen de CTC et une titration de CATT. La sensibilité et spécificité des tests de confirmation ont été calculées en utilisant la combinaison de tous les tests parasitologiques comme référence standard. Le coût de chaque méthode a été calculé et leur faisabilité a étéévaluée par des interviews structurées avec les techniciens.Résultats  La sensibilité des méthodes parasitologiques classiques était de 44,8% (IC 95%: 36,8–53,0), pour la CTC 56,5% (IC 95%: 48,3–64,5) pour la mAECT 75,3 % (IC 95%: 67,7–81,9). Le coût par test était de 2,82€ pour la mAECT et 0,76€ pour la CTC. Le temps pour l'obtention du résultat était de 29,78 min pour la mAECT et 18,25 min pour la CTC. Ces deux tests ont été jugés faisables sous les conditions de terrain.Conclusion  L'utilisation individuelle ou en combinaison de la CTC et de la mAECT comme tests de confirmation sur les personnes au CATT sur sang total apporterait une amélioration considérable de la détection des cas de trypanosomiase humaine africaine. Les deux tests se sont avérés faisables dans des conditions opérationnelles lorsque la disponibilité d'un courant de 220 V pouvait être garantie. Vue que le test mAECT est plus sensible mais considérablement plus coûteux, les analyses de coût‐efficacité de la faisabilité devraient guider au choix du meilleur algorithme.
Combining drinking water treatment and hand washing for diarrhoea prevention, a cluster randomised controlled trial
Authors: Luby Stephen P. , Agboatwalla Mubina , Painter John , Altaf Arshad , Billhimer Ward , Keswick Bruce , Hoekstra Robert M. 
Published: March 2006

SummaryObjectives  To evaluate the effectiveness of point of use water treatment with flocculent‐disinfectant on reducing diarrhoea and the additional benefit of promoting hand washing with soap.Methods  The study was conducted in squatter settlements of Karachi, Pakistan, where diarrhoea is a leading cause of childhood death. Interventions were randomly assigned to 47 neighbourhoods. Households in 10 neighbourhoods received diluted bleach and a water vessel; nine neighbourhoods received soap and were encouraged to wash hands; nine neighbourhoods received flocculent‐disinfectant water treatment and a water vessel; 10 neighbourhoods received disinfectant‐disinfectant water treatment and soap and were encouraged to wash hands; and nine neighbourhoods were followed as controls. Field workers visited households at least once a week from April to December 2003 to promote use of the interventions and to collect data on diarrhoea.Results  Study participants in control neighbourhoods had diarrhoea on 5.2% of days. Compared to controls, participants living in intervention neighbourhoods had a lower prevalence of diarrhoea: 55% (95% CI 17%, 80%) lower in bleach and water vessel neighbourhoods, 51% (95% CI 12%, 76%) lower in hand washing promotion with soap neighbourhoods, 64% lower (95% CI 29%, 90%) in disinfectant‐disinfectant neighbourhoods, and 55% (95% CI 18%, 80%) lower in disinfectant‐disinfectant plus hand washing with soap neighbourhoods.Conclusions  With an intense community‐based intervention and supplies provided free of cost, each of the home‐based interventions significantly reduced diarrhoea. There was no benefit by combining hand washing promotion with water treatment.
Bayesian spatial analysis and disease mapping: tools to enhance planning and implementation of a schistosomiasis control programme in Tanzania
Authors: Clements Archie C. A. , Lwambo Nicholas J. S. , Blair Lynsey , Nyandindi Ursuline , Kaatano Godfrey , Kinung'hi Safari , Webster Joanne P. , Fenwick Alan , Brooker Simon 
Published: March 2006

SummaryObjective To predict the spatial distributions ofSchistosoma haematobiumandS. mansoniinfections to assist planning the implementation of mass distribution of praziquantel as part of an on‐going national control programme in Tanzania.Methods Bayesian geostatistical models were developed using parasitological data from 143 schools.Results In theS. haematobiummodels, although land surface temperature and rainfall were significant predictors of prevalence, they became non‐significant when spatial correlation was taken into account. In theS. mansonimodels, distance to water bodies and annual minimum temperature were significant predictors, even when adjusting for spatial correlation. Spatial correlation occurred over greater distances forS. haematobiumthan forS. mansoni. Uncertainties in predictions were examined to identify areas requiring further data collection before programme implementation.Conclusion Bayesian geostatistical analysis is a powerful and statistically robust tool for identifying high prevalence areas in a heterogeneous and imperfectly known environment.
Ultrasound patterns and frequency of focal liver lesions after successful treatment of amoebic liver abscess
Authors: Blessmann Joerg , Khoa Nguyen Dinh , An Le Van , Tannich Egbert 
Published: March 2006

SummaryObjective  To evaluate the frequency and morphology of residual liver lesions in patients successfully treated for amoebic liver abscess.Methods  Retrospective ultrasound‐based study of 240 adult males from an amoebiasis‐endemic area in Vietnam with a documented clinical history of amoebic liver abscess. Subjects were re‐examined by hepatic ultrasound 1–13 years after abscess treatment.Results  In 17 subjects (7.1%) focal hypo‐ or isoechoic areas were identified within the liver with a diameter of 8–48 mm surrounded by a hyperechoic wall. These lesions were associated with positive amoeba serology, were located at the site of the previous abscess and their sonographic appearances corresponded to post‐amoebic liver abscess residues. Residues were found in all groups of patients irrespectively of the time‐span since the abscess was treated. However, lesions older than 7 years showed some degree of calcification. Otherwise, lesions were apparently inactive, as patients had no clinical symptoms or signs of inflammation and follow‐up after one year revealed no changes in size or pattern.Conclusion  The vast majority of amoebic liver abscesses resolve to a sonographically normal parenchymal pattern. However, in a small proportion of cases characteristic residues remain. These residues do not require further treatment or diagnostic intervention and should be considered in the differential diagnosis of space‐occupying liver lesions, in particular in patients from amoebiasis‐endemic areas.
Initial experience with bosentan therapy in patients considered ineligible for heart transplantation because of severe pulmonary hypertension
Authors: Perez‐Villa Felix , Cuppoletti Alfredo , Rossel Victor , Vallejos Isabel , Roig Eulalia 
Published: March 2006

Abstract: Background: Pre‐operative elevated pulmonary vascular resistance (PVR) has been associated with increased right ventricular failure and mortality after heart transplantation. The aim of this study was to assess the efficacy of bosentan, an oral endothelin‐receptor antagonist, to reduce PVR in patients considered ineligible for heart transplantation because of severe pulmonary hypertension.Methods: Seven patients with end‐stage congestive heart failure and considered ineligible for heart transplantation because of severe pulmonary hypertension (PVR>2.5 Wood units after nitroprusside infusion) were included in the study. They received bosentan 62.5 mg b.i.d. for four wk and 125 mg b.i.d. thereafter. Right heart catheterization was repeated after six wk of therapy.Results: After six wk of bosentan therapy, there was a significant decrease in PVR (6.0±2 vs. 3.8±2 Wood units, before vs. after bosentan; p=0.02), in PVR during nitroprusside infusion (3.3±1 vs. 2.1±1 Wood units, before vs. after bosentan; p=0.02) and in diastolic pulmonary artery pressure (33±7 vs. 23±7 mmHg, before vs. after bosentan; p=0.04). No significant adverse events were observed. After bosentan therapy, five patients had PVR≤2.5 Wood units. They were included in the waiting list and all five had a successful heart transplantation, although two of them required bosentan after surgery.Conclusions: In patients considered ineligible for heart transplantation because of high PVR, bosentan therapy significantly reduced PVR. These data suggest that therapy with endothelin‐receptor blockers might be useful to identify a subgroup of patients with high PVR who can benefit from heart transplantation.
The association between length of post‐kidney transplant hospitalization and long‐term graft and recipient survival
Authors: Lin Shih‐jui , Koford James K. , Baird Bradley C. , Habib Arsalan N. , Reznik Ilya , Chelamcharla Madhukar , Shihab Fuad S. , Goldfarb‐Rumyantzev Alexander S. 
Published: March 2006

Abstract: Background:There has been a general trend towards shortened length of post‐kidney transplant hospitalization (LOH). The decision regarding patients's discharge from the hospital theoretically may be based on several factors, including, but not limited to, patient well being, insurance status, family situation and other, mostly socio‐economic factors, as opposed to hard medical evidence. However, the appropriate LOH in kidney transplant recipients is not well studied regarding long‐term outcomes.Methods:This study retrospectively analysed the association between LOH and graft and recipient survival based on United States Renal Data System dataset. In total, 100 762 patients who underwent transplant during 1995–2002 were included. Kaplan–Meier survival analysis and Cox models were applied to the whole patient cohort and on sub‐groups stratified by the presence of delayed graft function, patient comorbidity index and donor type (deceased or living).Results:In recipient survival, both short (<4 d) and long (>5 d) LOH showed a significant adverse effect (p<0.01) on survival times. In the analysis of graft survival, long LOH (≥2 wk) also showed significant adverse effects (p<0.001) on survival times. However, short LOH (<4 d) did not reach statistical significance, although it was still associated with adverse effects on graft survival. These observations were consistent across the whole patient cohort and sub‐groups stratified by the presence of delayed graft function, patient comorbidity index and donor type.Conclusion:Clinical considerations should be used to make the decision regarding appropriate time of post‐kidney transplant recipient discharge. Based on this study, shorter than four d post‐kidney transplant hospitalization may potentially be harmful to long‐term graft and recipient survival.