bluuebunny/crossref_metadata_2025_split huggingface dataset:
Submicroscopic Plasmodium falciparum infections in pregnancy in Ghana
Authors: Mockenhaupt Frank P. , Rong Birgit , Till Holger , Eggelte Teunis A. , Beck Stefanie , Gyasi‐Sarpong Christian , Thompson William N. A. , Bienzle Ulrich 
Published: March 2003

Summary Malarial parasitaemia below the threshold of microscopy but detectable by polymerase chain reaction (PCR) assays is common in endemic regions. This study was conducted to examine prevalence, predictors, and effects of submicroscopic Plasmodium falciparum infections in pregnancy. In a cross‐sectional study among 530 pregnant women in Ghana, plasmodial infections were assessed by microscopy and PCR assays. Concentrations of haemoglobin and C‐reactive protein (CRP) were measured and antimalarial drugs (chloroquine, pyrimethamine) in urine were demonstrated by ELISA dipsticks. By microscopy, 32% of the women were found to harbour malaria parasites. This rate increased to 63% adding the results of the parasite‐specific PCR. P. falciparum was present in all but one infection. With increasing gravidity, infection rates and parasite densities decreased and the proportions of submicroscopic parasitaemia among infected women grew. Correspondingly, anaemia, fever and evidence of inflammation (CRP > 0.6 mg/dl) were more frequent in primigravidae than in multigravidae. Antimalarial drugs were detected in 65% of the women and were associated with a reduced prevalence of P. falciparum infections and a raised proportion of submicroscopic parasitaemia. Both gravidity and antimalarial drug use were independent predictors of submicroscopic P. falciparum infections. These infections caused a slight reduction of Hb levels and considerably increased serum concentrations of CRP. Conventional microscopy underestimates the actual extent of malarial infections in pregnancy in endemic regions. Submicroscopic P. falciparum infections are frequent and may contribute to mild anaemia and inflammation in seemingly aparasitaemic pregnant women.
Maternity care in rural Nepal: a health service analysis
Authors: Jahn Albrecht , Dar Iang Maureen , Shah Usha , Diesfeld H. J. 
Published: March 2003

Summary This study assesses the performance of maternity care and its specific service components (preventive interventions in antenatal care, antenatal screening, referral, obstetric care) in Banke District, Nepal, using a set of structure, process, and output/outcome indicators. Data sources included health service documents in 14 first level health units and two hospitals, covering 1378 pregnancies and 1323 deliveries, structured observations, antenatal exit interviews (n = 136) and interviews with maternity users (n = 146). Coverage of antenatal care (28%) and skilled delivery care (16%) was low. In antenatal care, preventive interventions were only partially implemented (effective iron supplementation in 17% of users). On average one minute was spent on individual counselling per consultation. 41% of pregnancies were identified as high risk and 15% received referral advice, which was followed in only 32%. Hospital deliveries accounted for 9.8% of all deliveries. Hospital‐based maternal mortality was 6.8/1000 births and the stillbirth rate 70/1000. High rates of stillbirth were observed in breech delivery (258/1000 births), caesarean section (143/1000) and twin delivery (133/1000). The risk of stillbirth was higher for rural women (RR 2.3; 95% CI 1.51–3.50) and appeared to be related to low socio‐economic status. Emergency admissions were rare and accounted for 3.4% of hospital deliveries or only 0.4% of all expected deliveries. There was hardly any accumulation of high‐risk pregnancies at hospital. The population‐based rate of caesarean section was 1.1% (urban 2.3%, rural 0.2%). The estimated unmet obstetric need was high (82 cases or 61% of expected live‐threatening maternal conditions did not receive appropriate intervention). The limited effectiveness of maternity care is the result of deficiencies of all service components. We propose a two‐pronged approach by starting quality improvement of maternity care from both ends of maternity services: preventive interventions for all women and hospital‐based obstetric care. Antenatal screening needs to be rationalized by reducing inflated risk catalogues that result in stereotypical and often rejected referral advice.
Hypothetical and actual willingness to pay for insecticide‐treated nets in five Nigerian communities
Authors: Onwujekwe Obinna , Chima Reginald , Shu Elvis , Nwagbo Douglas , Okonkwo Paul 
Published: March 2003

OBJECTIVES To determine the hypothetical and actual willingness of households to pay (WTP) for insecticide‐treated nets (ITNs), and compare these in areas with and without previous exposure to free ITNs. METHODOLOGY The contingent valuation method was used to determine the willingness of the heads of 1908 randomly selected households from five communities in south‐east Nigeria to pay for two sizes of ITNs. Two communities previously had free access to ITNs. Validity was assessed using multiple regression analyses, and by offering ITNs for sale to 200 randomly selected people drawn from the original sample. The data was collected between March and September 1998. FINDINGS Most respondents were willing to pay for ITNs: Mbano (93.26%), Ugwogo (97.69%), Orba (83.24%), Alor‐uno (95.37%), and Ibagwa‐ani (87.34%). In multivariate analyses, WTP was significantly associated with the number of people living in a household, sex of the respondent, average yearly expenditure on gifts and the type of savings scheme (P < 0.05). Some of the residences were also statistically significant in the two models used, and those with prior exposure to free ITNs were negatively related to WTP. Seventy‐six percent of those who were hypothetically willing to pay actually purchased them, and the WTP technique correctly predicted the choices of 80% of the respondents. CONCLUSION There was good evidence that stated WTP could be translated into actual WTP. However, peoples’ perception of affordability of the nets and its link to their WTP needs further exploration. The WTP technique is a potentially valid tool for market research in healthcare, as it was able to predict the direction of actual WTP for the ITNs. The hypothetical WTP amounts could be used as guide to know either the optimal price to charge for the ITNs or the level of subsidy to introduce.
Risk factors for hepatitis C virus infection in male adults in Rawalpindi–Islamabad, Pakistan
Authors: Bari Abdul , Akhtar Saeed , Rahbar Mohammad H. , Luby Stephen P. 
Published: March 2003

OBJECTIVE To identify risk factors associated with HCV infection in Islamabad–Rawalpindi. METHODS Fifty‐seven cases and 180 controls were enrolled from various departments of the nine major hospitals of the Rawalpindi–Islamabad during July–September 1998. Cases were enzyme‐linked immunosorbent assay (ELISA) positive for antibodies to HCV (anti‐HCV), aged 20–70 years, and residents of Islamabad or Rawalpindi division. Controls were anti‐HCV ELISA negatives of the same age range and from the same area. A structured questionnaire was used to collect data on demographic variables and potential risk factors, which was analysed by logistic regression to calculate crude and adjusted odds ratios (OR) and corresponding 95% confidence intervals (CI) for risk factors. RESULTS The final multivariate logistic regression model revealed that after adjusting for age, cases were more likely to have received therapeutic injections in the past 10 years (1–10 vs. 0 therapeutic injections; adjusted OR=2.8, 95% CI: 1.1–7.1; > 10 vs. 0 therapeutic injections; adjusted OR=3.1, 95% CI: 1.2–7.9) and were significantly more likely to have daily face (adjusted OR=5.1, 95% CI: 1.5–17.0) and armpit shaves (adjusted OR=2.9, 95% CI: 1.3–6.5) by a barber. CONCLUSION HCV control and prevention programs in this region should include safe injection practices and educate men about the risk of HCV infection from contaminated instruments used by barbers.
Reasons for poor cataract surgery uptake – a qualitative study in rural South Africa
Authors: Rotchford A. P. , Rotchford K. M. , Mthethwa L. P. , Johnson G. J. 
Published: March 2003

OBJECTIVES To understand the reasons for poor cataract surgery uptake in people with blindness or severe visual impairment in rural South Africa. METHODS A qualitative analysis of detailed, domiciliary interviews with a community‐based random sample of elderly Zulus who were blind or severely visually impaired as a result of operable cataract, who had previously been invited for surgery but had failed to attend. RESULTS Fear of surgery and a fatalistic attitude to the inevitability and irreversibility of blindness in old age were the main reasons for failure to attend for surgery. There was a lower level of disability and perceived need than had been assumed for people with such poor visual acuity. Non‐surgical western style health care for systemic illness was common but few patients had sought any form of assistance for their poor vision. Issues of cost and accessibility were relatively unimportant. CONCLUSION Provision of affordable and accessible cataract surgery for the blind and severely visually impaired members of a community does not guarantee that it will be taken up. Other barriers to surgery may be revealed when practical issues such as cost and accessibility are addressed. Perceptions of visual disability among subjects with cataract may differ from simple objective clinical standards.
Seroprevalence of varicella zoster and rubella antibodies among rural populations of the Chaco region, south‐eastern Bolivia
Authors: Bartoloni Alessandro , Bartalesi Filippo , Roselli Mimmo , Mantella Antonia , Dini Francesca , Carballo Esteban Salazar , Barron Virgilio Prieto , Paradisi Franco 
Published: March 2003

OBJECTIVE  To determine the seroprevalence of antibodies against varicella zoster virus (VZV) and rubella virus among the population of two rural areas, Camiri and Villa Montes, Chaco region, south‐eastern Bolivia. METHODS  In a cross‐sectional study, serum samples from randomly selected subjects were screened for VZV‐ and rubella antibodies using enzyme‐linked immunosorbent assay (ELISA). RESULTS  The prevalence of VZV antibodies was 80% (391 of 489). No significant differences were observed between genders and study areas. The prevalence increased with age with a seropositivity rate of 21.2% in the 1–4‐year‐old children, 56.9% in the 5–9 age group and 83.7% in the 10–14 age group, and reached 98.2% in over 45‐year olds. The prevalence of rubella virus antibodies was 76.9% (377 of 490), without significant differences between genders and study areas. Similar to the trend observed for VZV antibodies, the seroprevalence increased with age with a seropositivity rate of 18.1% in the 1–4‐year‐old children, 53.9% in the 5–9 age group and 78.4% in the 10–14 age group, and reached 94.7% in over 45‐year‐old subjects. Among the 95 women of childbearing age (15–44 years) the susceptibility rate was 11.6%. CONCLUSIONS  A common seroimmunological profile was evidenced for the two infections. The age‐specific profile of VZV seropositivity differs from that reported for other tropical countries where higher median age of seroconversion and lower seroprevalence among adults are observed. Data concerning the prevalence of immunity to rubella may be useful to evaluate the impact of the recently introduced rubella immunization programme.
Appropriate treatment of malaria? Use of antimalarial drugs for children's fevers in district medical units, drug shops and homes in eastern Uganda
Authors: Nshakira N. , Kristensen M. , Ssali F. , Reynolds Whyte S. 
Published: March 2003

OBJECTIVE To evaluate the quality of pharmaceutical care of malaria for children in eastern Uganda prescribed at government health units and drug shops, and administered by caretakers at home; and to assess its appropriateness in relation to national treatment guidelines, which recommend chloroquine over 3 days. METHODS We followed 463 children under 5 years whose caretakers attended two drug shops and two government health units to seek treatment for fever. The children were examined and the caretakers interviewed on the day of enrolment in the study (day 0), and in their homes on days 3 and 7. Data was collected on drug use prior to attending the shop or health unit, the treatment provided at these study sites, and the administration of drugs at home over the following 3 days. RESULTS Before attending the study sites, 72% of children had already been given some biomedical drugs, and 40% had received the recommended drug, chloroquine. Health workers prescribed chloroquine for 94% of the children, but only 34% of the recommended doses followed guidelines. Two‐thirds of the children were prescribed an injection of chloroquine. By day 3, according to caretaker reports, about 38% of the children had received chloroquine in compliance with the instructions given by the health workers and drug shop attendants. Only 28% of the children had received chloroquine at the optimal dose of 20–30 mg/kg recommended by national policy. CONCLUSION The methods were useful for examining adherence of both caretakers and health care providers to national guidelines and the extent to which caretakers were compliant with providers' prescriptions. Chloroquine and antipyretics were the drugs of choice for fever in these areas of rural eastern Uganda. But children did not receive the recommended dosage of chloroquine because of lack of compliance on the parts of providers as well as users of health care.
Comparison of three antigen detection methods for diagnosis and therapeutic monitoring of malaria: a field study from southern Vietnam
Authors: Huong Nguyen Mai , Davis Timothy M. E. , Hewitt Sean , Van Huong Nguyen , Uyen Tran Thi , Nhan Doan Hanh , Cong Le Dinh 
Published: March 2003

OBJECTIVES To compare the sensitivity, specificity and post‐treatment persistence of three commonly used rapid antigen detection methods. METHOD We studied 252 Vietnamese patients aged from 4 to 60 years, 157 with falciparum and 95 with vivax malaria and 160 healthy volunteers. An initial blood sample was taken for microscopy, and OptiMAL®, immunochromatographic test (ICT) malaria P.f./P.v.® and Paracheck‐Pf® tests. Patients with falciparum malaria were treated with an artesunate‐based combination regimen and those with vivax malaria received chloroquine. Eighty‐seven patients with falciparum malaria who were initially positive for one of the antigen tests and who remained blood smear‐negative underwent follow‐up testing over 28 days. RESULTS Paracheck‐Pf® was the most sensitive test for Plasmodium falciparum (95.8% vs. 82.6% for ICT malaria P.f./P.v.® and 49.7% for OptiMAL®). Specificities were all 100%. For vivax malaria, OptiMAL® performed better than ICT malaria P.f./P.v.® (sensitivities 73.7% and 20.0%, respectively), with 100% specificity in both cases. All tests had low sensitivities (≤ 75.0%) at parasitaemias < 1000/μl regardless of malaria species. During follow‐up, Paracheck‐Pf® remained positive in the greatest proportion of patients, especially at higher parasitaemias (> 10 000/μl). Residual OptiMAL® positivity occurred only in a relatively small proportion of patients (< 10%) with parasitaemias > 10 000/μl during the first 2 weeks after treatment. CONCLUSIONS Although microscopy remains the gold standard for malaria diagnosis, Paracheck‐Pf® may prove a useful adjunctive test in uncomplicated falciparum malaria in southern Vietnam. OptiMAL® had the lowest sensitivity for P. falciparum but it might have a use in the diagnosis of vivax malaria and perhaps to monitor efficacy of treatment for falciparum malaria where microscopy is unavailable.
Barriers to prompt and effective treatment of malaria in northern Sri Lanka
Authors: Reilley B. , Abeyasinghe R. , Pakianathar M. Vincent 
Published: March 2003

Summary BACKGROUND  For the past 18 years, northern Sri Lanka has been affected by armed ethnic conflict. This has had a heavy impact on displacement of civilians, health delivery services, number of health professionals in the area and infrastructure. The north of Sri Lanka has a severe malaria burden, with less than 5% of the national population suffering 34% of reported cases. Health care providers investigated treatment‐seeking behaviour and levels of treatment failure believed to be the result of lack of adherence to treatment. METHODS  Pre‐ and post‐treatment interviews with patients seeking treatment in the outpatient department (OPD) and focus groups. RESULTS  A total of 271 persons completed interviews: 54.4% sought treatment within 2 days of the onset of symptoms, and 91.9% self‐treated with drugs with prior to seeking treatment, mainly with paracetamol. Self‐treatment was associated with delaying treatment (RR 3.55, CI 1.23–10.24, P=0.002). In post‐treatment interviews, self‐reported default was 26.1%. The main reasons for not taking the entire regimen were side‐effects (57.6%) and disappearance of symptoms (16.7%). Focus groups indicated some lack of confidence in chloroquine treatment and prophylaxis, and scant enthusiasm for prevention methods. CONCLUSIONS  A number of factors contribute to a lack of access and a lower quality of care for malaria: lack of medical staff and facilities because of the fighting; lack of confidence in treatment, and perception of malaria as a routine illness. Prevention efforts need to take into account certain beliefs and practices to be successful.
Dynamics of dengue virus circulation: a silent epidemic in a complex urban area
Authors: Teixeira Maria da Glória , Barreto Maurício L. , Costa Maria da Conceição N. , Ferreira Leila Denize A. , Vasconcelos Pedro F. C. , Cairncross Sandy 
Published: March 2003

SummarySerotypes of dengue DEN‐1 and DEN‐2 have been reported in much of Brazil over the last 15 years, and DEN‐3 serotype was only recently detected. This prospective study was conducted in Salvador, a large city in north‐east Brazil, where two epidemics were previously recorded (DEN‐1 and DEN‐2). We obtained the seroprevalence and 1‐year incidence of dengue infections in the population of 30 sampling areas of Salvador and analysed the relationship between intensity of viral circulation, standard of living and vector density. High seroprevalence (68.7%) and annual incidence (70.6%) of infection for one or both circulating serotypes (DEN‐1 and DEN‐2) were found. High rates of transmission were observed in all studied areas, from the highest to the lowest socio‐economic status. The mean PI (Premise Index) for Aedes aegypti was 7.4% (range 0.27–25.6%). Even in the areas with the lowest PI (≤3%) the observed seroincidence was 54.6%. These findings highlighted the existence of a silent epidemic during a period perceived by the Health Services as of low endemicity, indicating the strength and speed of dengue transmission in the city of Salvador.
Effect of community‐wide use of insecticide‐treated nets for 3–4 years on malarial morbidity in Tanzania
Authors: Maxwell C. A. , Msuya E. , Sudi M. , Njunwa K. J. , Carneiro I. A. , Curtis C. F. 
Published: March 2003

SummaryObjectives  To investigate (1) benefits due to personal protection of individual net users vs. mass killing of mosquitoes within villages as a result of widespread net usage; (2) sustainability over several years of benefits against malarial morbidity of insecticide‐treated nets; (3) distribution of the benefits in different age groups of children and (4) whether, as a result of fading immunity, older age groups ‘paid for’ the benefits which they had enjoyed when younger.Methods  (1) Tabulation of earlier data to compare personal and community‐wide effects against mosquito vectors; (2) two cross‐sectional surveys for malaria parasitaemia, malarial fever, anaemia and splenomegaly in children in eight Tanzanian villages, in which there had been community‐wide use of bednets which had been annually re‐treated with alphacypermethrin for 3–4 years; (3) comparison between children of different age groups and with intact, torn or no nets in these villages and in 4–6 villages without nets.Results  A 90–95% reduction in infective bites outside nets in netted villages and an additional 54–82% reduction of bites among individual net users. Highly significant reductions (by 55–75%) in malarial morbidity for children aged 6 months to 2 years were found in netted villages with, for some outcomes, better results among individuals who themselves had intact treated nets. For older children, benefits were less clear or absent, but there was no sign that the benefits early in life were ‘paid for’ by worse outcomes in the netted villages later in childhood.Conclusions  The overall benefits to the community of widespread use of treated nets are sustainable and are not reversed in 3–4 years as a result of fading immunity. It is important to ensure high enough coverage to realize the full potential of the treated net method. By showing an impact on the vector population in the community these results provide a strong argument for organized free provision of net treatment, rather than relying on marketing.
Profile of eye lesions and vision loss: a cross‐sectional study in Lusambo, a forest–savanna area hyperendemic for onchocerciasis in the Democratic Republic of Congo
Authors: Kayembe D. L. , Kasonga D. L. , Kayembe P. K. , Mwanza J.‐C. K. , Boussinesq M. 
Published: March 2003

Summaryobjective  To determine baseline data regarding eye lesions and vision loss in five villages of Lusambo, an onchocerciasis‐hyperendemic forest–savanna area in the Democratic Republic of Congo (DRC), in preparation of mass ivermectin distribution.methods  Five villages were selected by simple randomization. Through a cross‐sectional design, 750 subjects were examined ophthalmologically. The eye examination included acuity visual measurement, slit‐lamp examination, ophthalmoscopy, intraocular pressure measurement, and visual field assessment by the Wu–Jones test.results  There was a high prevalence of onchocerciasis‐related eye lesions compared with non‐onchocercal lesions. Chorioretinitis (20%) was the most frequent disease, others were punctate keratitis and microfilariae in the anterior chamber in equal frequency (13.8%), white intraretinal deposits (10.4%) and iridocyclitis (8%). Vision loss was discovered in 8.5% of the subjects, of whom 0.5% had bilateral blindness, 2.2% had monocular blindness and 5.7% had visual impairment. Vision loss was mostly caused by onchocerciasis‐related diseases, especially those affecting the anterior segment of the eye.conclusion  Features of ocular onchocerciasis usually described in forest and savanna areas were both found in this forest–savanna zone of the DRC.