bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bednet impregnation for Chagas disease control: a new perspective
Authors: Kroeger A. , OrdoÃ±ez‐Gonzalez J. , Behrend M. , Alvarez G. 
Published: March 2003

background  To determine the efficacy and acceptability of deltamethrin‐impregnated bednets in controlling Chagas disease in South America.methods  In three endemic departments of Colombia, a qualitative study on people's knowledge about Chagas disease, vectors, preventive measures and their willingness for collaboration in control oper‐ ations was undertaken. Additionally, in an entomological study with 100 laboratory‐bred Chagas vectors (Rhodnius prolixus), vectors were released for 5 nights (20 each night) in an experimental room, with the human bait protected for one night by an unimpregnated and for four nights by a deltamethrin‐impregnated bednet (13 mg/m2). Vectors were stained with fluorescent powder for observation, collected after 10 h exposure in the experimental room and observed for a further 72 h.results  The study population did not know anything about Chagas disease, but believed the vector to transmit cutaneous leishmaniasis. Therefore willingness to take part in control operations was high. The experimental hut study showed a vector mortality rate of 95% in a room with impregnated nets and of 10% in a room with unimpregnated nets.conclusion  This study opens a new perspective for Chagas disease control in integrated vector borne disease prevention programmes.
Field trial of a haemoglobin colour scale: an effective tool to detect anaemia in preschool children
Authors: Montresor Antonio , Albonico Marco , Khalfan Nassor , Stoltzfus Rebecca J. , Tielsch James M. , Chwaya Hababu M. , Savioli Lorenzo 
Published: March 2003

Summary The objective of this study was to evaluate the performance of the Haemoglobin Colour Scale, developed by Stott and Lewis, to diagnose anaemia in a primary health care setting where anaemia was prevalent and severe. Three measures of anaemia were compared in 535 preschool children: haemoglobin based on the Haemoglobin Colour Scale, clinical assessment in three sites (conjunctiva, palm and nail bed) and haemoglobin based on a digital haemoglobinometer (HemoCue method) taken as gold standard. A statistically significant correlation (r = 0.80, coefficient = 0.77 and Y intercept = 2.33) was obtained between the results of the Haemoglobin Colour Scale and the HemoCue. In more than 80% of cases, the difference between the colour scale readings and the results of the HemoCue was within 1 g/dl. Of 415 anaemic children (Hb < 11 g/dl by HemoCue), 85.2% were so identified by the Haemoglobin Colour Scale and 19.7% were classified anaemic by clinical pallor. Of 19 severely anaemic children (Hb < 7 g/dl by HemoCue), 73.6% were identified as severely anaemic and 100% were classified as anaemic by the colour scale, 61.1% were classified as anaemic using clinical pallor. We found the Haemoglobin Colour Scale to be a useful tool in identifying anaemic and severely anaemic children. Efficiencies in term of cost, accuracy and time make it an important resource in primary health care settings in developing countries. Further testing with other staff in other settings is recommended to determine the usefulness of large‐scale distribution.
Outcome of meningitis caused by Streptococcus pneumoniae and Haemophilus influenzae type b in children in The Gambia
Authors: Goetghebuer Tessa , West T. Eoin , Wermenbol Vanessa , Cadbury Anna Louise , Milligan Paul , Lloyd‐Evans Nellie , Adegbola Richard A. , Mulholland E. Kim , Greenwood Brian M. , Weber Martin W. 
Published: March 2003

Summary In developing countries, endemic childhood meningitis is a severe disease caused most commonly by Streptococcus pneumoniae or Haemophilus influenzae type b (Hib). Although many studies have shown that fatality rates associated with meningitis caused by these organisms are high in developing countries, little is known about the long‐term outcome of survivors. The purpose of this study was to assess the importance of disabilities following pneumococcal and Hib meningitis in The Gambia. 257 children aged 0–12 years hospitalized between 1990 and 1995 with culture‐proven S. pneumoniae (n = 134) or Hib (n = 123) meningitis were included retrospectively in the study. 48% of children with pneumococcal meningitis and 27% of children with Hib meningitis died whilst in hospital. Of the 160 survivors, 89 (55%) were followed up between September 1996 and October 1997. Of the children with pneumococcal meningitis that were traced, 58% had clinical sequelae; half of them had major disabilities preventing normal adaptation to social life. 38% of survivors of Hib meningitis had clinical sequelae, a quarter of whom had major disabilities. Major handicaps found were hearing loss, mental retardation, motor abnormalities and seizures. These data show that despite treatment with effective antibiotics, pneumococcal and Hib meningitis kill many Gambian children and leave many survivors with severe sequelae. Hib vaccination is now given routinely in The Gambia; an effective pneumococcal vaccine is needed.
Willingness to pay for the retreatment of mosquito nets with insecticide in four communities of south‐eastern Nigeria
Authors: Onwujekwe Obinna , Shu Elvis , Chima Reginald , Onyido Angus , Okonkwo Paul 
Published: March 2003

Summary objectives  To determine the willingness to pay (WTP) for the retreatment of insecticide‐treated nets (ITN) in four malaria holoendemic communities of Nigeria. methods  Contingent valuation method. The study tool was a pretested interviewer‐administered questionnaire. Randomly selected households were the study units and household heads or their representatives were interviewed by locally trained interviewers. results  Most households were willing to pay for annual ITN retreatment in all four communities. The proportion of those willing to pay ranged from 79% to 91%. WTP amounts ranged from $0.05 to $5.26. The median from the aggregated data from the four communities was $0.21. Multivariate analysis showed that many explanatory variables were statistically significantly related to WTP for ITN retreatment. conclusion  WTP for ITN retreatment exists. The difficulty lies in implementing this. One possibility would be a community‐based ITN retreatment programme.
Getting to know HIV
Authors: Weiss Robin A. 
Published: March 2003

Summary Since the Human Immunodeficiency Virus was first isolated in 1983, we have come to know it in exquisite detail. Yet we still do not understand sufficiently how it causes disease. Neither do we know why chimpanzees and some African monkeys, which are the natural reservoir of the precursors of HIV‐1 and HIV‐2, can harbour similar levels of virus without becoming ill. Our knowledge of the replication cycle of HIV as a retrovirus has been pivotal in the development of antiviral drugs. Our knowledge of the cellular tropism and cell surface receptors exploited by the virus help to explain the pattern of immune deficiency, wasting and dementia that make up the clinical dimensions of AIDS. The extraordinary rate of genetic and phenotypic evolution of the virus – both within the infected individual and across the worldwide pandemic – partially explains why no vaccine constructs to date have been successful. HIV comprises just 9 genes but represents one of humanity's most formidable foes.
'Killer' canines: the morbidity and mortality of ebino in northern Uganda
Authors: Iriso Robert , Accorsi Sandro , Akena Stephen , Amone Jackson , Fabiani Massimo , Ferrarese Nicoletta , Lukwiya Matthew , Rosolen Teresa , Declich Silvia 
Published: March 2003

Summary In northern Uganda, unerupted primary canine teeth are commonly extracted because they are believed to cause diarrhoea, vomiting, and fever. This practice, known as ebino, is performed under very crude conditions often using unclean tools. To evaluate the morbidity and mortality of complications related to ebino, we retrospectively analysed discharge records from the paediatric ward of Lacor Hospital, Gulu. In the period 1992–98, ebino‐related complications, mainly sepsis and anaemia, were among the leading causes of admission (n = 740) and hospital death (n = 156, case fatality rate = 21.1%, proportional mortality rate = 3.3%). Discouraging the adoption of deeply rooted traditional practices that are potentially hazardous to health should be a public health priority in northern Uganda. This could be done by educating not only the general public, but also traditional healers and community and religious leaders, who could convey the knowledge to their people.
Extending anthelminthic coverage to non‐enrolled school‐age children using a simple and low‐cost method
Authors: Montresor Antonio , Ramsan Mahdi , Chwaya Hababu M. , Ameir Haji , Foum Ali , Albonico Marco , Gyorkos Theresa W. , Savioli Lorenzo 
Published: March 2003

School health programmes are the basis of the strategy defined by WHO to reduce morbidity due to soil‐transmitted nematodes and schistosomes in school age populations in developing countries. However, low rates of school enrolment can be a major factor limiting their success.In the present study enrolled children were informed by teachers on the date of the next deworming compaign and were invited to pass along this information to parents, siblings and friends of school‐age.On the day of the deworming campaign, teachers were instructed to administer anthelminthics to enrolled and not enrolled school‐age children present at school. In the month following the treatment day, information about coverage was collected by questionnaire in 257 households in two regions of Unguja Island, Zanzibar. Over 89% of school age children resulted treated (98.9% of those enrolled plus 60% of those not enrolled). The additional cost of treating non‐enrolled is limited to the cost of providing additional doses of anthelminthic drug in each school.Non‐enrolled school age children can easily, successfully and inexpensively included in school based deworming campaign. Managers of control programmes are invited to test this method adapting it in their particular and cultural environment.
Malaria in pregnancy: adverse effects on haemoglobin levels and birthweight in primigravidae and multigravidae
Authors: Shulman C. E. , Marshall T. , Dorman E. K. , Bulmer J. N. , Cutts F. , Peshu N. , Marsh K. 
Published: March 2003

BACKGROUND In areas of endemic transmission, malaria in pregnancy is associated with severe maternal anaemia and low birthweight babies. The prevalence of infection is highest in primigravidae (PG), and hence control efforts are usually geared towards this high risk group. Using a sensitive measure of placental infection, we investigated the relationship between active‐acute, active‐chronic and past placental infection with maternal anaemia and low birthweight in women of all gravidities. METHODS Between January 1996 and July 1997, 912 women delivering in Kilifi District Hospital, Kenya, were recruited. Haemoglobin and peripheral malaria slides were taken prior to delivery, placental biopsies and smears were taken at the time of delivery and birthweight and maternal height and weight were measured soon after birth. Information was obtained on socio‐economic and educational status. The association between placental malaria, severe anaemia and low birthweight was investigated for women of different gravidities. FINDINGS By placental histology, the prevalence of active or past malaria in all gravidities was high, ranging from 64% in PG to 30% in gravidities 5 and above. In gravidities 1–4, active malaria infection was associated with severe maternal anaemia, adjusted OR 2.21 (95% CI 1.36, 3.61). There was a significant interaction between chronic or past malaria and severe anaemia in their effects on birthweight, whereby the risk of low birthweight was very high in women with both chronic or past placental malaria and severe anaemia: OR 4.53 (1.19, 17.2) in PG; 13.5 (4.57, 40) in gravidities 2–4. INTERPRETATION In this area of moderate malaria transmission, women of all parities have substantially increased risk of low birthweight and severe anaemia as a result of malaria infection in pregnancy. The risk of low birthweight is likely to be particularly high in areas with a high prevalence of severe anaemia.
Female genital cutting in Kilimanjaro, Tanzania: changing attitudes?
Authors: Msuya Sia E. , Mbizvo Elizabeth , Hussain Akhtar , Sundby Johanne , Sam Noel E. , Stray‐Pedersen Babill 
Published: March 2003

OBJECTIVES To study the prevalence, type, social correlates and attitudes towards female genital cutting (FGC) among urban women in Kilimanjaro, Tanzania; and to examine the association between FGC and gynaecological problems, reproductive tract infections (RTIs) and HIV. METHODS In 1999, 379 women attending reproductive health care clinics were interviewed and underwent pelvic examination. Specimens for RTI/HIV diagnosis were taken. RESULTS Seventeen per cent had undergone FGC, mostly clitoridectomy (97%). Female genital cutting prevalence was significantly lower among educated, Christian and Chagga women. Women aged ≥35 were twice as likely to be cut as those < 25 years. Seventy‐six per cent of those who had undergone FGC intend not to perform the procedure on their daughters. Age < 25 years (P < 0.0001) and low parity (P < 0.01) were predictors of that intention. There was no association between RTIs, HIV or hepatitis B and FGC. CONCLUSION FGC is still fairly common but there is evidence of a change of attitude towards the practice, especially among young women. The opportunity to educate women who attend reproductive health care facilities on FGC should be taken.
Adherence to treatment guidelines in primary health care facilities in Botswana
Authors: Boonstra E. , Lindbaek M. , Khulumani P. , Ngome E. , Fugelli P. 
Published: March 2003

OBJECTIVES To assess the quality of nurses' prescribing through an assessment of their prescription in relation to diagnosis, and to investigate trends in drug use in Botswana primary health care. METHODS Key data regarding nurses' adherence to national prescription and treatment guidelines were obtained through participatory observation using a questionnaire, related to each consultation. Adherence was categorized into (i) Full adherence, (ii) acceptable adherence, (iii) acceptable adherence, but one or more useless, but not dangerous, drugs and (iv) insufficient or dangerous treatment. The study comprises data on nurses' prescriptions, diagnoses and quality of dispensing in 2994 consecutive consultations in 30 primary health care facilities in three districts of Botswana: Ngami East, Gaborone and Kgalagadi North. RESULTS The average number of drugs prescribed per patient was 2.3. Antibiotics were prescribed in 27% of all encounters. Full adherence was found in 44%, acceptable compliance in 20%, `acceptable, but one or more useless, but not dangerous, drugs' in 33% and `insufficient or dangerous treatment' in 3% of the consultations. Four factors were found to be independently associated with full adherence: patient age 16–31 years, specified diagnosis, type of health facility and nurses' years of practice (4–11 years best). CONCLUSION Although Botswana's health workers perform relatively well in terms of drug use indicators, there is a clear potential for improving health workers' adherence to national treatment guidelines.
Insecticide‐treated bednet use, anaemia, and malaria parasitaemia in Blantyre District, Malawi
Authors: Holtz Timothy H. , Marum Lawrence H. , Mkandala Christopher , Chizani Nyson , Roberts Jacquelin M. , Macheso Allan , Parise Monica E. , Kachur S. Patrick 
Published: March 2003

OBJECTIVE To evaluate the use of insecticide‐treated bednets and the effectiveness of social marketing for their distribution. METHODS Systematic cluster sample survey of 1080 households in 36 census enumeration areas across Blantyre district, Malawi, in February 2000. RESULTS A total of 672 households had one or more children under 5. Bednet ownership was low (20.5% of households) overall, and significantly lower in rural areas than urban areas (6.4 vs. 29.8%, P=0.001). Only 3.3% of rural children under 5 had slept under a net the previous night, compared with 24.0% of urban children (P < 0.001). When asked why they did not own a net, nearly all (94.9%) caretakers in households without nets stated they had no money to buy them. In multivariate statistical models that controlled for the influence of house structure, urban vs. rural location, gender of the head of household, and the primary caretaker's education, rural children under 5 in households without nets experienced a statistically significant higher prevalence of malaria parasitaemia [RR (risk ratio) 4.9, 95% CI (confidence interval) 2.3–10.5] than children in households with at least one bednet. This was also true for urban children under 5 (RR 2.1, 95% CI 1.0–4.2, P=0.04). CONCLUSION Social marketing approaches to promoting insecticide‐treated nets in Blantyre District may have produced measurable health benefits for children in those households in which residents bought and used the products. Market‐based approaches may take years to achieve high levels of coverage and may exaggerate inequities between urban and rural populations.
Maîtriser un espace sanitaire cohérent et performant dans les villes d'Afrique subsaharienne: le district de santéà l'épreuve
Authors: Grodos Daniel , Tonglet René 
Published: March 2003

Résumésituation du problème La santé dans les villes est un thème d'actualité en santé publique mais l'organisation des systèmes de santé urbains n'est pas l'objet d'une attention suffisante.objectif  Analyser les problèmes posés par l'organisation des systèmes de santé dans les villes d'Afrique subsaharienne et proposer un outil pour résoudre ces problèmes.méthode  Exposé d'une thèse basée sur une revue de l'expérience internationale en matière d'organisation des services et soins de santé en ville et sur plusieurs études de cas.résultats  Nous défendons l'idée que le modèle du district de santé doit être réexaminé dans la perspective de la maîtrise d'un espace sanitaire cohérent et performant en ville. Nous examinons ensuite les menaces particulières qui pèsent sur le district de santé dans le contexte urbain et nous soutenons la thèse que la prise au sérieux de celles‐ci impose de procéder à certaines adaptations du modèle de district de santé mais n'oblige aucunement à l'abandonner. Nous précisons enfin dans quelle mesure cette option pour un système local de santé intégré fondé sur la notion de district de santé se distingue d'autres options plus actuelles, comme la réforme du secteur de la santé préconisée par la Banque mondiale, les approches sectorielles du financement durable des dépenses de santé, les approches dites émergentes basées sur la promotion de la santé et les stratégies de survie des acteurs dans un contexte défavorable.conclusion  Une plus grande maîtrise de l'espace sanitaire dans les villes d'Afrique subsaharienne peut être acquise en structurant le système de santé sur la base des zones de responsabilité que sont les districts sanitaires, à condition d'utiliser le modèle de district avec un recul critique suffisant et de faire l'effort de préciser les éléments permettant de juger la fonctionnalité du district de santé dans le contexte urbain. La mise en œuvre de cette stratégie nécessite avant tout de prendre des décisions à caractère politique et n'appelle qu'accessoirement des solutions techniques. Il s'agit, entre autres, de légitimer une autorité sanitaire urbaine coordonnant les divers acteurs et disposant des moyens matériels et humains adéquats, de redéfinir le rôle des grands établissements hospitaliers, et de réguler la privatisation du secteur de la santé.
Too poor to pay: charging for insecticide‐treated bednets in highland Kenya
Authors: Guyatt Helen L. , Ochola Sam A. , Snow Robert W. 
Published: March 2003

SummaryWHO has proposed malaria control as a means to alleviate poverty. One of its targets includes a 30‐fold increase in insecticide‐treated nets (ITNs) in the next 5 years. How this service will be financed remains unclear. In July 2000, 390 homesteads in rural highland Kenya were interviewed on their willingness to pay for ITNs. The costs to a household of protecting themselves with ITNs were compared with current household expenditure. Homesteads expressed a willingness to pay for ITNs, but the amounts offered were not sufficient to cover the costs of providing this service without donor support to meet the difference. Furthermore, as most household expenditure was allocated to basic needs these interventions were ‘unaffordable’. The cost of protecting a household with ITNs would be equivalent to sending three children to primary school for a year. The aspiration by poor rural homesteads to protect themselves with ITNs is not compatible with their ability to pay. One option to have an immediate equitable impact on ITN coverage and break the cycle between malaria and poverty is to provide this service free of charge.
Combination of eflornithine and melarsoprol for melarsoprol‐resistant Gambian trypanosomiasis
Authors: Mpia Bokelo , Pépin Jacques 
Published: March 2003

SummaryObjective  To evaluate the efficacy and toxicity of a combination of eflornithine and melarsoprol among relapsing cases of Gambian trypanosomiasis.Methods  Forty‐two late‐stage Trypanosoma brucei gambiense trypanosomiasis patients relapsing after initial treatment with melarsoprol were treated with a sequential combination of intravenous eflornithine (100 mg/kg every 6 h for 4 days) followed by three daily injections of melarsoprol (3.6 mg/kg, up to 180 mg). They were then followed‐up for 24 months.Results  Two (4.8%) patients died during treatment. Of the 40 surviving patients, two had a treatment failure, 13 and 19 months after having received the combination therapy. By Kaplan–Meier analysis, the 2‐year probability of cure was 93.3% (95% confidence interval: 84.3–100%).Conclusion  This sequential combination has an efficacy and a toxicity similar to a 7‐day course of eflornithine monotherapy, but is easier to administer. Whether such therapeutic success corresponds tosynergism between eflornithine and melarsoprol, or merely means that 4 days of eflornithine monotherapy suffices for such patients, will need to be determined in a comparative trial.
Short communication: Point mutations in the dihydrofolate reductase and dihydropteroate synthase genes of Plasmodium falciparum isolates from Colombia
Authors: Schmider Nadja , Peyerl‐Hoffmann Gaby , Restrepo Marcos , Jelinek Tomas 
Published: March 2003

SummaryPoint mutations in the dihydrofolate reductase (DHFR) and dihydropteroate synthase (DHPS) genes of Plasmodium falciparum can lead to an increasing resistance of P. falciparum to pyrimethamine/sulphadoxine. We examined the prevalence of these mutations in 36 samples from Colombia. Analysed by polymerase chain reaction (PCR) for infection with P. falciparum, 25 (69%) tested positive. These positive isolates were tested further for point mutations in the genes of DHFR (codons 16, 51, 59, 108 and 164) and DHPS (codons 436, 437, 540, 581 and 613) by nested PCR and following mutation‐specific restriction enzyme digestion. Gene mutations occurred in both the DHFR and DHPS gene of the Colombian isolates, suggesting that resistance to antifolate drugs exists or may develop soon in Colombia.