bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quick detection of Leishmania in peripheral blood by flow cytometry. Is prestorage leucodepletion necessary for leishmaniasis prevention in endemic areas?
Authors: Kyriakou D. S. , Alexandrakis M. G. , Passam F. H. , Kourelis T. V. , Foundouli P. , Matalliotakis E. , Maniatis A. N. 
Published: December 2004

summary. Leishmaniasis is a serious health problem in various endemic areas. There are reports that the parasite can be transmitted via blood transfusions. We studied the clinical utility of flow cytometry for the screening of blood donors in an endemic area in Greece.Samples from 2000 blood donors from the area of Lasithi, Crete, Greece were examined by flow cytometry after labelling with a polyclonal antileishmania antibody conjugated with fluorescein‐isothiocyanate derived from infected canines in the area. The same blood samples were simultaneously examined for serum antileishmania antibodies, May–Grünwald staining of peripheral blood smears and polymerase chain reaction (PCR) in buffy coat to the minicircle of kinetoplastic DNA. Direct sequencing of the PCR‐amplified area helped discriminate leishmania species.Flow cytometry detected 33 cases with parasites in the peripheral blood leucocytes (1·65%), which were confirmed by PCR. One PCR‐positive case was negative by flow cytometry. After prestorage leucodepletion, no sample was positive by PCR. Antileishmania antibodies were positive in 304 (15%) cases.Flow cytometry was found to be a sensitive and rapid method of detecting leishmania in peripheral blood samples. Leucodepletion effectively reduces the detection of the parasite, thus minimizing the potential risk of leishmania transmission through blood transfusions in endemic areas.
Retrospective follow‐up of maternal deaths and their associated risk factors in a rural district of Tanzania
Authors: MacLeod Jana , Rhode Richard 
Published: December 2004

Summary objective  To determine the maternal mortality rate in a rural district of Tanzania and to measure the incidence of causes of maternal mortality, the presence of risk factors and the relationship with social and demographic factors. method  From January to December 1993 a retrospective recording of maternal deaths was completed using verbal autopsy and networking. results  A total of 76 deaths were found which is equivalent to a maternal mortality ratio of 961 per 100,000 live births for this 12‐month period of time. The leading causes of death were postpartum haemorrhage with retained placenta, anaemia, postpartum haemorrhage without retained placenta, AIDS complex and obstructed labour (in descending order of frequency). Maternal deaths were seen irrespective of group factors such as access to a main road, presence of antenatal risk factors and contact with health care personnel or a nearby facility before death. Mortality was also present both in home and hospital deliveries (excluding hospital referrals). Antenatal care had been received by 97.2% of the mothers who died after the second trimester. The referral rate even in the presence of a known antenatal risk factor was 34.6%. Patient compliance to the referral was only 44.4%. Mothers and their families followed strong cultural beliefs even when they were detrimental to the mother's health. Maternal deaths were proportionately higher among women >40 who were also gravid 5, but there was no significant increase in deaths in women < 19 years of age. conclusion Effective antenatal care, appropriate emergency treatment of complications, access to transportation and competent referral level care with adequate equipment encompass the most effective answers to reduction of maternal deaths at a district level.
Hospital costs of high‐burden diseases: malaria and pulmonary tuberculosis in a high HIV prevalence context in Zimbabwe
Authors: Hongoro Charles , McPake Barbara 
Published: December 2004

SummaryThis paper explores the measurement of hospital costs and efficiency in a context where data is scarce, incomplete or of poor quality. It argues that there is scope for using tracers to examine and compare hospital cost structures and relative efficiency in such contexts. Two high‐burden diseases, malaria and pulmonary tuberculosis, are used as tracers to calculate the average costs of inpatient care at selected tertiary hospitals. This study shows that it is feasible to prospectively collect cost data for specific diseases and explore in detail both patient cost distribution and susceptible areas for efficiency improvement. The present study found that the critical source of efficiency variation in public hospitals in Zimbabwe lies in the way hospital beds are used.
Overview of injection practices in two governorates in Egypt
Authors: Talaat Maha , El‐Oun Said , Kandeel Amr , Abu‐Rabei Wafa , Bodenschatz Caroline , Lohiniva Anna‐Lena , Hallaj Zoheir , Mahoney Frank J. 
Published: December 2004

Summaryobjective To describe the extent and characteristics of injection use and injection providers in Egypt, given that unsafe injections are associated with blood‐borne pathogen transmission.methods Household surveys of a population‐based sample of residents in the Nile Delta and in Upper Egypt; focus group discussions and in‐depth interviews with community target groups, formal and informal medical providers.results Of 4197 persons interviewed, 26.2% reported receiving an injection in the past 3 months. Of these, 77% reported it was for therapeutic indications. The age‐sex specific prevalence of injections was highest among children 0–2 years of age and among older adults. Women were more likely to report having an injection than men, particularly at the age above 20 years. Overall, respondents reported receiving on average 4.2 injections per year, indicating that up to 281 million injections are provided per year in Egypt. Injection administrators were public and private sector physicians, pharmacists, barbers, doctor assistants, housekeepers, relatives and friends. Injection prescribers were mostly private and public sector physicians. Of the 1101 respondents who received an injection in the past 3 months, 92 (8.4%) reported that the provider did not use a syringe taken from a closed sealed packet.conclusion The frequency of therapeutic injection use is high in Egypt and may contribute to blood‐borne pathogen transmission. The Ministry of Health and Population (MOHP) is developing interventions targeted towards promotion of injection safety and reduction of injection overuse on community basis as part of a comprehensive strategy to prevent blood‐borne pathogen transmission in Egypt.
Evidence‐based treatment guidelines for sexually transmitted infections developed with and for female sex workers
Authors: Behets Frieda M. T. F. , Rasolofomanana Justin Ranjalahy , Van Damme Kathleen , Vaovola Georgine , Andriamiadana Jocelyne , Ranaivo Adeline , McClamroch Kristi , Dallabetta Gina , van Dam Johannes , Rasamilalao Désiré , Rasamindra Andry ,   the Mad‐STI Working Group
Published: December 2004

Summarybackground  Sex work is frequently one of the few options women in low‐income countries have to generate income for themselves and their families. Treating and preventing sexually transmitted infections (STIs) among sex workers (SWs) is critical to protect the health of the women and their communities; it is also a cost‐effective way to slow the spread of HIV. Outside occasional research settings however, SWs in low‐income countries rarely have access to effective STI diagnosis.objectives  To develop adequate, affordable, and acceptable STI control strategies for SWs.methods  In collaboration with SWs we evaluated STIs and associated demographic, behavioural, and clinical characteristics in SWs living in two cities in Madagascar. Two months post‐treatment and counselling, incident STIs and associated factors were determined. Evidence‐based STI management guidelines were developed with SW representatives.results  At baseline, two of 986 SWs were HIV(+); 77.5% of the SWs in Antananarivo and 73.5% in Tamatave had at least one curable STI. Two months post‐treatment, 64.9% of 458 SWs in Antananarivo and 57.4% of 481 women in Tamatave had at least one STI. The selected guidelines include speculum exams; syphilis treatment based on serologic screening; presumptive treatment for gonorrhoea, chlamydia, and trichomoniasis during initial visits, and individual risk‐based treatment during 3‐monthly follow‐up visits. SWs were enthusiastic, productive partners.conclusions  A major HIV epidemic can still be averted in Madagascar but effective STI control is needed nationwide. SWs and health professionals valued the participatory research and decision‐making process. Similar approaches should be pursued in other resource‐poor settings where sex work and STIs are common and appropriate STI diagnostics lacking.
Clinical presentation of subacute sclerosing panencephalitis in Papua New Guinea
Authors: Mgone Charles S. , Mgone Joyce M. , Takasu Toshiaki , Miki Kenji , Kawanishi Ryuta , Asuo Peter G. , Kono Jacinta , Komase Katsuhiro , Alpers Michael P. 
Published: December 2004

SummaryEighty‐three children presented at Goroka Base Hospital in the Eastern Highlands Province (EHP) of Papua New Guinea over a period of 3 years and 9 months between February 1997 and November 2000 were confirmed to have subacute sclerosing panencephalitis (SSPE). Confirmation of the diagnosis was based on the demonstration of high titres of measles antibodies in the cerebrospinal fluid and/or serum in association with clinical features supportive of SSPE, including characteristic electroencephalographic changes and amplification of measles virus genome by reverse transcriptase polymerase chain reaction in some cases. The mean cerebrospinal fluid and serum enzyme immunoassay antibody levels among the SSPE patients were 38 250 and 860 580, respectively. The mean age of onset of SSPE was 7.9 ± 2.6 years and ranged between 2 and 14 years. The overall male to female ratio was 1.2:1 and 1.4:1 for EHP.
Ecological and molecular studies on emerging schistosomiasis mansoni in Dhofar Governorate, Sultanate of Oman
Authors: Moné Hélène , Mouahid Gabriel , Shaban Mahmoud A. , Al Jabri Ali A. , Boissier Jérôme , Ruppel Andreas , Idris Mohamed A. 
Published: December 2004

SummaryThe recent detection of some cases of autochtonous schistosomiasis mansoni in Dhofar, Oman, prompted a search for the transmission sites. The five field surveys we conducted from November 2000 to February 2002 provided ecological data on schistosomiasis in Dhofar. Twenty‐eight water bodies situated within 8–160 km from Salalah, the largest city of Dhofar and at altitudes of up to 900 m, were surveyed for freshwater snails. Biomphalaria arabica was found in 15 of them. Three sites (Tibraq, Siginitti and Arazat) had Schistosoma infected snails, the first snails shedding cercariae of this parasite ever collected in Oman. The parasite from Dhofar was analysed by Random Amplified Polymorphic DNA comparisons using 11 primers and 167 polymorphic fragments and had 87–88% similarity with Schistosoma mansoni from Guadeloupe, but only 37–38% similarity with S. rodhaini from Burundi. Thus, it is a strain of S. mansoni. During the November 2000 survey, the prosobranch snail Melanoides tuberculata was associated with B. arabica in 10 of the 13 B. arabica sites. Cercariae from other species of Digenea emerged from five of the B. arabica sites, including the three named above. This paper presents the first finding of S. mansoni in the Dhofar Governorate and represents an initial study of the biology of S. mansoni transmission. This parasite and its cycle need further biological and molecular characterization, and the clarification of its epidemiological status in Dhofar Governorate is an urgent task.
Prospective evaluation and comparison of the direct agglutination test and an rK39‐antigen‐based dipstick test for the diagnosis of suspected kala‐azar in Nepal
Authors: Chappuis F. , Rijal S. , Singh R. , Acharya P. , Karki B. M. S. , Das M. L. , Bovier P. A. , Desjeux P. , Le Ray D. , Koirala S. , Loutan L. 
Published: December 2004

SummaryThe diagnosis of visceral leishmaniasis (kala‐azar) remains difficult in rural endemic areas and practical and reliable tests are badly needed. Two serological tests, the Direct Agglutination Test (DAT) and an rK39‐antigen‐based dipstick test, were compared to parasitological diagnosis in a group of 184 patients presenting at a tertiary care centre in south‐eastern Nepal with a history of fever ≥14 days and splenomegaly; 139 patients had a parasitologically proven kala‐azar and 45 patients had a negative parasitological work‐up. The rK39 dipstick showed a sensitivity of 97% and a specificity of 71%. The DAT was up to 99% sensitive with a low cut‐off titre (1:400) but its specificity did not exceed 82% even with a high cut‐off titre (1:51 200). Both tests could be used for screening suspect patients in endemic areas. However, their use as confirmatory tests should be restricted to situations where the proportion of kala‐azar among clinical suspect patients is high. The rK39 dipstick is cheaper and easier to use than the DAT and could be used widely provided that both its performance and production remain stable.
Malaria in Mauritania: the first cases of malaria endemic to Nouakchott
Authors: Cortes H. , Morillas‐Márquez F. , Valero A. 
Published: December 2004

SummaryThe current situation of endemic malaria in Mauritania is not clear since, in most health centres, suspected malaria cases are not confirmed by parasitological analysis and diagnosis is based on clinical symptoms alone. To obtain reliable data about malaria in this country, thin and thick blood smears were taken from patients with symptoms compatible with the illness, who attended two hospitals: Polyclinic of Nouakchott, which serves one‐third of the country's population, where a malaria infection rate of 18.5% (77 of 446) was recorded; Plasmodium falciparum caused 61.85% of these, P. vivax 35.5% (28/77). In Kaedi Regional Hospital, provincial capital of the endemic Gorgol region, a prevalence of 25.49% (106 of 416) was recorded, with P. falciparum as the sole pathogenic species. Of the 77 cases of malaria diagnosed in Nouakchott, nine (seven of P. falciparum and two of P. vivax) were considered as endemic to the city. These cases were all children under 8 years of age except for one adult who had never left the capital, and this is the first time that cases endemic to this city have been detected.
Malaria morbidity, treatment‐seeking behaviour, and mortality in a cohort of young children in rural Burkina Faso
Authors: Müller Olaf , Traoré Corneille , Becher Heiko , Kouyaté Bocar 
Published: December 2004

SummaryObjective To describe the pattern of fever‐associated morbidity, treatment‐seeking behaviour for fever episodes, and cause‐specific mortality in young children of a malaria‐holoendemic area in rural Burkina Faso.Methods In a longitudinal community‐based intervention study, 709 representative children aged 6–31 months were followed daily over 6 months (including the main malaria transmission period) through village‐based field staff.results Of 1848 disease episodes, 1640 (89%) were fever episodes, and of those, 894 (55%) were attributed to malaria (fever + ≥5000 parasites/μl). Eighty‐five percent of fever episodes were treated, mainly with chloroquine and paracetamol, 69% of treatments took place in households, 16% in local health centres, 13% in villages, and 1% in hospitals. Treatment‐seeking in a health centre or hospital was associated with accessibility and disease severity. Cerebral malaria and malnutrition‐associated diarrhoea were the most frequently diagnosed causes of death. While most children with a post‐mortem diagnosis of diarrhoea had not received any treatment, children who died of malaria had often received insufficient treatment. In particular, there was a lack of an appropriate second‐line treatment at formal health services after chloroquine treatment had failed to resolve symptoms.conclusions These findings call for more effective prevention and treatment of malaria, malnutrition and diarrhoea in rural African communities, as well as for better supervision of existing malaria treatment guidelines in formal health services.
Significance of Cryptosporidium as an aetiology of acute infectious diarrhoea in elderly Indians
Authors: Gambhir I. S. , Jaiswal J. P. , Nath G. 
Published: December 2004

Summaryobjective  To explore the significance of Cryptosporidium isolation in elderly Indian with acute infectious diarrhoea and its clinical correlates.design  A hospital‐based clinico‐aetiological study of 120 patients aged 60 years or older, 25 adults younger than 60 years and 25 children up to age 14 with acute diarrhoea, and 57 apparently healthy elderly individuals.results  Cryptosporidium was isolated in 22 older patients with diarrhoea (18.3%) and was highly significant (P < 0.01) compared with healthy age‐matched controls. Of these patients 66% had a history of close contact with animals. Most (68%) Cryptosporidium infections occurred during the rainy season. Among the elderly patients 17% suffered from vomiting and abdominal pain, 31% were febrile; none were severely dehydrated. Stools numbered three to nine per day with duration of 5–17 days. Stool leucocytes were <6/hpf and no RBCs were seen. Isolation of Cryptosporidium in older persons was associated with diabetes mellitus (22.7%), tuberculosis (9.0%), malignancy (4.5%) and coronary artery disease (4.5%).conclusion  Cryptosporidium is an important cause of diarrhoea in elderly Indians, especially those with close contact with animals. The infection has a mild clinical course, is self‐limiting and does not cause dysenteric stool. Its effect on nutrition requires further study.
Infertility in Central Africa
Authors: Larsen Ulla 
Published: December 2004

Summaryobjectives To determine the prevalence and risk factors of primary and secondary infertility in the four Central African countries of Cameroon, Chad, Central African Republic and Gabon.methods Primary infertility was approximated by the percentage of women childless after at least 5 years of marriage. The percentage with no birth at least 5 years subsequent to a previous birth was considered to have secondary infertility. Logistic regression and discrete logistic regression models were estimated to determine the risk factors of primary and secondary infertility, respectively. The relatively few women who were defined as infertile and reported using a traditional or modern method of contraception at survey date were considered fertile to reduce bias from falsely classifying effective contraceptive users as infertile.results The prevalence of infertility was highest in Central African Republic and lowest in Chad: primary infertility ranged from 6.9% to 3.1% and secondary infertility for women aged 20–44 years ranged from 26.5% to 18.9%. Women married more than once vs. only once and formerly married women vs. women living with their husbands had higher odds of primary and secondary infertility. Also, younger cohorts had relatively higher risks of primary (born after 1970) and secondary infertility (born after 1960) compared with women born before 1960. In contrast, place of residence, religion, education of wife or husband and socio‐economic status were generally not associated with primary or secondary infertility.conclusions Infertility is still prevalent in Central Africa and new interventions aimed at reducing the incidence and social implications of pathologic infertility are needed.
Attitude of women in western Uganda towards pre‐packed, unit‐dosed malaria treatment for children
Authors: Kilian A. H. D. , Tindyebwa D. , Gülck T. , Byamukama W. , Rubaale T. , Kabagambe G. , Korte R. 
Published: December 2004

SummaryIn the context of a larger study on malaria related knowledge, attitudes, practices and beliefs in western Uganda 813 women aged 15–49 years were shown a sample of a pre‐packed, unit‐dosed malaria treatment for children, its use was explained and attitudes of the women were investigated. Of all women, 90.5% (86% urban, 92% rural) said they would prefer the pre‐packed over the conventional type of treatment and 93.9% of these were willing to pay between 0.17 (rural) and 0.29 (urban) US$ more for this treatment. Two‐thirds (67.8%) thought that they would not have to ask their spouses before making a decision on the kind of treatment and 59.5% said they would rather stock the treatment at home than buy it when a child gets sick. The most mentioned reason for preferring pre‐packs was their safety and cleanliness, while ease of application, dosing and compliance were secondary. We conclude that pre‐packed, unit‐dosed malaria treatment is accepted by the caretakers of children in the area studied and that they readily understand and accept its concept. This indicates a high potential for this approach to improve the home management of malaria fevers and reduce malaria‐related morbidity and mortality if adequate coverage can be achieved and if the intervention is embedded into an appropriate programme of behavioural change communication and provider training.
Malaria and property accumulation in rice production systems in the savannah zone of Côte d'Ivoire
Authors: Audibert M. , Mathonnat J. , Henry M. C. 
Published: December 2004

SummaryIrrigation stabilizes agricultural production and hence improves farmers’ living standards and conditions. The permanent presence of water may, however, increase the burden of water‐related parasitic diseases and counter the economic benefits of irrigation by reducing farmers’ health. The purpose of this study was to assess the impact of malaria on farm household property, beyond the health risk (studied elsewhere). The research question was: by weakening individuals, does malaria reduce productive capacities and income workers, and consequently limit their property accumulation? To test this hypothesis, we use data on property (farming equipment, livestock and durable consumer goods) and Plasmodium falciparum indicators generated by a study carried out in 1998 in the Ivorian savannah zone characterized by inland valley rice cultivation, with a sample of nearly 750 farming households. Property is influenced by many factors related to the size of the family, the area under cultivation and high parasite density infection rate of P. falciparum. A significant negative correlation between high‐density infection rate and the property values confirms that by reducing the living standards of households, malaria is a limiting factor for property accumulation.