bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of clinical pallor in the identification and treatment of children with moderate and severe anaemia
Authors: Muhe Lulu , Oljira Birhane , Degefu Hirut , Jaffar Shabbar , Weber Martin W. 
Published: March 2003

Summary background  Anaemia from malaria is a common problem in developing countries. Blood transfusion in developing countries is available in few hospitals. Children who are severely anaemic and may require urgent blood transfusion usually present to peripheral first‐level health facilities from where they must be referred to hospitals. Since most peripheral facilities do not determine haemoglobin levels, the decision on referral has to be made on clinical grounds. objectives  To evaluate the sensitivity and specificity of clinical pallor of the palms, nailbeds, conjunctivae, buccal mucosa or tongue against haemoglobin values and their reproducibility among health workers. methods  A total of 2540 children 2 months to 5 years of age presenting to a rural health centre in Ethiopia were enrolled. Clinically detected pallor was compared with measured blood haemoglobin concentrations. results  Any anaemia (haemoglobin < 11 g/dl) was found in 61% of the children. Severe anaemia (haemoglobin < 5 g/dl) was found in 4%. The presence of any pallor clinically correlated with moderate anaemia (haemoglobin level < 8 g/dl) could be detected with a sensitivity of 95% and a specificity of 64–68% when the palm and nailbeds were used and a sensitivity of 84% and a specificity of 81% when the conjunctivae were used. Severe anaemia was detected clinically as severe pallor in 50–56% of cases (with a specificity of 95–96%). Agreement between physicians was highest for conjunctivae and nailbed pallor (87%) and lowest for palm pallor (73%). Using multivariate analysis, identification of a systolic ejection murmur or altered sensorium, the presence of splenomegaly or malarial parasitaemia were independently predictive of severe and moderately severe anaemia. conclusions  Moderate and severe anaemia can be identified clinically in most cases for treatment and referral purposes. A systolic ejection murmur, altered sensorium, the presence of splenomegaly or malarial parasitaemia may be used as additional tools in considering urgent referral for blood transfusion.
Tolerability and efficacy of single‐dose diethyl carbamazine (DEC) or ivermectin in the clearance of Wuchereria bancrofti microfilaraemia in Pondicherry, south India
Authors: Subramanyam Reddy G. , Vengatesvarlou N. , Das P. K. , Vanamail P. , Vijayan A. P. , Kala Sasi , Pani S. P. 
Published: March 2003

Summary In a double blind design the tolerability and efficacy of single‐dose DEC (6 mg/kg/body weight) or ivermectin (400 μg/kg/body weight) was studied in 30 asymptomatic W. bancrofti parasite carriers each. Although both drugs were tolerated well, the adverse reaction score (DEC 0.5; ivermectin 1.5) and overall incidence (DEC 65.0%; ivermectin 93.3%) were significantly higher in the ivermectin group. Major adverse reactions were fever, headache and myalgia, all of which peaked on the second day post‐therapy. Efficacy was measured in terms of proportion of cases clearing parasitaemia and reduction in mean parasite density compared to pre‐therapy levels. Although at the end of one year the ivermectin group showed a significantly higher efficacy (34.8%, 97.0%) compared to DEC (8.3%, 83.8%), at the end of the second year there was no significant difference in efficacy between the drugs (73.7%, 99.5% for ivermectin; 47.8%, 98.9% for DEC). The tolerability and efficacy of the two drugs were not significantly different between gender, age and weight classes of patients.
Child malaria treatment practices among mothers in the district of Yanfolila, Sikasso region, Mali
Authors: Aly Théra Mahamadou , D'alessandro Umberto , Ouedraogo Adama , Packou Julienne , Ahmed Deida Souleymane Ould , Fané Moussa , Ade Gabriel , Alvez Fernanda , Doumbo Ogobara 
Published: March 2003

Summary We studied child malaria treatment practices among mothers living in the District of Yanfolila in southern Mali. For sampling, we first chose five of 13 health areas with probability proportional to size. Then villages, compounds and mothers with at least one child aged 1–5 years were randomly chosen. We assessed the spleen size of one 1–5 year‐old child of each mother, collected a thick blood film and recorded the body temperature of every child whose mother thought he/she was sick. 399 mothers in 28 villages were interviewed with a structured questionnaire divided into two parts. If the child had had soumaya (a term previously associated with uncomplicated malaria) during the past rainy season, we asked about signs and symptoms, health‐seeking behaviour (who the mother consulted first) and treatment. If not, information about knowledge of the disease and treatment to be given was collected. 86% of the mothers interviewed stated that their child had been sick and almost half of them had had soumaya. All mothers named at least one sign by which they recognized the disease. Vomiting, fever and dark urine/yellow eyes/jaundice were the three most common signs mentioned. 75.8% managed their child's disease at home and used both traditional and modern treatment. The most common anti‐malarial drug was chloroquine, often given at inappropriate dosage. The sensitivity and specificity of the mothers' diagnosis was poor, although this might be explained by the large percentage of children who had already been treated at the time of the interview. The results of our survey call for prompt educational action for the correct treatment of uncomplicated malaria/soumaya, particularly for mothers and possibly for shopkeepers. The high spleen rate (58.1%) among randomly selected children confirms that malaria is a common disease in this area. Improved case‐management at home could only be beneficial.
New approaches to spatially analyse primary health care usage patterns in rural South Africa
Authors: Tanser Frank , Hosegood Victoria , Benzler Justus , Solarsh Geoffrey 
Published: March 2003

OBJECTIVE To develop indices to quantitatively assess and understand the spatial usage patterns of health facilities in the Hlabisa district of South Africa. METHODOLOGY We mapped and interviewed more than 23 000 homesteads (approximately 200 000 people) in Hlabisa district, South Africa and spatially analysed their modal primary health usage patterns using a geographical information system. We generated contour maps of health service use and quantified the relationship between clinic catchments and distance‐defined catchments using inclusion and exclusion error. We propose the distance usage index (DUI) as an overall spatial measure of clinic usage. This index is the sum of the distances from clinic to all client homesteads divided by the sum of the distances from clinic to all homesteads within its distance‐defined catchment. The index encompasses inclusion, exclusion, and strength of patient attraction for each clinic. RESULTS Eighty‐seven per cent of homesteads use the nearest clinic. Residents of homesteads travel an average Euclidean distance of 4.72 km to attend clinics. There is a significant logarithmic relationship between distance from clinic and their use by homesteads (r2=0.774, P < 0.0001). The DUI values range between 31 and 198% (mean=110%, SD=43.7) for 12 clinics and highlight clinic usage patterns across the district. CONCLUSIONS The DUI is a powerful and informative composite measure of clinic usage. The results of the study have important implications for health care provision in developing countries.
Malaria control by residual insecticide spraying in Chingola and Chililabombwe, Copperbelt Province, Zambia
Authors: Sharp Brian , Van Wyk Pieter , Sikasote Janet B. , Banda Paul , Kleinschmidt Immo 
Published: March 2003

SummaryMalaria is endemic in the whole of Zambia and is the leading cause of morbidity and mortality. Prior to 1980, effective malaria control was achieved in the northern mining towns of Chingola and Chililabombwe by means of annual residual spraying programmes. In the 1970s, incidence rates wereaslow as 20/1000 p.a., but by 2000 had increased to 68/1000 p.a. in Chingola and to 158/1000p.a.in Chililabombwe. Konkola Copper Mines (KCM) initiated a malaria control programme in which all dwellings in the two towns and within a 10‐km radius were sprayed with either dichlorodiphenyltrichloroethane or a synthetic pyrethroid (Icon by ZENECA or Deltamethrin by Aventis). Houses were sprayed in November and December 2000, at the start of the peak transmission period. There was a statistically significant reduction in malaria incidence recorded at KCM health facilities in the two towns, representing a protective incidence rate ratio of 0.65 (95% CI 0.44, 0.97) when comparing the post‐spraying period with the corresponding period of the previous 2 years. This reduction followed a single round of house spraying during a year with higher rainfall than the preceding two and in an area where chloroquine was first‐line treatment. This house‐spraying programme is an example of private/public sector collaboration in malaria control.
Private pharmacies in Hanoi, Vietnam: a randomized trial of a 2‐year multi‐component intervention on knowledge and stated practice regarding ARI, STD and antibiotic/steroid requests
Authors: Chalker J. , Chuc N. T. K. , Falkenberg T. , Tomson G. 
Published: March 2003

SummaryObjectives  To assess the effectiveness of a multi‐component intervention on knowledge and reported practice amongst staff working in private pharmacies in Hanoi regarding four conditions: urethral discharge [sexually transmitted diseases (STD)], acute respiratory infection (ARI), and non‐prescription requests for antibiotics and steroids.Method  Randomized controlled trial with staff working in 22 matched pair intervention and control private pharmacies who were administered a semistructured questionnaire on the four conditions before and 4 months after the interventions. The interventions focused on the four conditions and were in sequence (i) regulations enforcement; (ii) face‐to‐face education and (iii) peer influence. Outcome measures were knowledge and reported change in practice for correct management of tracer conditions.Results  The intervention/control‐pairs (22 after drop‐outs) were analysed pre‐ and post‐intervention using the Wilcoxon signed rank test. STD: More drug sellers stated they would ask about the health of the partner (P = 0.03) and more said they would advise condom use (P = 0.01) and partner notification (P = 0.04). ARI: More drug sellers stated they would ask questions regarding fever (P = 0.01), fewer would give antibiotics (P = 0.02) and more would give traditional medicines (P = 0.03). Antibiotics request: Fewer said they would sell a few capsules of cefalexin without a prescription (P = 0.02). Steroid requests: No statistical difference was seen in the numbers who said they would sell steroids without a prescription as numbers declined in both intervention and control groups (P = 0.12).Conclusion  The three interventions in series over 17 months were effective in changing the knowledge and reported practice of drug sellers in Hanoi.
Is hygiene promotion cost‐effective? A case study in Burkina Faso
Authors: Borghi J. , Guinness L. , Ouedraogo J. , Curtis V. 
Published: March 2003

Summaryobjectives To estimate the incremental cost‐effectiveness of a large‐scale urban hygiene promotion programme in terms of reducing the incidence of childhood diarrhoeal disease in Bobo‐Dioulasso, Burkina Faso.methods Total and incremental costs of the programme were estimated retrospectively from the perspectives of the provider, from the households who change their behaviour as a result of the programme and from society (the sum of the two). The programme effects were derived from an intervention study that estimated the impact on handwashing with soap after handling child stools through a time‐series method of observing 37 319 mothers. Using data from the literature, the associated reductions in childhood morbidity and mortality were estimated. The direct medical savings and indirect savings of caregiver time and lost productivity associated with child death were estimated from interviews with households and health workers. The cost and outcome data were combined to provide an estimate of the cost per mother who starts handwashing with soap as a result of the programme and the cost per case of childhood diarrhoea averted.results The total provider cost (including start‐up and 3‐year running costs) was $302 507. Core programme activities accounted for 31% of the cost, administration 40%. The total cost to the 7286 households associated with changing behaviour during the 3 years of programme implementation was $160 125 ($7.3 per year per household). An estimated 8638 cases of diarrhoea, 864 outpatient consultations, 324 hospital referrals and 105 deaths were averted by the programme during this time. Savings to the provider from reduced treatment costs were estimated at $10 716 and savings to the households from averted treatment cost were $9136, resulting in a total saving to society of $19 852, increasing to $393 967 if indirect savings are included. The incremental provider cost per case of diarrhoea averted was $33.8. The incremental cost to society was $51.3 falling to $7.9 if indirect savings are included. If the programme were to be replicated elsewhere, savings in the international research input and start‐up costs could reduce provider costs to $26.9 per case of diarrhoea averted. The annual cost of the programme represents 0.001% of the national health budget for Burkina Faso. The direct annual cost of implementing the programme at the household level represents 1.3% of annual household income.conclusion Hygiene promotion reduces the occurrence of childhood diarrhoea in Burkina Faso at less than 1% of the Ministry of Health budget and less than 2% of the household budget, and could be widely replicated at lower cost.
The Rakai Project counselling programme experience
Authors: Matovu Joseph K. B. , Kigozi Godfrey , Nalugoda Fred , Wabwire‐Mangen Fred , Gray Ronald H. 
Published: March 2003

SummaryDuring the initial survey (April 1999–January 2000) of an ongoing Community HIV Epidemiological Research (CHER) study, adults aged 15–49 years in 56 study communities were enrolled into the study. Knowledge, Attitude, Behaviour, Practice questionnaires were administered and blood was obtained from 77.6%. HIV testing was performed using two different enzyme immunosorbent assays with Western blot confirmation of discordant results and first time positives. All those who gave blood had free and unlimited access to voluntary counselling and testing (VCT), and were free to participate as individuals or couples. HIV results were provided in people's homes by trained and certified project resident counsellors. Ninety per cent of those who were bled requested their HIV results, while 64.6% of those who requested their HIV results received them. The proportion of people receiving HIV results has almost doubled in the last 6 years (1994–2000) from about 35% in 1994/1995 to 65% in 1999/2000. These data indicate high proportions of acceptance and receipt of VCT in this rural population‐based cohort, suggesting that home delivery of VCT could offer a unique opportunity for people in the rural areas to access counselling and testing services, given adequate resources.
Assessment of functional limitations caused by Mycobacterium ulcerans infection: towards a Buruli Ulcer Functional Limitation Score
Authors: Ellen Debora E. , Stienstra Ymkje , Teelken Margreet A. , Dijkstra Pieter U. , Van Der Graaf Winette T. A. , Van Der Werf Tjip S. 
Published: March 2003

SummaryThe purpose of this study of treated Buruli ulcer patients in Ghana was to identify and assess late sequelae of treated Buruli ulcer using a goniometer, and to develop a scoring system for functional limitations. Of 78 patients, 58% (n = 45) had a reduction in the range of motion of one or more joints: 30% (n = 23) had one or more functional limitations of the leg and 21% (n = 16) of the arm; 49% (n = 38) had a functional limitation. Of all patients with affected knees, the predicted average extent of limitation was 63%. In patients with affected ankles, limitation was 78% on average; in those with elbow involvement, this was 76% on average, and in wrists involved, 65%. All of the hands involved were markedly restricted. We propose a simplified and functional scoring system that should be tested for validation in a second patient sample, and, if properly validated and adjusted, can be used in future intervention trials.
Urinary schistosomiasis in preschool children in settlements around Oyan Reservoir in Ogun State, Nigeria: implications for control
Authors: Mafiana C. F. , Ekpo U. F. , Ojo D. A. 
Published: March 2003

SummaryWe determined the prevalence of urinary schistosomiasis in preschool children below the age of 5 years in three settlements around Oyan Reservoir in Ogun State, Nigeria. Of 209 children screened, 150 (71.8%) had an infection, with no significant difference between males and females; 42.9% of infants were infected. Both prevalence and intensity of infection increased significantly with age (P < 0.005). Most (62.7%) infections were light (<50 eggs/10 ml urine). A 17.7 percentage of the children had visible haematuria, which increased with age (P < 0.005). Focus group discussions (FGDs) with adult men and women revealed that infection in preschool children was primarily because of exposure occasioned by the mothers' domestic (washing and bathing) and occupational (fishing) activities, while older children could go swimming on their own. Although the participants claimed that using a different water supply may not be effective in combating the disease, as their entire existence was tied to the reservoir, we propose that health education geared towards changing behaviour and attitudes is necessary. As preschool children are a source of both contamination and transmission, control programmes must take them into account.
Short communication: Concomitant malaria and filariasis infections in Georgetown, Guyana
Authors: Chadee Dave D. , Rawlins Samuel C. , Tiwari T. S. B. 
Published: March 2003

SummaryLymphatic filariasis and malaria are endemic in Guyana, South America. To determine the prevalence of concomitant infections, we conducted a 1‐year survey of febrile patients attending the malaria (day) and filariasis (night) clinics in Georgetown. In all, 1278 thick blood smears were collected: 769 for filariasis, of which 103 were positive forWuchereria bancrofti,and three for bothW. bancroftiand malaria parasites; and 509 for malaria, 21 of which tested positive for malaria and 17 for both malaria and filariasis. The age groups and sex of the infected persons with malaria andW. bancroftiare described. These results suggest that the incidence of concomitant infections in Guyana may be quite low but efforts should be made to reduce the disease burden in Georgetown, Guyana.
Identification of major allergens ofMalassezia pachydermatisin dogs with atopic dermatitis andMalasseziaovergrowth
Authors: Chen Tai‐An , Halliwell Richard E. W. , Pemberton Alan D. , Hill Peter B. 
Published: March 2003

AbstractWe have previously shown that both atopic and normal dogs generate an IgG response to antigens ofMalassezia pachydermatis. The aim of this study was to compare IgE responses to separated proteins ofM. pachydermatisin 28 atopic dogs withMalasseziadermatitis and 22 clinically normal dogs using Western immunoblotting. Six different detection systems were evaluated in order to assess sensitivity and eliminate nonspecific binding and cross‐reactivity. The protocol yielding the best results utilized a monoclonal mouse antidog IgE, an alkaline phosphatase conjugated goat antimouse IgG which had been passed through a canine IgG column 3 times, a chemiluminescent substrate and a digital imaging system. Proteins of 45, 52, 56 and 63 kDa were recognized by more than 50% of the atopic dog sera and thus represented major allergens. Only a minority of normal dogs showed faint IgE binding to these proteins. The results indicate that the majority of atopic dogs withMalasseziadermatitis have a greater IgE response than normal dogs, suggesting an IgE‐mediated immune response may be clinically important in the pathogenesis of the disease.
Influence of vitamin E on mast cell mediator release
Authors: Gueck Thomas , Aschenbach Jörg Rudolph , Fuhrmann Herbert 
Published: March 2003

Abstract We investigated the influence of vitamin E on mediator activity and release in a canine mastocytoma cell line (C2) as a model for canine atopic dermatitis. Cells were incubated without and with vitamin E (100 µm) for 24 h. The histamine and prostaglandin D2 (PGD2) release as well as the chymase and tryptase activity were measured. To stimulate the PGD2 and histamine release, cells were incubated with the wasp venom peptide mastoparan (50 µm) for 30 or 45 min. Nonstimulated as well as mastoparan‐stimulated histamine and PGD2 release was reduced significantly in vitamin E‐treated cells. The activity of chymase tended to decrease, but the tryptase activity of C2 cells was not influenced by vitamin E. These results indicate that vitamin E decreased the production and release of inflammatory mediators in C2 cells, suggesting that vitamin E might have a possible beneficial effect in inflammatory diseases.
Diabetic dermopathy and internal complications in diabetes mellitus
Authors: Shemer, MD Avner , Bergman, MD Reuven , Linn, MD, Drph Shai , Kantor, MD Yoram , Friedman‐Birnbaum, MD Rachel 
Published: March 2003

Background Diabetic dermopathy is the most common cutaneous marker of diabetes mellitus. The relationship of diabetic dermopathy to internal complications of diabetes mellitus, such as nephropathy, retinopathy, and neuropathy, is still unknown. MethodsThe possible role of diabetic dermopathy as a clinical sign of internal complications in diabetes mellitus was investigated. One hundred and seventy‐three patients with diabetes mellitus, of whom 125 (72%) had insulin‐dependent diabetes mellitus and 48 (28%) had non‐insulin‐dependent diabetes mellitus, were studied. ResultsDiabetic dermopathy was present in 69 (40%) of patients, statistically more significant in patients 50 years of age and older. The mean diabetic duration was significantly higher in patients with diabetic dermopathy than in those without. The associations of diabetic dermopathy with retinopathy, nephropathy, and neuropathy were each statistically significant, and the increased frequency of diabetic dermopathy correlated with an increased number of these three complications in each patient. Conclusions Some of the factors that affect the development of internal complications in diabetes mellitus may play a role in the development of diabetic dermopathy, and diabetic dermopathy may serve as a clinical sign of an increased likelihood of these internal complications in diabetic patients.