bluuebunny/crossref_metadata_2025_split huggingface dataset:
Household drinking water in developing countries: a systematic review of microbiological contamination between source and point‐of‐use
Authors: Wright Jim , Gundry Stephen , Conroy Ronan 
Published: January 2004

SummaryObjective  To assess the extent and causes of microbiological contamination of household drinking water between source and point‐of‐use in developing countries.Methods  A systematic meta‐analysis of 57 studies measuring bacteria counts for source water and stored water in the home to assess how contamination varied between settings.Results  The bacteriological quality of drinking water significantly declines after collection in many settings. The extent of contamination after water collection varies considerably between settings, but is proportionately greater where faecal and total coliform counts in source water are low.Conclusions  Policies that aim to improve water quality through source improvements may be compromised by post‐collection contamination. Safer household water storage and treatment is recommended to prevent this, together with point‐of‐use water quality monitoring.
The changing epidemiology of malaria in Ifakara Town, southern Tanzania
Authors: Schellenberg David , Menendez Clara , Aponte John , Guinovart Caterina , Mshinda Hassan , Tanner Marcel , Alonso Pedro 
Published: January 2004

SummaryBetween 1995 and 2000 there were marked changes in the epidemiology of malaria in Ifakara, southern Tanzania. We documented these changes using parasitological and clinical data from a series of community‐ and hospital‐based studies involving children up to the age of 5 years. There was a right shift and lowering in the age‐specific parasite prevalence in the community‐based cohort studies. The incidence of clinical malaria in placebo‐receiving infants in additional study cohorts dropped from 0.8 in 1995 to 0.43 episodes per infant per year in 2000, an incidence rate ratio of 0.53 (95% confidence interval: 0.404, 0.70, P < 0.0001). At the same time, there was an increase in the total number of malaria admissions and a marked right shift in the age pattern of these admissions (median age in 1995 1.55 years vs. 2.33 in 2000, P < 0.0001). However, the burden of malaria deaths remained in infants. We discuss how these dramatic changes in the epidemiology of malaria may have arisen from the use of currently available malaria control tools. Caution is required in the interpretation of hospital‐based data as it is likely to underestimate the impact of anaemia on mortality in the community, where most paediatric deaths occur. Even in low/moderate malaria transmission settings, where older children suffer most malaria episodes, targeting effective malaria control at infants may produce important reductions in infant mortality caused by malaria.
Malaria transmission dynamics at a site in northern Ghana proposed for testing malaria vaccines
Authors: Appawu Maxwell , Owusu‐Agyei Seth , Dadzie Samuel , Asoala Victor , Anto Francis , Koram Kwadwo , Rogers William , Nkrumah Francis , Hoffman Stephen L. , Fryauff David J. 
Published: January 2004

SummaryWe studied the malaria transmission dynamics in Kassena Nankana district (KND), a site in northern Ghana proposed for testing malaria vaccines. Intensive mosquito sampling for 1 year using human landing catches in three micro‐ecological sites (irrigated, lowland and rocky highland) yielded 18 228 mosquitoes. Anopheles gambiae s.l. and Anopheles funestus constituted 94.3% of the total collection with 76.8% captured from the irrigated communities. Other species collected but in relatively few numbers were Anopheles pharoensis (5.4%) and Anopheles rufipes (0.3%). Molecular analysis of 728 An. gambiae.s.l. identified Anopheles gambiae s.s. as the most dominant sibling species (97.7%) of the An. gambiae complex from the three ecological sites. Biting rates of the vectors (36.7 bites per man per night) were significantly higher (P < 0.05) in the irrigated area than in the non‐irrigated lowland (5.2) and rocky highlands (5.9). Plasmodium falciparum sporozoite rates of 7.2% (295/4075) and 7.1% (269/3773) were estimated for An. gambiae s.s. and An. funestus, respectively. Transmission was highly seasonal, and the heaviest transmission occurred from June to October. The intensity of transmission was higher for people in the irrigated communities than the non‐irrigated ones. An overall annual entomological inoculation rate (EIR) of 418 infective bites was estimated in KND. There were micro‐ecological variations in the EIRs, with values of 228 infective bites in the rocky highlands, 360 in the lowlands and 630 in the irrigated area. Approximately 60% of malaria transmission in KND occurred indoors during the second half of the night, peaking at daybreak between 04.00 and 06.00 hours. Vaccine trials could be conducted in this district, with timing dependent on the seasonal patterns and intensity of transmission taking into consideration the micro‐geographical differences and vaccine trial objectives.
Genetic markers of resistance to pyrimethamine and sulfonamides in Plasmodium falciparum parasites compared with the resistance patterns in isolates of Escherichia coli from the same children in Guinea‐Bissau
Authors: Kofoed Poul‐Erik , Alfrangis Michael , Poulsen Anja , Rodrigues Amabelia , Gjedde Susanne Borum , Rønn Anita , Rombo Lars 
Published: January 2004

SummaryThe antifolate drugs sulphadoxine and pyrimethamine are used for treatment of chloroquine‐resistant Plasmodium falciparum in Africa. Resistance to pyrimethamine has been associated with point mutations in the dhfr‐gene and resistance to sulphadoxine with mutations in the dhps‐gene. There is concern that the use of the antifolates trimethoprim and sulphamethoxazole for treatment of other infectious diseases will result in the selection of malaria parasites with mutations in these genes. In Guinea‐Bissau, where sulfonamide and trimethoprim‐containing drugs have been used extensively, we decided to assess the prevalence of mutations in the dhfr‐and dhps‐gene in P. falciparum isolated from children suffering from acute malaria and to assess the resistance patterns to trimethoprim/sulphamethoxazole in Escherichia coli isolated from the same patients. A thick film and a blood sample for polymerase chain reaction (PCR) were obtained from 100 children attending the Bandim Health Centre in Bissau with symptoms compatible with malaria. Furthermore, a stool sample was collected from the same children and cultured for E. coli. Of the cultured E. coli, 67% were resistant both to sulfonamides and trimethoprim, 4% to sulfonamides alone, 3% to trimethoprim alone while 26% were fully sensitive to both drugs. PCR was successfully performed in 97 blood samples. Of these, 41% had triple mutations at the dhfr‐gene (at codons 51, 59 and 108), and 15% had triple mutations plus mutation at codon 437 in the dhps‐gene. Only 45% harboured the wild‐type dhfr‐gene. Thus both bacterial resistance and mutations in the parasitic genes were common, but not linked in the individual child. As sulphadoxine–pyrimethamine has only been used as a second line treatment for chloroquine resistant malaria in Guinea‐Bissau for a few years, it is worrying to find a high prevalence of mutations in the parasitic genes coding for resistance to these drugs. Therefore, restricting the use of sulphadoxine–pyrimethamine for the treatment of chloroquine resistant malaria might not be sufficient to prevent the development of resistance in the parasites as long as antifolate drugs are used extensively.
Epidemiological and entomological surveillance of the co‐circulation of DEN‐1, DEN‐2 and DEN‐4 viruses in French Guiana
Authors: Fouque Florence , Garinci Romuald , Gaborit Pascal 
Published: January 2004

SummaryWe surveyed the disease epidemiology of dengue in French Guiana after the first dengue haemorrhagic fever epidemic from 1991 to 1993 and during an endemic period from 1993 to 1995. DEN‐1, DEN‐2 and DEN‐4 viruses were isolated from patients and DEN‐4 was also isolated from Aedes aegypti mosquitoes. Cases of dengue were reported from all over the country, not only from urban areas, but also from rural areas and isolated human settlements, indicating widespread circulation of the viruses. The mosquito vector A. aegypti was found in all inhabited areas of French Guiana and small outdoor containers were the most common breeding grounds. Some ecological features of A. aegypti, such as larvae breeding in Bromeliad plants in the rainforest, a non‐exclusive anthropophily and a high vertical transmission rate for dengue viruses, indicate that A. aegypti can behave as a reservoir for dengue viruses in silent areas. Dengue viruses may survive at an endemic level and cause outbreaks when unknown conditions become more favourable. This finding adds to our knowledge of the natural history of dengue viruses in the Americas.
The efficacy of chloroquine, sulfadoxine–pyrimethamine and a combination of both for the treatment of uncomplicated Plasmodium falciparum malaria in an area of low transmission in western Uganda
Authors: Ndyomugyenyi Richard , Magnussen Pascal , Clarke Siân 
Published: January 2004

SummaryWe conducted an efficacy study of chloroquine (CQ), sulfadoxine–pyrimethamine (SP) and a combination of both (SP + CQ) for the treatment of uncomplicated malaria in an area of low transmission with low drug pressure. On day 3, fever clearance was 97.4% (95% CI, 86.8–99.9), 100% (95% CI, 87.2–100) and 96.6% (95% CI, 82.2–99.9) in the CQ, SP and SP + CQ groups, respectively, (P = 0.65). On day 14, clinical success was 92.5% (95% CI, 79.6–98.4), 100% (95% CI, 87.2–100) and 100% (95% CI, 88.1–100) in the CQ, SP and CQ + SP groups, respectively. Clinical failure was seen in 7.5% with 5% (95% CI, 0.61–16.9) early treatment failure and 2.5% (95% CI, 0.06–13.2) late treatment failure of cases in the CQ group and 0% in the SP and SP + CQ groups. Parasitological resistance was observed at RI level in 10% (95% CI, 2.8–23.7), 18.5% (95% CI, 6.3–38.1) and 6.9% (95% CI, 0.85–22.8) for the CQ, SP and SP + CQ, respectively (P = 0.37). There was no age‐dependent difference in clinical failure or parasitological resistance in any of the treatment groups and prior CQ use within the last 2 weeks did not affect CQ treatment outcome. The findings of this study suggest that CQ is still effective for the treatment of uncomplicated malaria in this area of low transmission and SP. However, combination therapy of SP + CQ is recommended to delay the development SP resistance, and regular surveillance for emerging CQ and SP resistance is needed to plan for alternative antimalarial drug regimens.
Addition of artesunate to chloroquine for treatment of Plasmodium falciparum malaria in Gambian children causes a significant but short‐lived reduction in infectiousness for mosquitoes
Authors: Drakeley Christopher J. , Jawara Musa , Targett Geoffrey A. T. , Walraven Gijs , Obisike Uche , Coleman Rosalind , Pinder Margaret , Sutherland Colin J. 
Published: January 2004

SummaryObjectives  Combination therapy using existing anti‐malarials together with artesunate (AS) has been advocated as a method to slow the spread of drug resistance. We assessed the effect on Plasmodium falciparum transmissibility of the addition of AS to chloroquine (CQ) in an area of The Gambia where resistance to CQ is increasing.Methods  Gambian children with acute uncomplicated P. falciparum malaria were treated with either CQ monotherapy (n = 120) or the combination of CQ plus three doses of AS (CQ/AS; n = 352). Post‐treatment sexual‐stage parasitaemia was assessed during a 4‐week follow‐up period. Experimental infections of Anopheles gambiae s.s. mosquitoes were performed with blood from patients who were carrying gametocytes 7 days after starting treatment (n = 69).Results  The addition of AS significantly reduced post‐treatment prevalence and mean density of gametocytes in the first 14 days (day 7: 43.7%vs. 12.4%, 62.4/μl vs. 6.2/μl; day 14: 32.9%vs. 3.7%; 21.9/μl vs. 5.2/μl; CQ vs. CQ/AS), although by day 28 the benefits of the combination were substantially less marked (40.5%vs. 21.8%; 23.0/μl vs. 63.1/μl; CQ vs. CQ/AS). The duration of gametocyte carriage over the study period was significantly lower in the CQ/AS group (5.2 days vs. 1.5 days; CQ vs. CQ/AS). The estimated infectious proportion of children at day 7 was also lower in the combination group (19.2%vs. 3.4%; CQ vs. CQ/AS), as were the proportion of mosquitoes infected and mean oocyst density (11.5%vs. 0.9%; 0.3 vs. 0.01; CQ vs. CQ/AS). Treatment failure was associated with threefold and twofold higher gametocyte carriage rates during follow‐up in CQ and CQ/AS groups, respectively (P < 0.001 in both cases), and 26‐fold and 2.3‐fold higher intensity of infection at day 7 among CQ‐ and CQ/AS‐treated children, respectively (P = 0.002 and 0.30, respectively).Conclusion  The benefits of adding AS to CQ monotherapy in lowering gametocyte prevalence and density were transient, suggesting that the addition of AS delayed, but did not prevent, the emergence of gametocytes. This is consistent with our finding that treatment failure, and thus the presence of CQ‐resistant parasites, was significantly associated with a higher gametocyte carriage rate in both treatment groups. At day 7, CQ monotherapy significantly favoured transmission of resistant infections, which showed an 11‐fold greater intensity of transmission compared with infections that were successfully treated. In contrast, the combination of CQ/AS did not significantly favour resistant infections at day 7. We conclude that significant transmission‐reduction is achieved by the combination but is not maintained because of the recrudescence of CQ‐resistant parasites.
Use of antenatal care services and intermittent preventive treatment for malaria among pregnant women in Blantyre District, Malawi
Authors: Holtz Timothy H. , Patrick Kachur S. , Roberts Jacquelin M. , Marum Lawrence H. , Mkandala Christopher , Chizani Nyson , Macheso Allan , Parise Monica E. 
Published: January 2004

SummaryMalaria in pregnancy contributes to low birth weight and increased infant mortality. As part of WHO's Roll Back Malaria initiative, African heads of state pledged that by 2005, 60% of pregnant women will receive malaria chemoprophylaxis or intermittent preventive treatment (IPT). We performed a cluster sample survey to study the use of sulfadoxine–pyrimethamine (SP) for IPT among recently pregnant women in February 2000 in Blantyre District, Malawi. Among 391 women in the sample, 98.6% had attended antenatal clinic at least once and 90.2% knew that SP/IPT was recommended during pregnancy. Overall, only 36.8% received the full recommended two‐dose regimen of SP/IPT. Using data from 187 women with antenatal clinic cards, we found that residence location, housing type and gender/age/education of the head of household were not associated with failure to receive SP/IPT. Adjusting for education, multigravid women were more likely not to receive the recommended SP/IPT regimen (RR 1.2, 95% CI 1.02–1.5, P = 0.03). A substantial effort to improve the delivery and use of SP/IPT in Malawi will be necessary, but the Roll Back Malaria 2005 goal appears achievable.
ONO‐8815Ly, an EP2 agonist that markedly inhibits uterine contractions in women
Authors: Steinwall M. , Åkerlund M. , Bossmar T. , Nishii M. , Wright M. 
Published: January 2004

Objective  To determine the effect of ONO‐8815Ly on uterine contractions.Design  A randomised, double‐blind, placebo‐controlled, dose‐ascending, cross‐over study.Setting  Department of Obstetrics and Gynaecology, University Hospital of Lund, Sweden.Population  Seventeen, healthy, parous and permanently sterilised women.Methods  Intrauterine pressure was recorded on days 1–3 of bleeding of two menstruations. Subjects were intravenously treated with 4 or 8 μg/minute of ONO‐8815Ly or placebo for 130 minutes. Intravenous bolus injections of oxytocin, 50 pmol/kg body weight, were given 10 minutes before, during infusion after 60 and 120 minutes and 60 minutes after completion of infusion. The plasma concentrations of ONO‐8815Ly were measured in samples obtained immediately before each oxytocin injection.Main outcome measure  Area under pressure recording curve (AUC) 10 minutes before and after each oxytocin injection.Results  Twelve women, six in each dose group, completed both recordings. Of these, two women of each group were not included in efficacy analysis due to non‐responsiveness to oxytocin or missing baseline value. The AUC over 10 minutes before oxytocin injection after 60 minutes of infusion of ONO‐8815Ly at 4 and 8 μg/minute was reduced to 21% and 37% of that before infusion, respectively. The AUC after oxytocin at that time amounted to 21% and 19%, respectively, of that before infusion. The activity and responsiveness remained low after 120 minutes but started to return to baseline 60 minutes after stopping infusion. Placebo had no effect.Conclusions  ONO‐8815Ly is a potent inhibitor of spontaneous uterine contractility in non‐pregnant women and it reduces the uterine response to oxytocin injections.
Women's perceptions of decision‐making about hysterectomy
Authors: Skea Z. , Harry V. , Bhattacharya S. , Entwistle V. , Williams B. , MacLennan G. , Templeton A. 
Published: January 2004

Objective  To explore women's views of decision‐making relating to hysterectomy.Design  Structured questionnaire and in‐depth interview surveys.Setting  A teaching hospital and a district general hospital in northeast Scotland.Sample  Women scheduled for hysterectomy for benign menstrual problems.Methods  Pre‐operative questionnaires were sent to a consecutive sample of women booked for hysterectomy. A purposive sample was interviewed post‐operatively.Main outcome measures  Women's experiences of, and satisfaction with, information provision, communication and decision‐making processes; the relationship between views of decision‐making processes and decisions made.Results  One hundred and four women (66%) returned questionnaires. Most responded positively to structured questions about the process by which the decision to have a hysterectomy was reached. Almost all (97%) reported satisfaction with the decision made. Twenty women were interviewed post‐operatively. A number, including some who had responded positively on the questionnaire, described aspects of the decision‐making process that were suboptimal. Women's perceptions of the decision‐making process, including the way their doctors communicated with them, did impinge on their views of the course of action selected. Some women had residual doubts about the appropriateness of hysterectomy.Conclusions  In a significant minority of women, there are important shortcomings in current patterns of information provision and communication relating to decision‐making. These are unlikely to be picked up by conventional structured patient feedback surveys. Further efforts are required to ensure that women are adequately informed and involved in decisions about gynaecological treatments.
Feasibility of central co‐ordinated EMA/CO for gestational trophoblastic disease in the Netherlands
Authors: van der Houwen Clasien , Rietbroek Ron C. , Lok Christianne A.R. , Ten Kate‐Booij Marianne J. , Lammes Frits B. , Ansink Anca C. 
Published: January 2004

Objective  In the Netherlands, high risk gestational trophoblastic disease (GTD) patients are treated in different referral hospitals with a national working party on trophoblastic tumours having a co‐ordinating function. Our purpose was to evaluate whether this policy is a satisfactory alternative to complete centralisation.Design  A retrospective study of all etoposide, methotrexate, actomycin D, cyclophosphamide and vincristine (EMA/CO)‐treated women in the Netherlands between 1986 and 1997. Data regarding risk factors, treatment results and toxicity were collected.Setting  Ten hospitals; 2 general, 6 academical and 2 oncology centres.Population  Fifty EMA/CO‐treated women registered by the central registration unit of the Dutch Working Party on Trophoblastic Disease.Methods  Patients files and quarterly reports of the Dutch Working Party.Main outcome measures  Cure rate and consistency of treatment in different hospitals.Results  EMA/CO treatment was administered in 10 different hospitals. All patients were discussed during the meetings of the Dutch Working Party and overall, 86% of patients were cured. Consistency in treatment was good.Conclusions  Cure rates were comparable with results of single institution series. We conclude that treatment of high risk GTD patients in different referral hospitals with concentration of expertise in a working party is a good alternative to centralisation of treatment in GTD specialised hospitals.
The use of oral misoprostol for pre‐abortion cervical priming: a randomised controlled trial of 400 versus 200 μg in first trimester pregnancies
Authors: Oppegaard Kevin S. , Abdelnoor Mikael , Nesheim Britt‐Ingjerd , Jerve Fridtjof , Eskild Anne 
Published: January 2004

Objective  To compare the impact of 200 and 400 μg oral misoprostol on pre‐operative cervical priming in both primi‐ and multigravidae prior to first trimester termination of pregnancy. Pre‐operative cervical dilatation and bleeding were assessed.Design  Randomised controlled trial.Setting  Norwegian university teaching hospital.Sample  Five hundred and fifty‐one women undergoing surgical termination of pregnancy between 7 and 12 weeks of gestation.Methods  Patients were randomised to either 200 or 400 μg of oral misoprostol 10–16 hours before vacuum aspiration. The degree of cervical dilatation prior to abortion by vacuum aspiration was measured. Pre‐operative bleeding and pain were recorded and vaginal bleeding was measured.Main outcome measures  Degree of pre‐operative cervical dilatation and pre‐operative bleeding.Results  The mean cervical dilatation was 5.8 mm (SD 1.7) for the women who received 400 μg misoprostol and 5.4 mm (SD 1.4) for those who received 200 μg (P= 0.004). The pre‐operative dilatation was larger in multigravidae than in primigravidae in both dosage groups. The odds ratio (OR) of pre‐operative bleeding was 3.3 (95% confidence interval [CI] 2.1–5.0) in the 400 μg dosage group, as compared with the group receiving 200 μg misoprostol. The occurrence of bleeding was dose‐dependent. Frequency of bleeding was similar in multigravidae compared with primigravidae in the 400 μg dosage group, whereas the occurrence of bleeding was less in primigravidae than multigravidae in the 200 μg dosage group. Only 89 out of 551 patients bled one or more grams. The volumes measured were not statistically significantly different. Complications were minor, and were distributed equally between the two dosage groups.Conclusions  The 200 μg oral misoprostol compared with the 400 μg oral misoprostol given 10–16 hours before first trimester surgical abortions results in less pre‐operative vaginal bleeding and in a statistically, although not clinically significant reduction in cervical dilatation.