Diesfeld Hj

Bio: Diesfeld Hj is an academic researcher from University College West. The author has contributed to research in topics: Tropical medicine. The author has an hindex of 1, co-authored 1 publications receiving 6 citations.

Control of scabies, skin sores and haematuria in children in the Solomon Islands: another role for ivermectin

Abstract: Objective To assess the effects of a 3-year programme aimed at controlling scabies on five small lagoon islands in the Solomon Islands by monitoring scabies, skin sores, streptococcal skin contamination, serology and haematuria in the island children. Methods Control was achieved by treating almost all residents of each island once or twice within 2 weeks with ivermectin (160–250 µg/kg), except for children who weighed less than 15 kg and pregnant women, for whom 5% permethrin cream was used. Reintroduction of scabies was controlled by treating returning residents and visitors, whether or not they had evident scabies. Findings Prevalence of scabies dropped from 25% to less than 1% (P < 0.001); prevalence of sores from 40% to 21% (P < 0.001); streptococcal contamination of the fingers in those with and without sores decreased significantly (P = 0.02 and 0.047, respectively) and anti-DNase B levels decreased (P = 0.002). Both the proportion of children with haematuria and its mean level fell (P = 0.002 and P < 0.001, respectively). No adverse effects of the treatments were seen. Conclusion The results show that ivermectin is an effective and practical agent in the control of scabies and that control reduces the occurrence of streptococcal skin disease and possible signs of renal damage in children. Integrating community-based control of scabies and streptococcal skin disease with planned programmes for controlling filariasis and intestinal nematodes could be both practical and produce great health benefits.

Prevalence of congenital malaria in minna, north central Nigeria.

Abstract: The study was designed to determine the true prevalence of congenital, cord, and placental malaria in General Hospital Minna, North Central Nigeria. Peripheral blood smears of near-term pregnant women, as well as the placental, cord, and peripheral blood smears of their newborn babies, were examined for malaria parasites, using the Giemsa staining technique. Out of 152 pregnant women screened, 21 (13.82%) of them were infected with malaria parasites. Of the 152 new born babies, 4 (2.63%) showed positive peripheral parasitaemia. Placental parasitaemia was 7/152 (4.61%), while cord blood parasitaemia was 9/152 (5.92%). There were strong associations between peripheral and cord malaria parasitaemia and congenital malaria (P 0.05). Malaria parasitaemia occurred more frequently in primigravidae than multigravidae.

Female Genital Mutilation Reconstruction for Plastic Surgeons-A Call to Arms.

Abstract: The practice of female genital mutilation (FGM) is performed for historically engrained cultural beliefs with no recognized health benefits. FGM continues to be practiced secondary to motivating factors based on cultural beliefs, the majority of which aim to maintain the "purity" of the female victim. The World Health Organization has classified FGM into 4 types ranging from partial clitoral resection to complete clitoral excision along with the majority of the vulva. The list of short and long-term complications is extensive and morbid, including injury to the patient's sexuality and feminine identity. Reconstructive surgery can be an important addition to psychotherapy for these women with the goal of correcting the appearance of the vulva to achieve a more normal appearance, and to restore clitoral function. We suggest that this represents an opportunity for plastic surgeons to use our wealth of reconstructive knowledge to provide restoration of form and function to FGM victims.

Other health personnel in health educational activities in an under-fives clinic in Northern Nigeria.

Abstract: A basic health service is a network of peripheral, intermediate, and central health establishment, staffed by adequately trained professional and auxiliary personnel, capable of performing effectively a group of functions essential to the health of the people (WHO 1969). I n the Third National Development Plan for Nigeria, 1975-80, a Basic Health Unit refers to a network comprising one comprehensive health centre (30 beds), four health centres (48 beds), five mobile clinics and twenty health clinics to serve a target population of 50,000 within an administrative Division or District (Federal Republic of Nigeria 1975). The Plan will substantially provide the infrastructure necessary to achieve the Federal Government's aim of total health coverage of the nation by stages. At the moment, about 25% of the population receive some form of health care and this coverage was expected to reach 40% by 1980. In this Plan, the training of other health professionals and auxiliaries has been intensified. Due to scarce resources, staff and materials must be matched at appropriate levels so as to maximize the overall health benefits to the community. This will also help to establish a health care system that is best adapted to the local conditions and the level of our health technology (Howard 1978). In any busy out-patients department (OPD) in Nigeria, the consulting staff, be they doctors or nurses, are so overworked that they have very little time for well-planned health education activities, which should have been important components of their work schedules. This is necessary because communicable diseases form the bulk of the consultations, treatment, and admissions (Fig. 1) . In the 1979 studies, well babies formed only 7% of the study population while protein calorie malnutrition (PCM). resoiratory infections. and gastroenteritis ' were the leading causes of morbidity. From studies in similar populations, infant mortality rates varied between 50 and 150 per 1,000 total live births, while the childhood mortality rate was as high as 350 per 1,000 children under five years of age (Malumfashi Project 1975). Because of such statistics as found in the Under5 Clinic in Samaru Health Centre, in Northern Nigeria, we devised a plan whereby clinic attendants and auxiliaries were trained to play specific roles in the health team concept of a comprehensive health service. The concept of enrolling anyone capable of helping us in improving health was used at varionis levels according to their training, experience, and particularly their health educational roles. 1. The Records Unit. This is usually where the babies and their mothers make the first contact with the clinic and the impressions gained here are of the utmost importance for the acceptance of modern medicine. Both first and surnames are easily interchangable among the Hausas, and this poses a problem in correct identification and documentation on subsequent visits. For example, Isa Uthman may re-register as Uthman Isa on a second visit. It is impressed upon the records clerk that checks should be applied to prevent errors. He has the added responsibility of impressing upon the mothers the necessity of presenting the small retrieval cards. Valuable time is lost when these are not produced and issuing of temporary cards leads to discontinuity in treatment schedules.

A Bayesian phase 2 model based adaptive design to optimise antivenom dosing: application to a dose-finding trial for a novel Russell's viper antivenom in Myanmar

Abstract: For most antivenoms there is little information from clinical studies to infer the relationship between dose and efficacy or dose and toxicity. Antivenom dose-finding studies usually recruit too few patients (e.g. less than 20) relative to clinically significant event rates (e.g. 5%). Model based adaptive dose-finding studies make efficient use of accrued patient data by using information across dosing levels, and converge rapidly to the contextually defined `optimal dose9. Adequate sample sizes for adaptive dose-finding trials can be determined by simulation studies. We propose a model based, Bayesian phase 2 type, adaptive clinical trial design for the characterisation of optimal initial antivenom doses in contexts where both efficacy and toxicity are measured as binary endpoints. This design is illustrated in the context of dose-finding for Daboia siamensis Eastern Russell9s viper) envenoming in Myanmar. The design formalises the optimal initial dose of antivenom as the dose closest to that giving a pre-specified desired efficacy, but resulting in less than a pre-specified maximum toxicity. For Russell9s viper efficacy is defined as the restoration of blood coagulability within six hours, and toxicity is defined as anaphylaxis. Comprehensive simulation studies compared the expected behaviour of the model based design to a simpler rule based design (a modified `3+39 design). The model based design can identify the optimal dose after fewer patients than the rule based design. Open source code for the simulations can be used to calculate sample sizes under a priori beliefs of efficacy and toxicity. Antivenom dose-finding trials would benefit from using standard model based adaptive designs. Dose-finding trials where rare events (e.g. 5% occurrence) are of clinical importance necessitate larger sample sizes than current practice. We will apply the model based design to determine a safe and efficacious dose for a novel lyophilised antivenom to treat Daboia siamensis envenoming in Myanmar.