Showing papers by "Umberto D'Alessandro published in 2005"

Epidemiology of forest malaria in central Vietnam: a large scale cross-sectional survey

Abstract: In Vietnam, a large proportion of all malaria cases and deaths occurs in the central mountainous and forested part of the country. Indeed, forest malaria, despite intensive control activities, is still a major problem which raises several questions about its dynamics.

Malaria and urbanization in sub-Saharan Africa

Abstract: There are already 40 cities in Africa with over 1 million inhabitants and the United Nations Environmental Programme estimates that by 2025 over 800 million people will live in urban areas. Recognizing that malaria control can improve the health of the vulnerable and remove a major obstacle to their economic development, the Malaria Knowledge Programme of the Liverpool School of Tropical Medicine and the Systemwide Initiative on Malaria and Agriculture convened a multi-sectoral technical consultation on urban malaria in Pretoria, South Africa from 2nd to 4th December, 2004. The aim of the meeting was to identify strategies for the assessment and control of urban malaria. This commentary reflects the discussions held during the meeting and aims to inform researchers and policy makers of the potential for containing and reversing the emerging problem of urban malaria.

Editorial: Should artemisinin‐based combination treatment be used in the home‐based management of malaria?

Abstract: Most cases of uncomplicated malaria are managed outside the formal health sector with drugs bought from shops or kiosks. This is especially true in poor low-literacy populations with inadequate access to health services. The practice of self-medication can be an advantage as a shorter delay between onset of disease and effective treatment has been linked to a lower risk of death (D’Alessandro et al. 1997). A study in Ethiopia reported a 40% reduction in under-5 mortality when providing to mothers simple training and antimalarial drugs for the treatment at home of their children. But the intervention was implemented in an area where a community-based primary health care programme had been operating the health system for over 20 years and the community health workers distributing the drugs had been frequently supervised. Therefore these results should be interpreted with caution when considering elsewhere the implementation of a similar strategy. The African leaders at the Abuja Summit on Roll Back Malaria (RBM) held in April 2000 endorsed the laudable goal of having by 2005 at least 60% of African malaria patients on prompt access to affordable and appropriate treatment within 24 h of the onset of symptoms. RBM has ever since promoted home-based management of malaria (HBM) as ‘a simple and effective intervention that puts malaria drugs into the hands of mothers and community based caregivers’. (excerpt)

Plasmodium falciparum genotyping by microsatellites as a method to distinguish between recrudescent and new infections

Abstract: In vivo tests for susceptibility to antimalarial drugs require molecular methods to distinguish recrudescence from new infection. The most commonly used DNA markers (merozoite surface proteins [MSPs]) are under immune selective pressure, which might lead to misclassification. We evaluated immunologically neutral microsatellite markers in blood samples collected during a drug efficacy trial in Rwanda. Fifty percent of the infections classified as recrudescent by MSP were classified as new by microsatellite markers. Reciprocally, 23.3% of infections classified as recrudescent by microsatellite markers were identified as new by MSP. In drug efficacy studies, microsatellite markers should complement MSP genotyping to distinguish a recrudescence from a new infection.

Malaria infection among pregnant women attending antenatal clinics in six Rwandan districts

Abstract: The aim of the study was to assess the knowledge attitude and practices of pregnant women towards malaria and their association with malaria morbidity. Cross-sectional malaria survey of 1432 pregnant women attending six health centres each of them situated in a specific health district in Rwanda from September to October 2002. The overall prevalence of malaria infection was 13.6% and all infections but two were caused by Plasmodium falciparum. The six health districts were significantly different in terms of malaria prevalence which varied between 11.5% and 15.4% in four and was <5% in the other two districts. The prevalence of anaemia and splenomegaly mirrored that of malaria infection. In three districts the prevalence of infection was significantly higher in primigravidae than in secundigravidae and multigravidae (P = 0.01) while in two others it did not vary with parity. Bed net use was low – only 13.1% of the women had at least one bed net at home and 8.3% of them slept under it – and significantly different between districts. Most women knew that malaria might have serious consequences for their pregnancy and that insecticide-treated bed nets are useful for malaria prevention. However the bed net market price [1525 Rwandan Francs (RFr) approximately 1.6€] was much higher than that considered as affordable and acceptable (389 RFr approximately 0.3€). Malaria in pregnancy is a major problem in Rwanda even in the districts of low transmission. Bed net use among pregnant women is low. The option of providing free insecticide-treated bed nets to pregnant women should be explored and possibly implemented; it could rapidly increase bed net use and earlier attendance to antenatal clinics with clear benefits for the women’s health. (authors)