Showing papers in "Tropical Medicine & International Health in 2002"
TL;DR: To assess whether educational status is associated with HIV‐1 infection in developing countries by conducting a systematic review of published literature.
Abstract: OBJECTIVES To assess whether educational status is associated with HIV-1 infection in developing countries by conducting a systematic review of published literature. METHODS Articles were identified through electronic databases and hand searching key journals. Studies containing appropriately analysed individual level data on the association between educational attainment and HIV-1 status in general population groups were included. RESULTS Twenty-seven articles with appropriately analysed results from general population groups in developing countries were identified, providing information on only six countries. Large studies in four areas in Africa showed an increased risk of HIV-1 infection among the more educated, whilst among 21-year-old Thai army conscripts, longer duration of schooling was strongly protective against HIV infection. The association between education and schooling in Africa was stronger in rural areas and in older cohorts, but was similar in men and women. Serial prevalence studies showed little change in the association between schooling and HIV over time in Tanzania, but greater decreases in HIV prevalence among the more educated in Uganda, Zambia and Thailand. CONCLUSIONS In Africa, higher educational attainment is often associated with a greater risk of HIV infection. However, the pattern of new HIV infections may be changing towards a greater burden among less educated groups. In Thailand those with more schooling remain at lower risk of HIV infection.
304 citations
TL;DR: Uganda was finally declared Ebola free on 27 February 2001, 42 days after the last case was reported, and all levels of the community spontaneously demonstrated solidarity and response to public health interventions.
Abstract: An outbreak of Ebola disease was reported from Gulu district, Uganda, on 8 October 2000. The outbreak was characterized by fever and haemorrhagic manifestations, and affected health workers and the general population of Rwot-Obillo, a village 14 km north of Gulu town. Later, the outbreak spread to other parts of the country including Mbarara and Masindi districts. Response measures included surveillance, community mobilization, case and logistics management. Three coordination committees were formed: National Task Force (NTF), a District Task Force (DTF) and an Interministerial Task Force (IMTF). The NTF and DTF were responsible for coordination and follow-up of implementation of activities at the national and district levels, respectively, while the IMTF provided political direction and handled sensitive issues related to stigma, trade, tourism and international relations. The international response was coordinated by the World Health Organization (WHO) under the umbrella organization of the Global Outbreak and Alert Response Network. A WHO/CDC case definition for Ebola was adapted and used to capture four categories of cases, namely, the 'alert', 'suspected', 'probable' and 'confirmed cases'. Guidelines for identification and management of cases were developed and disseminated to all persons responsible for surveillance, case management, contact tracing and Information Education Communication (IEC). For the duration of the epidemic that lasted up to 16 January 2001, a total of 425 cases with 224 deaths were reported countrywide. The case fatality rate was 53%. The attack rate (AR) was highest in women. The average AR for Gulu district was 12.6 cases/10 000 inhabitants when the contacts of all cases were considered and was 4.5 cases/10 000 if limited only to contacts of laboratory confirmed cases. The secondary AR was 2.5% when nearly 5000 contacts were followed up for 21 days. Uganda was finally declared Ebola free on 27 February 2001, 42 days after the last case was reported. The Government's role in coordination of both local and international support was vital. The NTF and the corresponding district committees harmonized implementation of a mutually agreed programme. Community mobilization using community-based resource persons and political organs, such as Members of Parliament was effective in getting information to the public. This was critical in controlling the epidemic. Past experience in epidemic management has shown that in the absence of regular provision of information to the public, there are bound to be deleterious rumours. Consequently rumour was managed by frank and open discussion of the epidemic, providing daily updates, fact sheets and press releases. Information was regularly disseminated to communities through mass media and press conferences. Thus all levels of the community spontaneously demonstrated solidarity and response to public health interventions. Even in areas of relative insecurity, rebel abductions diminished considerably.
271 citations
TL;DR: It is concluded that the accuracy of clinical algorithms for diagnosing malaria is not sufficient to determine whether antimalarial drugs should be given to children presenting with febrile illness and in highly endemic areas where laboratory support is not available, the policy of offering anti-malaria drugs to all children presented with a febRIle illness recommended by the integrated child management initiative is appropriate.
Abstract: Several attempts have been made to identify symptoms and signs based algorithms for diagnosing malaria. In this paper, we review the results of published studies and assess the risks and benefits of this approach in different epidemiological settings. Although in areas with a low prevalence the risk of failure to treat malaria resulting from the use of algorithms was low, the reduction in the wastage of drugs was trivial. The odds of wastage of drugs increased by 1.49 (95% confidence limit 1.45-1.51) for each 10% decrease in the prevalence of malaria. In highly endemic areas the algorithms had a high risk of failure to treat malaria. The odds of failure to treat increased by 1.57 (95% confidence limit 1.50-1.65) for each 10% increase in the prevalence. Furthermore, the best clinical algorithms for diagnosing malaria were site-specific. We conclude that the accuracy of clinical algorithms for diagnosing malaria is not sufficient to determine whether antimalarial drugs should be given to children presenting with febrile illness. In highly endemic areas where laboratory support is not available, the policy of offering antimalarial drugs to all children presenting with a febrile illness recommended by the integrated child management initiative is appropriate.
248 citations
TL;DR: The existence of a silent epidemic during a period perceived by the Health Services as of low endemicity is highlighted, indicating the strength and speed of dengue transmission in the city of Salvador.
Abstract: Serotypes of dengue DEN-1 and DEN-2 have been reported in much of Brazil over the last 15 years, and DEN-3 serotype was only recently detected. This prospective study was conducted in Salvador, a large city in north-east Brazil, where two epidemics were previously recorded (DEN-1 and DEN-2). We obtained the seroprevalence and 1-year incidence of dengue infections in the population of 30 sampling areas of Salvador and analysed the relationship between intensity of viral circulation, standard of living and vector density. High seroprevalence (68.7%) and annual incidence (70.6%) of infection for one or both circulating serotypes (DEN-1 and DEN-2) were found. High rates of transmission were observed in all studied areas, from the highest to the lowest socio-economic status. The mean PI (Premise Index) for Aedes aegypti was 7.4% (range 0.27-25.6%). Even in the areas with the lowest PI (
227 citations
TL;DR: Sustainability over several years of benefits against malarial morbidity of insecticide‐treated nets and whether, as a result of fading immunity, older age groups ‘paid for’ the benefits which they had enjoyed when younger are investigated.
Abstract: OBJECTIVES To investigate (1) benefits due to personal protection of individual net users vs mass killing of mosquitoes within villages as a result of widespread net usage; (2) sustainability over several years of benefits against malarial morbidity of insecticide-treated nets; (3) distribution of the benefits in different age groups of children and (4) whether, as a result of fading immunity, older age groups 'paid for' the benefits which they had enjoyed when younger METHODS (1) Tabulation of earlier data to compare personal and community-wide effects against mosquito vectors; (2) two cross-sectional surveys for malaria parasitaemia, malarial fever, anaemia and splenomegaly in children in eight Tanzanian villages, in which there had been community-wide use of bednets which had been annually re-treated with alphacypermethrin for 3-4 years; (3) comparison between children of different age groups and with intact, torn or no nets in these villages and in 4-6 villages without nets RESULTS A 90-95% reduction in infective bites outside nets in netted villages and an additional 54-82% reduction of bites among individual net users Highly significant reductions (by 55-75%) in malarial morbidity for children aged 6 months to 2 years were found in netted villages with, for some outcomes, better results among individuals who themselves had intact treated nets For older children, benefits were less clear or absent, but there was no sign that the benefits early in life were 'paid for' by worse outcomes in the netted villages later in childhood CONCLUSIONS The overall benefits to the community of widespread use of treated nets are sustainable and are not reversed in 3-4 years as a result of fading immunity It is important to ensure high enough coverage to realize the full potential of the treated net method By showing an impact on the vector population in the community these results provide a strong argument for organized free provision of net treatment, rather than relying on marketing
188 citations
TL;DR: It is concluded that children with heavy worm burdens and poor nutritional status are most likely to suffer cognitive impairment, and the domains of verbal short‐term memory and speed of information processing are thosemost likely to be affected.
Abstract: Cross-sectional studies of the relationship between helminth infection and cognitive function can be informative in ways that treatment studies cannot However, interpretation of results of many previous studies has been complicated by the failure to control for many potentially confounding variables We gave Tanzanian schoolchildren aged 9-14 a battery of 11 cognitive and three educational tests and assessed their level of helminth infection We also took measurements of an extensive range of potentially confounding or mediating factors such as socioeconomic and educational factors, anthropometric and other biomedical measures A total of 272 children were moderately or heavily infected with Schistosoma haematobium, hookworm or both helminth species and 117 were uninfected with either species Multiple regression analyses, controlling for all confounding and mediating variables, revealed that children with a heavy S haematobium infection had significantly lower scores than uninfected children on two tests of verbal short-term memory and two reaction time tasks In one of these tests the effect was greatest for children with poor nutritional status There was no association between infection and educational achievement, nor between moderate infection with either species of helminth and performance on the cognitive tests We conclude that children with heavy worm burdens and poor nutritional status are most likely to suffer cognitive impairment, and the domains of verbal short-term memory and speed of information processing are those most likely to be affected
184 citations
TL;DR: Because many of the anticipated behavioural effects caused by insecticidal use will be avoided by the use of untreated nets, studies on the efficacy of untreatednets are required.
Abstract: The use of insecticide-treated bednets (ITNs) has been widely adopted as an important method for malaria control. Few data exist on effects of ITNs on mosquito biology and ecology, other than the development of insecticide resistance against the insecticides used. There is no hard evidence that the insecticide resistance recorded is the result of insecticidal use on bednets or from agricultural use. Resistance against pyrethroids, the preferred class of insecticides for ITN use, has been recorded from countries in Asia, Africa and South America. Resistance is expressed as reduced excito-repellency and mortality of mosquitoes exposed to insecticide-treated materials. In the absence of resistance, however, most studies on ITN effects report a reduced survival of adult mosquitoes as well as mass killing. Other effects are highly variable, and shifts in time of biting, feeding site and blood hosts have occasionally been reported, but not in proportion to the scale of ITN use. In general, a reduced sporozoite rate is recorded in ITN programmes. Because many of the anticipated behavioural effects caused by insecticidal use will be avoided by the use of untreated nets, studies on the efficacy of untreated nets are required. Examples are presented in which untreated nets provided a reasonable degree of protection against malaria.
179 citations
TL;DR: Investigation of domestic domain contamination with indicator bacteria showed that extreme contamination values that are often thought to originate within the domestic domain have to be attributed to the public domain transmission, i.e. filling and washing of the water pitchers.
Abstract: Even if drinking water of poor rural communities is obtained from a 'safe' source, it can become contaminated during storage in the house. To investigate the relative importance of this domestic domain contamination, a 5-week intervention study was conducted. Sixty-seven households in Punjab, Pakistan, were provided with new water storage containers (pitchers): 33 received a traditional wide-necked pitcher normally used in the area and the remaining 34 households received a narrow-necked water storage pitcher, preventing direct hand contact with the water. Results showed that the domestic domain contamination with indicator bacteria is important only when the water source is relatively clean, i.e. contains less than 100 Escherichia coli per 100 ml of water. When the number of E. coli in the water source is above this value, interventions to prevent the domestic contamination would have a minor impact on water quality compared with public domain interventions. Although the bacteriological water quality improved, elimination of direct hand contact with the stored water inside the household could not prevent the occasional occurrence of extreme pollution of the drinking water at its source. This shows that extreme contamination values that are often thought to originate within the domestic domain have to be attributed to the public domain transmission, i.e. filling and washing of the water pitchers. This finding has implications for interventions that aim at the elimination of these extreme contaminations.
176 citations
TL;DR: Cryptosporidium isolates from diarrhoeal stools of human immunodeficiency virus (HIV)‐infected patients in Thailand were genetically analysed by sequencing the variable region in the 18S rRNA gene and displayed unique sequences from those of other known species.
Abstract: Cryptosporidium isolates from diarrheal stools of HIV-infected patients in Thailand were genetically analyzed by sequencing the variable region in the 18S ribosomal ribonucleic acid (rRNA) gene. 29 isolates from 4 children and 25 adults attending King Chulalongkorn Memorial Hospital in Bangkok during 1996 and 2000 were analyzed. All patients suffered from chronic watery diarrhea and had low CD4+ lymphocytes (mean + or - standard deviation = 105.5 + or - 132.2 cells/mcl). 4 Cryptosporidium species were identified i.e. C. parvum (genotype 1) C. meleagridis C. muris and C. felis occurring in 24 3 1 and 1 isolates respectively. Oocysts of C. muris were significantly larger than oocysts of other species; C. felis was the smallest in these populations P < 0.01). Sequences of the internal transcribed spacer 1 (ITS1) 5.8S rRNA and ITS2 regions of C. muris and C. meleagridis identified in this study displayed unique sequences from those of other known species. Based on a limited number of isolates analyzed only C. meleagridis and C. muris were found in HIV-infected children whereas the genotype 1 of C. parvum predominated in HIV-infected adults. (authors)
164 citations
TL;DR: The relationship between socioeconomic status (SES), risk factors for HIV infection and HIV status in an urban population with high prevalence of HIV infection in sub‐Saharan Africa is examined.
Abstract: OBJECTIVE: To examine the relationship between socioeconomic status (SES), risk factors for HIV infection and HIV status in an urban population with high prevalence of HIV infection in sub-Saharan Africa. METHODS: Cross-sectional population survey of adults from the city of Kisumu, Kenya, in 1996. Around 1000 men and 1000 women aged 15-49 years were interviewed using a structured questionnaire, and most gave a venous blood sample for HIV testing. SES was represented by a composite variable of educational status, occupation and household utilities. Multiple regression was used to examine whether SES was associated with HIV infection or with risk factors for HIV infection. RESULTS: Human immunodeficiency virus prevalence was 19.8% in males and 30.2% in females. Higher SES was associated with a more mobile lifestyle, later sexual debut and marriage among both sexes, and with circumcision among men aged 25-49 and condom use among women aged 25-49. Higher levels of alcohol consumption were associated with an increased risk of HIV infection and were more common amongst those of higher SES. HSV-2 infection was strongly associated with an increased risk of HIV infection and was more common among those of lower SES. HIV was associated with a lower SES among females aged 15-24 whereas in males aged 15-24 and females aged 25-49 there was some indication that it was associated with higher SES. Among males aged 25-49 there was no association between HIV infection and SES. CONCLUSIONS: Risk of infection was high among groups of all SES. Risk profiles suggested men and women of lower SES maybe at greater risk of newly acquired HIV infection. New infections may now be occurring fastest among young women of the lowest SES.
163 citations
TL;DR: Determinants of diarrhoea morbidity included poor hygiene (unsafe disposal of faeces and wastewater), education level of household head, obtaining water from surface sources or wells and per capita water used for cleaning, and Hygiene practices are an important complement to improved water and sanitation in reducing diarrhoeA morbidity.
Abstract: published studies on domestic water use and environmental health in East Africa, based on direct observations or other reliable research methods. The objective of this study was to carry out a repeat analysis of domestic water use and environmental health in East Africa based on DOW I. The study was conducted in the same sites as DOW I. Field assistants spent at least 1 day in each household observing and conducting semi-structured interviews. They measured the amount of water collected, recorded the amount of water used in the home, and noted household socio-demographic characteristics, prevalence of diarrhoea, state and use of latrines, sources of water and conditions of use. We surveyed 1015 households in 33 sites in Uganda, Tanzania and Kenya in 1997. From 1967 to 1997, the prevalence of diarrhoea, in the week preceding the survey, increased from 6% to 18% in Kenya and from 16% to 21% in Uganda; it declined slightly in Tanzania (11–8%). Determinants of diarrhoea morbidity included poor hygiene (unsafe disposal of faeces and wastewater), education level of household head, obtaining water from surface sources or wells and per capita water used for cleaning. Hygiene practices are an important complement to improved water and sanitation in reducing diarrhoea morbidity.
TL;DR: Results show that secondary infection is very common in tungiasis, and caused by a variety of highly pathogenic microorganisms, including Staphyloccous aureus and various enterobacteriaceae.
Abstract: Tungiasis is caused by penetration of the female sand flea Tunga penetrans into the epidermis of its host. It is endemic in many countries in Latin America, the Caribbean and sub-Saharan Africa. Although superinfection is a common clinical observation, the frequency and the pattern of bacterial pathogens associated with tungiasis have never been investigated systematically. We conducted a prospective clinico-bacteriological study with patients living in a shantytown in Fortaleza, capital of Ceara State (Northeast Brazil), where tungiasis is hyperendemic. Swabs were taken from 78 patients with multiple lesions after surgical extraction of the parasite, and the specimens were cultured for aerobic and anaerobic microorganisms. Ninety-nine specimens were investigated for aerobic bacteria, from which 146 pathogens were identified. The most common species were Staphyloccous aureus (35.5%) and various enterobacteriaceae (29.5%). Bacillus sp., Enteroccous faecalis, Streptococcus pyogenes and Pseudomonas sp. were also isolated. Eighty-four anaerobic cultures yielded 20 pathogens: in eight cases we detected Peptostreptococcus sp., in seven cases Clostridium sp., and in five cases non-identifiable gram-negative bacilli. These results show that secondary infection is very common in tungiasis, and caused by a variety of highly pathogenic microorganisms. It is proposed that T. penetrans acts as a foreign body facilitating biofilm formation within the epidermis. To prevent spreading of pathogens to the surrounding tissue and/or the systemic circulation, sand fleas should be surgically extracted immediately after penetration.
TL;DR: People are willing to treat existing nets and to buy ITNs, but only if such services would be offered at reduced prices and in closer proximity to the households, have practical implications for the design of ITN programmes in rural areas of sub‐Saharan Africa (SSA).
Abstract: Malaria-related knowledge, attitudes and practices (KAP) were examined in a rural and partly urban multiethnic population of Kossi province in north-western Burkina Faso prior to the establishment of a local insecticide-treated bednet (ITN) programme. Various individual and group interviews were conducted, and a structured questionnaire was administered to a random sample of 210 heads of households in selected villages and the provincial capital of Nouna. Soumaya, the local illness concept closest to the biomedical term malaria, covers a broad range of recognized signs and symptoms. Aetiologically, soumaya is associated with mosquito bites but also with a number of other perceived causes. The disease entity is perceived as a major burden to the community and is usually treated by both traditional and western methods. Malaria preventive practices are restricted to limited chloroquine prophylaxis in pregnant women. Protective measures against mosquitoes are, however, widespread through the use of mosquito nets, mosquito coils, insecticide sprays and traditional repellents. Mosquito nets are mainly used during the rainy season and most of the existing nets are used by adults, particularly heads of households. Mosquito nets treated with insecticide (ITN) are known to the population through various information channels. People are willing to treat existing nets and to buy ITNs, but only if such services would be offered at reduced prices and in closer proximity to the households. These findings have practical implications for the design of ITN programmes in rural areas of sub-Saharan Africa (SSA).
TL;DR: To improve malaria control in this area, people need to be educated on the connection between mosquitoes and malaria and on seeking biomedical treatment for convulsions and the malaria control programme could collaborate with traditional and private health care providers to increase promotion of insecticide‐impregnated mosquito nets.
Abstract: To understand people's perceptions of malaria and their implications for control programmes, we held focus group discussions (FGDs) and conducted semi-structured interviews (SSIs) with community members in Mbarara, Uganda. Mosquitoes were perceived as the cause or transmitters of malaria but the causation/transmission model of people differed from biomedical facts. Convulsions, a common complication of malaria, were perceived as a supernatural ailment, best treated by traditional medicine, as was splenomegaly. More than 70% of the patients with malaria had treatment from non-public health sources. This included self-treatment (13%), use of traditional healers (12%) and use of private medical practitioners/pharmacists (69%). Although 26% (887/3309) used bednets to prevent malaria, only 7% of the nets were impregnated with insecticide. People who did not use bednets cited discomfort because of heat/humidity and their high cost as reasons. To improve malaria control in this area, people need to be educated on the connection between mosquitoes and malaria and on seeking biomedical treatment for convulsions. The malaria control programme could collaborate with traditional and private health care providers to increase promotion of insecticide-impregnated mosquito nets.
TL;DR: This work proposes an alternative explanation for a real, albeit temporal, mortality advantage for first‐generation immigrants, and argues that there are differences in the progression of the health transition between the immigrants’ countries of origin and industrialized host countries.
Abstract: First-generation immigrant populations in industrialized countries frequently have a lower mortality than the host population, a finding that is unexpected and often dismissed as the result of bias. We propose an alternative explanation for a real, albeit temporal, mortality advantage. We base our argument on two premises: First, that there are differences in the progression of the health transition between the immigrants’ countries of origin and industrialized host countries; and, second, that there are differences in the speed at which changes in mortality from various causes occur after migration. Mortality from treatable communicable and maternal conditions, still high in many countries of origin, quickly declines to levels close to those of the host country. Mortality from ischaemic heart disease, the most common cause of death in the host countries, takes years or decades to rise to comparable heights. This is because of the time lag between increases in risk factor levels and an increased risk of coronary death. Hence, first-generation immigrants may initially experience a lower mortality than the host population, a point that has so far been under-appreciated in discussions of immigrant mortality. After adopting a western lifestyle immigrants face an increasing risk of ischaemic heart disease. The increase occurs on top of a persisting risk from conditions associated with childhood deprivation, e.g. stomach cancer and stroke – the unfinished agenda of the health transition that immigrants experience.
TL;DR: Significant positive association of F. hepatica with protozooses following a one host life cycle, such as Giardia intestinalis suggests that human infection mainly occurs through drinking water.
Abstract: We detected 10 protozoan and nine helminth species in surveys of 338 5-15 year-old Quechua schoolchildren in three communities of the Asillo zone of the Puno region, located at a very high altitude of 3910 m in the Peruvian Altiplano. The area proved to be hyperendemic for human fascioliasis with a 24.3% overall mean prevalence of Fasciola hepatica, local prevalences ranging between 18.8 and 31.3%, and infection intensities of up to 2496 eggs per gram of faeces (epg), with 196-350 epg (mean: 279 epg) and 96-152 epg (123 epg) as arithmetic and geometric means, respectively. Prevalences did not significantly vary between schools and in relation to sex. No statistical differences were found in intensities between schools, nor according to sex or age groups between and within schools, although the highest overall egg counts were detected in girls and in the youngest age group. Asillo zone is a man-made irrigation area built only recently to which both liver fluke and lymnaeid snails have quickly adapted. The region appears to be isolated from the Northern Bolivian Altiplano natural endemic area. Such man-made water resources in high altitude areas of Andean countries pose a high fascioliasis risk. Significant positive association of F. hepatica with protozooses following a one host life cycle, such as Giardia intestinalis, suggests that human infection mainly occurs through drinking water. This is supported by additional evidence such as the absence of typical aquatic vegetation in the drainage channels inhabited by lymnaeid snails, the absence of aquatic vegetables in the traditional nutrition habits of the Quechua inhabitants, and the lack of potable water systems inside dwellings, which requires inhabitants to obtain water from irrigation canals and drainage channels.
TL;DR: This study aims to determine the frequency and determinants of knowledge of dengue infection in three sites in northern Thailand, and to compare prevention measures of people with and without knowledge ofdengue.
Abstract: Summary objective To determine the frequency and determinants of knowledge of dengue infection in three sites in northern Thailand, and to compare prevention measures of people with and without knowledge of dengue. methods In May 2001 we conducted an epidemiological survey among 1650 persons living in three areas in northern Thailand. Knowledge of dengue and the use of prevention measures were measured by means of a structured questionnaire. Differences in knowledge of dengue and the use of prevention measures between risk groups were calculated by chi-square test. Logistic regression was used to identify determinants of knowledge. results Of the 1650 persons, 67% had knowledge of dengue. Fever (81%) and rash (77%) were the most frequently mentioned symptoms. Persons with knowledge of dengue reported a significantly higher use of prevention measures than persons without knowledge of dengue. In multivariate analyses, knowledge of dengue significantly differed by age, sex, occupation and site (P < 0.05). Younger people knew more about dengue than older persons: adjusted odds ratio (aOR) of 6.75 [95% confidence interval (CI): 4.32‐10.6] for the 15‐29 age group compared with people aged 60 and older. In comparison with farmers (reference group), knowledge of dengue was significantly higher among students (aOR: 10.6, 95% CI: 4.27‐26.4), but lower among housewives or unemployed persons (aOR: 0.44, 95% CI: 0.31‐0.64). conclusion The overall knowledge of dengue was high, but housewives, unemployed and old persons had relatively little knowledge of dengue. Therefore, these groups may need special attention in future dengue education programmes. Persons with knowledge of the disease more frequently reported the use of preventive measures, indicating the value of education programmes as a tool in dengue prevention.
TL;DR: This work estimates the economic effects of integrated malaria control implemented during the colonial period and sustained for 20 years in four copper mining communities of the former Northern Rhodesia (now Zambia) and concludes that copper extraction and social and economic development would have been impossible without it.
Abstract: It has long been suggested that malaria is delaying the economic development of countries that are most severely affected by the disease. Several studies have documented the economic consequences of malaria at the household level, primarily in communities engaged in subsistence farming. A missing element is the appraisal of the economic impact of malaria on the industrial and service sectors that will probably become the backbone of many developing economies. We estimate the economic effects of integrated malaria control implemented during the colonial period and sustained for 20 years in four copper mining communities of the former Northern Rhodesia (now Zambia). Integrated malaria control was characterized by strong emphasis on environmental management, while part of the mining communities also benefited from rapid diagnosis and treatment and the use of bednets. The programmes were highly successful as an estimated 14,122 deaths, 517,284 malaria attacks and 942,347 work shift losses were averted. Overall, 127,226 disability adjusted life years (DALYs) were averted per 3-year incremental period. The cumulative costs of malaria control interventions were 11,169,472 US dollars (in 1995 US dollars). Because the control programmes were so effective, the mining companies attracted a large reservoir of migrant labourers and sustained healthy work forces. The programmes averted an estimated 796,622 US dollars in direct treatment costs and 5,678,745 US dollars in indirect costs as a result of reduced work absenteeism. Within a few years of programme initiation, Northern Rhodesia became the leading copper producer in Africa, and mining generated the dominant share of national income. Copper production and revenues, which increased dramatically during malaria control interventions, amounted to the equivalent of 7.1 billion US dollars (in 1995 US dollars). Integrated malaria control in copper mining communities was a sound investment. It had payoff for public and occupational health, generally, and without it copper extraction and social and economic development would have been impossible.
TL;DR: This review discusses how the use of molecular genetic techniques such as the polymerase chain reaction are helping in the management and prevention of malaria.
Abstract: This review discusses how the use of molecular genetic techniques such as the polymerase chain reaction are helping in the management and prevention of malaria.
TL;DR: The common immunopathogenetic basis for the deleterious effects parasitic diseases may have on the natural history of HIV infection seems to be a particular type of chronic immune activation and a preferential activation of the T helper (Th)2 type of help.
Abstract: HIV and parasitic infections interact and affect each other mutually. Whereas HIV infection may alter the natural history of parasitic diseases, impede rapid diagnosis or reduce the efficacy of antiparasitic treatment, parasitoses may facilitate the infection with HIV as well as the progression from asymptomatic infection to AIDS. We review data on known interactions for malaria, leishmaniasis, Human African Trypanosomiasis, Chagas' disease, onchocerciasis, lymphatic filariasis, schistosomiasis and intestinal helminthiases. The common immunopathogenetic basis for the deleterious effects parasitic diseases may have on the natural history of HIV infection seems to be a particular type of chronic immune activation and a preferential activation of the T helper (Th)2 type of help. Control of parasitic diseases should complement the tools currently used in combating the HIV pandemic.
TL;DR: To compare the sensitivity, specificity and post‐treatment persistence of three commonly used rapid antigen detection methods, a sensitivity and specificity study is conducted at the single-shot and double-shot levels.
Abstract: OBJECTIVES To compare the sensitivity, specificity and post-treatment persistence of three commonly used rapid antigen detection methods.
METHOD We studied 252 Vietnamese patients aged from 4 to 60 years, 157 with falciparum and 95 with vivax malaria and 160 healthy volunteers. An initial blood sample was taken for microscopy, and OptiMAL®, immunochromatographic test (ICT) malaria P.f./P.v.® and Paracheck-Pf® tests. Patients with falciparum malaria were treated with an artesunate-based combination regimen and those with vivax malaria received chloroquine. Eighty-seven patients with falciparum malaria who were initially positive for one of the antigen tests and who remained blood smear-negative underwent follow-up testing over 28 days.
RESULTS Paracheck-Pf® was the most sensitive test for Plasmodium falciparum (95.8% vs. 82.6% for ICT malaria P.f./P.v.® and 49.7% for OptiMAL®). Specificities were all 100%. For vivax malaria, OptiMAL® performed better than ICT malaria P.f./P.v.® (sensitivities 73.7% and 20.0%, respectively), with 100% specificity in both cases. All tests had low sensitivities (≤ 75.0%) at parasitaemias 10 000/μl). Residual OptiMAL® positivity occurred only in a relatively small proportion of patients ( 10 000/μl during the first 2 weeks after treatment.
CONCLUSIONS Although microscopy remains the gold standard for malaria diagnosis, Paracheck-Pf® may prove a useful adjunctive test in uncomplicated falciparum malaria in southern Vietnam. OptiMAL® had the lowest sensitivity for P. falciparum but it might have a use in the diagnosis of vivax malaria and perhaps to monitor efficacy of treatment for falciparum malaria where microscopy is unavailable.
TL;DR: This study was designed to assess the diagnostic utility of both the standard test and a commonly employed modified test in the diagnosis of dengue haemorrhagic fever.
Abstract: Summary OBJECTIVES A positive tourniquet test is one of several clinical parameters considered by the World Health Organization to be important in the diagnosis of dengue haemorrhagic fever, but no formal evaluation of the test has been undertaken. As many doctors remain unconvinced of its usefulness, this study was designed to assess the diagnostic utility of both the standard test and a commonly employed modified test. METHODS METHODS A prospective evaluation of the standard sphygmomanometer cuff tourniquet test, compared with a simple elastic cuff tourniquet test, was carried out in 1136 children with suspected dengue infection admitted to a provincial paediatric hospital in southern Viet Nam. RESULTS RESULTS There was good agreement between independent observers for both techniques, but the sphygmomanometer method resulted in consistently greater numbers of petechiae. This standard method had a sensitivity of 41.6% for dengue infection, with a specificity of 94.4%, positive predictive value of 98.3% and negative predictive value of 17.3%. The test differentiated poorly between dengue haemorrhagic fever (45% positive) and dengue fever (38% positive). The simple elastic tourniquet was less sensitive than the sphygmomanometer cuff, but at a threshold of 10 petechiae (compared with the WHO recommendation of 20) per 2.5 cm 2 the sensitivity for the elastic tourniquet rose to 45% (specificity 85%). Other evidence of bleeding was frequently present and the tourniquet test provided additional information to aid diagnosis in only 5% of cases. CONCLUSION CONCLUSION The conventional tourniquet test adds little to the diagnosis of dengue in hospitalized children. The simple, cheap elastic tourniquet may be useful in diagnosing dengue infection in busy rural health stations in dengue endemic areas of the tropics. A positive test should prompt close observation or early hospital referral, but a negative test does not exclude dengue infection.
TL;DR: The effectiveness of the partnership emerges from its review process, flexibility to modify its modus operandi to overcome obstacles, independence from the commercial sector, and its ability to link access, rational use, technical assistance, and policy development.
Abstract: Public-private partnerships have become central to efforts to combat infectious diseases. The characteristics of specific partnerships, their governance structures, and their ability to effectively address the issues for which they are developed are being clarified as experience is gained. In an attempt to promote access to and rational use of second-line anti-tuberculosis (TB) drugs for the treatment of multidrug-resistant TB, a unique partnership known as the Green Light Committee (GLC) was established by the World Health Organization. This partnership relies on five categories of actors to achieve its goal: academic institutions, civil society organizations, bilateral donors, governments of resource-limited countries, and a specialized United Nations agency. While the for-profit private sector is involved in terms of supplying concessionally priced drugs it is excluded from decision-making. The effectiveness of the partnership emerges from its review process, flexibility to modify its modus operandi to overcome obstacles, independence from the commercial sector, and its ability to link access, rational use, technical assistance, and policy development. The GLC mechanism may be useful in the development of other partnerships needed in the rational allocation of resources and tools for combating additional infectious diseases.
TL;DR: Prevalence of FGC was highest among the Bini and Urhobo, among those with the least education, and particularly high among adherents to Pentecostal churches; this was independent of related social factors.
Abstract: Despite growing public resistance to the practice of female genital cutting (FGC), documentation of its prevalence, social correlates or trends in practice are extremely limited, and most available data are based on self-reporting. In three antenatal and three family planning clinics in South-west Nigeria we studied the prevalence, social determinants, and validity of self-reporting for FGC among 1709 women. Women were interviewed on social and demographic history, and whether or not they had undergone FGC. Interviews were followed by clinical examination to affirm the occurrence and extent of circumcision. In total, 45.9% had undergone some form of cutting. Based on WHO classifications by type, 32.6% had Type I cuts, 11.5% Type II, and 1.9% Type III or IV. Self-reported FGC status was valid in 79% of women; 14% were unsure of their status, and 7% reported their status incorrectly. Women are more likely to be unsure of their status if they were not cut, or come from social groups with a lower prevalence of cutting. Ethnicity was the most significant social predictor of FGC, followed by age, religious affiliation and education. Prevalence of FGC was highest among the Bini and Urhobo, among those with the least education, and particularly high among adherents to Pentecostal churches; this was independent of related social factors. There is evidence of a steady and steep secular decline in the prevalence of FGC in this region over the past 25 years, with age-specific prevalence rates of 75.4% among women aged 45-49 years, 48.6% among 30-34-year olds, and 14.5% among girls aged 15-19. Despite wide disparities in FGC prevalence across ethnic, religious and educational groups, the secular decline is evident among all social subgroups.
TL;DR: To evaluate the quality of pharmaceutical care of malaria for children in eastern Uganda prescribed at government health units and drug shops, and administered by caretakers at home, and to assess its appropriateness in relation to national treatment guidelines, which recommend chloroquine over 3 days.
Abstract: This study aimed to evaluate the quality of pharmaceutical care of malaria for children in eastern Uganda prescribed at government health units and drug shops and administered by caretakers at home; and to assess its appropriateness in relation to national treatment guidelines which recommend chloroquine over 3 days. The authors followed 463 children under 5 years whose caretakers attended two drug shops and two government health units to seek treatment for fever. The children were examined and the caretakers interviewed on the day of the day of enrollment in the study (day 0) and in their homes on days 3 and 7. Data was collected on drug use prior to attending the shop or health unit the treatment provided at these study sites and the administration of drugs at home over the following 3 days. Results showed that before attending the study sites 72% of children had already been given some biomedical drugs and 40% had received the recommended drug chloroquine. Health workers prescribed chloroquine for 94% of the children but only 34% of the recommended doses followed guidelines. Two-thirds of the children were prescribed an injection of chloroquine. By day 3 according to caretaker reports about 38% of the children had received chloroquine in compliance with the instructions given by the health workers and drug shop attendants. Only 28% of the children had received chloroquine at the optimal dose of 20-30 mg/kg recommended by national policy. Overall the methods were useful for examining adherence of both caretakers and health care providers to national guidelines and the extent to which caretakers were compliant with providers prescriptions. Chloroquine and antipyretics were the drugs of choice for fever in these areas of rural eastern Uganda. But children did not receive the recommended dosage of chloroquine because of lack of compliance on the parts of providers as well as users of health care. (authors)
TL;DR: 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, the aim is to establish a baseline for estimating the cost of this programme.
Abstract: OBJECTIVES: 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.
TL;DR: DEN infections are frequent in travellers to endemic areas in Asia; most remain subclinical; the risk of infection showed marked seasonal variation.
Abstract: We studied the incidence of dengue virus (DEN) infections in a cohort of Dutch short-term travellers to endemic areas in Asia during 1991-92. Sera were collected before and after travel. All post-travel sera were tested for DEN immunoglobulin M (IgM) [IgM capture (MAC)-enzyme-linked immunosorbent assay (ELISA)] and IgG (indirect ELISA). Probable DEN infection was defined as IgM seroconversion or a fourfold rise in IgG ratio in the absence of cross-reaction with antibody to Japanese encephalitis virus (JEV). Infections were considered clinically apparent in case of febrile illness (> 24 H) with headache, myalgia, arthralgia or rash. Probable DEN infection was found in 13 of 447 travellers (incidence rate 30/1000 person-months, 95% CI 17.4-51.6). One infection was considered secondary; no haemorrhagic fever occurred. The clinical-to-subclinical infection rate was 1 : 3.3. The risk of infection showed marked seasonal variation. DEN infections are frequent in travellers to endemic areas in Asia; most remain subclinical.
TL;DR: To measure the prevalence of depression amongst postpartum and non‐postpartum Nepalese women in Kathmandu using the Edinburgh Postpartum Depression Scale (EPDS) and to assess the ease of use and validity of the scale compared with Diagnostic and Statistical Manual of Mental Disorders (DSM‐IV) criteria for major depression.
Abstract: The aim of this study is to measure the prevalence of depression among postpartum and non-postpartum Nepalese women in Kathmandu using the Edinburgh Postpartum Depression Scale (EPDS) and to assess the ease of use and validity of the scale compared with Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for major depression. The authors screened 100 women 2-3 months post-delivery and 40 control women using the EPDS. All those who screened positive for depression and 20% of the negatives also underwent a structured interview to assess depression by DSM-IV criteria. Findings revealed that the predictive errors were minimized by using an EPDS score > or = 13 to define depression. Using this threshold there was no difference in depression prevalence between postpartum women (12%) and the control group (12.5%) (Fishers exact test P > 0.05). Compared with DSM-IV the sensitivity specificity and positive predictive values were 100 92.6 and 41.6% respectively. Overall the prevalence of postpartum depression (PPD) in Nepalese women and the validity and ease of use of the EPDS in the setting of a postnatal clinic in Kathmandu are all surprisingly similar to the results of numerous studies in developed countries. Despite poor living conditions PPD is no more common than the background depression rate among Nepalese women. It can be reliably detected by trained clinical nurses using the EPDS screening test. These results may have implications for the planning of mental health resources for women in other developing countries. (authors)
TL;DR: High proportions of acceptance and receipt of VCT in this rural population‐based cohort are indicated, suggesting that home delivery of V CT could offer a unique opportunity for people in the rural areas to access counselling and testing services, given adequate resources.
Abstract: During 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 776% 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 646% 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
TL;DR: To study the uptake of socially marketed insecticide‐treated nets and their impact on malaria and anaemia in pregnancy; and to report on a discount voucher system which aimed to increase coverage in pregnancy.
Abstract: To study the uptake of socially marketed insecticide-treated nets (ITNs) and their impact on malaria and anaemia in pregnancy; and to report on a discount voucher system which aimed to increase coverage in pregnancy.A 12-month cross-sectional study of women in the second or third trimester of pregnancy. ITN use and other factors were assessed by questionnaire and a blood sample taken for malaria parasitaemia and anaemia. 'Non-users' of ITNs included both women not using any net and women using untreated nets. Fifty three per cent of pregnant women used ITNs. Women aged 15-19, primigravidae, unmarried women, and those with no access to cash had the lowest ITN use. Fewer ITN users were positive for malaria than ITN non-users (25 vs. 33%: P=0.06), and the protective efficacy (PE) for parasitaemia was 23% (CI 2-41). Multiparous ITN users had a twofold decrease in parasite density compared with multiparous non-ITN users (625 parasites/microl vs. 1173 parasited/microl: P=0.01). Fewer ITN users were anaemic (Hb < 11 g/dl) than ITN non-users (72 vs. 82%: P=0.01). ITNs had a PE of 12% (CI 2-21) against mild anaemia and a PE of 38% (CI 4-60) against severe anaemia (Hb < 8 g/dl). There was a trend in the prevalence of severe, mild and no anaemia, and of high density, low density and no malaria infection by ITN status. Recently treated nets were most effective at preventing malaria and anaemia (prevalence of mild anaemia was 68% compared with 82% for those without nets (P=0.002); prevalence of malaria was 22% compared with 33% for those without nets (P=0.02). Knowledge and reported use of the discount voucher system were low. Further qualitative research is ongoing. A modest impact of ITNs on pregnancy malaria and anaemia was shown in our high malaria transmission setting. The development of ITN programmes for malaria control should include pregnant women as a specific target group.