Therapeutic efficacy of antimalarial drugs along the eastern Indo-Nepal border: a cross-border collaborative study.

This collaborative cross-border study was performed to determine the therapeutic efficacy of antimalarial drugs used by the National Programmes for falciparum malaria along the eastern Indo-Nepal border where there is unregulated population movement across the border. The study was conducted at sites in Jhapa District, Nepal and Darjeeling District, India. The study was conducted from August 2003 to February 2004, following the WHO 28 day treatment protocol. The efficacy of chloroquine was tested in India among 91 subjects and of sulfadoxine-pyrimethamine in Nepal among 107 subjects with laboratory-confirmed Plasmodium falciparum malaria. Of the 102 subjects who completed the study in Nepal, there were 21 (20.6%) treatment failures comprising 7 (6.9%) early treatment failures (ETF) and 14 (14.7%) late treatment failures (LTF) (5 late clinical failures [LCF] and 9 late parasitological failures [LPF]). Of the 89 subjects who completed the study in India, there were 46 (51.7%) treatment failures comprising 7 (7.9%) ETFs and 39 (43.8%) LTFs (13 LCFs and 26 LPFs). Based on WHO guidelines both countries need to review their drug policy urgently and make appropriate changes, taking into account aspects of cross-border collaboration in the control of drug-resistant malaria.

Development and evaluation of a health education intervention against Taenia solium in a rural community in Mexico.

A comprehensive study was undertaken in a rural community in the state of Morelos, Mexico to evaluate health education as an intervention measure against Taenia solium. An educational program was developed to promote recognition and knowledge of the transmission of the parasite and to improve hygienic behavior and sanitary conditions that foster transmission. The effects of educational intervention were evaluated by measuring changes in knowledge and practices and prevalence of human taeniasis and swine cysticercosis before and after the campaign. The health education strategy was implemented with the active participation of the population based on the information obtained from a sociologic study. A questionnaire was designed and used before, immediately after the intervention, and six months later. Statistically significant improvements occurred in knowledge of the parasite, its life cycle, and how it is acquired by humans; however, changes in behavior related to transmission were less dramatic and persistent. The prevalences of cysticercosis in pigs at the start of the education intervention were 2.6% and 5.2% by lingual examination and antibody detection (immunoblot assay), respectively, and approximately one year after the intervention they were 0% and 1.2% (P < 0.05). These changes were accompanied by significant reductions in the reported access of pigs to sources of infection and freedom to roam. We conclude that health education, developed along with community involvement, reduced opportunities for transmission of T. solium in the human-pig cycle.

PIP: Neurocysticercosis is an important health problem in Mexico, as well as in many other countries of Latin America, Asia, and Africa where conditions permit completion of the cestode's life cycle in pigs and humans. A study was conducted in a rural community in the state of Morelos, Mexico, to determine whether health education could be an effective measure against Taenia solium. An educational program was developed with community input to promote recognition and knowledge of the transmission of the parasite and to improve hygienic behavior and sanitary conditions which foster transmission. The effects of the educational intervention were then assessed by measuring changes in knowledge, practices, and the prevalence of human taeniasis and swine cysticercosis before and after the campaign. Statistically significant improvements occurred with regard to knowledge of the parasite, its life cycle, and how it is acquired by humans. However, changes in behavior related to transmission were less marked and persistent. Lingual examination and antibody detection found cysticercosis among 2.6% and 5.2% of pigs, respectively, at the start of the intervention. At approximately 1 year after the intervention, prevalences had declined to 0% and 1.2%. The decline was accompanied by significant reductions in the reported access of pigs to sources of infection and freedom to roam.

Evaluation of the diethylcarbamazine provocative test in the diagnosis of Wuchereria bancrofti infections in the Nigerian savanna and the effects on Dipetalonema perstans.

Large scale filariasis surveys in rural areas for microfilaraemia, especially of periodic types such as Wuchereria bancrofti are known to cause considerable administrative, technical and social problems. The present investigation was carried out in the population of two villages in the Malumfashi district of the Northern Nigerian savanna. From the survey results, the sensitivity and specificity of two techniques-day-time diethylcarbamazine (DEC) provocative test by blood smear and concentration, and night-blood examination by smear and concentration especially for W. bancrofti-were assessed. Day-time DEC provocative test proved to be efficient in terms of sensitivity and specificity, compared with the night-blood method, for W. bancrofti detection but less so for Dipetalonema perstans, the other blood microfilaria found in this population during these studies. A regression line between night-blood survey results for W. bancrofti and the results from day-time DEC provocative test was calculated. With the help of this regression line it is possible to estimate W. bancrofti microfilarial prevalence for night surveys, using the DEC provocative test results of day-time surveys. This can be done with minimal, but known, loss of accuracy and incurs fewer administrative, technical and social difficulties.

Endemic disease and development: the leishmaniases.

Health and sustainable development are intricately interwoven. Communities under pressure from a barrage of endemic diseases face tremendous obstacles in achieving an improved quality of life. The leishmaniases are examples of hitherto underestimated parasitic zoonoses which place those communities affected at significant risk of morbidity, debility and mortality. This article summarizes the experience of community-based applied research projects on leishmaniasis supported by the Canadian International Development Research Centre, in Lebanon, Jordan, Ethiopia, Kenya, Tunisia, Mexico, Costa Rica, Colombia, Peru, and Brazil. The article examines the role of leishmaniasis-associated morbidity versus mortality, and the impact of these diseases on a community's capacity to develop. It further analyzes the various determinants of leishmaniasis infection, disease and outcomes, and their interactions at the individual as well as the community level. Adverse health implications as a result of external and intervening factors are examined. Such factors include ecological/environmental changes such as those arising from developmental projects, unplanned urbanization, and continuous movements of populations. The paper views strategies for prevention and control of leishmaniases in the context of socio-political and economic constraints of the affected countries. Particularly emphasized is the need to take into account the knowledge base, beliefs, perceptions and practices of the population by incorporating active community participation in preventive and intervention practices. Leishmaniasis poses a particular challenge to classical health systems that tend to resist innovative change needed to address socio-political and economic realities of the present and future decades.

Seroprevalence of West Nile, Rift Valley, and sandfly arboviruses in Hashimiah, Jordan.

We conducted a serosurvey among patients of a health center in Hashimiah, a Jordanian town of 30,000 inhabitants located near a wastewater treatment plant and its effluent channel. Serum samples from 261 patients >/=5 years of age were assessed for immunoglobulin G (IgG) and IgM antibodies against West Nile, sandfly Sicilian, sandfly Naples, and Rift Valley viruses; the seroprevalence of IgG antibodies was 8%, 47%, 30%, and 0%, respectively. Female participants were more likely to have been infected than male. Persons living within 2 km of the treatment plant were more likely to have been infected with West Nile (p=0.016) and sandfly Sicilian (p=0.010) viruses. Raising domestic animals within the house was a risk factor for sandfly Sicilian (p=0.003) but not for sandfly Naples virus (p=0.148). All serum samples were negative for IgM antibodies against the tested viruses. Our study is the first documentation of West Nile and sandfly viruses in Jordan and calls attention to the possible health hazards of living close to wastewater treatment plants and their effluent channels.