Toxoplasmosis among pregnant women: high seroprevalence and risk factors in Kinshasa, Democratic Republic of Congo

<p><b>OBJECTIVE</b>To determine the seroprevalence of toxoplasmosis in pregnant women, as well as the proportion of acutely infected and risk factors in the Democratic Republic of Congo.</p><p><b>METHODS</b>Thirty maternities in Kinshasa were randomly selected and women attending antenatal consultation were invited to participate. They were interviewed with a structured questionnaire about known risk factors (age, meat consumption, contact with soil, and presence of cat) and a venous blood sample was taken. Sera were analysed for total immunoglobulins (Ig) by VIDAS Toxo Competition using Enzyme Linked Fluorescent Assay. IgM was determined by VIDIA Toxo IgM and IgG avidity by VIDAS Toxo IgG avidity.</p><p><b>RESULTS</b>A total of 781 women were included. Median age was 28 years old (IQR: 8.5). And 627 women (80.3%; 95% CI: 77.5-83.1) were found to be positive to total Ig and 17 out of 387 (4.4%; 95% CI: 2.3-6.4) were positive to IgM. IgG avidity was low for 2 (11.8%) women, intermediate for 2 (11.8%) and high for 13 women (76.4%). There was no statistically significant association between Toxoplasma gondii infection and any risk factors assessed.</p><p><b>CONCLUSION</b>In Kinshasa, toxoplasmosis endemicity is highly prevalent. One woman out of twenty five had a recent toxoplasmosis infection and 20% were not protected against primo-infection, indicating a need for measures to prevent and control toxoplasmosis during pregnancy.</p>

Toxoplasmosis among pregnant women：High seroprevalence and risk factors in Kinshasa, Democratic Republic of Congo

Objective:To determine the seroprevalence of toxoplasmosis in pregnant women, as well as the proportion of acutely infected and risk factors in the Democratic Republic of Congo. Methods:Thirty maternities in Kinshasa were randomly selected and women attending antenatal consultation were invited to participate. They were interviewed with a structured questionnaire about known risk factors (age, meat consumption, contact with soil, and presence of cat) and a venous blood sample was taken. Sera were analysed for total immunoglobulins (Ig) by VIDAS Toxo Competition using Enzyme Linked Fluorescent Assay. IgM was determined by VIDIA Toxo IgM and IgG avidity by VIDAS Toxo IgG avidity. Results: A total of 781 women were included. Median age was 28 years old (IQR: 8.5). And 627 women (80.3%; 95%CI: 77.5-83.1) were found to be positive to total Ig and 17 out of 387 (4.4%;95%CI: 2.3-6.4) were positive to IgM. IgG avidity was low for 2 (11.8%) women, intermediate for 2 (11.8%) and high for 13 women (76.4%). There was no statistically significant association between Toxoplasma gondii infection and any risk factors assessed. Conclusion: In Kinshasa, toxoplasmosis endemicity is highly prevalent. One woman out of twenty five had a recent toxoplasmosis infection and 20%were not protected against primo-infection, indicating a need for measures to prevent and control toxoplasmosis during pregnancy.

Vector control interventions for visceral leishmaniasis elimination initiative in South Asia, 2005-2010.

The Visceral Leishmaniasis (VL) Elimination Initiative in the Indian subcontinent was launched in 2005 as a joint effort between the governments in the Region (India, Nepal and Bangladesh) and the World Health Organization (WHO). The objective is to reduce the annual VL incidence below 1/10,000 inhabitants by 2015 based on detection and treatment of VL cases and vector control. We present here a review of studies published in the period 2005-2010 on the efficacy of different tools to control Phlebotomus argentipes. The review indicates that the current indoor residual spraying (IRS) and novel vector control methods mainly insecticide treated nets (ITN) have low effectiveness for several reasons. Efforts to improve quality of IRS operations and further research on alternative and integrated vector control methods need to be promoted to reach the VL elimination target by 2015.

Challenge of Reducing Perinatal Mortality in Rural Congo: Findings of a Prospective, Population-based Study.

Each year, an estimated six million perinatal deaths occur worldwide, and 98% of these deaths occur in low- and middle-income countries. These estimates are based on surveys in both urban and rural areas, and they may underrepresent the problem in rural areas. This study was conducted to quantify perinatal mortality, to identify the associated risk factors, and to determine the most common causes of early neonatal death in a rural area of the Democratic Republic of the Congo (DRC). Data were collected on 1,892 births. Risk factors associated with perinatal deaths were identified using multivariate analysis with logistic regression models. Causes of early neonatal deaths were determined by physician-review of information describing death. The perinatal mortality rate was 61 per 1,000 births; the stillbirth rate was 30 per 1,000 births; and the early neonatal death rate was 32 per 1,000 livebirths. Clinically-relevant factors independently associated with perinatal death included: low birthweight [odds ratio (OR)=13.51, 95% confidence interval (CI) 7.82-23.35], breech presentation (OR)=12.41; 95% CI 4.62-33.33), lack of prenatal care (OR=2.70, 95% CI 1.81-4.02), and parity greater than 4 (OR=1.93 95% CI 1.11-3.37). Over one-half of early neonatal deaths (n=37) occurred during the first two postnatal days, and the most common causes were low birthweight/prematurity (47%), asphyxia (34%), and infection (8%). The high perinatal mortality rate in rural communities in the DRC, approximately one-half of which is attributable to early neonatal death, may be modifiable. Specifically, deaths due to breech presentation, the second most common risk factor, may be reduced by making available emergency obstetric care. Most neonatal deaths occur soon after birth, and nearly three-quarters are caused by low birthweight/prematurity or asphyxia. Neonatal mortality might be reduced by targeting interventions to improve neonatal resuscitation and care of larger preterm infants.

How do health care providers deal with kala-azar in the Indian subcontinent.

Background & objectives: Three countries, Bangladesh, India and Nepal, set out to eliminate kala-azar by 2015. This study was aimed to document the knowledge and practices in kala-azar case management of public and private health providers in these three countries. Methods: A health care provider survey was conducted in 2007 at 4 study sites, viz., Muzaffarpur and Vaishali districts in India, Mahottari district in Nepal, and Rajshahi district in Bangladesh. Interviews were conducted with formal and informal health care providers at their home or practice. Results: About half of the providers in India and Nepal knew the rapid diagnostic test rK39 recommended by the elimination initiative, but this was not in Bangladesh. Knowledge of the recommended first-line drug, miltefosine, was good in India and Nepal but less so in Bangladesh. Interpretation & conclusions: Innovative tools for VL care have not yet been fully taken up by private for profit care providers in the three countries that launched a VL elimination initiative. The elimination initiative needs to address these gaps in private providers’ knowledge, given their substantial share in the care of VL patients.

Effect of untreated bed nets on blood-fed Phlebotomus argentipes in kala-azar endemic foci in Nepal and India

Observational studies in the Indian subcontinent have shown that untreated nets may be protective against visceral leishmaniasis (VL). In this study, we evaluated the effect of untreated nets on the blood feeding rates of Phlebotomus argentipes as well as the human blood index (HBI) in VL endemic villages in India and Nepal. The study had a "before and after intervention" design in 58 households in six clusters. The use of untreated nets reduced the blood feeding rate by 85 percent (95 percent CI 76.5-91.1 percent) and the HBI by 42.2 percent (95 percent CI 11.1-62.5 percent). These results provide circumstantial evidence that untreated nets may provide some degree of personal protection against sand fly bites.

Participación comunitaria en la prevención del dengue: un abordaje desde la perspectiva de los diferentes actores sociales / Community participation in dengue prevention: an approach from the perspective of different social actors

OBJETIVO: explorar las percepciones sobre la participación comunitaria en la prevención del dengue durante la investigación formativa de un proyecto comunitario. MATERIAL Y MÉTODOS: Estudio conducido en tres  reas de salud de Santiago de Cuba durante el año 2000. Se combinan técnicas cualitativas y cuantitativas para explorar opiniones de los profesionales de salud, líderes comunitarios y una muestra aleatoria de población. RESULTADOS: Los profesionales identifican la no participación de la comunidad y sus propias limitaciones para involucrarla activamente en la prevención. Los líderes refieren falta de motivación, y la población vincula la eliminaci¢n del vector con el uso de tecnologías. Se perciben barreras en la aceptación de las actividades del programa de control y en general la "participación" es interpretada como "colaboración". CONCLUSIONES: La población ha trasferido responsabilidad del control del Aedes aegypti al sector salud. Se evidencia la necesidad de unificar conceptos sobre la participación comunitaria y conciliar intereses entre usuarios y proveedores de los servicios para lograr una real movilización social.

Participación comunitaria en el control de Aedes aegypti: opiniones de la población en un municipio de La Habana, Cuba / Community participation in the control of Aedes aegypti: opinions of the population in one section of Havana, Cuba

OBJETIVO: Analizar las opiniones sobre la participación comunitaria entre los residentes de un municipio de Ciudad de La Habana, Cuba, con el fin de identificar los criterios clave para elaborar una estrategia participativa de control de Aedes aegypti. MÉTODOS: El estudio se realizó de septiembre a octubre de 1999 en el municipio Playa de Ciudad de La Habana, Cuba. En una primera fase se realizaron entrevistas abiertas a informantes clave de la comunidad (brigadistas sanitarios y activistas de higienización con más de cinco años de residencia en la zona) seleccionados aleatoriamente de las nueve áreas de salud del municipio. Mediante la técnica de análisis de contenido cualitativo se identificaron términos, expresiones comunes y conceptos clave relacionados con la participación comunitaria en el área y se elaboró un cuestionario con escala de Líkert que fue aplicado en una segunda fase a una muestra poblacional del municipio. Se calcularon los índices de posición y los intervalos de confianza para cada enunciado, según la opinión de los encuestados, y se identificaron los criterios más relevantes entre la población, tanto por su connotación positiva como negativa. RESULTADOS: De las entrevistas a informantes clave surgieron como variables más importantes a explorar: 1) la participación comunitaria en la higienización ambiental, 2) el papel e imagen de los líderes y las organizaciones comunitarias, y 3) la participación comunitaria, en sentido general, en la solución de cualquier problema de la comunidad. Los resultados de la encuesta a la población reflejaron que los miembros de la comunidad reconocieron la utilidad de la participación comunitaria en la solución de problemas locales y, en particular, en el control de A. aegypti.Entre las opiniones en favor de la participación comunitaria se identificaron la valoración del trabajo en grupos, el conocimiento por parte de las autoridades locales de los problemas comunitarios y el reconocimiento de la obligación de los ciudadanos de tomar parte en el desarrollo de su comunidad. Resultaron más desfavorables las opiniones acerca de la imagen de los líderes y del tipo de beneficio que podría traer consigo la participación comunitaria. CONCLUSIONES: Las opiniones de la población acerca de la participación comunitaria obtenidas en este estudio sirvieron de base para el diseño de nuevas estrategias para el control de A. aegypti. La metodología utilizada puede servir para planificar procesos participativos...

Objective. To analyze opinions on community participation held by residents of one section of the city of Havana, Cuba, in order to identify key criteria to use in preparing a participatory strategy for controlling the Aedes aegypti mosquito. Methods. The study was conducted from September to October 1999 in Playa, one of the 15 municipios (districts) that make up the city of Havana, Cuba. In the first phase of the study, interviews were carried out with key informants, including health brigade members and sanitation activists, who had lived in Playa for more than five years. The key informants were selected randomly from the nine health areas that the Playa municipio has. Qualitative content analysis was used to identify terms, common expressions, and key concepts related to community participation in the area. In the study's second phase a questionnaire using a Likert scale was prepared for application with a population sample from Playa. Based on the answers from the respondents, a point score with a confidence interval was calculated for of the 30 statements on the questionnaire. The point scores for those statements were used to identify the population's most relevant criteria, that is, the statements producing the strongest agreement and the ones producing the strongest disagreement. Results. In the first phase, from the interviews with key informants, the three most important variables to explore were identified as: (1) community participation in environmental cleanup, (2) the role and image of community leaders and of community organizations, and (3) community participation, in a general sense, in solving any problem in the community. In the second phase, the population survey indicated that the members of the community recognized the usefulness of community participation in solving local problems, especially for controlling A. aegypti. Among the statements on the questionnaire that had the highest levels of agreement were ones dealing with the value of working together as a team, the knowledge that local authorities had of community problems, and recognition of the obligation that citizens have to take part in developing the community. The statements that had the lowest level of agreement had to do with the need to reward­with more than just words of thanks­residents who regularly serve the community and with the view that the majority of community leaders weremore concerned with their personal well-being than with the problems of the community. Conclusions. The opinions on community participation identified among the population in Playa served as the basis for designing new strategies for controlling A. aegypti. The methodology utilized in this study could be used to plan local participatory processes, both in Cuba and in other countries, and could be applied to other problems whose solution requires community participation