Knowledge, Attitudes and Practices Relevant to Malaria Control in Remote Island Populations of Manus, Papua New Guinea

A community-based cross-sectional survey of 262 participants in four island communities of Manus, Papua New Guinea was conducted using a structured questionnaire to examine possible factors of malaria prevalence, including education experiences, knowledge, attitudes, and preventive behaviors, in relation to antimalarial antibody titers. Bivariate and multivariate analyses revealed that micro-environmental conditions caused inter-community differences in malaria prevalence. Ninety-nine percent of the subject villagers recognized mosquito bites as a cause of malaria transmission, which explains the high possession rate of bednets. There was a significant correlation between malaria education experience at schools and knowledge (<i>p</i> < 0.01) and between knowledge and bednet use (<i>p</i> < 0.05). However, regular bednet users were only 35% of the total, due primarily to feelings of discomfort, heat, and stuffiness inside the bednet. Villagers’ behavior of consulting an aid post orderly (APO) in case of high fever significantly lowered the titer level (<i>p</i> < 0.05), while their bednet use did not. This unexpected result was attributable to inappropriate bednet use and to daily living patterns, including both subsistence and social activities. We conclude that information regarding lifestyles and attitudes toward bednet use as well as malaria education experience at schools are particularly important for practical malaria prevention.

THE EFFECT OF MEDICATION ON QUESTIONNAIRE ANALYSIS OF CHILDREN WITH SCHISTOSOMA MANSONI INFECTION IN TANZANIA

The effect of mass treatment on questionnaire results in the diagnosis of schistosomiasis mansoni was examined in 267 school children in an endemic area of Tanzania by Kato-Katz analysis of fecal specimens. The questionnaire asked for information about self-diagnosis, abdominal symptoms, blood in stools, history of wild water contact, stool examination and medication for schistosomiasis, and knowledge of the disease. A logistic regression analysis disclosed a significant association between schistosomiasis and "diarrhea" (p ≈ 0.007; odds ratio, 32.0; confidence interval, 2.5 - 403.3) and "abdominal enlargement" (p ≈ 0.003; odds ratio, 15.2; confidence interval, 2.6 - 90.1) among 61 children who had no history of medication for schistosomiasis. The sensitivity and specificity of the model were 86% and 64%, respectively. In contrast, no significant correlation was observed either for the 116 treated children, or for all the 267 children after the mass treatment. We conclude, therefore, that for children who had no history of medication for schistosomiasis, the questionnaire for abdominal manifestations provides reliable information on <I>S. mansoni</I> infection. However, once a child takes medication, the questionnaire becomes unreliable. This observation suggests that immunomodulation by anti-schistosomiasis drugs that kill adult worms exerts an effect on the appearance of abdominal manifestations and might explain the ambiguity of clinical symptoms in chronically infested patients, except in terminal cases. Further studies are required to develop a simple, rapid and cost-effective diagnostic method for monitoring <I>S. mansoni</I> infection after medication in local areas without resort to laboratory-based identification of schistosomiasis.

A SIMULATION SHEDS A LIGHT ON THE PRESENT HIV EPIDEMIC

A hypothetical community of one million people where birth rate and death rate are equal was applied to the modified deferential equations Lipsitch and Nowak published in 1995 in order to examine the impact of partner acquisition change on the HIV epidemic over a relatively short term. The results showed that if the partner exchange rate increases from two to three per year in the population, the epidemic caused by a more virulent strain would overweigh that caused by a less virulent strain within a century. This result reveals that an increase in the rate of partner acquisition gives the more virulent strain an advantage in terms of propagating the virus in a given population, at least over a relatively short term of several decades. The partner acquisition rate also exerts an influence on the magnitude of the HIV epidemic and the time it needs to reach a peak in the hypothetical community.<BR>These results indicate that increased sexual contact may be even more important than expected and thus shed a new light on the present HIV epidemic.