Subject(s)
Clinical Competence , Ethics, Medical , Humans , Physicians/psychology , Social Change , ThailandABSTRACT
The sensitivity, specificity and convenience of carrying out malaria diagnosis in acridine orange stained capillary tubes using a fluorescent microscope (the QBC system) was compared to screening for Plasmodia on conventional Giemsa stained thick smears. A dilution study revealed that the QBC is able to detect Plasmodia in as low a dilution as 5 organisms per ul. The QBC system was evaluated at a district hospital in Thailand. A preliminary study of 186 patients compared the QBC system to the routine malaria screening procedure (screening up to 30 microscopic fields on a thick smear). The sensitivity of the QBC was found to be 98.9% with a specificity of 94.4%. A second combined series of 465 febrile subjects were screened by thick smear and these results were compared to the QBC. 202 were positive for malaria on both QBC and thick smear. Sensitivity in this study was found to be 99.5% (202/203) and the specificity was 94.6% (248/262). When both series were combined, there were 14 QBC malaria positives that were not detected on thick smear, and 2 QBC malaria false negatives among the 651 patients studied. The parasite densities in these cases were between 10 and 320,000 organisms/microliters. The QBC system provided only a crude estimate of the level of parasitemia. The species of Plasmodia (P. falciparum and P. vivax) were correctly identified on QBC in 78% of cases.
Subject(s)
Acridine Orange/diagnosis , Animals , Azure Stains/diagnosis , Evaluation Studies as Topic , Humans , Malaria/epidemiology , Mass Screening/methods , Microscopy, Fluorescence/methods , Plasmodium falciparum , Plasmodium vivax , Sensitivity and Specificity , Thailand/epidemiologyABSTRACT
A study was conducted to determine the current situation of human rabies post-exposure prophylaxis (PEP) in Bangkok for the period 1984-1986. A review of all Bangkok residents receiving PEP at the Queen Saovabha Memorial Institute revealed an increasing incidence rate of PEP from 10.1 cases per 10,000 persons in 1984 to 12.6 cases per 10,000 persons in 1986. The highest incidence rate was observed in young males aged 5-14 years. About 68% of individuals receiving PEP had exposures to bites, especially by dogs, and nearly 30% of PEP cases were due to non-bite exposures. Dogs were responsible for 90% of PEP cases, of which 59% were exposed to stray dogs. Exposure to domestic dogs and cats constituted about 36% of PEP. Approximately 55% of persons received PEP for exposures to animal sources not proven rabid. To reduce the number of PEP, the programme should be directed towards the swift reduction of susceptible animals, which can be achieved by effective elimination of stray dogs and immunization of domestic dogs and cats. Massive health education to the public emphasizing the importance of prevention and control of rabies should be undertaken. The programme for control of rabies can be effective if there is an increased awareness and cooperation among professional people, health personnel, and other people in the community.