RESUMEN
BACKGROUND: Routine monitoring of anti-malarial drugs is recommended for early detection of drug resistance and to inform national malaria treatment guidelines. In Ethiopia, the national treatment guidelines employ a species-specific approach. Artemether-lumefantrine (AL) and chloroquine (CQ) are the first-line schizonticidal treatments for Plasmodium falciparum and Plasmodium vivax, respectively. The National Malaria Control and Elimination Programme in Ethiopia is considering dihydroartemisinin-piperaquine (DHA/PPQ) as an alternative regimen for P. falciparum and P. vivax. METHODS: The study assessed the clinical and parasitological efficacy of AL, CQ, and DHA/PPQ in four arms. Patients over 6 months and less than 18 years of age with uncomplicated malaria mono-infection were recruited and allocated to AL against P. falciparum and CQ against P. vivax. Patients 18 years or older with uncomplicated malaria mono-infection were recruited and randomized to AL or dihydroartemisinin-piperaquine (DHA/PPQ) against P. falciparum and CQ or DHA/PPQ for P. vivax. Patients were followed up for 28 (for CQ and AL) or 42 days (for DHA/PPQ) according to the WHO recommendations. Polymerase chain reaction (PCR)-corrected and uncorrected estimates were analysed by Kaplan Meier survival analysis and per protocol methods. RESULTS: A total of 379 patients were enroled in four arms (n = 106, AL-P. falciparum; n = 75, DHA/PPQ- P. falciparum; n = 142, CQ-P. vivax; n = 56, DHA/PPQ-P. vivax). High PCR-corrected adequate clinical and parasitological response (ACPR) rates were observed at the primary end points of 28 days for AL and CQ and 42 days for DHA/PPQ. ACPR rates were 100% in AL-Pf (95% CI: 96-100), 98% in CQ-P. vivax (95% CI: 95-100) at 28 days, and 100% in the DHA/PPQ arms for both P. falciparum and P. vivax at 42 days. For secondary endpoints, by day three 99% of AL-P. falciparum patients (n = 101) cleared parasites and 100% were afebrile. For all other arms, 100% of patients cleared parasites and were afebrile by day three. No serious adverse events were reported. CONCLUSION: This study demonstrated high therapeutic efficacy for the anti-malarial drugs currently used by the malaria control programme in Ethiopia and provides information on the efficacy of DHA/PPQ for the treatment of P. falciparum and P. vivax as an alternative option.
Asunto(s)
Antimaláricos , Artemisininas , Malaria Falciparum , Malaria Vivax , Humanos , Combinación Arteméter y Lumefantrina/uso terapéutico , Cloroquina/uso terapéutico , Plasmodium falciparum , Antimaláricos/uso terapéutico , Plasmodium vivax , Etiopía , Arteméter , Artemisininas/uso terapéutico , Malaria Vivax/tratamiento farmacológico , Malaria Falciparum/tratamiento farmacológicoRESUMEN
BACKGROUND: There is a high risk of Plasmodium vivax parasitaemia following treatment of falciparum malaria. Our study aimed to quantify this risk and the associated determinants using an individual patient data meta-analysis in order to identify populations in which a policy of universal radical cure, combining artemisinin-based combination therapy (ACT) with a hypnozoitocidal antimalarial drug, would be beneficial. METHODS AND FINDINGS: A systematic review of Medline, Embase, Web of Science, and the Cochrane Database of Systematic Reviews identified efficacy studies of uncomplicated falciparum malaria treated with ACT that were undertaken in regions coendemic for P. vivax between 1 January 1960 and 5 January 2018. Data from eligible studies were pooled using standardised methodology. The risk of P. vivax parasitaemia at days 42 and 63 and associated risk factors were investigated by multivariable Cox regression analyses. Study quality was assessed using a tool developed by the Joanna Briggs Institute. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42018097400). In total, 42 studies enrolling 15,341 patients were included in the analysis, including 30 randomised controlled trials and 12 cohort studies. Overall, 14,146 (92.2%) patients had P. falciparum monoinfection and 1,195 (7.8%) mixed infection with P. falciparum and P. vivax. The median age was 17.0 years (interquartile range [IQR] = 9.0-29.0 years; range = 0-80 years), with 1,584 (10.3%) patients younger than 5 years. 2,711 (17.7%) patients were treated with artemether-lumefantrine (AL, 13 studies), 651 (4.2%) with artesunate-amodiaquine (AA, 6 studies), 7,340 (47.8%) with artesunate-mefloquine (AM, 25 studies), and 4,639 (30.2%) with dihydroartemisinin-piperaquine (DP, 16 studies). 14,537 patients (94.8%) were enrolled from the Asia-Pacific region, 684 (4.5%) from the Americas, and 120 (0.8%) from Africa. At day 42, the cumulative risk of vivax parasitaemia following treatment of P. falciparum was 31.1% (95% CI 28.9-33.4) after AL, 14.1% (95% CI 10.8-18.3) after AA, 7.4% (95% CI 6.7-8.1) after AM, and 4.5% (95% CI 3.9-5.3) after DP. By day 63, the risks had risen to 39.9% (95% CI 36.6-43.3), 42.4% (95% CI 34.7-51.2), 22.8% (95% CI 21.2-24.4), and 12.8% (95% CI 11.4-14.5), respectively. In multivariable analyses, the highest rate of P. vivax parasitaemia over 42 days of follow-up was in patients residing in areas of short relapse periodicity (adjusted hazard ratio [AHR] = 6.2, 95% CI 2.0-19.5; p = 0.002); patients treated with AL (AHR = 6.2, 95% CI 4.6-8.5; p < 0.001), AA (AHR = 2.3, 95% CI 1.4-3.7; p = 0.001), or AM (AHR = 1.4, 95% CI 1.0-1.9; p = 0.028) compared with DP; and patients who did not clear their initial parasitaemia within 2 days (AHR = 1.8, 95% CI 1.4-2.3; p < 0.001). The analysis was limited by heterogeneity between study populations and lack of data from very low transmission settings. Study quality was high. CONCLUSIONS: In this meta-analysis, we found a high risk of P. vivax parasitaemia after treatment of P. falciparum malaria that varied significantly between studies. These P. vivax infections are likely attributable to relapses that could be prevented with radical cure including a hypnozoitocidal agent; however, the benefits of such a novel strategy will vary considerably between geographical areas.
Asunto(s)
Antimaláricos/uso terapéutico , Combinación Arteméter y Lumefantrina/uso terapéutico , Malaria Vivax/tratamiento farmacológico , Plasmodium vivax/patogenicidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Artemisininas/uso terapéutico , Niño , Preescolar , Femenino , Humanos , Lactante , Malaria/tratamiento farmacológico , Malaria Falciparum/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Parasitemia/tratamiento farmacológico , Plasmodium vivax/efectos de los fármacos , Adulto JovenRESUMEN
We review the current state of quality assurance in laboratories of the five Central Asia Republics (CARs), focusing on laboratory equipment, and compare quality assurance approaches with CLSI standards. The laboratories of the CARs faced exceptional challenges including highly-structured laboratory systems that retain centralized and outmoded Soviet-era approaches to quality assurance, considerably jeopardizing the validity of laboratory tests. The relative isolation of the CARs, based on geography and almost exclusive use of the Russian language, further hamper change. CARs must make high-level government decisions to widely implement quality assurance programs within their laboratory systems, within which approaches to the management of laboratory equipment will be a prominent part.
Asunto(s)
Equipos y Suministros/normas , Laboratorios/normas , Garantía de la Calidad de Atención de Salud/métodos , Asia Central , Países en Desarrollo , Humanos , Mantenimiento , Evaluación de Programas y Proyectos de SaludRESUMEN
[This corrects the article DOI: 10.1371/journal.pmed.1002299.].
RESUMEN
BACKGROUND: Recent efforts in malaria control have resulted in great gains in reducing the burden of Plasmodium falciparum, but P. vivax has been more refractory. Its ability to form dormant liver stages confounds control and elimination efforts. To compare the efficacy and safety of primaquine regimens for radical cure, we undertook a randomized controlled trial in Ethiopia. METHODS AND FINDINGS: Patients with normal glucose-6-phosphate dehydrogenase status with symptomatic P. vivax mono-infection were enrolled and randomly assigned to receive either chloroquine (CQ) or artemether-lumefantrine (AL), alone or in combination with 14 d of semi-supervised primaquine (PQ) (3.5 mg/kg total). A total of 398 patients (n = 104 in the CQ arm, n = 100 in the AL arm, n = 102 in the CQ+PQ arm, and n = 92 in the AL+PQ arm) were followed for 1 y, and recurrent episodes were treated with the same treatment allocated at enrolment. The primary endpoints were the risk of P. vivax recurrence at day 28 and at day 42. The risk of recurrent P. vivax infection at day 28 was 4.0% (95% CI 1.5%-10.4%) after CQ treatment and 0% (95% CI 0%-4.0%) after CQ+PQ. The corresponding risks were 12.0% (95% CI 6.8%-20.6%) following AL alone and 2.3% (95% CI 0.6%-9.0%) following AL+PQ. On day 42, the risk was 18.7% (95% CI 12.2%-28.0%) after CQ, 1.2% (95% CI 0.2%-8.0%) after CQ+PQ, 29.9% (95% CI 21.6%-40.5%) after AL, and 5.9% (95% CI 2.4%-13.5%) after AL+PQ (overall p < 0.001). In those not prescribed PQ, the risk of recurrence by day 42 appeared greater following AL treatment than CQ treatment (HR = 1.8 [95% CI 1.0-3.2]; p = 0.059). At the end of follow-up, the incidence rate of P. vivax was 2.2 episodes/person-year for patients treated with CQ compared to 0.4 for patients treated with CQ+PQ (rate ratio: 5.1 [95% CI 2.9-9.1]; p < 0.001) and 2.3 episodes/person-year for AL compared to 0.5 for AL+PQ (rate ratio: 6.4 [95% CI 3.6-11.3]; p < 0.001). There was no difference in the occurrence of adverse events between treatment arms. The main limitations of the study were the early termination of the trial and the omission of haemoglobin measurement after day 42, resulting in an inability to estimate the cumulative risk of anaemia. CONCLUSIONS: Despite evidence of CQ-resistant P. vivax, the risk of recurrence in this study was greater following treatment with AL unless it was combined with a supervised course of PQ. PQ combined with either CQ or AL was well tolerated and reduced recurrence of vivax malaria by 5-fold at 1 y. TRIAL REGISTRATION: ClinicalTrials.gov NCT01680406.
Asunto(s)
Artemisininas/uso terapéutico , Cloroquina/uso terapéutico , Etanolaminas/uso terapéutico , Fluorenos/uso terapéutico , Malaria Vivax/prevención & control , Primaquina/uso terapéutico , Adolescente , Adulto , Antimaláricos/farmacología , Antimaláricos/uso terapéutico , Combinación Arteméter y Lumefantrina , Artemisininas/farmacología , Niño , Preescolar , Cloroquina/farmacología , Combinación de Medicamentos , Etanolaminas/farmacología , Etiopía , Femenino , Fluorenos/farmacología , Humanos , Lactante , Masculino , Plasmodium vivax/efectos de los fármacos , Primaquina/farmacología , Adulto JovenRESUMEN
BACKGROUND: Intestinal helminth infections are major parasitic diseases causing public health problems in Ethiopia. Although the epidemiology of these infections are well documented in Ethiopia, new transmission foci for schistosomiasis are being reported in different parts of the country. The objective of this study was to assess the prevalence of Schistosoma mansoni and other intestinal helminth infections among school children and determine the endemicity of schistosomiasis in Wolaita Zone, southern Ethiopia. METHODS: Cross-sectional parasitological and malacological surveys were conducted by collecting stool samples for microscopic examination and snails for intermediate host identification. Stool samples were collected from 503 children and processed for microscopic examination using Kato-Katz and formalin-ether concentration methods. Snails collected from aquatic environments in the study area were identified to species level and Biomphalaria pfeifferi snails, the intermediate host of S. mansoni,, were individually exposed to artificial light in order to induce cercariae shedding. Cercariae shed from snails were used to infect laboratory-bred Swiss albino mice in order to identify the schistosome to species level. RESULTS: The overall prevalence of intestinal helminth infections was 72.2% among school children. S. mansoni infection prevalence was 58.6%. The prevalence and intensity of S. mansoni infections varied among schools and sex of children. Swimming was the only factor reported to be significantly associated with S. mansoni infection (AOR = 2.954, 95% CI:1.962-4.449). Other intestinal helminth species identified were hookworms (27.6%), Ascaris lumbricoides (8.7%), E. vermicularis (2.8%), Taenia species (2.6%), T. trichiura (1.2%) and H. nana (0.6%). Only B. pfeifferi snails collected from streams shed schistosome cercariae and 792 adult S. mansoni worms were harvested from mice exposed to cercariae shed from B. pfeifferi on the 6th week post-exposure. CONCLUSION: The present study found high level of intestinal helminth infections in the study area. The study also confirmed autochthonous transmission and endemicity of S. mansoni as evidenced by both parasitological and malacological findings as well as by further establishing infections in lab-bred mice. Therefore, there is a need to include the area in the control programs with anti-helminth drugs and also consider other complementary measures including sanitation, provision of clean water supply, and snail control.
Asunto(s)
Heces/parasitología , Parasitosis Intestinales/epidemiología , Esquistosomiasis mansoni/epidemiología , Adolescente , Animales , Niño , Preescolar , Estudios Transversales , Etiopía/epidemiología , Humanos , Masculino , Prevalencia , Schistosoma mansoni/aislamiento & purificación , Instituciones Académicas/estadística & datos numéricos , Estudiantes/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Malaria and HIV/AIDS constitute major public health problems in Ethiopia, but the burden associated with malaria-HIV co-infection has not been well documented. In this study, the burden of malaria among HIV positive and HIV negative adult outpatients attending health facilities in Oromia National Regional State, Ethiopia was investigated. METHODS: A comparative cross-sectional study among HIV-positive patients having routine follow-up visits at HIV care and treatment clinics and HIV-seronegative patients attending the general medical outpatient departments in 12 health facilities during the peak malaria transmission season was conducted from September to November, 2011. A total of 3638 patients (1819 from each group) were enrolled in the study. Provider initiated testing and counseling of HIV was performed for 1831 medical outpatients out of whom 1819 were negative and enrolled into the study. Malaria blood microscopy and hemoglobin testing were performed for all 3638 patients. Data was analyzed using descriptive statistics, Chi square test and multivariate logistic regression. RESULTS: Of the 3638 patients enrolled in the study, malaria parasitaemia was detected in 156 (4.3%); malaria parasitaemia prevalence was 0.7% (13/1819) among HIV-seropositive patients and 7.9% (143/1819) among HIV-seronegative patients. Among HIV-seropositive individuals 65.4% slept under a mosquito bed net the night before data collection, compared to 59.4% of HIV-seronegative individuals. A significantly higher proportion of HIV-seropositive malaria-negative patients were on co-trimoxazole (CTX) prophylaxis as compared to HIV-malaria co-infected patients: 82% (1481/1806) versus 46% (6/13) (P = 0.001). HIV and malaria co-infected patients were less likely to have the classical symptoms of malaria (fever, chills and headache) compared to the HIV-seronegative and malaria positive counterparts. Multivariate logistic regression showed that HIV-seropositive patients who come for routine follow up were less likely to be infected by malaria (OR = 0.23, 95% CI = 0.09-0.74). CONCLUSION: The study documented lower malaria prevalence among the HIV-seropositive attendants who come for routine follow up. Clinical symptoms of malaria were more pronounced among HIV-seronegative than HIV-seropositive patients. This study also re-affirmed the importance of co-trimoxazole in preventing malaria symptoms and parasitaemia among HIV-positive patients.
Asunto(s)
Coinfección/epidemiología , Infecciones por VIH/complicaciones , Malaria/epidemiología , Pacientes Ambulatorios , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antiinfecciosos/uso terapéutico , Quimioprevención , Estudios Transversales , Etiopía/epidemiología , Femenino , Humanos , Malaria/prevención & control , Masculino , Persona de Mediana Edad , Prevalencia , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Adulto JovenRESUMEN
BACKGROUND: Accurate early diagnosis and prompt treatment is one of the key strategies to control and prevent malaria in Ethiopia where both Plasmodium falciparum and Plasmodium vivax are sympatric and require different treatment regimens. Microscopy is the standard for malaria diagnosis at the health centres and hospitals whereas rapid diagnostic tests are used at community-level health posts. The current study was designed to assess malaria microscopy capacity of health facilities in Oromia Regional State and Dire Dawa Administrative City, Ethiopia. METHODS: A descriptive cross-sectional study was conducted from February to April 2011 in 122 health facilities, where health professionals were interviewed using a pre-tested, standardized assessment tool and facilities' laboratory practices were assessed by direct observation. RESULTS: Of the 122 assessed facilities, 104 (85%) were health centres and 18 (15%) were hospitals. Out of 94 health facilities reportedly performing blood films, only 34 (36%) used both thin and thick smears for malaria diagnosis. The quality of stained slides was graded in 66 health facilities as excellent, good and poor quality in 11(17%), 31 (47%) and 24 (36%) respectively. Quality assurance guidelines and malaria microscopy standard operating procedures were found in only 13 (11%) facilities and 12 (10%) had involved in external quality assessment activities, and 32 (26%) had supportive supervision within six months of the survey. Only seven (6%) facilities reported at least one staff's participation in malaria microscopy refresher training during the previous 12 months. Although most facilities, 96 (79%), had binocular microscopes, only eight (7%) had the necessary reagents and supplies to perform malaria microscopy. Treatment guidelines for malaria were available in only 38 (31%) of the surveyed facilities. Febrile patients with negative malaria laboratory test results were managed with artemether-lumefantrine or chloroquine in 51% (53/104) of assessed health facilities. CONCLUSIONS: The current study indicated that most of the health facilities had basic infrastructure and equipment to perform malaria laboratory diagnosis but with significant gaps in continuous laboratory supplies and reagents, and lack of training and supportive supervision. Overcoming these gaps will be critical to ensure that malaria laboratory diagnosis is of high-quality for better patient management.
Asunto(s)
Técnicas de Laboratorio Clínico/estadística & datos numéricos , Centros Comunitarios de Salud/estadística & datos numéricos , Malaria Falciparum/diagnóstico , Malaria Vivax/diagnóstico , Parasitología/estadística & datos numéricos , Técnicas de Laboratorio Clínico/instrumentación , Técnicas de Laboratorio Clínico/normas , Estudios Transversales , Etiopía/epidemiología , Humanos , Malaria Falciparum/epidemiología , Malaria Falciparum/prevención & control , Malaria Vivax/epidemiología , Malaria Vivax/prevención & controlRESUMEN
Understanding the distribution patterns of medically significant sandflies is crucial for effective vector and disease control planning. This study focused on investigating the abundance and distribution of phlebotomine sandflies, specifically emphasizing Phlebotomus pedifer (Diptera: Psychodidae), the vector of Leishmania aethiopica responsible for cutaneous leishmaniasis in the highlands of southern Ethiopia. The study employed CDC light traps and sticky paper traps in various habitats, including human houses, farm fields, and rock cliffs, with and without the presence of hyraxes. The study was conducted along an altitudinal gradient in Kindo Didaye district, Wolaita Zone. A total of 7,994 sandflies belonging to 2 genera, Phlebotomus (26.1%) and Sergentomyia (73.9%), were collected. In the genus Phlebotomus, P. pedifer (74.1%) was the most abundant, followed by P. alexandri (18.05%) and P. gibiensis (7.85%). Altitude showed a strong positive association with the density and distribution of P. pedifer and a negative association with those of P. alexandri, P. gibiensis, and Sergentomyia spp. Furthermore, the study revealed distinct habitat preferences, with P. pedifer showing the highest mean density in hyrax dwellings, followed by human houses, and the lowest in farm fields. These findings provide valuable insights for planning targeted control measures against P. pedifer in both indoor and outdoor environments, particularly in the highland and midland areas of the study region.
Asunto(s)
Altitud , Distribución Animal , Phlebotomus , Psychodidae , Animales , Etiopía , Phlebotomus/fisiología , Psychodidae/fisiología , Masculino , Insectos Vectores/fisiología , Femenino , Densidad de Población , EcosistemaRESUMEN
BACKGROUND: Cutaneous leishmaniasis (CL) is a neglected tropical disease that is caused by a Leishmania parasite and transmitted by the bite of infected female sandflies. Community awareness is an essential component of disease control and prevention. Therefore, this study aimed to assess the community's knowledge, attitude, and practice toward CL in Wolaita zone, southern Ethiopia. METHODS: A community-based cross-sectional study design was employed to include 422 study subjects selected using a systematic sampling technique from two districts, Kindo Didaye and Sodo Zuria. A pretested structured questionnaire was used to collect data from the household heads. Bivariate and multivariate logistic regression analyses were performed to determine the relationship between the participants' knowledge about CL and socio-demographic characteristics. RESULTS: Out of the 422 study participants, only 19% had good knowledge of CL in general. Most (67.1%) of the respondents knew CL by its local name ("bolbo" or "moora") though this knowledge varied highly over the study districts. The majority (86.3%) of respondents did not know how CL is acquired, though they considered CL a health problem. Most (62.8%) respondents believed that CL was an untreatable disease. Most (77%) participants responded that CL patients preferred to go to traditional healers for treatment. Herbal treatment was the most (50.2%) used to treat CL. Knowledge about CL was significantly associated with sex, age, and study districts. CONCLUSION: The overall knowledge, attitude, and practice about CL and its prevention in the study area were low. This emphasizes the need to implement health education and awareness campaign to reduce the risk of CL infection. Policymakers and stakeholders should also give due attention to the prevention and treatment of CL in the study area.
Asunto(s)
Leishmaniasis Cutánea , Población Rural , Humanos , Femenino , Etiopía/epidemiología , Estudios Transversales , Conocimientos, Actitudes y Práctica en Salud , Leishmaniasis Cutánea/epidemiología , Leishmaniasis Cutánea/prevención & control , Enfermedades DesatendidasRESUMEN
BACKGROUND: In vivo efficacy assessments of the first-line treatments for Plasmodium falciparum malaria are essential for ensuring effective case management. In Ethiopia, artemether-lumefantrine (AL) has been the first-line treatment for uncomplicated P. falciparum malaria since 2004. METHODS: Between October and November 2009, we conducted a 42-day, single arm, open label study of AL for P. falciparum in individuals >6 months of age at two sites in Oromia State, Ethiopia. Eligible patients who had documented P. falciparum mono-infection were enrolled and followed according to the standard 2009 World Health Organization in vivo drug efficacy monitoring protocol. The primary and secondary endpoints were PCR uncorrected and corrected cure rates, as measured by adequate clinical and parasitological response on days 28 and 42, respectively. RESULTS: Of 4426 patients tested, 120 with confirmed falciparum malaria were enrolled and treated with AL. Follow-up was completed for 112 patients at day 28 and 104 patients at day 42. There was one late parasitological failure, which was classified as undetermined after genotyping. Uncorrected cure rates at both day 28 and 42 for the per protocol analysis were 99.1% (95% CI 95.1-100.0); corrected cure rates at both day 28 and 42 were 100.0%. Uncorrected cure rates at day 28 and 42 for the intention to treat analysis were 93.3% (95% CI 87.2-97.1) and 86.6% (95% CI 79.1-92.1), respectively, while the corrected cure rates at day 28 and 42 were 94.1% (95% CI 88.2-97.6) and 87.3% (95% CI 79.9-92.7), respectively. Using survival analysis, the unadjusted cure rate was 99.1% and 100.0% adjusted by genotyping for day 28 and 42, respectively. Eight P. falciparum patients (6.7%) presented with Plasmodium vivax infection during follow-up and were excluded from the per protocol analysis. Only one patient had persistent parasitaemia at day 3. No serious adverse events were reported, with cough and nausea/vomiting being the most common adverse events. CONCLUSIONS: AL remains a highly effective and well-tolerated treatment for uncomplicated falciparum malaria in the study setting after several years of universal access to AL. A high rate of parasitaemia with P. vivax possibly from relapse or new infection was observed. TRIAL REGISTRATION: NCT01052584.
Asunto(s)
Antimaláricos/administración & dosificación , Artemisininas/administración & dosificación , Etanolaminas/administración & dosificación , Fluorenos/administración & dosificación , Malaria Falciparum/tratamiento farmacológico , Plasmodium falciparum/efectos de los fármacos , Adolescente , Combinación Arteméter y Lumefantrina , Niño , Preescolar , ADN Protozoario/genética , ADN Protozoario/aislamiento & purificación , Combinación de Medicamentos , Etiopía , Femenino , Humanos , Masculino , Plasmodium falciparum/aislamiento & purificación , Reacción en Cadena de la Polimerasa , Análisis de Supervivencia , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Anemia, the world's most common micro-nutrient deficiency disorder, can affect a person at any time and at all stages of life. Though all members of the community may face the problem, children aged 6-23 months are particularly at higher risk. If left untreated, it adversely affects the health, cognitive development, school achievement, and work performance. However, little was investigated among young children in Sub-Saharan countries including Ethiopia. This research aimed to investigate its magnitude and correlates to address the gap and guide design of evidence based intervention. METHODS: A community-based cross-sectional study was conducted from May -June 2016 in rural districts of Wolaita Zone. Multi-stage sampling technique was applied and 990 mother-child pairs were selected. Socio-demography, health and nutritional characteristics were collected by administering interview questionnaire to mothers/care-givers. Blood samples were taken to diagnose anemia by using HemoCue device, and the status was determined using cut-offs used for children aged 6-59 months. Hemoglobin concentration below 11.0 g/dl was considered anemic. Data were analyzed with Stata V14. Bivariate and multivariable logistic regressions were applied to identify candidates and predictor variables respectively. Statistical significance was determined at p-value < 0.05 at 95% confidence interval. RESULTS: The mean hemoglobin level of children was 10.44±1.3g/dl, and 65.7% of them were anemic. Among anemic children, 0.4% were severely anemic (<7.0g/dl), while 28.1% and 37.2% were mildly (10.0-10.9g/dl) and moderately (7.0-9.9g/dl) anemic, respectively. In the multivariable analysis, having maternal age of 35 years and above (AOR = 1.96), being government employee (AOR = 0.29), being merchant (AOR = 0.43) and 'other' occupation (AOR = 3.17) were correlated with anemia in children in rural Wolaita. Similarly, receiving anti-helminthic drugs (AOR = 0.39), being female child (AOR = 1.76), consuming poor dietary diversity (AOR = 1.40), and having moderate household food insecurity (AOR = 1.72) were associated with anemia in rural Wolaita. CONCLUSION: A large majority of children in the rural Wolaita were anemic and the need for proven public health interventions such as food diversification, provision of anti-helminthic drugs and ensuring household food security is crucial. In addition, educating women on nutrition and diet diversification, as well as engaging them with alternative sources of income might be interventions in the study area.
Asunto(s)
Anemia/epidemiología , Dieta/efectos adversos , Abastecimiento de Alimentos/estadística & datos numéricos , Renta/estadística & datos numéricos , Estado Nutricional , Factores Socioeconómicos , Anemia/etiología , Estudios Transversales , Etiopía/epidemiología , Femenino , Humanos , Lactante , Masculino , Prevalencia , Factores de RiesgoRESUMEN
INTRODUCTION: The scale-up of effective HIV viral load (VL) testing is an urgent public health priority. Implementation of testing is supported by the availability of accurate, nucleic acid based laboratory and point-of-care (POC) VL technologies and strong WHO guidance recommending routine testing to identify treatment failure. However, test implementation faces challenges related to the developing health systems in many low-resource countries. The purpose of this commentary is to review the challenges and solutions from the large-scale implementation of other diagnostic tests, namely nucleic-acid based early infant HIV diagnosis (EID) and CD4 testing, and identify key lessons to inform the scale-up of VL. DISCUSSION: Experience with EID and CD4 testing provides many key lessons to inform VL implementation and may enable more effective and rapid scale-up. The primary lessons from earlier implementation efforts are to strengthen linkage to clinical care after testing, and to improve the efficiency of testing. Opportunities to improve linkage include data systems to support the follow-up of patients through the cascade of care and test delivery, rapid sample referral networks, and POC tests. Opportunities to increase testing efficiency include improvements to procurement and supply chain practices, well connected tiered laboratory networks with rational deployment of test capacity across different levels of health services, routine resource mapping and mobilization to ensure adequate resources for testing programs, and improved operational and quality management of testing services. If applied to VL testing programs, these approaches could help improve the impact of VL on ART failure management and patient outcomes, reduce overall costs and help ensure the sustainable access to reduced pricing for test commodities, as well as improve supportive health systems such as efficient, and more rigorous quality assurance. These lessons draw from traditional laboratory practices as well as fields such as logistics, operations management and business. CONCLUSIONS: The lessons and innovations from large-scale EID and CD4 programs described here can be adapted to inform more effective scale-up approaches for VL. They demonstrate that an integrated approach to health system strengthening focusing on key levers for test access such as data systems, supply efficiencies and network management. They also highlight the challenges with implementation and the need for more innovative approaches and effective partnerships to achieve equitable and cost-effective test access.
Asunto(s)
Antígenos CD4/análisis , Infecciones por VIH/virología , Carga Viral , Análisis Costo-Beneficio , Diagnóstico Precoz , Infecciones por VIH/tratamiento farmacológico , Humanos , Lactante , Sistemas de Atención de Punto , Salud Pública , Pruebas SerológicasRESUMEN
BACKGROUND: Optimal use of long-lasting insecticidal (LLINs) for malaria prevention depends on mass distribution, the users' perception and behaviour of local malaria vectors. This study was aimed at assessing knowledge, attitude and practice (KAP) of communities about LLINs and fabric integrities and insecticidal activities of nets under use in Wolaita zone, Sothern Ethiopia. METHODS: Semi-structured interview questionnaires were used to collect data on KAP variables and WHO cone bioassay was used to test the insecticidal activity of sampled nets against an insectary colony of Anopheles arabiensis. Holes and repairs on surfaces of sample nets were counted and categorized following WHO guidelines to assess their fabric integrities. Chi-square (χ(2)) tests were used to verify associations between the demographic profiles of the respondents and their responses to KAP questionnaires. RESULTS: Out of a total of 770 household heads interviewed, 323 (42%) and 447 (58%) were males and females, respectively. The average family size in the surveyed households was 5.25 (±0.70 SE, range 1-12). The majority (81.1%) of the households owned at least one LLIN. The average numbers of LLINs being used and sleeping places in the households were 1.61 (0.04 SE, range 0-4) and 2.27(0.03 SE, range 1-6), respectively. Most of the respondents (n = 687; 89.2%) believed LLINs prevent malaria by killing or acting as physical barriers against mosquitoes. About 21 and 14% of the respondents considered children under five years and pregnant women as priority groups for sleeping under LLINs. Households use LLINs consistently throughout the year (86.4%) and tuck nets into bedding materials while sleeping (90.1%). Physical inspection of fabric integrity of sampled LLINs revealed holes ranging from size 1 (0.5-2 cm) to size 4 (> 25 cm) mostly on lower ("right/left") surfaces. Moreover, most surfaces of sampled LLINs caused 100% knockdown and mortality on insectary colonies of Anopheles arabiensis. CONCLUSIONS: The overall knowledge, attitude and practice about LLINs were satisfactory in the study areas. However, the family size net ratio must be narrowed and attention needs to be given to malaria vulnerable groups (children < 5 years of age and pregnant women). Continuous monitoring and evaluation of use and durability (fabric integrity and insecticidal activity) of LLINs should be conducted to avoid misuse and associated attrition of nets before the intended period.
Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Mosquiteros Tratados con Insecticida , Insecticidas/farmacología , Adolescente , Adulto , Animales , Anopheles , Niño , Preescolar , Recolección de Datos , Etiopía , Femenino , Humanos , Masculino , Embarazo , Factores de TiempoRESUMEN
BACKGROUND: It is unknown to what extent the non-HIV population utilises laboratories supported by the President's Emergency Plan for AIDS Relief (PEPFAR). OBJECTIVES: We aimed to describe the number and proportion of laboratory tests performed in 2009 and 2011 for patients referred from HIV and non-HIV services (NHSs) in a convenience sample collected from 127 laboratories supported by PEPFAR in Tanzania. We then compared changes in the proportions of tests performed for patients referred from NHSs in 2009 vs 2011. METHODS: Haematology, chemistry, tuberculosis and syphilis test data were collected from available laboratory registers. Referral sources, including HIV services, NHSs, or lack of a documented referral source, were recorded. A generalised linear mixed model reported the odds that a test was from a NHS. RESULTS: A total of 94 132 tests from 94 laboratories in 2009 and 157 343 tests from 101 laboratories in 2011 were recorded. Half of all tests lacked a documented referral source. Tests from NHSs constituted 42% (66 084) of all tests in 2011, compared with 31% (29 181) in 2009. A test in 2011 was twice as likely to have been referred from a NHS as in 2009 (adjusted odds ratio: 2.0 [95% confidence interval: 2.0-2.1]). CONCLUSION: Between 2009 and 2011, the number and proportion of tests from NHSs increased across all types of test. This finding may reflect increased documentation of NHS referrals or that the laboratory scale-up originally intended to service the HIV-positive population in Tanzania may be associated with a 'spillover effect' amongst the general population.
RESUMEN
OBJECTIVE: To establish the prevalence and associated risk factors of Schistosoma mansoni (S. mansoni) infection among schoolchildren at a village in Wolaita Zone, Southern Ethiopia. METHODS: A cross-sectional study was carried out among primary schoolchildren. A total of 384 randomly selected study subjects provided stool samples for parasitological examination by Kato-Katz and Formalin-Ether concentration techniques. Secondary parasitological data were obtained from Health Center Laboratory to see the previous history of S. mansoni infection in the area. Statistical analysis was performed using SPSS software version 16. RESULTS: From the total children examined, 85.4% were found positive for at least one helminth infection. S. mansoni infection (81.3%) was the most prevalent and the prevalence of STH was 32%. Moderate and heavy infection intensities were only observed in S. mansoni infections. The overall heavy intensity of infection was 56.4%. Contact to Bisare stream was the most important factor for S. mansoni infection (OR 3.9) followed by herding cattle near the stream (OR 2.527). Males were twice more likely to get the infection than females (OR 1.923). Analysis of secondary parasitological data showed that S. mansoni infection was a leading helminthic infection over the past years. CONCLUSIONS: The present study found a higher intensity and prevalence of S. mansoni infection in a rural village of Wolaita Zone. Therefore, appropriate integrated control and prevention measures need to be implemented in the study area.
RESUMEN
BACKGROUND: Both podoconiosis and soil-transmitted helminth (STH) infections occur among barefoot people in areas of extreme poverty; however, their co-morbidity has not previously been investigated. We explored the overlap of STH infection and podoconiosis in Southern Ethiopia and quantified their separate and combined effects on prevalent anemia and hemoglobin levels in podoconiosis patients and health controls from the same area. METHODS AND PRINCIPAL FINDINGS: A two-part comparative cross-sectional study was conducted in Wolaita zone, southern Ethiopia. Data were collected from adult patients presenting with clinically confirmed podoconiosis, and unmatched adult neighborhood controls living in the same administrative area. Information on demographic and selected lifestyle factors was collected using interviewer-administered questionnaires. Stool samples were collected and examined qualitatively using the modified formalin-ether sedimentation method. Hemoglobin level was determined using two different methods: hemoglobinometer and automated hematology analyzer. A total of 913 study subjects (677 podoconiosis patients and 236 controls) participated. The prevalence of any STH infection was 47.6% among patients and 33.1% among controls (p<0.001). The prevalence of both hookworm and Trichuris trichiura infections was significantly higher in podoconiosis patients than in controls (AOR 1.74, 95% CI 1.25 to2.42, AOR 6.53, 95% CI 2.34 to 18.22, respectively). Not wearing shoes and being a farmer remained significant independent predictors of infection with any STH. There was a significant interaction between STH infection and podoconiosis on reduction of hemoglobin level (interaction p valueâ=â0.002). CONCLUSIONS: Prevalence of any STH and hookworm infection was higher among podoconiosis patients than among controls. A significant reduction in hemoglobin level was observed among podoconiosis patients co-infected with hookworm and 'non-hookworm STH'. Promotion of consistent shoe-wearing practices may have double advantages in controlling both podoconiosis and hookworm infection in the study area.
Asunto(s)
Elefantiasis/epidemiología , Infecciones por Uncinaria/epidemiología , Enfermedades Desatendidas/epidemiología , Tricuriasis/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Comorbilidad , Estudios Transversales , Etiopía/epidemiología , Heces/parasitología , Femenino , Hemoglobinas/análisis , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Población Rural , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: In vivo efficacy assessments of antimalarials are essential for ensuring effective case management. In Ethiopia, chloroquine (CQ) without primaquine is the first-line treatment for Plasmodium vivax in malarious areas, but artemether-lumefantrine (AL) is also commonly used. METHODS AND FINDINGS: In 2009, we conducted a 42-day efficacy study of AL or CQ for P. vivax in Oromia Regional State, Ethiopia. Individuals with P. vivax monoinfection were enrolled. Primary endpoint was day 28 cure rate. In patients with recurrent parasitemia, drug level and genotyping using microsatellite markers were assessed. Using survival analysis, uncorrected patient cure rates at day 28 were 75.7% (95% confidence interval (CI) 66.8-82.5) for AL and 90.8% (95% CI 83.6-94.9) for CQ. During the 42 days of follow-up, 41.6% (47/113) of patients in the AL arm and 31.8% (34/107) in the CQ arm presented with recurrent P. vivax infection, with the median number of days to recurrence of 28 compared to 35 days in the AL and CQ arm, respectively. Using microsatellite markers to reclassify recurrent parasitemias with a different genotype as non-treatment failures, day 28 cure rates were genotype adjusted to 91.1% (95% CI 84.1-95.1) for AL and to 97.2% (91.6-99.1) for CQ. Three patients (2.8%) with recurrent parasitemia by day 28 in the CQ arm were noted to have drug levels above 100 ng/ml. CONCLUSIONS: In the short term, both AL and CQ were effective and well-tolerated for P. vivax malaria, but high rates of recurrent parasitemia were noted with both drugs. CQ provided longer post-treatment prophylaxis than AL, resulting in delayed recurrence of parasitemia. Although the current policy of species-specific treatment can be maintained for Ethiopia, the co-administration of primaquine for treatment of P. vivax malaria needs to be urgently considered to prevent relapse infections. TRIAL REGISTRATION: ClinicalTrials.gov NCT01052584.