Social and behavioral factors associated with Clonorchis infection in one commune located in the Red River Delta of Vietnam.

Social behavioral factors associated with Clonorchis infection are needed for control measures. The population in Nga Tan commune were randomly sampled and questioned to determine knowledge, perception, and health behavioral factors associated with Clonorchis infection among heads of households. The cellophane thick smear method was applied to examine their stool samples. Seven hundred and seventy-one cases were examined, the positive rates were 17.2%, 66.9%, 78.7%, 15.9%, and 0.14% for Clonorchis sinensis, Ascaris lumbricoides, Trichuris trichiura, hookworm, and Dicrocoelium dendriticum respectively. There was no significant difference between the infection rate of clonorchiasis, education level, and family income groups (p > 0.05). But there was significance difference between the infection rate of clonorchiasis and people living in different family sizes (p < 0.01). Thirty-four clonorchiasis patients treated with praziquantel 25 mg/kg/day for three days showed a cure rate in 30 days of 97.1%.

Malaria control through impregnated bednets--a pilot project in selected villages in Lao PDR.

In 7 villages on the foothills of the Houayxai district of the Bokeo Province in Lao PDR between midyear 1995 to midyear 1997 an attempt was made to test the acceptability and use of DDT impregnated bed nets as well as environmental and behavioral risk factors. About 380 women between 15 to 45 years old and their children in the age range of 1 to 14 years had been studied. A pre-tested questionnaire had been applied and blood from women and children was taken from the finger prick and a conventional thick and thin blood smear was performed, fixed Giemsa stained and examined for malaria parasites. DDT (dichlorodiphenyltrichloroethane) impregnated mosquito nets were distributed in the intervention villages. The availability of mosquito nets increased statistically significant from approximately 50% to 70% for all family members in the intervention area between 1995 and 1997 and statistically significant decreased in the control area from 79% to 45.1%. There was a statistically significant decrease in malaria attacks as claimed by the females for the intervention area but not for the control villages. The proportion of positive blood smears did decrease overall for women and children in between 1995 to 1997. Occupation, location of the house and use of mosquito nets had been determined as the most important risk factors.

Cost-effectiveness analysis of artesunate and quinine + tetracycline for the treatment of uncomplicated falciparum malaria in Chanthaburi, Thailand.

A randomized, controlled, malaria-clinic-based field trial was carried out to compare the cost-effectiveness of a 5-day 700-mg oral artesunate and a 7-day quinine + tetracycline regimen for the treatment of uncomplicated falciparum malaria in Thailand. Cost-effectiveness was determined from the providers' perspective and based on curative effectiveness. A total of 137 patients, aged 15-60 years, attending a malaria clinic were followed for 28 days, 60 of them received quinine + tetracycline and 77 received artesunate. Cure rates were assessed on day 5 (artesunate) and day 7 (quinine + tetracycline), using the intention-to-treat approach. Cost-effectiveness and sensitivity analyses were performed by varying the day 5/day 7 curative effectiveness and cost of artesunate. The cure rate with artesunate (100%) was significantly higher than with quinine + tetracycline (77.4%) (relative risk adjusted for sex (aRR) = 1.32, 95% confidence interval (CI) = 1.12-1.55; referent quinine + tetracycline). Artesunate was more cost-effective than quinine + tetracycline at the following costs: artesunate, < or = US$0.36 per 50-mg tablet; quinine, US$0.06 per 300-mg tablet; tetracycline, US$0.02 per 250-mg capsule; and services per case found, < or = US$11.49. Because of the higher cure rate and higher cost-effectiveness of the artesunate regimen compared with quinine + tetracycline, we recommend its use for the treatment of uncomplicated falciparum malaria in malaria clinics in Thailand.

PIP: Findings are presented from a randomized, controlled, malaria clinic-based field trial conducted to compare the cost-effectiveness of a 5-day 700 mg oral artesunate and a 7-day quinine and tetracycline regimen to treat uncomplicated falciparum malaria in Thailand. Cost-effectiveness was determined from the providers' perspective and based upon curative effectiveness. 137 patients, aged 15-60 years, attending a malaria clinic were followed for 28 days. 60 received quinine and tetracycline, while 77 received artesunate. Cure rates were assessed on day 5 (artesunate) and day 7 (quinine and tetracycline). The cure rate with artesunate was 100%, significantly higher than the 77.4% rate with quinine and tetracycline. Artesunate was more cost-effective than quinine and tetracycline, with artesunate costing a maximum of US$0.36 per 50 mg tablet, quinine at US$0.06 per 300 mg tablet, tetracycline at US$0.02 per 250 mg capsule, and services per case found no higher than US$11.49.

Evaluation of direct agglutination test (DAT) as an immunodiagnostic tool for diagnosis of visceral leishmaniasis in Nepal.

Before field application of the direct agglutination test (DAT) for leishmaniasis, it was assessed as a diagnostic tool. Fifteen confirmed visceral leishmaniasis cases (bone marrow aspiration positive), 120 tuberculosis, 58 leprosy, 15 malaria, 26 intestinal parasitic infection cases, 24 endemic healthy controls from adjacent to the study area, and 18 controls from Kathmandu (who had never visited the VL endemic areas) were tested for anti-leishmanial antibody agglutination titers. Two of the tuberculosis cases were positive for anti-leishmanial agglutinating antibodies at 1:800. All the visceral leishmaniasis confirmed cases were reactive to anti-leishmanial antibody at > or = 1:3,200. Other specimens were negative for serology. The sensitivity of the direct agglutination test was 100% and the specificity was 99.2%. The direct agglutination test had positive and negative predictive values of 100% and 99.2% respectively. The direct agglutination test has been found to be simple, rapid, reliable, economic, safe and adaptable to micro-techniques using microtiter plates. It is specific and sensitive. The direct agglutination test is simple enough for it to be performed in a field laboratory.

Compliance with artesunate and quinine + tetracycline treatment of uncomplicated falciparum malaria in Thailand.

A randomized, controlled, malaria-clinic-based field trial was conducted to compare compliance with a 7-day quinine + tetracycline regimen and a 5-day 700-mg artesunate regimen for the treatment of uncomplicated falciparum malaria in a community in Thailand. Of 137 patients, aged 15-60 years attending a malaria clinic, 77 received artesunate and 60 received quinine + tetracycline. Compliance and cure rates were evaluated on days 5 (artesunate) and 7 (quinine + tetracycline) using patient interview/residual pill counts and peripheral blood smear, respectively. Data were analysed using the intention-to-treat approach, and the reasons for compliance and noncompliance were investigated. Compliance was significantly higher (98.4%) with artesunate than with quinine + tetracycline (71.7%) (relative risk adjusted for sex (aRR) = 1.39 (95% C.I. = 1.15-1.68); referent: quinine + tetracycline). Cure rate (100%) was higher in those receiving artesunate than quinine + tetracycline (77.4%) (aRR = 1.32 (95% C.I. = 1.12-1.55)). Reasons for compliance included the desire to be cured and to follow the advice of malaria staff/employer, and the simple dosing regimen. Noncompliance was mostly due to adverse reactions and forgetting to take the drugs. These results can serve as a baseline for designing and evaluating new interventions to improve compliance, as well as for studying cost-effectiveness to help drug policy decision-making. We recommend a strategy which integrates a short-course, once-a-day regimen (with minimal adverse reactions), a better delivery system for antimalarial drugs and health education, and an enhanced advisory role of malaria staff. Considering the higher compliance rate and curative effectiveness of artesunate, we recommend its use instead of quinine + tetracycline for the treatment of uncomplicated malaria in clinics in Thailand.

Initial evaluation of low-dose phenobarbital as an indicator of compliance with antimalarial drug treatment.

Since poor compliance with antimalarial therapy is often suspected but difficult to prove, this study attempted to establish a model for predicting the plasma concentration of phenobarbital (given in low doses in conjunction with the drug) as an indicator of compliance. Phenobarbital was chosen because its value had been demonstrated as a marker of compliance in long-course therapies, any significant departure from steady-state concentrations (achieved with full compliance) indicating one or more missed doses. Therapy for uncomplicated malaria varies from 5 days with artesunate to 7 days with quinine + tetracycline. Volunteers with confirmed falciparum malaria were randomized into 5 groups and given malaria therapy as well as phenobarbital daily for 3-7 days. Plasma samples for determination of phenobarbital concentrations were taken just prior to the daily dose of phenobarbital. Although there was a clear and predictable individual pattern of blood concentrations following each dose of phenobarbital, inter-individual variation in blood levels was significant and reduced their predictive value beyond the second day's dose. The cause of the variations is not clear; it could be attributable to different sources of the drug, previous intake of phenobarbital by the patient, or differences in drug absorption and disposition in malaria patients. Results for the 5-day artesunate regimen suggest that phenobarbital may be useful as a marker of compliance if the patient stops medication after 3 days; clear differences were evident at the end of the course of treatment between plasma phenobarbital concentrations in individuals completing the 5-day course and those who stopped after 3 days. For the quinine-tetracycline regimen, results suggest that it may be possible to discriminate between subjects where there is a 3-day difference in treatment. Phenobarbital is a better discriminant when dosing is every 24 hours as with artesunate, rather than the 8-hourly regimen for quinine-tetracycline. When measuring compliance for malaria treatment, if it is important to know what proportion of patients reach 3, 5 or 7 days of compliance, then phenobarbital might have a role to play in this assessment, but further investigations in more patients would be required. Alternatively, different markers could be used for the doses to be given on these days and, as long as the patient does not mix the doses for the different days, sequential doses and determination of compliance could be based on an "all or none" detection of the marker rather than on drug levels.

Malaria-related social and behavioral risk factors in Thailand: a review.

A review of the social and behavioral risk factors that have been implicated in malaria infection in Thailand was done as a basis for designing a conceptual framework in formulating recommendations of strategies and research needs to ensure better implementation and/or maximization of the effectiveness of existing malaria control measures in the country. These factors can be broadly divided into three categories: (1) social and behavioral risk factors favoring increased occurrence and transmission, ie population movements, irregular use or non-use of mosquito nets, partial or non-conformance with residual DDT house spraying, etc, (2) behavioral risk factors predisposing to occurrence of severe and complicated malaria, not clearly known, probably delayed treatment, (3) behavioral risk factors related to occurrence of drug resistance, ie treatment-seeking patterns, practices of drug utilization and population movements. Recommendations on research needs as well as strategies for a more effective control program are given.

Colaboración campesina contra la distomiasis hepática

Villagers exposed to liver fluke infection in north-east Thailand were advised to pay for diagnosis and treatment. On the basis of the response obtained a project for the control of the parasite in seven provinces has been planned, within the framework of a primary health care scheme

Sociodemographic and behavioural factors associated with hospital malaria patients in Kanchanaburi, Thailand.

A hospital-based case-control study was conducted at Paholpolpayuhasena Hospital, Kanchanaburi, Thailand to investigate social and behavioural factors believed to be associated with malaria occurrence. Data were obtained from 210 malaria and 210 non-malaria patients presenting at the hospital from August to September 1984. All study subjects were interviewed by trained interviewers using a structured interview form. The results showed that the malaria cases were predominantly male, under age 30 and single. Bivariate analysis showed a significant association for knowledge of transmission, use of mosquito nets, and residing or working in forested areas 2 weeks before the illness with malaria occurrence. Logistic regression analysis revealed that age, education, duration of stay in the area and knowledge of transmission were significantly associated with disease occurrence. After adjusting for these variables, use of a mosquito net was also found to be significantly associated with occurrence. Residence or work place 2 weeks before the illness was another variable significantly associated with the presence of malaria infection even after adjustment for age and knowledge of transmission. The groups found in this study to be at high risk of malaria infection were younger age groups, forest-related workers and migrant workers. The results of this study suggest that efforts should be made to identify these people and target them for malaria health education.

Health behavior, treatment-seeking patterns, and cost of treatment for patients visiting malaria clinics in western Thailand.

A clinic-based case-control study was conducted at two malaria clinics in western Thailand in order to investigate social and behavioral factors believed to be associated with malaria occurrence. The finding was that the malaria cases were predominantly male, under age 25 and single. The results showed a significant association for use of mosquito nets, conformance with DDT spraying and residing in forested areas two weeks before occurrence of illness with malaria. Analysis of symptoms revealed fever, headache and chills to be the major noticeable symptoms initiating treatment. Three basic treatment-seeking patterns were observed. The results of this study suggest that particular attention should be given to malaria health education for younger age groups and forest-related people. In addition, attention should also be given to ways of increasing awareness of symptoms, and motivation of people to use malaria clinics for malaria screening and treatment at onset of first symptoms in order to eliminate treatment-seeking at ineffective first sources. Malaria Voluntary Collaborators, Village Health Volunteers and Village Health Communicators have an important role in convincing people in malarious areas to use malaria clinics for malaria screening and treatment when the villagers develop malaria-like symptoms. This would reduce disease transmission and severity by reducing the delay for efficacious treatment and would also reduce the cost of malaria treatment.

Migration and disease problems: a study of pattern of migration in an endemic area of malaria in Thailand.

The preliminary results of a study of rural-rural migration in an endemic area of malaria is reported. The study on socio-economic status of migrant workers was made during the post planting season of sugarcane plantation in Tambon Nong Rhee Kanchanaburi Province. Among 9,311 population in four villages of this Tambon, 15.4% were migrants and 45.5% were from the northeast provinces of Thailand. Almost half of the migrant population came to the area for the first time and stayed for six months mostly during the sugarcane cutting season. No significant difference in experience with malaria (as recognized by the people not from blood examination) between the local population and the migrants was observed from the interview. However, the duration of migration seemed to relate with the risk of contracting malaria.