Hyperglycaemia, hypertension and their risk factors among Palestine refugees served by UNRWA.

UNRWA's noncommunicable disease screening activities were evaluated among 7762 refugees screened for hypertension and type 2 diabetes in Jordan, Syrian Arab Republic, Lebanon, Gaza Strip and West Bank in June 2007. People were referred for screening most commonly because of age (both sexes), followed by smoking (males) and family history (females). Atotal of 9% ofscreened people were diagnosed with hypertension/ diabetes. Being older than 40 years, obese or with a positive family history of diabetes or cardiovascular disease increased the risk of presenting with hypertension and/or hyperglycaemia 3.5, 1.6 and 1.2 times respectively. Differences in risk factor detection and screening outcome in relation to differences in lifestyle are discussed.

Hyperglycaemia, hypertension and their risk factors among Palestine refugees served by UNRWA

UNRWA's noncommunicable disease screening activities were evaluated among 7762 refugees screened for hypertension and type 2 diabetes in Jordan, Syrian Arab Republic, Lebanon, Gaza Strip and West Bank in June 2007. People were referred for screening most commonly because of age [both sexes], followed by smoking [males] and family history [females]. A total of 9% of screened people were diagnosed with hypertension/diabetes. Being older than 40 years, obese or with a positive family history of diabetes or cardiovascular disease increased the risk of presenting with hypertension and/or hyperglycaemia 3.5, 1.6 and 1.2 times respectively. Differences in risk factor detection and screening outcome in relation to differences in lifestyle are discussed

Anaemia among pregnant Palestinian women in the Occupied Palestinian Territory.

OBJECTIVE: To assess anaemia prevalence and correlated social and biological determinants among pregnant women in the Occupied Palestinian Territory (oPt). DESIGN: A cross-sectional survey conducted among pregnant women attending/accessing UNRWA (United Nations Relief and Works Agency for Palestine Refugees in the Near East) health centres in the Gaza Strip and the West Bank in September and October 2006. SETTING: Fifty-five UNRWA health centres in the oPt (eighteen in the Gaza Strip and thirty-seven in the West Bank). SUBJECTS: A random sample of 1740 pregnant women. RESULTS: Overall anaemia prevalence was 38.6 % (95 % CI 36.3, 40.9 %). A substantial difference in anaemia prevalence was observed between the Gaza Strip and the West Bank (44.9 % v. 31.1 %, respectively), as well as a significant increase in anaemia prevalence in the Gaza Strip compared with an Agency-wide survey conducted in 2004 (44.9 % v. 35.7 %, respectively). Anaemia prevalence was found to increase with age, parity and trimester of gestation. CONCLUSIONS: Anaemia still appears to be a public health problem among pregnant women in spite of UNRWA interventions. The West Bank shows prevalence rates similar to those observed in neighbouring countries, while the Gaza Strip has higher rates. Prevalence rates of anaemia among pregnant Palestinian women are more than two times higher than those observed in Europe.

Could malaria reappear in Italy?

Because of concern about the possible reintroduction of malaria transmission in Italy, we analyzed the epidemiologic factors involved and determined the country's malariogenic potential. Some rural areas in central and southern Italy have high receptivity because of the presence of potential malaria vectors. Anopheles labranchiae is probably susceptible to infection with Plasmodium vivax strains, but less likely to be susceptible to infection with P. falciparum. Its vulnerability is low because of the low presence of gametocyte carriers (imported cases) during the season climatically favorable to transmission. The overall malariogenic potential of Italy appears to be low, and reintroduction of malaria is unlikely in most of the country. However, our investigations showed that the malaria situation merits ongoing epidemiologic surveillance.

Malaria in the WHO European Region (1971-1999).

The number of autochthonous reported cases of malaria fell from 90 506 to 37 170 between 1996 and 1999 in the WHO European Region. There has been, however, an eight-fold increase in imported cases since the 1970s: 1500 cases were reported in 1972, 13 000 cases in 1999. France, Germany, Italy, and the United Kingdom are the west European countries with the largest numbers of cases.

[Epidemiologic surveillance system and control of malaria in the central highlands of Madagascar: results 1999-2000]. / Système de surveillance épidémiologique et d'alerte du paludisme sur les Hautes Terres Centrales de Madagascar: résultats 1999-2000.

The central highlands in Madagascar are characterized by an unstable occurrence of malaria with the risk of sporadic outbreaks. In major parts of the region DDT indoor spraying campaigns have been carried out from 1993 to 1998. This strategy was in 1999 replaced by another anti-vector intervention program targeting residual foci as detected by a surveillance and early warning system. This system is based on monitoring of presumptive malaria cases in the communities by which the number of presumptive cases exceeded a defined warning threshold value per month. The system was in the follow-up period shown to be very sensitive to variation of the coverage of anti-vector interventions: the number of presumptive cases decreased in the villages in which indoor spraying had been carried out and a minor increase was observed in those villages, where indoor spraying has been suspended. An increase of malaria cases was observed in 44 (20.8%) out of 212 study sites in the same period. The increase was in particular predominant in areas at lower attitude at the outer zones of the central highlands.

[The malaria situation in the WHO European region]. / Situatsiia po maliarii v Evropeiskom regione VOZ.

The number of indigenous malaria cases in European region peaked in 1997, when 77,985 cases were officially reported. These were caused almost exclusively by P. vivax, P. falciparum being restricted to a rather limited number of cases in Tajikistan only. Another important problem in the European Region is the importation of malaria associated with a high fatality rate from tropical endemic countries. There were 841 cases of malaria in Armenia, 567 of which were locally transmitted, 30 out of 81 districts recorded malaria cases. 89% of the indigenous cases were registered in Masis district, in the Ararat valley. In 1998, total number of cases increased to 1156. Of the 542 indigenous cases registered, 376 were in Masis district. 9911 cases were officially reported in 1997 in Azerbaijan and 5175 cases in 1998. Approximately half of malaria cases were reported from seven districts: Nakhichivan (10.4%), Imishli (14.6%), Fizuli (8.1%), Sabirabad (6.8%), Saatly (6%), Bejlagan (5.6%) and Bilasuvar (4.8%). Local transmission is also reported from the periurban areas of Baku, where many displaced people are living in temporary shelters. In 1997, a total of 30,054 malaria cases were officially registered in Tajikistan, of which 85.3% occurred in the Khatlon region, 10.5% in Dushanbe region, 3.5% in Gorno-Badakhshan region and 0.7% in Leninabad region. Following implementation of malaria control activities with WHO assistance, the number of malaria cases officially registered in 1998 dropped to 19,361 (187 were cases of falciparum malaria). A dramatic change occurred in malaria situation in Turkmenistan in 1998, when 115 indigenous cases were registered. The majority of malaria cases (104) were registered in the Kushka district, in south-east of Turkmenistan, among military service personnel. In recent years, the Government of Turkey has renewed its efforts to fight malaria, incorporating them into GAP with support from UNDP and WHO. In 1998, 36,451 cases were reported, 87.1% from southeastern Anatolia, 8.7% from Adana area and 4.2% from other areas of Turkey. The epidemics in Armenia, Azerbaijan, Tajikistan and Turkey are having a considerable impact on the malaria situation in neighbouring countries of the European Region. Malaria cases have been imported from Turkey mainly to western Europe; from Azerbaijan to the Russian Federation, Georgia, and the Republic of Moldova; and from Tajikistan to the central Asian republics and to the Russian Federation. WHO made all possible efforts to mobilize and coordinate assistance from international community. WHO/EURO organized missions to those NIS where there is a risk of malaria epidemics. Most of the very limited funds reserved for epidemic prevention and control were immediatelly used to provide a limited stock of antimalarial drugs and to help the national institutions in Kazakhstan and Uzbekistan implement antimalarial activities. In 1997, with the financial support of the Italian Government and the technical assistance of the Instituto Superiore di Sanità in Rome (WHO collaborating centre for research and training in planning tropical disease control) and of the Martsinovsky Institute of Medical Parasitology and Tropical Medicine in Moscow (WHO collaborating centre on vivax malaria), the training of health personnel in the field of malaria diagnosis, treatment and control was initiated in Armenia, Azerbaijan, Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. In 1996-1997, Japan provided financial support for a large malaria control project in Tajikistan, and Norway supported activities carried out in 1997 to tackle the malaria outbreak in Armenia. In 1997-1998, Italy supported malaria prevention activities in Kazakhstan, Kyrgyzstan and Uzbekistan, and some of the malaria activities carried out in Tajikistan under the integrated Management of Childhood Illness initiative. Several training courses and seminars were carried out in Turkey in 1998 by the national malaria contro

Compliance and tolerability of mefloquine and chloroquine plus proguanil for long-term malaria chemoprophylaxis in groups at particular risk (the military).

An historical prospective study was performed on 5120 Italian soldiers deployed in Somalia and Mozambique in 1992-94, to determine compliance and tolerability of long-term malaria chemoprophylaxis with chloroquine plus proguanil (C + P) and with mefloquine. Compliance with C + P among 3734 soldiers on duty in Somalia for 3.8 +/- 1.8 months and with mefloquine among 1386 soldiers on duty in Mozambique for 3.4 +/- 1.5 months was 90.3% and 95.7%, respectively (P < 0.01). Chemoprophylaxis curtailment rate due to side-effects was 1.5% among C + P users and 0.9% among mefloquine users (P = NS). Compliance with chemoprophylaxis and medication curtailment rate due to side-effects did not change significantly for either C + P or mefloquine, even after 3 months of continuous prophylaxis. Chemoprophylaxis curtailment rate was significantly lower in subjects aged < or = 25 years than in older subjects (1.3% vs. 2.5% for C + P [P < 0.05] and 0.4% vs. 3.3% for mefloquine [P < 0.01]). These results further support the evidence that both C + P and mefloquine regimens may be safely used in long-term malaria chemoprophylaxis. Moreover, weekly mefloquine seems easier to perform than C + P and not to increase prophylaxis discontinuation due to side-effects. Mefloquine regimen should therefore be considered the elective chemoprophylaxis for groups at particular risk of chloroquine-resistant Plasmodium falciparum malaria and especially for young male subjects.

Re-emerging malaria in the WHO European region: control priorities and constraints.

Malaria has been identified by some of the countries in the European Region of the World Health Organization as a priority, due to the re-emergence of the problem. This paper aims to present the situation of indigenous malaria in the Region and the strategy to be adopted to roll back malaria.

Control of epidemic malaria on the highlands of Madagascar.

The Malagashy national malaria control programme ('Programme National de Lutte contre le Paludisme', PNLP) has been developing, since 1996, an epidemiological early warning system for malaria epidemics in the Central Highlands with the support of the Italian Development Cooperation. The system is based on the monitoring of malaria morbidity (clinical diagnosis) in 536 peripheral health centres (CSB) of the Highlands. The intervention area corresponds to 27 districts of the Antananarivo and Fianarantsoa provinces (4.7 million inhabitants) and spans around 100,000 square km. For each CSB a monthly warning threshold, defined as the 1993-1996 monthly mean number of malaria cases plus two standard deviations, was established. Three levels of epidemic alert have been defined according to the number of times the cases of presumptive malaria surpassed the threshold and according to the reported presence of severe malaria cases. The surveillance system relies also on the monitoring, in district hospitals of the Highlands, of the Plasmodium falciparum infection rate among clinically diagnosed malaria cases. A total of 185,589 presumptive malaria cases, corresponding to a 42/1000 malaria incidence, were recorded in 1997 by the surveillance system. During the same year 184 alerts of 2nd degree were reported. During 1998 173,632 presumptive malaria cases corresponding to a 38/1000 incidence were reported and 207 alerts of 2nd degree were detected; 75 of these alerts were investigated with ad hoc surveys and 3 initial malaria epidemics identified and controlled. Out of 6884 presumptive malaria cases diagnosed in the district hospitals during 1997-1998, only 835 (12.1%) have been confirmed by microscopy (P. falciparum 81.7%, P. vivax 15.0%, P. malariae 2.5%, P. ovale 0.2%, mixed infections 0.6%); 22.4% of these infections were imported cases from coastal endemic areas. The efficiency of the system in monitoring the trend of malaria morbidity and in the rapid detection and response to malaria epidemics is still being evaluated.

Malaria in Maremma, Italy.

BACKGROUND: In August, 1997, a woman with no history of travel to malarious regions developed Plasmodium vivax malaria. She lived in a rural area of Italy where indigenous Anophyles labranchiae mosquitoes were present. METHODS AND FINDINGS: An environmental investigation was done within a 3 km radius of the patient's house. Adult mosquitoes and larvae were collected and examined by PCR with the gene for plasmodium circumsporozoite protein as target. About 200 people living in the area were interviewed to detect possible carriers of P. vivax. FINDINGS: None of the mosquitoes captured were carrying any malarial organisms. The house-to-house investigation identified a 7-year-old girl who had had a feverish illness a few days after her arrival in Italy from India, and who, 3 months later, still had P. vivax in her blood; she and her mother had antimalarial antibodies. INTERPRETATION: These investigations suggest that the index case of malaria was caused by local anopheline mosquitoes infected with exogenous P. vivax.

Morphometric multivariate analysis of field samples of adult Anopheles arabiensis and An. gambiae s.s. (Diptera: Culicidae).

The Afrotropical complex of sibling species Anopheles gambiae Giles includes the most efficient vectors of human malaria south of the Sahara. Anopheles arabiensis Patton and An. gambiae s.s. Giles are the members of the complex more adapted to the human environment. They are sympatric and synchronic over most of their distribution range; however, they show a different involvement in malaria transmission, with An. gambiae being more anthropophilic and endophilic than An. arabiensis. Discriminating between them is essential for a correct assessment of epidemiological parameters. The identification is currently achieved through recognition of species-specific chromosomal inversions or by molecular biology techniques. Both methods require considerable technical resources, not always available in the field. We carried out a morphometric analysis of field and laboratory samples of An. arabiensis and An. gambiae s.s. from sites in Madagascar, Burkina Faso, Mali, and Liberia to evaluate the degree of morphological differentiation. We examined 17 morphometric characters in samples representing each of the geographic sites. All of the measures were significantly larger for An. arabiensis (regardless of the collection site), demonstrating an intrinsic greater body size of this species. To assess the reliability associated with the multivariate statistic, we applied the discriminant function analysis, which provided a method for predicting to which group a new case will most likely be assigned. In a blind experiment, the morphometric method correctly identified approximately 85% of field-collected An. arabiensis and An. gambiae s.s., which provided a relatively simple method to approximate the relative frequencies of the 2 species in areas in which their concurrent presence was already known. The influence of laboratory conditions on the morphometrics of the 2 species was also analyzed.

Malaria surveillance in Italy : 1986-1996 analysis and 1997 provisional data.

A surveillance system for malaria was established in Italy to prevent a possible return of disease transmission after the eradication. Reporting malaria and 43 other infectious diseases is mandatory. Local laboratories diagnose clinical cases of malaria m

Prevention and morbidity of malaria in non-immune subjects; a case-control study among Italian troops in Somalia and Mozambique, 1992-1994.

The impact of malaria on Italian troops taking part in 1992-1994 in the United Nations Organization humanitarian missions in Somalia and Mozambique is discussed. In Somalia, 18 cases of Plasmodium falciparum malaria occurred among 11,600 soldiers; the overall attack rate was 0.4 cases/1000/month of exposure and the risk of malaria was effectively reduced by chemoprophylaxis with chloroquine plus proguanil (C+P) (odds ratio [OR] = 0.05, 95% confidence limits [95% CL] 0.02-0.16). In Mozambique, 119 cases of P.falciparum malaria occurred among 4800 soldiers; most cases (100) occurred in the first months of deployment (late March-June 1993), with an attack rate of 17 cases/1000/month, when C+P was the recommended chemoprophylactic regimen; the remaining 19 cases occurred subsequently, with an attack rate of 1.8 cases/1000/month, after C+P was replaced by mefloquine in July 1993. Protection achieved by C+P was unsatisfactory (OR = 0.37, 95% CL 0.21-0.67), while chemoprophylaxis with mefloquine effectively reduced the risk of malaria in Mozambique (OR = 0.03; 95% CL 0.01-0.10). A significant number of malaria infections was also detected among soldiers following their return home from Somalia (147 cases) and Mozambique (40 cases); these were due mainly to P. vivax. Fifteen of 113 P. vivax primary infections imported from Somalia (13.3%) relapsed 2-13 months after the primary attack. Because of the small proportion of relapsing P. vivax tropical strains, primaquine may be limited to radical treatment of relapses or, more extensively, of all P. vivax infections, but it should not be necessarily given to all asymptomatic subjects returning from tropical endemic areas, as is generally suggested for particular groups at risk.

Identification of a North American mosquito species, Aedes atropalpus (Diptera: Culicidae), in Italy.

In late September 1996, during a routine survey for Aedes albopictus in Italy, a population of Aedes atropalpus s.s. was discovered in the Veneto Region (northern Italy). Larvae were collected in 2 tire storage areas belonging to tire recapping companies that imported loads of car and large equipment used tires from eastern Europe and North America. Aedes atropalpus is found only in North America and hence it is the origin of this species. Control measures were carried out in October, but by then any remaining Ae. atropalpus would have been diapausing in the egg stage. A follow-up survey will be conducted in the spring of 1997 to assess if Ae. atropalpus has been established in the area and the extent of the spread in Italy.

Age-related prevalence of Plasmodium falciparum circumsporozoite antibody in an hyperendemic area of Madagascar, and its relationship with parasite prevalence.

An epidemiologic survey on malaria endemicity levels, including entomologic, parasitologic, and immunologic indicators, was carried out in a village of the Madagascar highlands (Analaroa) at the end of the 1990-1991 rainy season. The results indicate that malaria is hyperendemic and Anopheles funestus is the main vector in the area. The prevalence of parasitemia decreased with age from a maximum level of about 60% in children less than five years of age to a minimum of about 16% among those more than 29 years of age. The prevalence of Plasmodium falciparum circumsporozoite antibodies (Ab-Cs) increased with age from a minimum level of about 10% in children less than five years of age to a maximum of 71.7% among those more than 29 years of age. An inverse correlation was observed between P. falciparum prevalence and levels of Ab-Cs and parasite prevalence. The study confirmed that prevalence and Ab-Cs levels are reliable indicators of malaria endemicity in hyperendemic areas. Schoolchildren between five and 14 years of age are considered the most practical and susceptible group for this kind of epidemiologic study.

Characterization of the Culex pipiens complex (Diptera: Culicidae) in Madagascar.

Morphological analysis of phallosome and multilocus electrophoresis were used to characterize populations of the Culex pipiens L. complex from Madagascar. Samples phenotypically and genetically corresponding to Cx. p. quinquefasciatus Say were found on the east and west coasts, whereas, on the high plateau, 1 sample was composed mostly of phenotypical Cx. p. pipiens L., genetically introgressed with quinquefasciatus at some loci (Hbdh, Aat-2, and Hk-1). A hybrid zone between the 2 taxa was detected on the plateau on a genetic basis, whereas at the morphological level a predominance of Cx. p. quinquefasciatus specimens and deficit of intermediates was observed. Accordingly, morphological analysis failed to describe satisfactorily the hybridization phenomena. Despite the high level of gene exchange, a complete mixing of the 2 gene pools apparently does not occur, possibly because of differential selective pressures in the climatically heterogeneous environment of the Madagascar plateau.