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1.
Proc Natl Acad Sci U S A ; 116(18): 8931-8940, 2019 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-30975758

RESUMO

Schistosomiasis is a water-based, infectious disease with high morbidity and significant economic burdens affecting >250 million people globally. Disease control has, with notable success, for decades focused on drug treatment of infected human populations, but a recent paradigm shift now entails moving from control to elimination. To achieve this ambitious goal, more sensitive diagnostic tools are needed to monitor progress toward transmission interruption in the environment, especially in low-intensity infection areas. We report on the development of an environmental DNA (eDNA)-based tool to efficiently detect DNA traces of the parasite Schistosoma mansoni directly in the aquatic environment, where the nonhuman part of the parasite life cycle occurs. This is a report of the successful detection of S. mansoni in freshwater samples by using aquatic eDNA. True eDNA was detected in as few as 10 cercariae per liter of water in laboratory experiments. The field applicability of the method was tested at known transmission sites in Kenya, where comparison of schistosome detection by conventional snail surveys (snail collection and cercariae shedding) with eDNA (water samples) showed 71% agreement between the methods. The eDNA method furthermore detected schistosome presence at two additional sites where snail shedding failed, demonstrating a higher sensitivity of eDNA sampling. We conclude that eDNA provides a promising tool to substantially improve the environmental surveillance of S. mansoni Given the proper method and guideline development, eDNA could become an essential future component of the schistosomiasis control tool box needed to achieve the goal of elimination.


Assuntos
DNA Ambiental/análise , Esquistossomose/diagnóstico , Esquistossomose/genética , Animais , Vetores de Doenças , Monitoramento Ambiental/métodos , Fezes , Humanos , Quênia , Doenças Negligenciadas/diagnóstico , Schistosoma mansoni/genética , Esquistossomose/transmissão , Esquistossomose mansoni/parasitologia , Caramujos
2.
J Helminthol ; 93(3): 313-318, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-29606160

RESUMO

The presence and distribution of various species of canine hookworms in Africa are poorly known. The main objective of this study, therefore, was to identify the hookworm species present in canine faecal samples from Morogoro, Tanzania, using molecular techniques. Faecal samples from 160 local dogs were collected and hookworm positive samples processed to recover larvae for further molecular characterization. DNA was extracted from pools of larvae from individual samples (n = 66), which were analysed subsequently using two different molecular approaches, polymerase chain reaction-linked restriction fragment length polymorphism (PCR-RFLP) and species-specific PCR coupled with Sanger sequencing. The PCR-RFLP technique detected only the presence of the ubiquitous Ancylostoma caninum in the 66 samples. However, by species-specific PCR coupled with Sanger sequencing we identified ten samples with A. braziliense, two with Uncinaria stenocephala and five with A. ceylanicum. Thus, all four known species of canine hookworms were identified in Morogoro, Tanzania. To our knowledge this is the first report of the detection of the presence of U. stenocephala and A. ceylanicum in Africa using molecular techniques. In addition to their veterinary importance, canine hookworms have zoonotic potential and are of public health concern.


Assuntos
Ancylostomatoidea/classificação , Ancylostomatoidea/isolamento & purificação , Fezes/parasitologia , Ancylostomatoidea/genética , Animais , DNA de Helmintos/química , DNA de Helmintos/isolamento & purificação , Doenças do Cão/parasitologia , Cães , Infecções por Uncinaria/parasitologia , Infecções por Uncinaria/veterinária , Reação em Cadeia da Polimerase , Polimorfismo de Fragmento de Restrição , Análise de Sequência de DNA , Tanzânia
3.
Tidsskr Nor Laegeforen ; 139(12)2019 Sep 10.
Artigo em Nor, Inglês | MEDLINE | ID: mdl-31502800

RESUMO

BACKGROUND: In July 2013, the Department of Paediatric and Adolescent Medicine at Østfold Hospital Trust introduced nitrous oxide as an option for procedural sedation of children and adolescents. MATERIAL AND METHOD: During the period 13 July 2013-25 August 2017, 311 procedures were performed with nitrous oxide in 238 patients aged 4-17 years. Age, sex, type and duration of procedure, any supplementary medications, complications and whether the procedure would previously have required general anaesthesia, were recorded in a form. The child rated the effectiveness of nitrous oxide using a graded age-appropriate 10-point pain scale, and the nurse rated it as good, moderate or none. RESULTS: The children reported a median pain score of 2/10 (interquartile range 0-4), and nurses rated effectiveness as good in 247 of 304 (81 %) cases. For 43 % of procedures, the nurse felt that general anaesthesia would have been necessary had the department not had access to nitrous oxide. Adverse effects, most often dizziness, were reported in 110 of 311 procedures (35 %). In 7 of 311 procedures (2 %), the patient experienced adverse effects that resulted in stoppage of the procedure. The procedure was completed in 286 (92 %) children. INTERPRETATION: Nitrous oxide is a useful option for children who require procedural sedation, and means that more procedures can be performed without general anaesthesia.


Assuntos
Anestésicos Inalatórios , Óxido Nitroso , Utilização de Procedimentos e Técnicas , Adolescente , Analgésicos/administração & dosagem , Analgésicos/efeitos adversos , Analgésicos/farmacologia , Anestesia Geral/estatística & dados numéricos , Anestesia Local , Anestésicos Inalatórios/administração & dosagem , Anestésicos Inalatórios/efeitos adversos , Anestésicos Inalatórios/farmacologia , Criança , Pré-Escolar , Contraindicações de Medicamentos , Feminino , Humanos , Masculino , Óxido Nitroso/administração & dosagem , Óxido Nitroso/efeitos adversos , Óxido Nitroso/farmacologia , Noruega , Enfermeiras e Enfermeiros , Medição da Dor , Utilização de Procedimentos e Técnicas/normas , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Resultado do Tratamento
4.
BMC Infect Dis ; 17(1): 652, 2017 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-28962552

RESUMO

BACKGROUND: The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) focus is on randomized trials of different approaches to mass drug administration (MDA) in endemic countries in Africa. Because their studies provided an opportunity to evaluate the effects of mass treatment on Schistosoma-associated morbidity, nested cohort studies were developed within SCORE's intervention trials to monitor changes in a suite of schistosomiasis disease outcomes. This paper describes the process SCORE used to select markers for prospective monitoring and the baseline prevalence of these morbidities in four parallel cohort studies. METHODS: In July 2009, SCORE hosted a discussion of the potential impact of MDA on morbidities due to Schistosoma infection that might be measured in the context of multi-year control. Candidate markers were reviewed and selected for study implementation. Baseline data were then collected from cohorts of children in four country studies: two in high endemic S. mansoni sites (Kenya and Tanzania), and two in high endemic S. haematobium sites (Niger and Mozambique), these cohorts to be followed prospectively over 5 years. RESULTS: At baseline, 62% of children in the S. mansoni sites had detectable eggs in their stool, and 10% had heavy infections (≥ 400 eggs/g feces). Heavy S. mansoni infections were found to be associated with increased baseline risk of anemia, although children with moderate or heavy intensity infections had lower risk of physical wasting. Prevalence of egg-positive infection in the combined S. haematobium cohorts was 27%, with 5% of individuals having heavy infection (≥50 eggs/10 mL urine). At baseline, light intensity S. haematobium infection was associated with anemia and with lower scores in the social domain of health-related quality-of-life (HRQoL) assessed by Pediatric Quality of Life Inventory. CONCLUSIONS: Our consensus on practical markers of Schistosoma-associated morbidity indicated that height, weight, hemoglobin, exercise tolerance, HRQoL, and ultrasound abnormalities could be used as reference points for gauging treatment impact. Data collected over five years of program implementation will provide guidance for future evaluation of morbidity control in areas endemic for schistosomiasis. TRIAL REGISTRATION: These cohort studies are registered and performed in conjunction with the International Standard Randomised Controlled Trial Registry trials ISRCTN16755535 , ISRCTN14117624 , ISRCTN95819193 , and ISRCTN32045736 .


Assuntos
Anti-Helmínticos/uso terapêutico , Esquistossomose Urinária/tratamento farmacológico , Esquistossomose mansoni/tratamento farmacológico , Anemia/tratamento farmacológico , Anemia/etiologia , Animais , Criança , Estudos de Coortes , Fezes/parasitologia , Humanos , Quênia/epidemiologia , Masculino , Morbidade , Moçambique/epidemiologia , Níger/epidemiologia , Prevalência , Qualidade de Vida , Schistosoma haematobium/patogenicidade , Schistosoma mansoni/patogenicidade , Esquistossomose Urinária/epidemiologia , Esquistossomose mansoni/epidemiologia , Tanzânia/epidemiologia
5.
J Biosoc Sci ; 49(2): 265-275, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27180827

RESUMO

A majority of Zambian children live in impoverished communities that lack safe water and proper sanitation, exposing them to urogenital and intestinal helminths. Efforts to mitigate this plight have been implemented through mass drug administration aimed at deworming school-age and under-five children against schistosomiasis and soil-transmitted helminths. However, the disease status of adults living in the same communities as the treated children remains unknown. The aim of this study was to describe the potential contribution of infected adult populations to the transmission of these infections in southern Zambia. A cross-sectional study was conducted in April and May 2013 as part of baseline survey for a larger study in Mazabuka and Siavonga Districts. Stool and urine samples of 2829 adults from five catchment areas were collected and processed using Kato-Katz and urine filtration methods, respectively. Adults from Siavonga had a 13.9% combined prevalence of Schistosoma haematobium and S. mansoni, and 12.1% combined prevalence of Ascaris lumbricoides and hookworm. There was no S. mansoni in Mazabuka, and only a 5.3% prevalence of S. haematobium and 7.4% combined prevalence of A. lumbricoides and hookworm. Additionally, no Trichuris trichiura infections were observed in the two districts. Despite most of these infections being categorized as light intensity, heavy infection intensities were also found for all four parasite species. If this infected adult population is left untreated, the possibility of it acting as a reservoir of infections and ultimately transmitting the infections to treated children remains. Therefore, there is need to consider alternative treatment strategies that incorporate adults, thereby reducing the risk of contaminating the environment and perpetuating transmission to children.


Assuntos
Reservatórios de Doenças/parasitologia , Helmintíase/epidemiologia , Helmintíase/transmissão , Esquistossomose/epidemiologia , Esquistossomose/transmissão , Solo/parasitologia , Adolescente , Adulto , Animais , Ascaris lumbricoides/isolamento & purificação , Estudos Transversais , Gerenciamento Clínico , Fezes/parasitologia , Feminino , Helmintíase/parasitologia , Helmintíase/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Schistosoma haematobium/isolamento & purificação , Schistosoma mansoni/isolamento & purificação , Esquistossomose/parasitologia , Esquistossomose/prevenção & controle , Inquéritos e Questionários , Trichuris/isolamento & purificação , Adulto Jovem , Zâmbia/epidemiologia
6.
BMC Infect Dis ; 16: 229, 2016 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-27230666

RESUMO

BACKGROUND: The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) was established in 2008 to answer strategic questions about schistosomiasis control. For programme managers, a high-priority question is: what are the most cost-effective strategies for delivering preventive chemotherapy (PCT) with praziquantel (PZQ)? This paper describes the process SCORE used to transform this question into a harmonized research protocol, the study design for answering this question, the village eligibility assessments and data resulting from the first year of the study. METHODS: Beginning in 2009, SCORE held a series of meetings to specify empirical questions and design studies related to different schedules of PCT for schistosomiasis control in communities with high (gaining control studies) and moderate (sustaining control studies) prevalence of Schistosoma infection among school-aged children. Seven studies are currently being implemented in five African countries. During the first year, villages were screened for eligibility, and data were collected on prevalence and intensity of infection prior to randomisation and the implementation of different schemes of PZQ intervention strategies. RESULTS: These studies of different treatment schedules with PZQ will provide the most comprehensive data thus far on the optimal frequency and continuity of PCT for schistosomiasis infection and morbidity control. CONCLUSIONS: We expect that the study outcomes will provide data for decision-making for country programme managers and a rich resource of information to the schistosomiasis research community. TRIAL REGISTRATION: The trials are registered at International Standard Randomised Controlled Trial registry (identifiers: ISRCTN99401114 , ISRCTN14849830 , ISRCTN16755535 , ISRCTN14117624 , ISRCTN95819193 and ISRCTN32045736 ).


Assuntos
Anti-Helmínticos/administração & dosagem , Praziquantel/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Esquistossomose/epidemiologia , África/epidemiologia , Animais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Prevalência , Serviços Preventivos de Saúde , Schistosoma haematobium , Schistosoma mansoni , Esquistossomose/prevenção & controle
7.
Parasitol Res ; 115(3): 1027-37, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26573519

RESUMO

Avian schistosomes are widespread parasites of snails and waterfowl and may cause cercarial dermatitis (swimmer's itch) in humans, a disease that is frequently reported in European countries. These parasites are known to occur in Denmark, but here, we applied a new approach using molecular tools to identify the parasites at species level. In order to do that, 499 pulmonate freshwater snails (Radix sp., Lymnaea stagnalis, Stagnicola sp. and Planorbarius corneus) were sampled from 12 lakes, ponds, and marshes in the greater Copenhagen area. Avian schistosome cercariae were identified by microscopy and subjected to molecular investigation by sequencing and phylogenetic analysis of the 5.8S and ITS2 ribosomal DNA for species identification. Additionally, snail hosts belonging to the genus Radix were identified by sequencing and phylogenetic analysis of partial ITS2 ribosomal DNA. Three out of 499 snails shed different species of Trichobilharzia cercariae: Trichobilharzia szidati was isolated from L. stagnalis, Trichobilharzia franki from Radix auricularia and Trichobilharzia regenti from Radix peregra. In the light of the public health risk represented by bird schistosomes, these findings are of concern and, particularly, the presence of the potentially neuro-pathogenic species, T. regenti, in Danish freshwaters calls for attention.


Assuntos
Dermatite/parasitologia , Schistosomatidae/patogenicidade , Esquistossomose/parasitologia , Dermatopatias Parasitárias/parasitologia , Caramujos/parasitologia , Animais , Doenças das Aves/parasitologia , Aves , Cercárias/classificação , Cercárias/genética , Cercárias/isolamento & purificação , Cercárias/patogenicidade , DNA de Helmintos/química , DNA de Helmintos/isolamento & purificação , DNA Ribossômico/química , Dinamarca/epidemiologia , Dermatite/epidemiologia , Água Doce/parasitologia , Variação Genética , Humanos , Lymnaea/parasitologia , Filogenia , Schistosomatidae/classificação , Schistosomatidae/genética , Schistosomatidae/isolamento & purificação , Esquistossomose/epidemiologia , Dermatopatias Parasitárias/epidemiologia
8.
Palliat Support Care ; 14(5): 456-67, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-26513022

RESUMO

OBJECTIVE: When caring for a loved one with a life-limiting illness, a caregiver's own physical, emotional, and spiritual suffering can be profound. While many interventions focus on physical and emotional well-being, few caregiver interventions address existential and spiritual needs and the meaning that caregivers ascribe to their role. To evaluate the feasibility and acceptability of the process and content of Caregiver Outlook, we employed a manualized chaplain-led intervention to improve well-being by exploring role-related meaning among caregivers of patients with a life-limiting illness. METHOD: We conducted a single-arm pre-post pilot evaluation among caregivers of patients with advanced cancer or amyotrophic lateral sclerosis (ALS). Caregivers completed three chaplain-led intervention sessions focusing on (1) a relationship review, (2) forgiveness, and (3) legacy. Outcomes administered at baseline and at 1 and 2 weeks after the intervention included quality of life, anxiety, depression, spiritual well-being, religious coping, caregiver burden, and grief. RESULTS: The sample (N = 31) included a range of socioeconomic status groups, and the average age was approximately 60 years. A third of them worked full-time. Some 74% of our participants cared for a spouse or partner, and the other quarter of the sample cared for a parent (13%), child (10%), or other close family member (3%). At baseline, participants did not demonstrate clinical threshold levels of anxiety, depression, or other indicators of distress. Outcomes were stable over time. The qualitative results showed the ways in which Caregiver Outlook was assistive: stepping back from day-to-day tasks, the opportunity to process emotions, reflecting on support received, provoking thoughts and emotions between sessions, discussing role changes, stimulating communication with others, and the anonymity of a phone conversation. Both religious and nonreligious participants were pleased with administration of the chaplain intervention. SIGNIFICANCE OF RESULTS: The acceptability and feasibility of Caregiver Outlook were demonstrated among caregivers of patients with an advanced illness. Our pilot findings suggest minor modifications to study participant screening, interventionist guidance, and the study measures.


Assuntos
Cuidadores/psicologia , Clero , Cuidados Paliativos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Pesquisa Qualitativa , Qualidade de Vida/psicologia , Estresse Psicológico/psicologia , Estresse Psicológico/terapia , Doente Terminal/psicologia , Recursos Humanos
9.
BMC Infect Dis ; 15: 423, 2015 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-26466681

RESUMO

BACKGROUND: Sustaining high uptake of praziquantel is key for long-term control of schistosomiasis. During mass treatment in 2013, we randomized 12 primary schools into two groups; one group received education messages for schistosomiasis prevention for two months prior to mass treatment, while the other, in addition to the education messages, received a pre-treatment snack shortly before mass treatment. The uptake of praziquantel in the snack schools was 94 % compared to 79 % in the non-snack schools. During mass treatment in 2014, no snack was provided. We compared the uptake of praziquantel in 2014 to that in 2013 and attempt to explain the reasons for the observed differences. METHODS: Serial cross sectional surveys were conducted among a random sample of children from the 12 primary schools, 1 month after mass treatment in 2013 and 2014 to measure uptake of praziquantel, reported side effects attributable to praziquantel and prevalence and intensity of schistosomiasis infection. Differences in the demographic and descriptive variables between the 2013 and 2014 samples were compared using chi squared tests for categorical variables and student's t-test for geometric mean intensity of S. mansoni infection. RESULTS: Uptake of praziquantel reduced from 93.9 to 78.0 % (p = 0.002) in the snack schools but was unchanged in the non-schools 78.7 and 70.4 % (p = 0.176). The occurence of side-effects attributable to praziquantel increased from 34.4 to 61.2 % (p = 0.001) in the snack schools but was unchanged in the non-snack schools; 46.9 and 53.2 % (p = 0.443). Although the prevalence of S. mansoni infection increased in both the snack and non-snack schools, the differences did not reach statistical significance;1.3 and 7.5 % (p = 0.051) and 14.1 and 22.0 % (p = 0.141), respectively. Similarly, the difference in the geometric mean intensity of S. mansoni infection in both the snack and non-snack schools was not statistically significant; 38.3 eggs per gram of stool (epg) and 145.7 epg (p = 0.197) and 78.4 epg and 322.5 epg (p = 0.120), respectively. CONCLUSION: Our results show that in absence of food, uptake of praziquantel reduced and the side-effects of the drug increased. However, the reduced uptake did not affect the prevalence and intensity of schistosomiasis among school children. Rescinding of the provision of the snack is what probably caused the reduction in uptake of treatment in the subsequent mass treatment cycle.


Assuntos
Praziquantel/uso terapêutico , Esquistossomose mansoni/tratamento farmacológico , Esquistossomose/tratamento farmacológico , Dor Abdominal/etiologia , Adolescente , Criança , Estudos Transversais , Demografia , Diarreia/etiologia , Tontura/etiologia , Ingestão de Alimentos , Fezes/parasitologia , Feminino , Humanos , Masculino , Doenças Negligenciadas , Praziquantel/efeitos adversos , Prevalência , Esquistossomose/epidemiologia , Esquistossomose/prevenção & controle , Esquistossomose mansoni/epidemiologia , Esquistossomose mansoni/prevenção & controle
10.
BMC Palliat Care ; 14: 12, 2015 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-25927207

RESUMO

BACKGROUND: Despite recognition of the centrality of professional board-certified chaplains (BCC) in palliative care, the discipline has little research to guide its practices. To help address this limitation, HealthCare Chaplaincy Network funded six proposals in which BCCs worked collaboratively with established researchers. Recognizing the importance of interdisciplinary collaboration in the development of a new field, this paper reports on an exploratory study of project members' reflections over time on the benefits and challenges of conducting inter-disciplinary spiritual care research. METHODS: Data collection occurred in two stages. Stage 1 entailed two independent, self-reflective focus groups, organized by professional discipline, mid-way through the site projects. Stage 2 entailed end-of-project site reports and a conference questionnaire. RESULTS: Eighteen professionals participated in the group discussions. Stage 1: researchers perceived chaplains as eager workers passionately committed to their patients and to research, and identified challenges faced by chaplains in learning to conduct research. Chaplains perceived researchers as passionate about their work, were concerned research might uncover negative findings for their profession, and sensed they used a dissimilar paradigm from their research colleagues regarding the 'ways of relating' to knowledge and understanding. Stage 2: researchers and chaplains noted important changes they ascribed to the interdisciplinary collaboration that were classified into six domains of cultural and philosophical understanding: respect; learning; discovery; creativity; fruitful partnerships; and learning needs. CONCLUSIONS: Chaplains and researchers initially expressed divergent perspectives on the research collaborations. During the projects' lifespans, these differences were acknowledged and addressed. Mutual appreciation for each discipline's strengths and contributions to inter-professional dialogue emerged.


Assuntos
Serviço Religioso no Hospital/organização & administração , Clero/psicologia , Comportamento Cooperativo , Pesquisa sobre Serviços de Saúde/organização & administração , Pesquisadores/psicologia , Adulto , Feminino , Grupos Focais , Humanos , Comunicação Interdisciplinar , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Percepção , Inquéritos e Questionários
11.
J Biosoc Sci ; 47(4): 505-20, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24735860

RESUMO

Despite attempts to control intestinal schistosomiasis through school-based mass drug administration (MDA) with praziquantel using school teachers in Uganda, less than 30% of the school children take the treatment in some areas. The aim of the study was to understand why the uptake of praziquantel among school children is low and to suggest strategies for improved uptake. This was a cross-sectional qualitative study in which 24 focus group discussions and 15 key informant interviews were conducted 2 months after MDA. The focus group discussions were held with school children in twelve primary schools and the key informant interviews were held with school teachers, sub-county health assistants and the District Vector Control Officer. The study shows that the low uptake of praziquantel among school children is a result of a complex interplay between individual, interpersonal, institutional, community and public policy factors. The individual and interpersonal factors underpinning the low uptake include inadequate information about schistosomiasis prevention, beliefs and attitudes in the community about treatment of schistosomiasis and shared concerns among children and teachers about the side-effects of praziquantel, especially when the drug is taken on an empty stomach. The institutional, policy and community factors include inadequate preparation and facilitation of teachers and the school feeding policy, which requires parents to take responsibility for providing their children with food while at school, yet many parents cannot meet the cost of a daily meal due to the prevailing poverty in the area. It is concluded that strategies to improve uptake of praziquantel among school children need to be multi-pronged addressing not only the preparation and motivation of teachers and health education for children, but also the economic and political aspects of drug distribution, including the school feeding policy.


Assuntos
Praziquantel/uso terapêutico , Esquistossomose mansoni/tratamento farmacológico , Esquistossomicidas/uso terapêutico , Adolescente , Criança , Estudos Transversais , Docentes , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , Motivação , Doenças Negligenciadas , Pais/educação , Pesquisa Qualitativa , Esquistossomose mansoni/terapia , Instituições Acadêmicas , Resultado do Tratamento , Uganda/epidemiologia
12.
PLoS Med ; 11(5): e1001640, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24824051

RESUMO

BACKGROUND: School-based mass treatment with praziquantel is the cornerstone for schistosomiasis control in school-aged children. However, uptake of treatment among school-age children in Uganda is low in some areas. The objective of the study was to examine the effectiveness of a pre-treatment snack on uptake of mass treatment. METHODS AND FINDINGS: In a cluster randomized trial carried out in Jinja district, Uganda, 12 primary schools were randomized into two groups; one received education messages for schistosomiasis prevention for two months prior to mass treatment, while the other, in addition to the education messages, received a pre-treatment snack shortly before mass treatment. Four weeks after mass treatment, uptake of praziquantel was assessed among a random sample of 595 children in the snack schools and 689 children in the non-snack schools as the primary outcome. The occurrence of side effects and the prevalence and mean intensity of Schistosoma mansoni infection were determined as the secondary outcomes. Uptake of praziquantel was higher in the snack schools, 93.9% (95% CI 91.7%-95.7%), compared to that in the non-snack schools, 78.7% (95% CI 75.4%-81.7%) (p = 0.002). The occurrence of side effects was lower in the snack schools, 34.4% (95% CI 31.5%-39.8%), compared to that in the non-snack schools, 46.9% (95% CI 42.2%-50.7%) (p = 0.041). Prevalence and mean intensity of S. mansoni infection was lower in the snack schools, 1.3% (95% CI 0.6%-2.6%) and 38.3 eggs per gram of stool (epg) (95% CI 21.8-67.2), compared to that in the non-snack schools, 14.1% (95% CI 11.6%-16.9%) (p = 0.001) and 78.4 epg (95% CI 60.6-101.5) (p = 0.001), respectively. CONCLUSIONS: Our results suggest that provision of a pre-treatment snack combined with education messages achieves a higher uptake compared to the education messages alone. The use a pre-treatment snack was associated with reduced side effects as well as decreased prevalence and intensity of S. mansoni infection. TRIAL REGISTRATION: www.ClinicalTrials.gov NCT01869465


Assuntos
Esquistossomose/tratamento farmacológico , Esquistossomose/epidemiologia , Lanches , Adolescente , Criança , Intervalos de Confiança , Feminino , Humanos , Modelos Logísticos , Masculino , Razão de Chances , Praziquantel/uso terapêutico , Prevalência , Resultado do Tratamento , Uganda/epidemiologia
13.
Southeast Asian J Trop Med Public Health ; 45(6): 1243-51, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26466410

RESUMO

Lymphatic filariasis (LF), malaria and soil transmitted helminthiasis (STH) cause major health problems in Nepal, but in spite of this very few stud- ies have been carried out on these parasitic infections in Nepal. A cross sectional survey of all three categories of parasitic infections was carried out in Deuda- kala Village of Bardiya District, western Nepal. A total of 510 individuals aged 5 years and above were examined from finger prick blood for circulating filarial antigen (CFA), malaria antigen using a rapid diagnostic test (RDT), and malaria DNA using a PCR-based assay. In addition, 317 individuals were examined for soil-transmitted helminth (STH) eggs by the Kato-Katz technique. Prevalence of LF, malaria (antigen) and STH infection was 25.1%, 0.6% and 18.3%, respectively. PCR analysis did not detect any additional malaria cases. The prevalence of LF and STH infections differ significantly among different age groups and ethnic communities. The high prevalence of LF in the community studied indicates an immediate need for implementing a mass drug administration program for its control in this particular geographical area of Nepal.


Assuntos
Filariose Linfática/epidemiologia , Helmintíase/epidemiologia , Malária/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Humanos , Pessoa de Meia-Idade , Nepal/epidemiologia , Prevalência , Adulto Jovem
14.
BMC Infect Dis ; 13: 590, 2013 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-24330594

RESUMO

BACKGROUND: Realization of the public health benefits of mass drug administration (MDA) for the control of schistosomiasis depends on achieving and maintaining high annual treatment coverage. In Uganda, the uptake of preventive treatment for schistosomiasis among school-age children in 2011 was only 28%. Strategies are needed to increase uptake. METHODS: Serial cross-sectional surveys were conducted at baseline (after MDA in 2011) and at follow-up MDA in 2012 where teacher motivation was provided and supervision strengthened in Jinja district of Uganda. Uptake of praziquantel was assessed in 1,010 randomly selected children from 12 primary schools during the baseline survey and in another set of 1,020 randomly selected children from the same primary schools during the follow-up survey. RESULTS: Self-reported uptake of praziquantel increased from 28.2% (95% CI 25.4%-30.9%) at baseline to 48.9% (95% CI 45.8%-52.0%) (p < 0.001) at follow-up. Prevalence and intensity of Schistosoma mansoni infection were unchanged and moderate on both occasions; 35.0% (95% CI: 25.4%-37.9%) and 32.6% (95% CI: 29.6%-35.5%) (p = 0.25) and 156.7 eggs per gram of stool (epg) (95% CI: 116.9-196.5) and 133.1 epg (95% CI: 99.0-167.2) (p = 0.38), respectively. There was no change in the proportion of children reporting side effects attributable to praziquantel at baseline (49.8%, 95% CI 43.8%-55.8%) and at follow-up (46.6%, 95% CI 42%.1-51.2%) (p = 0.50) as well as in the proportion of children with correct knowledge of schistosomiasis transmission and control between the baseline (45.9%, 95% CI 42.7%-73.7%) and follow-up (44.1%, 95% CI 41.0%- 47.2%) (p = 0.42). CONCLUSION: Although teacher motivation and supervision to distribute treatment increased the uptake of praziquantel among school-age children, the realized uptake is still lower than is recommended by the World Health Organization (WHO) and apparently too low to affect the prevalence and intensity of schistosomiasis among the children. Additional measures are needed to increase uptake of praziquantel if school-based MDA is to achieve the objective of preventive chemotherapy.


Assuntos
Anti-Helmínticos/administração & dosagem , Praziquantel/administração & dosagem , Esquistossomose mansoni/tratamento farmacológico , Esquistossomose mansoni/psicologia , Adolescente , Animais , Criança , Estudos Transversais , Docentes , Feminino , Seguimentos , Humanos , Masculino , Adesão à Medicação , Motivação , Prevalência , Schistosoma mansoni/efeitos dos fármacos , Schistosoma mansoni/isolamento & purificação , Schistosoma mansoni/fisiologia , Esquistossomose mansoni/epidemiologia , Esquistossomose mansoni/prevenção & controle , Instituições Acadêmicas , Estudantes/psicologia , Uganda/epidemiologia
15.
Parasitology ; 140(1): 109-14, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22906211

RESUMO

Despite being the most prevalent nematode infections of man in Western Europe and North America, our knowledge of the genetic variability in Enterobius vermicularis is fragmented. We here report on a genetic study of pinworms in Denmark, performed using the cytochrome oxidase I (cox1) gene, with DNA extracted from individual eggs collected from clinical (human) samples. We collected cellophane-tape-test samples positive for pinworm eggs from 14 Departments of Clinical Microbiology in Denmark and surface-sterilized the eggs using a 1% hypochlorite solution before performing conventional PCR. Twenty-two haplotypes were identified from a total of 58 Danish patients. Cluster analysis showed that all Danish worms grouped together with human samples from Germany and Greece and with samples from Japanese chimpanzees designated as 'type B'. Analysis of molecular variance showed no significant difference or trends in geographical distribution of the pinworms in Denmark, and several haplotypes were identical or closely related to samples collected in Germany, Greece and Japan. However, worms from the 4 countries were found to belong to different populations, with Fst values in the range of 0·16 to 0·47. This study shows pinworms in Denmark to be a homogenous population, when analysed using the cox1 mitochondrial gene.


Assuntos
DNA Mitocondrial/genética , Enterobius/genética , Variação Genética , Animais , Dinamarca , Complexo IV da Cadeia de Transporte de Elétrons/genética , Enterobius/classificação , Alemanha , Grécia , Haplótipos , Japão , Dados de Sequência Molecular
16.
J Vis Exp ; (191)2023 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-36715405

RESUMO

Neonatal piglets have been extensively used as translational models for perinatal asphyxia. In 2007, we adapted a well-established piglet asphyxia model by introducing cardiac arrest. This enabled us to study the impact of severe asphyxia on key outcomes, including the time taken for the return of spontaneous circulation (ROSC), as well as the effect of chest compressions according to alternative protocols for cardiopulmonary resuscitation. Due to the anatomical and physiological similarities between piglets and human neonates, piglets serve as good models in studies of cardiopulmonary resuscitation and hemodynamic monitoring. In fact, this cardiac arrest model has provided evidence for guideline development through research on resuscitation protocols, pathophysiology, biomarkers, and novel methods for hemodynamic monitoring. Notably, the incidental finding that a substantial fraction of piglets have pulseless electrical activity (PEA) during cardiac arrest may increase the applicability of the model (i.e., it may be used to study pathophysiology extending beyond the perinatal period). However, the model generation is technically challenging and requires various skill sets, dedicated personnel, and a fine balance of the measures, including the surgical protocols and the use of sedatives/analgesics, to ensure a reasonable rate of survival. In this paper, the protocol is described in detail, as well as experiences with adaptations to the protocol over the years.


Assuntos
Asfixia Neonatal , Reanimação Cardiopulmonar , Parada Cardíaca , Animais , Suínos , Humanos , Recém-Nascido , Asfixia , Retorno da Circulação Espontânea , Parada Cardíaca/terapia , Hemodinâmica , Reanimação Cardiopulmonar/métodos , Asfixia Neonatal/terapia , Modelos Animais de Doenças
17.
Appl Environ Microbiol ; 78(17): 5994-6000, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22706058

RESUMO

The potential for the transport of viable Cryptosporidium parvum oocysts through soil to land drains and groundwater was studied using simulated rainfall and intact soil columns which were applied raw slurry or separated liquid slurry. Following irrigation and weekly samplings over a 4-week period, C. parvum oocysts were detected from all soil columns regardless of slurry type and application method, although recovery rates were low (<1%). Soil columns with injected liquid slurry leached 73 and 90% more oocysts compared to columns with injected and surface-applied raw slurries, respectively. Among leachate samples containing oocysts, 44/72 samples yielded viable oocysts as determined by a dye permeability assay (DAPI [4',6'-diamidino-2-phenylindole]/propidium iodide) with the majority (41%) of viable oocysts found in leachate from soil columns with added liquid slurry. The number of viable oocysts was positively correlated (r = 0.63) with the total number of oocysts found. Destructively sampling of the soil columns showed that type of slurry and irrigation played a role in the vertical distribution of oocysts, with more oocysts recovered from soil columns added liquid slurry irrespective of the irrigation status. Further studies are needed to determine the effectiveness of different slurry separation technologies to remove oocysts and other pathogens, as well as whether the application of separated liquid slurry to agricultural land may represent higher risks for groundwater contamination compared to application of raw slurry.


Assuntos
Cryptosporidium parvum/isolamento & purificação , Cryptosporidium parvum/fisiologia , Oocistos/fisiologia , Esgotos/parasitologia , Solo/parasitologia , Água/parasitologia , Sobrevivência Celular , Purificação da Água
18.
Parasitology ; 138(12): 1586-92, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21349218

RESUMO

OBJECTIVE: There is limited information on the acceptability and safety of praziquantel for treatment of schistosomiasis in children below the age of four years. In addition, although mebendazole has been extensively used together with praziquantel against infections with schistosomiasis and soil-transmitted helminthiasis (STH) in school-aged children, no specific acceptability or safety studies have been published on this drug combination in younger children. METHODS: A randomized clinical trial was conducted to determine the safety of praziquantel alone and in combination with mebendazole in the treatment of Schistosoma mansoni and STH in children aged 1 to 4 years. RESULTS: A total of 596 children from Bwondha fishing community in Mayuge district and Wang-Kado fishing community in Nebbi district were investigated using duplicate Kato-Katz thick smears of two stool samples and 130 (21·8%) were found infected with S. mansoni. Of these, 19·2% (25) had heavy intensity of infections. Of the infected children, 82 were included and randomised into praziquantel (40 mg/kg) + mebendazole (500 mg) or praziquantel (40 mg/kg) alone. CONCLUSION: Many symptoms were reported before treatment while very few were reported after treatment and all on treatment day. No serious adverse events were reported or observed after treatment. Praziquantel with or without mebendazole was well tolerated in small children in the study area.


Assuntos
Anti-Helmínticos/administração & dosagem , Helmintíase/tratamento farmacológico , Mebendazol/administração & dosagem , Praziquantel/administração & dosagem , Esquistossomose mansoni/tratamento farmacológico , Animais , Anti-Helmínticos/efeitos adversos , Ascaríase/tratamento farmacológico , Ascaríase/parasitologia , Ascaris lumbricoides/isolamento & purificação , Pré-Escolar , Quimioterapia Combinada , Fezes/parasitologia , Feminino , Helmintíase/complicações , Helmintíase/epidemiologia , Infecções por Uncinaria/tratamento farmacológico , Infecções por Uncinaria/epidemiologia , Humanos , Lactente , Masculino , Mebendazol/efeitos adversos , Contagem de Ovos de Parasitas , Praziquantel/efeitos adversos , Prevalência , Schistosoma mansoni/isolamento & purificação , Esquistossomose mansoni/complicações , Esquistossomose mansoni/epidemiologia , Método Simples-Cego , Solo/parasitologia , Inquéritos e Questionários , Resultado do Tratamento , Tricuríase/tratamento farmacológico , Tricuríase/epidemiologia , Uganda/epidemiologia
19.
Parasitology ; 138(12): 1578-85, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21320386

RESUMO

This study assessed the impact of adding community-directed treatment (ComDT) to the routine health facility (HF)-based treatment on prevalence and intensity of soil transmitted helminth (STH) infections among children aged 12 to 59 months. Repeated cross-sectional surveys were conducted among randomly selected children of this age group from the intervention area (HF+ComDT area) and the comparison area (HF area) at baseline (n=986), 12 months (n=796) and 18 months (n=788) follow-up. The prevalence of Ascaris lumbricoides was significantly higher in the HF+ComDT as compared to the HF area at baseline (P=0·048), but not at 12 and 18 months follow-up. At baseline the HF+ComDT area had significantly higher intensities of A. lumbricoides compared to the HF area (P<0·001), but not at 12 and 18 months follow-ups. Prevalence and intensity of hookworm did not differ significantly between treatment arms at any time. Analysis of trends showed a significant decrease in prevalence of A. lumbricoides and hookworm in the HF+ComDT area (P<0·001), of hookworm in the HF area (P<0·05), but not of A. lumbricoides in the HF area. It is concluded that the ComDT approach generally enhanced the treatment effect among under-five year children and that this alternative approach may also have advantages in other geographical settings.


Assuntos
Ancylostomatoidea/isolamento & purificação , Anti-Helmínticos/uso terapêutico , Ascaríase/tratamento farmacológico , Ascaris lumbricoides/isolamento & purificação , Serviços de Saúde Comunitária/organização & administração , Infecções por Uncinaria/tratamento farmacológico , Distribuição por Idade , Animais , Ascaríase/epidemiologia , Proteção da Criança , Pré-Escolar , Estudos Transversais , Coleta de Dados , Seguimentos , Infecções por Uncinaria/epidemiologia , Humanos , Lactente , Mebendazol/uso terapêutico , Contagem de Ovos de Parasitas , Prevalência , Solo/parasitologia , Zâmbia/epidemiologia
20.
Trop Anim Health Prod ; 43(3): 567-72, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21088893

RESUMO

During the last 30 years, pig production in Uganda and neighbouring counties has increased markedly. Pigs are mainly kept as a source of income for small-scale farmers; however, the pig production is subject to several constraints, one of them being worm infections. A study was carried out in rural communities in Kabale District in the South Western part of Uganda in September and October 2007 in order to estimate the prevalence of gastrointestinal nematode parasites in pigs based on coprological examination. Fifty-six households were randomly selected and visited. Housing system and deworming history were recorded. Faeces was sampled from rectum of one to five pigs (age, 3-12 months) per household. A total of 106 pigs were examined coprologically of which 91% excreted nematode eggs. The following prevalences of nematode eggs were recorded: strongyles (89%), Ascaris suum (40%), Trichuris suis (17%) and spiruroid eggs (48%). On household level, rearing pigs on slatted floors in pens significantly reduced the faecal egg excretion of strongyle eggs with almost 80% (p=0.010) and a significant interaction between floor type and anthelmintic treatment was found for spiruroids (p=0.037). Fifteen T. suis egg positive pigs were selected for post-mortem examination of the gastrointestinal tract. The post-mortem examinations revealed that 93% pigs were infected with Oesophagostomum spp. (worm burden, min-max 10-2,180), 73% with A. suum (1-36), 67% with T. suis (6-58), and 20% with Hyostrongylus rubidus (worms not quantified). In general, nematode infections were widespread and polyparasitism common in pigs in Uganda. However, worm burdens were moderate which may be related to recent deworming or to the practice of rearing pigs on slatted floors in wooden elevated pens.


Assuntos
Enteropatias Parasitárias/veterinária , Nematoides/crescimento & desenvolvimento , Infecções por Nematoides/veterinária , Doenças dos Suínos/parasitologia , Criação de Animais Domésticos/métodos , Animais , Distribuição de Qui-Quadrado , Fezes/parasitologia , Feminino , Enteropatias Parasitárias/epidemiologia , Enteropatias Parasitárias/parasitologia , Masculino , Infecções por Nematoides/epidemiologia , Infecções por Nematoides/parasitologia , Contagem de Ovos de Parasitas/veterinária , Prevalência , População Rural , Suínos , Doenças dos Suínos/epidemiologia , Uganda/epidemiologia
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