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.

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.

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.

Plasmodium falciparum circumsporozoite antibody prevalence in Madagascar: a longitudinal study in three different epidemiologic areas.

A longitudinal study on the prevalence of Plasmodium falciparum circumsporozoite antibodies (Ab-CS) was carried out in 15 villages of three epidemiologic areas of Madagascar: the highlands, east coast, and the southwest region. A total of 3,967 blood samples were collected from November 1989 to April 1991 from cohorts of resident schoolchildren. The prevalence of Ab-CS in the examined population varied greatly according to the different ecoepidemiologic areas of the country. A correlation analysis was made between Ab-CS and P. falciparum parasite prevalence in the same population. High Ab-CS prevalence rates (25-75%) and levels (optical density = 0.28-0.76) were observed in the villages of the east coast (mesoendemic stable malaria). The Ab-CS prevalence rates varied from 0 to 37% in the highlands and southwest region villages (unstable malaria). The use of Ab-CS prevalence is proposed to be a useful and reliable seroepidemiologic marker of malaria endemicity in those areas of Madagascar in which malaria transmission is high and continues for more than four months a year.

Ecology of viruses isolated from sand flies in Italy and characterized of a new Phlebovirus (Arabia virus).

A total of 84 virus strains was obtained from 16,374 male and female sand flies (Phlebotomus perniciosus and P. perfiliewi) collected in two localities of Tuscany region in Italy between 1980 and 1985. Thirty-seven (44%) were identified as Toscana virus (family Bunyaviridae, genus Phlebovirus) and 47 (56%) as a new member of the Phlebotomus fever serogroup, Arbia virus. The characteristics of this new serotype are described. The overall virus isolation rate from sand flies was 0.5 per 100 insects processed. Virus isolation rates for both viruses were similar in different years and in the two localities, suggesting that the two virus types were active in the sand fly population simultaneously. Each year, the largest number of isolates were obtained during July, corresponding to the period of maximal sand fly population density. Both viruses were repeatedly isolated from male sand flies, suggesting transovarial transmission in nature. Serologic data showed no evidence of infection among domestic and wild animals. However, a strain of Toscana virus was isolated from the brain of a bat (Pipistrellus kuhli), indicating a possible involvement of this species in the ecology of the virus. Serologic tests did not provide definitive evidence for human infection by Arbia virus.

Detection and anatomical localization of Plasmodium falciparum circumsporozoite protein and sporozoites in the afrotropical malaria vector Anopheles gambiae s.l.

Salivary glands from Anopheles gambiae s.l. collected in Burkina Faso, West Africa, were analyzed by both microscopic examination and immunoradiometric assay to determine the Plasmodium falciparum sporozoite rates. Using the same mosquito samples, the immunoassay revealed positive salivary glands with low sporozoite loads, which were frequently missed by microscopy. A closer agreement between both techniques was found using salivary glands with high sporozoite loads. We also found a number of mosquitoes with uninfected salivary glands which harbored the circumsporozoite antigen in their thoraces. In a particular village these mosquitoes represented 43.5% of all sporozoite antigen carrying specimens.

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.

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.

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.

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.

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

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.

Further observations on chemoprophylaxis and prevalence of malaria using questionnaire data in urban and rural areas of Burkina Faso.

A cross-sectional study of malaria prevalence (98.6% Plasmodium falciparum) was carried out in Ouagadougou (Burkina Faso) and in 3 neighbouring villages on 2117 children, zero to five years old. Data on antimalarial prophylaxis and treatment were obtained from the child's parent using an interviewer-administered questionnaire. Regular weekly chloroquine consumption lowered the parasite rate but a significant increase with respect to parasite density was recorded in protected children from the rural area. No significant differences related to previous antimalarial treatments were observed in parasite rate or density. Antimalarial treatments were less frequent in children under chemoprophylaxis. Information about dosage and date of therapy was not recalled by most of the interviewed parents. Problems and suggestions for questionnaire data are briefly discussed.

[Dispersion of Anopheles gambiae s.l. in an urban zone of Ouagadougou (Burkina Faso)]. / Etude sur la dispersion d'Anopheles gambiae s.l. dans une zone urbaine à Ouagadougou (Burkina Faso).

Dispersion of Anopheles gambiae s.l. from larval breeding places was examined in the town of Ougadougou, Burkina Faso. A suitable study area was chosen, characterized by high concentration of larval breeding places along a water reservoir. Mosquito density per room was calculated from the results of pyrethrum spray catches carried out on a series of seven groups of collecting stations along a transect from 100 to 1050 m from the water reservoir area. High density and uniform distribution of houses and human host in the urban area appear associated with a remarkably low degree of dispersion since most of An. gambiae s.l. were collected within 200 m (males) or 300 m (females) from the breeding sites. Malaria transmission is consequently very focal in these conditions.

Insecticide susceptibility levels of Anopheles gambiae s.l. in the area of Ouagadougou, Burkina Faso.

Tests to evaluate the susceptibility level in Anopheles gambiae s.1. from Ouagadougou and two nearby villages have been carried out. Anopheles gambiae s.1. larvae from Ouagadougou showed complete susceptibility to organophosphates and carbamates, and adults showed low-level resistance to DDT. Nine percent survival of adult An. gambiae s.1. to one-hour exposure of 4% DDT was observed in samples from Zagtouli village while in those from Koubri village, where dieldrin also was tested, resistance to both organochlorine insecticides was detected.

[A longitudinal entomologic survey on the transmission of malaria in Ouagadougou (Burkina Faso)]. / Enquete entomologique longitudinale sur la transmission du paludisme à Ouagadougou (Burkina Faso).

A longitudinal entomological malaria survey was carried out in five zones of the town of Ouagadougou, Burkina Faso, and in three neighbouring villages. The main vector is Anopheles gambiae s.l. with An. funestus having a role in some localities during the dry season. Pyrethrum spray catches were carried out once or twice per month to determine variations in vector density. Inoculation rates were estimated from the number of blood-fed vectors per man and from the sporozoite rates. Larval sampling was routinely carried out all over the urban area in order to map the larval breeding sites. Widely different degrees of malaria transmission were documented in the urban area mainly related to the spatial and temporal distribution of An. gambiae larval breeding sites. Higher inoculation rates, depending both on higher vector densities and sporozoite rates, were documented in the villages.

[Prevalence of malaria in Ouagadougou and the surrounding rural environment during the period of maximal transmission]. / Prévalence du paludisme à Ouagadougou et dans le milieu rural limitrophe en période de transmission maximale.

The prevalence of malaria infections was estimated in six different areas of the town of Ouagadougou, Burkina Faso, and in three neighbouring villages. Thick and thin blood films from a total of 2,117 children less than 5 years old were examined at the peak of the transmission season (August-September). Plasmodium falciparum was found in more than 98% of the positive slides. The overall parasite index at Ouagadougou was 16%, while indices from 51 to 88% were recorded in the three villages. Significant differences were observed between the six urban areas within the town as well as between the three villages. The highest parasite rates in the town were clearly associated with major breeding places of An. gambiae s.l. indicating a remarkable focality of transmission. Significant differences were observed between groups of children from houses only 300 m apart. Chemoprophylaxis appears to play an important role in determining parasite rates lower than expected in one of the three villages.

[Chromosomal study of Anopheles gambiae and Anopheles arabiensis in Ouagadougou (Burkina Faso) and various neighboring villages]. / Etude chromosomisque d'Anopheles gambiae et Anopheles arabiensis à Quagadougou (Burkina Faso) et dans quelques villages voisins.

Adult females of Anopheles gambiae s.1. were collected by pyrethrum spray catch in Ouagadougou (Burkina Faso, formerly Upper Volta) and in four neighbouring villages. The collections have been carried out mostly during the 1984 rainy season. Monthly collections in some sampling sites allowed a preliminary longitudinal study. By analysis of nurse cell polytene chromosomes in adult females, An. gambiae s.str. and An. arabiensis were identified in the study area. Both species showed polymorphisms for various paracentric inversions. In all samples of An. arabiensis the frequencies of the alternative karyotypes were in Hardy-Weinberg equilibrium, suggesting panmictic conditions. Conversely, An. gambiae s.str. showed a different situation, since most of its samples had strong deficiency of certain expected heterokaryotypes. This same phenomenon was already observed in Mali, leading to the splitting of gambiae s.str. into different chromosomal forms, partially or totally reproductively isolated from each other. Each chromosomal form is characterized by different chromosomal polymorphisms. Two of these forms, Mopti and Savanna, were detected in the study area. Mopti chromosomal form is apparently associated with the presence of permanent waters (i.e. the "barrages" north of the town), while Savanna is usually found in situations where breeding places are mainly dependent from rain (e.g. in villages far from "barrages" or at the town's center).

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.

The Anopheles gambiae complex in the Federal Islamic Republic of Comoros (Indian Ocean): some cytogenetic and biometric data.

Samples of adult females of the Anopheles gambiae complex from thirteen localities of three islands of the Comoro Archipelago (Anjouan, Grande Comore and Moheli) were identified by analysis of ovarian polytene chromosomes as An. gambiae s.s. The samples showed only the inversion polymorphism 2La, the mean frequency of the inverted arrangement being 38%. A significantly higher frequency of the inverted arrangement 2La was observed in the localities with a lower annual rainfall. Similarities between the chromosomal polymorphism of the samples from Comoros and that of coastal eastern African countries suggest a probable continental origin of the An. gambiae s.s. populations in the Comoro Archipelago. A biometric analysis was carried out on the palpal index and the number of coeloconic sensilla, two characters partially diagnostic between fresh- and salt-water members of the gambiae complex. The palpal index of the 2La homozygous inverted females of An. gambiae s.s. was found to be significantly higher than the index of standard homozygotes and heterozygotes, suggesting a relation between the inversion and this biometric character. No An. merus was identified, although larvae of An. gambiae s.l. were observed breeding in brackish water.