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From evaluating skilled care initiative in rural Burkina Faso to policy implications for safe motherhood in Africa
No full textThe definitive version is available at www3.interscience.wiley.comEvaluation findings from a particular setting need to be generalized into policy implications if they are to find widespread use. Skilled attendance at delivery is widely regarded as one of the most important intervention strategies for safe motherhood in low-resource settings, particularly in Africa, but implementations of such strategies are often not rigorously evaluated or interpreted into future policy. Initiative for Maternal Mortality Programme Assessment (Immpact) has applied a package of research-based monitoring and evaluation tools to assess the Family Care International Skilled Care Initiative in Ouargaye District, Burkina Faso. This evaluation research aimed to generate reliable, evidence-based policies for accelerating safe motherhood programmes in Burkina Faso and elsewhere in Africa. Five policy priorities were identified as representing real chances of improving the safety of motherhood: (1) enhancing national coverage of delivery by professionally skilled attendants; (2) to provide a network of 24-h basic emergency obstetric care within 5 km; (3) to have an effective referral system, equipped and resourced to undertake a reasonable number of Caesarean sections; (4) to promote community mobilization activities as a lever to increasing delivery care utilization; and (5) to implement strategies to remove financial barriers to delivery care. To meet Millennium Development Goal five by 2015, both supply and demand side constraints on the provision of quality maternity care have to be addressed, which in turn need greater political commitment and funding
Access to artemisinin combination therapy for malaria in remote areas of Cambodia
No full textBackground: Malaria-endemic countries are switching antimalarial drug policy to artemisinin combination therapies
(ACTs) and the global community are considering the setting up of a global subsidy mechanism in order to make them
accessible and affordable. However, specific interventions may be needed to reach remote at-risk communities and to
ensure that they are used appropriately. This analysis documents the coverage with ACTs versus artemisinin
monotherapies, and the effectiveness of malaria outreach teams (MOTs) and Village Malaria Workers (VMWs) in
increasing access to appropriate diagnosis and treatment with ACTs in Cambodia, the first country to switch national
antimalarial drug policy to an ACT of artesunate and mefloquine (A+M) in 2000.
Methods: A cross-sectional survey was carried out in three different types of intervention area: with VMWs, MOTs and
no specific interventions. Individuals with a history of fever in the last three weeks were included in the study and
completed a questionnaire on their treatment seeking and drug usage behaviour. Blood was taken for a rapid diagnostic
test (RDT) and data on the household socio-economic status were also obtained.
Results: In areas without specific interventions, only 17% (42/251) of respondents received a biological diagnosis, 8%
(17/206) of respondents who received modern drug did so from a public health facility, and only 8% of them (17/210)
received A+M. Worryingly, 78% (102/131) of all artemisinin use in these areas was as a monotherapy. However, both
the VMW scheme and MOT scheme significantly increased the likelihood of being seen by a trained provider (Adjusted
Odds Ratios (AOR) of 148 and 4 respectively) and of receiving A+M (AORs of 2.7 and 7.7 respectively).
Conclusion: The coverage rates of appropriate diagnosis and treatment of malaria were disappointingly low and the use
of artemisinin monotherapy alarmingly high. This reflects the fragmented nature of Cambodia's health system in remote
areas and the reliance placed by these communities on informal vendors from whom artemisinin monotherapies are
widely available. However VMWs in particular are an effective means of improving access to malaria diagnosis and
treatment. The VMW scheme and the social marketing of RDTS and blister-packaged artesunate and mefloquine have
both been scaled up nationally. Case management in the public sector has also reportedly improved. Given recent
concerns regarding the development of artemisinin drug resistance on the Thai-Cambodia border, the effectiveness of
these measures in reducing the use of artemisinin monotherapy needs to be urgently re-evaluated
Heterologous expression, purification and characterisation of the extracellular domain of trypanosome invariant surface glycoprotein ISG75
No full textThe invariant surface glycoprotein ISG75 is a transmembrane glycoprotein occurring on the surface of the bloodstream-form Trypanozoon. This study describes the expression and purification of the N-terminal extracellular domain of ISG75, a novel target for development of diagnostic tests for trypanosomosis. To facilitate disulfide formation in the cytoplasm, a 1287-bp cDNA fragment encoding ISG75 from Trypanosoma brucei gambiense was expressed in a thioredoxin reductase, glutathione oxidoreductase double mutant Escherichia coli strain. An accessory plasmid pRIL, providing the argI, ileY, and leuW tRNAs, was necessary for efficient heterologous translation of the ISG75 mRNA. The recombinant double-tagged (streptavidine and histidine) ISG75 was purified by two-step affinity chromatography. Addition of l-glutamic acid and l-arginine in the buffer solutions was crucial to stabilise the protein during purification. The purified soluble protein was characterised by circular dichroism spectroscopy, reverse-phase high pressure liquid chromatography and mass spectrometry. It has an alpha-helical folded conformation, is homogeneous and pure (99%). Furthermore, sera of Trypanosoma brucei-infected animals specifically recognise this recombinant ISG75; and rabbit antiserum raised against the recombinant ISG75 detects all species of the Trypanozoon subgenus in parasite preparations
Vector monitoring at Belgian outbreak sites during the bluetongue epidemic of 2006
No full textIn response to the first bluetongue outbreak in Belgium a monitoring programme was started at the end of August 2006 to identify possible vectors transmitting the disease. Black light traps were deployed at 36 outbreak sites and captured 1959 Culicoides specimens belonging to 16 different species. Eighty four percent of the biting midges captured belonged to the C. obsoletus complex, among them C. obsoletus s.s., C. dewulfi and C. scoticus, three suspected bluetongue vectors. The Veterinary and Agrochemical Research Centre detected viral RNA in pools of individuals belonging to this complex. Culicoides pulicaris, a potential bluetongue vector in Italy, should yet not be excluded as a possible vector in Belgium as this species was frequently found around outbreak sites, notwithstanding this species is not easily captured with the trapping techniques used during this survey
Management of Mycobacterium ulcerans infection in a pregnant woman in Benin using rifampicin and clarithromycin
No full textFive-fold increase in Trypanosoma congolense isolates resistant to diminazene aceturate over a seven-year period in eastern Zambia
No full textTwo groups of Trypanosoma congolense isolates collected from cattle in 1996 (n=39) and 2003 (n=38) in the Eastern Province of Zambia were analyzed by BclI-PCR-RFLP to assess the evolution of diminazene aceturate (DA) resistance over a period of seven years. The results show a significant increase of DA resistance in this relatively short period of time. In 1996, among the 39 isolates, 61.5% were found sensitive, 12.8% resistant and 25.7% had a mixed BclI-PCR-RFLP profile. In 2004, among the 38 isolates, 10.5% were found sensitive, 63.2% were resistant and 26.3% showed a mixed BclI-PCR-RFLP profile. In vivo tests in mice showed that isolates with a sensitive or mixed RFLP profile were sensitive to DA whereas isolates with a resistant RFLP profile were resistant. Since there are no indications that the drug pressure has increased between 1996 and 2003, it is suggested that genetic exchange of resistance genes might explain the increased frequency of resistance to DA
