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Establishment of a panel of reference Trypanosoma evansi and Trypanosoma equiperdum strains for drug screening
No full textThe animal pathogenic protozoan, Trypanosoma evansi, leads to a wasting disease in equines, cattle and camels, commonly known as Surra. It is extensively distributed geographically with a wide range of mammalian hosts and causes great economical loss. Trypanosoma equiperdum causes a venereal disease called Dourine in horses and donkeys. Chemotherapy appears to be the most effective form of control for T. evansi, whereas infections caused by T. equiperdum are considered incurable. Due to emerging drug resistance, efficient control of T. evansi is severely threatened, emphasising the urgent need to find new alternative drugs. A drug profile for a panel of T. evansi and T. equiperdum strains has been established for the four standard drugs currently used in treatment. The (3)H-hypoxanthine incorporation assay was used to obtain 50% inhibitory concentration (IC(50)) values for each standard drug against the various strains. The results indicate the presence (and in some cases, the emergence) of drug resistance in several strains. This panel of characterised strains with known drug sensitivities and resistances will be of great value for the screening of new active compounds, in comparison with the four standard drugs currently available
Effect of deworming on atopy, asthma, allergic rhinoconjunctivitis and atopic dermatitis in Cuban children
No full textScreening for Rift Valley fever infection in northern Somalia; a GIS based survey method to overcome the lack of sampling frame
No full textFollowing repeated import bans imposed by Saudi Arabia on livestock originated from Somalia due to suspicion of Rift Valley fever (RVF) presence and the severe socio-economic consequences of this, it was imperative for the Somaliland government to carry out surveillance activities in order to determine the status of transboundary diseases in its territory. A GIS computer software (Arcview) was used to overcome the lack of lists of sampling sites due to the high mobility of pastoral nomadic herds in the study area. This method proved very convenient and flexible for the random selection of sampling sites and thus the compliance with the requirements by the World Organisation for Animal Health (OIE) for statistically valid methods if the surveillance outcome is to meet international recognition and acceptance. Screening in Somaliland in 2001 and in Puntland in 2003 which targeted mainly sheep and goats aged 1-2 years (97% of surveyed animals) revealed no signs compatible with the disease but an overall sero-prevalence of 2+/-0.02% (90/4570) and 5+/-0.3% (206/4050), respectively. The spatial distribution showed clusters of high sero-prevalence located mostly in the Nugal Valley. This trend was confirmed by the follow-up survey implemented in Somaliland in 2004 with a herd prevalence of 80+/-6% and a within-herd prevalence up to 50% located again in the Nugal Valley. This result suggests the maintenance and increase of RVF virus activity in the valley. In addition conditions favourable to the breeding and survival of the vector population and the high density of livestock make the Nugal Valley an area of high risk for a RVF outbreak where sentinel herds will be placed
Offering integrated care for HIV/AIDS, diabetes and hypertension within chronic disease clinics in Cambodia
No full textPROBLEM: In Cambodia, care for people with HIV/AIDS (prevalence 1.9%) is expanding, but care for people with type II diabetes (prevalence 5-10%), arterial hypertension and other treatable chronic diseases remains very limited. APPROACH: We describe the experience and outcomes of offering integrated care for HIV/AIDS, diabetes and hypertension within the setting of chronic disease clinics. LOCAL SETTING: Chronic disease clinics were set up in the provincial referral hospitals of Siem Reap and Takeo, 2 provincial capitals in Cambodia. RELEVANT CHANGES: At 24 months of care, 87.7% of all HIV/AIDS patients were alive and in active follow-up. For diabetes patients, this proportion was 71%. Of the HIV/AIDS patients, 9.3% had died and 3% were lost to follow-up, while for diabetes this included 3 (0.1%) deaths and 28.9% lost to follow-up. Of all diabetes patients who stayed more than 3 months in the cohort, 90% were still in follow-up at 24 months. LESSONS LEARNED: Over the first three years, the chronic disease clinics have demonstrated the feasibility of integrating care for HIV/AIDS with non-communicable chronic diseases in Cambodia. Adherence support strategies proved to be complementary, resulting in good outcomes. Services were well accepted by patients, and this has had a positive effect on HIV/AIDS-related stigma. This experience shows how care for HIV/AIDS patients can act as an impetus to tackle other common chronic diseases
Engaging the private sector for tuberculosis control; much advocacy on a meagre evidence base [editorial]
No full textThe definitive version is available at www3.interscience.wiley.co
Costs and coverage of reproductive health interventions in three rural refugee-affected districts, Uganda
No full textThe definitive version is available at www3.interscience.wiley.comBACKGROUND: Uganda has hosted an estimated 200,000 refugees in post-emergency phase settlements interspersed within host communities since 1990. However, refugee health service runs parallel to host in most refugee-affected districts. The process of integration of health services began in 1999. OBJECTIVE: To estimate and compare the costs and coverage of reproductive health (RH) interventions in refugee and host populations in three rural West Nile refugee-affected districts of Uganda. METHODS: Data on costs of RH interventions were collected through a survey in 38/116 (33%) health facilities (3 public hospitals and 35 health centres). Data on coverage of RH interventions were collected from all 116 health facilities in the three rural refugee-affected districts for 2 years, 2003 and 2004. RESULTS: The costs and coverage of RH interventions significantly varied between population categories and among levels of refugee and host health facilities. Per capita cost of health care is 2.7 times higher for the refugee than the host population (US4.85). The cost per RH intervention is higher in the refugee than in the host health system (US2.73). Significantly more refugees attend antenatal care [99.4% (95% CI, 97.5-100) vs. 53.5% (53.22-53.78); P < 0.0001]. The proportion of births in health facilities was significantly greater among refugees [37.3% (36.12-38.48) vs. 15.2% (15.01-15.39); P < 0.05]. Major obstetrical interventions for absolute maternal indications were significantly more frequent among refugees than the host population living in the same region [1.02% (0.79-1.25) vs. 0.85% (0.80-0.90); P < 0.05]. CONCLUSIONS: Our study has shown higher costs and coverage in refugee than host health services. The findings suggest policy recommendations for improving the capacity, financing, organization and the performance of host health system in the refugee-affected settings
Antimonial treatment of visceral leishmaniasis: are current in vitro susceptibility assays adequate for prognosis of in vivo therapy outcome?
No full textIn most of the Indian subcontinent, the first line treatment for visceral leishmaniasis (VL) is sodium stibogluconate (SSG), an antimonial drug, but the efficacy of the drug varies according to region. We aimed to characterize the in vitro antimony susceptibility of clinical isolates of Nepalese VL patients, and to correlate this in vitro parasite phenotype to clinical therapy outcome. Thirty-three clinical isolates of L. donovani were taken from patients with known disease history. These isolates were typed and the susceptibility of intracellular amastigotes to pentavalent (SbV) and trivalent (SbIII) antimonials was determined. We observed (i) 22 SbV-resistant isolates out of 33 tested and (ii) 3 SbIII-resistant isolates out of 12 tested. Amongst the latter, there were three combinations of in vitro phenotypes: (i) parasites sensitive (n=4) or (ii) resistant to both drugs (n=3) and (iii) resistant to SbV only (n=5). There was no geographical clustering in terms of in vitro susceptibility. The relation between the in vitro susceptibility to antimonials and the corresponding in vivo treatment outcome was ambiguous. Our results highlight the need to adjust the currently used Leishmania drug susceptibility assays if they are to be used for prognosis of in vivo SSG treatment outcome