577 research outputs found
Data on Heavy metal in coastal sediments from South East Coast of Tamilnadu, India using Energy Dispersive X-ray Fluorescence (EDXRF) Technique
No full textAbstractThis article contains the chemical and geographical data and figures for the chemical data in sediments of East Coast (Pattipulam to Dhevanampattinam) of Tamilnadu. The obtained data are related to the research article “Heavy Metal Assessment in Sediment Samples Collected From Pattipulam to Dhevanampattinam along the East Coast of Tamil Nadu Using EDXRF Technique” (Chandramohan et al., 2016) [1]. Chemical data are collected from Energy dispersive X-ray fluorescence spectrometer (EDXRF). Furthermore, the obtained chemical data describes it in more detail in the figures
Verbal autopsies for assessing causes of adult death: development and validation of a model tool
No full textData on adult mortality are very limited in sub-Saharan Africa where only small proportions of deaths occur in health facilities. In such settings, ascertainment of causes of death from data obtained from relatives or associates of the deceased through interviews in surveys or longitudinal surveillance systems appears to be an attractive option. This technique, known as verbal autopsy (VA) is based on the assumption that important causes of death have distinctive symptoms and signs, and these can be recognised, remembered and reported by lay respondents, and that based on the reported information causes of death can be reached. The existing experience of VA for adult death is limited mainly to maternal deaths and the validity of VA for adult death is unknown. We developed a VA questionnaire, mortality classification system and "expert opinion" based algorithms for reaching diagnoses for adult deaths and tested their validity on deaths occurring at hospitals in Tanzania (n=315), Ethiopia (n=249) and Ghana (n=232). Hospital records of adult deaths occurring at study hospitals from June 1993 to April 1995 were collected prospectively. VA interviews were conducted by trained non-medical interviewers. Caused of death from VA data were reached by a panel of three physicians and by a computerised algorithm. The validity of VA was assessed by comparing the VA diagnoses with hospital diagnoses. Specificity of VA fell below 95% only for few common causes of adult death. Sensitivity and kappa of VA for all common causes of adult death were low and this suggests that the accuracy of VA at the individual level is low. However, the misclassification of causes of death was bi-directional and the number of false positive and false negative diagnosis for most common causes of adult death tend to be similar. Thus there was robust agreement between the true and VA estimates of cause specific mortality fractions of common causes of adult death and VA is useful for assessing cause specific mortality fractions of common causes of adult death
Prevalence and under-detection of gambiense human African trypanosomiasis during mass screening sessions in Uganda and Sudan
No full textBACKGROUND: Active case detection through mass community screening is a major control strategy against human African trypanosomiasis (HAT, sleeping sickness) caused by T. brucei gambiense. However, its impact can be limited by incomplete attendance at screening sessions (screening coverage) and diagnostic inaccuracy. METHODS: We developed a model-based approach to estimate the true prevalence and the fraction of cases detected during mass screening, based on observed prevalence, and adjusting for incomplete screening coverage and inaccuracy of diagnostic algorithms for screening, confirmation and HAT stage classification. We applied the model to data from three Médecins Sans Frontières projects in Uganda (Adjumani, Arua-Yumbe) and Southern Sudan (Kiri). RESULTS: We analysed 604 screening sessions, targeting about 710,000 people. Cases were about twice as likely to attend screening as non-cases, with no apparent difference by stage. Past incidence, population size and repeat screening rounds were strongly associated with observed prevalence. The estimated true prevalence was 0.46% to 0.90% in Kiri depending on the analysis approach, compared to an observed prevalence of 0.45%; 0.59% to 0.87% in Adjumani, compared to 0.92%; and 0.18% to 0.24% in Arua-Yumbe, compared to 0.21%. The true ratio of stage 1 to stage 2 cases was around two-three times higher than that observed, due to stage misclassification. The estimated detected fraction was between 42.2% and 84.0% in Kiri, 52.5% to 79.9% in Adjumani and 59.3% to 88.0% in Arua-Yumbe. CONCLUSIONS: In these well-resourced projects, a moderate to high fraction of cases appeared to be detected through mass screening. True prevalence differed little from observed prevalence for monitoring purposes. We discuss some limitations to our model that illustrate several difficulties of estimating the unseen burden of neglected tropical diseases
Intermittent preventive treatment of malaria in pregnancy: at the crossroads of public health policy.
No full textThe intermittent preventive treatment of malaria in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) has been a key component of the focused antenatal care package for nearly a decade, reducing the burden of low birthweight attributable to malaria in sub-Saharan Africa. However, SP has lost parasite sensitivity in many sub-Saharan locations during the same period, rendering its beneficial effect in IPTp debatable. Malaria transmission has also declined in some epidemiological settings. There is no evidence to suggest, however, that the risk of malaria in pregnancy without preventive measures has declined in the same locations. Thus, the urgency to identify efficacious drugs and/or new strategies to prevent malaria in pregnancy remains as great as ever. We summarise the results of recently published SP-IPTp studies from areas of high drug resistance and/or low malaria transmission. We also present the evidence for mefloquine and azithromycin-based combinations (ABCs), two leading drug options to replace SP in IPTp. We discuss optimal dosing for ABCs and their likely protection against several sexually transmitted and reproductive tract infections. We also summarise data from a diagnosis-based alternative to IPTp known as the intermittent screening and treatment (IST) for malaria. Clinical and operational research is urgently needed to compare birth outcomes achieved by IPTp with ABCs vs. IST using an efficacious antimalarial therapy
Azithromycin plus chloroquine: combination therapy for protection against malaria and sexually transmitted infections in pregnancy.
No full textINTRODUCTION: The first-line therapy for the intermittent preventive treatment of malaria in pregnancy (IPTp) is sulphadoxine-pyrimethamine (SP). There is an urgent need to identify safe, well-tolerated and efficacious alternatives to SP due to widespread Plasmodium falciparum resistance. Combination therapy using azithromycin and chloroquine is one possibility that has demonstrated adequate parasitological response > 95% in clinical trials of non-pregnant adults in sub-Saharan Africa and where IPTp is a government policy in 33 countries. AREAS COVERED: Key safety, tolerability and efficacy data are presented for azithromycin and chloroquine, alone and/or in combination, when used to prevent and/or treat P. falciparum, P. vivax, and several curable sexually transmitted and reproductive tract infections (STI/RTI). Pharmacokinetic evidence from pregnant women is also summarized for both compounds. EXPERT OPINION: The azithromycin-chloroquine regimen that has demonstrated consistent efficacy in non-pregnant adults has been a 3-day course containing daily doses of 1 g of azithromycin and 600 mg base of chloroquine. The pharmacokinetic evidence of these compounds individually suggests that dose adjustments may not be necessary when used in combination for treatment efficacy against P. falciparum, P. vivax, as well as several curable STI/RTI among pregnant women, although clinical confirmation will be necessary. Mass trachoma-treatment campaigns have shown that azithromycin selects for macrolide resistance in the pneumococcus, which reverses following the completion of therapy. Most importantly, no evidence to date suggests that azithromycin induces pneumococcal resistance to penicillin
Development, implementation and evaluation of community-based surveillance system in rural Cambodia
No full textA community-based surveillance system was developed and implemented in rural areas in Cambodia. The system aimed to provide timely and representative information on major health problems and life events that would permit rapid and effective control of outbreaks and communicable diseases in general in rural communities. In the system, lay people were trained as Village Health Volunteers to report suspected outbreaks, important infectious diseases, and vital events occurring in their communities to local health staff who analysed the data and gave feedback to the volunteers during their monthly meetings. An evaluation conducted one year after implementation of the community-based surveillance system began found that the system was able to detect outbreaks early, regularly monitor communicable disease trends, and to continuously provide updated information on pregnancies, births and deaths in the rural areas. The sensitivity and specificity of case reporting by Village Health Volunteers were found to be quite high. In addition, the community-based surveillance system triggered effective responses from both health staff and Village Health Volunteers in outbreak and disease control and prevention. The results suggest that a community-based surveillance system can successfully fill the gaps of the current health facility-based disease surveillance system in the rapid detection of outbreaks, in the effective monitoring of communicable diseases, and in the notification of vital events in rural Cambodia. Empowered local people and health staff can accurately report, analyse and act upon significant health problems in their community within a surveillance system they develop, own and operate. The community-based surveillance system could easily be integrated with the current disease surveillance system. Its replication or adaptation for use in other rural areas in Cambodia and in other developing countries would be likely feasible and beneficial, as well as cost-effective
An evaluation of the performance and usage of ICT Pf malaria rapid diagnostic test, in the Limopo South Africa
No full textAim: This thesis aimed to evaluate the performance and usage of ICT Pf Malaria Rapid Diagnostic Test (MRDT), in an operational setting in the Limpopo Province, South Africa.
Methods: Four studies were conducted to: assess factors affecting MRDT use (exploratory study- conducted as part of formative work); determine ICT Pf accuracy (cross-sectional study amongst 405 patients with prospective observational cohort component for follow-up); determine the performance of MRDT end-users (crosssectional observational study) and assess the suitability of using positive control antigen wells (PCWs) for routine quality control.
Results: Key informants reported that MRDT accuracy, end-user proficiency and MRDT quality affect MRDT use and impact. The accuracy study found that sensitivity, specificity, positive and negative predictive values of ICT Pf test were 99.48% (99% Cl; 96.17-100.00%), 96.26% (99% Cl; 94.7-100%) 98.48 (99% Cl 98.41 -100.00%) and 96.26% (99% Cl 91.53-98.79%) respectively. Febrile patients with 'sweating' were 5 times more likely to be ICT Pf positive than those without sweating. Among the 68 patients who returned for day-seven follow up 23 (33%) were ICT Pf positive; however all were microscopy-negative. End-user proficiency: of the 15 recommended steps for MRDT use, 50% of end-users performed 11 or more steps correctly; 50% of end-users interpreted 90% of pre-prepared tests correctly. The false negative interpretation rate was 15%. The quality control study revealed that diluting PCWs with MRDT-negative blood gave better signals than diluting with citrate buffer. PCWs maintain signal strength when stored up to 30 days at 25°C at rural health clinics.
Conclusions: Although ICT Pf MRDT can be used for malaria diagnosis in Limpopo, test sensitivity at low level parasitaemias in field settings need to be established. The ICT Pf test should not be used for assessing cure post-treatment. End-user proficiency needs improvement. PCWs can be used to monitor MRDT quality at PHC level
Informed consent comprehension in African research settings
No full textObjectivePrevious reviews on participants' comprehension of informed consent information have focused on developed countries. Experience has shown that ethical standards developed on Western values may not be appropriate for African settings where research concepts are unfamiliar. We undertook this review to describe how informed consent comprehension is defined and measured in African research settings.MethodsWe conducted a comprehensive search involving five electronic databases: Medline, Embase, Global Health, EthxWeb and Bioethics Literature Database (BELIT). We also examined African Index Medicus and Google Scholar for relevant publications on informed consent comprehension in clinical studies conducted in sub-Saharan Africa. 29 studies satisfied the inclusion criteria; meta-analysis was possible in 21 studies. We further conducted a direct comparison of participants' comprehension on domains of informed consent in all eligible studies.ResultsComprehension of key concepts of informed consent varies considerably from country to country and depends on the nature and complexity of the study. Meta-analysis showed that 47% of a total of 1633 participants across four studies demonstrated comprehension about randomisation (95% CI 13.9–80.9%). Similarly, 48% of 3946 participants in six studies had understanding about placebo (95% CI 19.0–77.5%), while only 30% of 753 participants in five studies understood the concept of therapeutic misconception (95% CI 4.6–66.7%). Measurement tools for informed consent comprehension were developed with little or no validation. Assessment of comprehension was carried out at variable times after disclosure of study information. No uniform definition of informed consent comprehension exists to form the basis for development of an appropriate tool to measure comprehension in African participants.ConclusionsComprehension of key concepts of informed consent is poor among study participants across Africa. There is a vital need to develop a uniform definition for informed consent comprehension in low literacy research settings in Africa. This will be an essential step towards developing appropriate tools that can adequately measure informed consent comprehension. This may consequently suggest adequate measures to improve the informed consent procedure.ObjectifLes normes éthiques élaborées selon les valeurs occidentales ne sont peut-être pas appropriées au contexte africain où les concepts de recherche ne sont pas familiers. Cette revue décrit comment la compréhension du consentement éclairé est définie et mesurée dans les cadres de recherche africains.MéthodesDes recherches ont été effectuées sur Medline, Embase, Global Health, EthxWeb, base de données de la Bioéthique Littérature, Index Medicus African et Google Scholar pour des publications pertinentes sur la compréhension du consentement éclairé dans les études cliniques menées en Afrique sub-saharienne. 29 études répondaient aux critères d'inclusion; une méta-analyse a été possible pour 21 études. La compréhension des participants sur les domaines du consentement éclairé dans toutes les études admissibles a été comparée directement.RésultatsLa compréhension des concepts clés du consentement éclairé varie considérablement selon les pays et dépend de la nature et de la complexité de l’étude. La méta-analyse a montré que 47% des participants ont compris la randomisation (IC95%: 13,9 - 80,9%), 48% ont compris le placebo (IC95%: 19,0 - 77,5%), 30% ont compris le concept de méprise thérapeutique (IC95%: 4,6 - 66,7%). Les outils de mesure de la compréhension du consentement éclairé étaient développés avec peu ou pas de validation.ConclusionsLa compréhension des concepts clés du consentement éclairé est faible en Afrique. Il y a une nécessité vitale d’élaborer une définition uniforme pour la compréhension du consentement éclairé dans les cadres de recherche avec un faible niveau d'alphabétisation en Afrique.ObjetivoLos estándares éticos desarrollados basándose en valores occidentales podrían no ser apropiados para emplazamientos Africanos en donde los conceptos de investigación no son familiares. En esta revisión se describe como la comprensión del consentimiento informado se define y mide en un centro de investigación Africano.MétodosSe buscaron publicaciones relevantes sobre la comprensión del consentimiento informado en estudios clínicos en África subsahariana en Medline, Embase, Global Health, EthxWeb, Bioethics Literature Database, African Index Medicus y Google Scholar. 29 estudios satisfacían los criterios de inclusión y el metaanálisis era posible para 21. La comprensión del consentimiento informado por parte de los participantes se comparó directamente en todos los estudios elegibles.ResultadosLa comprensión de conceptos claves del consentimiento informado varió de forma considerable entre países, y dependía de la naturaleza y de la complejidad del estudio. El meta-análisis mostró que un 47% entendía la aleatorización (IC 95% 13.9-80.9%); un 48% entendía el placebo (IC 95% 19.0-77.5%); y un 30% entendió el concepto terapéutico errado (IC 95% 4.6-66.7%). Las herramientas para medir la comprensión del consentimiento informado se desarrollaron con poca o ninguna validación.ConclusionesEn África, la comprensión de conceptos claves del consentimiento informado es pobre. Existe una necesidad vital de desarrollar una definición uniforme para la comprensión del consentimiento informado en lugares con bajos niveles de alfabetización en África
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