150 research outputs found
Cost implications of improving malaria diagnosis: findings from north-eastern Tanzania.
No full textBACKGROUND: Over diagnosis of malaria contributes to improper treatment, wastage of drugs and resistance to the few available drugs. This paper attempts to estimate the rates of over diagnosis of malaria among children attending dispensaries in rural Tanzania and examines the potential cost implications of improving the quality of diagnosis. METHODOLOGY/PRINCIPAL FINDINGS: The magnitude of over diagnosis of malaria was estimated by comparing the proportion of outpatient attendees of all ages clinically diagnosed as malaria to the proportion of attendees having a positive malaria rapid diagnostic test over a two month period. Pattern of causes of illness observed in a or=5 year age group in the lower transmission site (RR 14.0 95%CI 8.2-24.2). In the low transmission site the proportion of morbidity attributable to malaria was substantially lower in <2 year old cohort compared to children seen at routine care system. (0.08% vs 28.2%; p<0.001). A higher proportion of children were diagnosed with ARI in the <2 year old cohort compared to children seen at the routine care system ( 42% vs 26%; p<0.001). Using a RDT reduced overall drug and diagnostic costs by 10% in the high transmission site and by 15% in the low transmission site compared to total diagnostic and drug costs of treatment based on clinical judgment in routine health care system. IMPLICATIONS: The introduction of RDTs is likely to lead to financial savings. However, improving diagnosis to one disease may lead to over diagnosis of another illness. Quality improvement is complex but introducing RDTs for the diagnosis of malaria is a good start
IgG responses to Anopheles gambiae salivary antigen gSG6 detect variation in exposure to malaria vectors and disease risk.
No full textAssessment of exposure to malaria vectors is important to our understanding of spatial and temporal variations in disease transmission and facilitates the targeting and evaluation of control efforts. Recently, an immunogenic Anopheles gambiae salivary protein (gSG6) was identified and proposed as the basis of an immuno-assay determining exposure to Afrotropical malaria vectors. In the present study, IgG responses to gSG6 and 6 malaria antigens (CSP, AMA-1, MSP-1, MSP-3, GLURP R1, and GLURP R2) were compared to Anopheles exposure and malaria incidence in a cohort of children from Korogwe district, Tanzania, an area of moderate and heterogeneous malaria transmission. Anti-gSG6 responses above the threshold for seropositivity were detected in 15% (96/636) of the children, and were positively associated with geographical variations in Anopheles exposure (OR 1.25, CI 1.01-1.54, p = 0.04). Additionally, IgG responses to gSG6 in individual children showed a strong positive association with household level mosquito exposure. IgG levels for all antigens except AMA-1 were associated with the frequency of malaria episodes following sampling. gSG6 seropositivity was strongly positively associated with subsequent malaria incidence (test for trend p = 0.004), comparable to malaria antigens MSP-1 and GLURP R2. Our results show that the gSG6 assay is sensitive to micro-epidemiological variations in exposure to Anopheles mosquitoes, and provides a correlate of malaria risk that is unrelated to immune protection. While the technique requires further evaluation in a range of malaria endemic settings, our findings suggest that the gSG6 assay may have a role in the evaluation and planning of targeted and preventative anti-malaria interventions
Корекція інсуфляцією киснем, субстанцією “КД-234” та реамберином гострого респіраторного дистрес-синдрому у щурів: ефективність комбінованої дії = Correction of acute respiratory distress syndrome in rats by the insufflation of oxygen substance "KD-234" and Reamberin: efficacy of combined actions
No full textSavchuk Samwel, Oliynyk Oleksandr, Tsaryk Lubov. Корекція інсуфляцією киснем, субстанцією “КД-234” та реамберином гострого респіраторного дистрес-синдрому у щурів: ефективність комбінованої дії = Correction of acute respiratory distress syndrome in rats by the insufflation of oxygen substance "KD-234" and Reamberin: efficacy of combined actions. Journal of Education, Health and Sport. 2016;6(7):195-206. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.57323
http://ojs.ukw.edu.pl/index.php/johs/article/view/3673
The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 755 (23.12.2015).
755 Journal of Education, Health and Sport eISSN 2391-8306 7
© The Author (s) 2016;
This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland
Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium,
provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License
(http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited.
This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial
use, distribution and reproduction in any medium, provided the work is properly cited.
The authors declare that there is no conflict of interests regarding the publication of this paper.
Received: 25.06.2016. Revised 09.07.2016. Accepted: 09.07.2016.
Корекція інсуфляцією киснем, субстанцією “КД-234” та реамберином гострого респіраторного дистрес-синдрому у щурів: ефективність комбінованої дії
Correction of acute respiratory distress syndrome in rats by the insufflation of oxygen substance "KD-234" and Reamberin: efficacy of combined actions
Самвел Савчук, Олександр Олійник, Любов Царик
Samwel Savchuk, Oleksandr Oliynyk, Lubov Tsaryk
Тернопільський державний медичний університет ІМ. І.Я. Горбачевського
Horbachevsky Ternopil State Medical University
Резюме. У статті наведено результати дослідження ефективності впливу інсуфляції кисню, похідного ксантину – солі 3-(8-бромо-1,3-диметил-2,6-діоксо-2,3-дигідро-1Н-пурин-7(6Н)-іл)пропаноату (субстанції «КД-234») і реамберину шляхом вивчення динаміки продуктів пероксидного окиснення ліпідів та антиоксидантного захисту в умовах експериментального гострого респіраторного дистрес-синдрому.
Встановлено істотний позитивний вплив на пероксидне окиснення ліпідів комбінації інсуфляції кисню із похідним ксантину (зменшення ТБК-АП у ССГ-тварин – на 38,8 %, у НСГ-тварин – на 60,9 % (р<0,05)) та з реамберином (зниження ТБК-АП у ССГ-тварин – на 24,4 %, у НСГ-тварин – на 54,9 % (р<0,05)) порівняно з монотерапією. При цьому найкращий антирадикальний ефект у групі тварин з ГРДС відмічено при комбінованому застосуванні інсуфляції кисню із похідним ксантину. Поєднане застосування інсуфляції киснем і субстанції «КД-234» в умовах експериментального гострого респіраторного дистрес-синдрому має схожий влив на ферментну ланку антиоксидантної системи як за умови корекції інсуфляцією киснем, проте значно підвищує антиоксидантно-прооксидантний індекс тканини печінки (р<0,05), тоді як комбінація інсуфляції кисню із реамберином не має значимого впливу як на ферментну, так і неферментну ланки системи антиоксидантного захисту.
Abstract. The article is showed the results of the effectiveness of insufflation of oxygen xanthine derivative salt (Substance "KD-234") and Reamberin according to the studies of the lipid peroxidation and antioxidant protection products dynamics in experimental acute respiratory distress symptoms.
It was established a significant positive effect of oxygen insufflation with xanthine derivatives with Reamberin combination on lipid peroxidation (reduction of MDA (p <0.05)) compared to monotherapy. It was the gratest antiradical effect in the group of animals with ARDS during the combined use of oxygen insufflation xanthine derivative. The combined use of oxygen insufflation and substance "KD-234" in the conditions of experimental acute respiratory distress syndrome were showed similar impact on link enzymatic antioxidant system both in terms of oxygen insufflation correction. It was significantly increased the antioxidant-prooxidant index in liver (p <0.05), while the combination of oxygen insufflation with Reamberin had a significant effect on the enzyme and nonenzyme parts of antioxidant protection.
Ключові слова: респіраторний дистрес-синдром, похідні ксантину, реамберин, ефективність.
Keywords: acute respiratory distress syndrome, xanthine derivatives, Reamberin, efficiency
Mode of action and choice of antimalarial drugs for intermittent preventive treatment in infants.
No full textIntermittent preventive treatment in infants (IPTi) is an effective and safe malaria control strategy. However, it remains unclear what antimalarials should be used to replace sulfadoxine-pyrimethamine (SP) when and where SP is no longer an effective drug for IPTi. Work recently conducted in Tanzania, combined with the findings of previous studies, indicates that IPTi is essentially intermittent chemoprophylaxis; consequently, long-acting antimalarials that provide a long period of post-treatment prophylaxis will be the most effective alternative to SP. However, because of concerns about development of drug resistance, new combinations of long-acting drugs are urgently needed
Impact of insecticide treated mosquito nets and low dose monthly diethylcarbamazine on lymphatic filariasis infection between 1999 and 2004 in two endemic communities of north-eastern Tanzania
No full textLymphatic filariasis (LF) is among the poverty related neglected tropical diseases earmarked for elimination using mass drug administration (MDA) strategy. Additional use of insecticide treated mosquito nets (ITNs) might enhance elimination of LF infection. Between August 1998 and July 1999, all individuals aged ≥ 8 months from Magoda and Mpapayu villages in north-eastern Tanzania, were administered with monthly low dose diethylcarbamazine (DEC) at a dosage of 50mg in children aged < 15 years and 100mg in adults aged ≥ 15 years. ITNs were also distributed to Magoda in December 1998 and to Mpapayu in March 2001. The main objective of our study was to assess the impact of ITNs and low dose DEC on microfilaria (mf) prevalence and intensity and incidence of new mf infections. Four annual cross-sectional surveys were conducted between 1999 and 2004 in the two villages to screen for Wuchereria bancrofti microfilariae in individuals aged ≥ 1 year. Overall, 80% of the population in Magoda and 66% in Mpapayu were covered during these surveys. Results revealed a significant decrease in both mf prevalence and intensity in both villages. Furthermore, there was a steady decrease in mf incidence in Magoda; with 36.7 cases per 1000 person years in 2000 and 7.4 in 2004.  In Mpapayu, the incidence initially increased from 20.8 cases in 2000 to 24.3 in 2001 and then decreased to 7.2 cases in 2004.  Individuals using ITNs in Magoda had significantly lower risk of mf (OR=0.681; 95%CI: 0.496-0.934); and the risk of new infections was reduced by 58.8% (95%CI: 30.3-75.4). These results suggest that when MDA is complemented with ITNs there is high likelihood to half filariasis transmission within a shorter period than using chemotherapy alone
Cost implications of improving malaria diagnosis: findings from north-eastern Tanzania. PLoS One 5: e8707
No full textBackground: Over diagnosis of malaria contributes to improper treatment, wastage of drugs and resistance to the few available drugs. This paper attempts to estimate the rates of over diagnosis of malaria among children attending dispensaries in rural Tanzania and examines the potential cost implications of improving the quality of diagnosis. Methodology/Principal Findings: The magnitude of over diagnosis of malaria was estimated by comparing the proportion of outpatient attendees of all ages clinically diagnosed as malaria to the proportion of attendees having a positive malaria rapid diagnostic test over a two month period. Pattern of causes of illness observed in a,2 year old cohort of children over one year was compared to the pattern of causes of illness in,5 year old children recorded in the routine health care system during the same period. Drug and diagnostic costs were modelled using local and international prices. Over diagnosis of malaria by the routine outpatient care system compared to RDT confirmed cases of malaria was highest among,5 year old children in the low transmission site (RR 17.9, 95 % CI 5.8–55.3) followed by the$5 year age group in the lower transmission site (RR 14.0 95%CI 8.2– 24.2). In the low transmission site the proportion of morbidity attributable to malaria was substantially lower in,2 year old cohort compared to children seen at routine care system. (0.08 % vs 28.2%; p,0.001). A higher proportion of children wer
Impact of insecticide treated mosquito nets and low dose monthly diethylcarbamazine on lymphatic filariasis infection between 1999 and 2004 in two endemic communities of north-eastern Tanzania
No full textLymphatic filariasis (LF) is among the poverty related neglected
tropical diseases earmarked for elimination using mass drug
administration (MDA) strategy. Additional use of insecticide treated
mosquito nets (ITNs) might enhance elimination of LF infection. Between
August 1998 and July 1999, all individuals aged ≥ 8 months from
Magoda and Mpapayu villages in northeastern Tanzania, were administered
with monthly low dose diethylcarbamazine (DEC) at a dosage of 50mg in
children aged < 15 years and 100mg in adults aged ≥ 15 years.
ITNs were also distributed to Magoda in December 1998 and to Mpapayu in
March 2001. The main objective of our study was to assess the impact of
ITNs and low dose DEC on microfilaria (mf) prevalence and intensity and
incidence of new mf infections. Four annual cross-sectional surveys
were conducted between 1999 and 2004 in the two villages to screen for
Wuchereria bancrofti microfilariae in individuals aged ≥ 1
year. Overall, 80% of the population in Magoda and 66% in Mpapayu were
covered during these surveys. Results revealed a significant decrease
in both mf prevalence and intensity in both villages. Furthermore,
there was a steady decrease in mf incidence in Magoda; with 36.7 cases
per 1000 person years in 2000 and 7.4 in 2004. In Mpapayu, the
incidence initially increased from 20.8 cases in 2000 to 24.3 in 2001
and then decreased to 7.2 cases in 2004. Individuals using ITNs in
Magoda had significantly lower risk of mf (OR=0.681; 95%CI:
0.496-0.934); and the risk of new infections was reduced by 58.8%
(95%CI: 30.3-75.4). These results suggest that when MDA is complemented
with ITNs there is high likelihood to half filariasis transmission
within a shorter period than using chemotherapy alone
Is Housing Quality Associated with Malaria Incidence among Young Children and Mosquito Vector Numbers? Evidence from Korogwe, Tanzania.
No full textSeveral studies conducted in Northeast Tanzania have documented declines in malaria transmission even before interventions were scaled up. One explanation for these reductions may be the changes in socio-environmental conditions associated with economic development, and in particular improvements in housing construction. This analysis seeks to identify (1) risk factors for malaria incidence among young children and (2) household and environmental factors associated with mosquito vector numbers collected in the child's sleeping area. Both analyses focus on housing construction quality as a key determinant. For 435 children enrolled in a larger trial of intermittent preventive treatment for malaria in infants in the Korogwe District in Tanga, Northeastern Tanzania, detailed information on their dwelling characteristics were collected in the last year of the trial. Principal components analysis was used to construct an index of housing structure quality and converted to quintile units for regression analysis. Univariate and multivariate random effects negative binomial regressions were used to predict risk factors for child malaria incidence and the mean total number of indoor female Anopheles gambiae and funestus mosquitoes collected per household across three occasions. Building materials have substantially improved in Korogwe over time. Multivariate regressions showed that residing in rural areas (versus urban) increased malaria incidence rates by over three-fold and mean indoor female A. gambiae and funestus numbers by nearly two-fold. Compared to those residing in the lowest quality houses, children residing in the highest quality houses had one-third lower malaria incidence rates, even when wealth and rural residence were controlled for. Living in the highest quality houses reduced vector numbers while having cattle near the house significantly increased them. Results corroborate findings from other studies that show associations between malaria incidence and housing quality; associations were concentrated amongst the highest quality houses
Int J Infect Dis
No full textObjectives:Malaria and sexually transmitted and reproductive tract infections (STIs/RTIs) are highly prevalent in sub-Saharan Africa and associated with poor pregnancy outcomes. We investigated the individual and combined effects of malaria and curable STIs/RTIs on fetal growth in Kenya, Tanzania, and Malawi.Methods:This study was nested within a randomized trial comparing monthly intermittent preventive treatment for malaria in pregnancy with sulfadoxine-pyrimethamine vs dihydroartemisinin-piperaquine, alone or combined with azithromycin. Fetal weight gain was assessed by serial prenatal ultrasound. Malaria was assessed monthly, and Treponema pallidum, Neisseria gonorrhoeae, Trichomonas vaginalis, Chlamydia trachomatis, and bacterial vaginosis at enrollment and in the third trimester. The effect of malaria and STIs/RTIs on fetal weight/birthweight Z-scores was evaluated using mixed-effects linear regression.Results:In total, 1435 pregnant women had fetal/birth weight assessed 3950 times. Compared to women without malaria or STIs/RTIs (n = 399), malaria-only (n = 267), STIs/RTIs only (n = 410) or both (n = 353) were associated with reduced fetal growth (adjusted mean difference in fetal/birth weight Z-score [95% confidence interval]: malaria = 120.18 [ 120.31, 120.04], P = 0.01; STIs/RTIs = 120.14 [ 120.26, 120.03], P = 0.01; both = 120.20 [ 120.33, 120.07], P = 0.003). Paucigravidae experienced the greatest impact.Conclusion:Malaria and STIs/RTIs are associated with poor fetal growth especially among paucigravidae women with dual infections. Integrated antenatal interventions are needed to reduce the burden of both malaria and STIs/RTIs.WT_/Wellcome TrustUnited Kingdom/CC999999/ImCDC/Intramural CDC HHSUnited States/INV-002781/GATES/Bill & Melinda Gates FoundationUnited States/MC_PC_MR/P006914/1/MRC_/Medical Research CouncilUnited Kingdom
Population pharmacokinetic and pharmacodynamic properties of intramuscular quinine in Tanzanian children with severe Falciparum malaria.
No full textAlthough artesunate is clearly superior, parenteral quinine is still used widely for the treatment of severe malaria. A loading-dose regimen has been recommended for 30 years but is still often not used. A population pharmacokinetic study was conducted with 75 Tanzanian children aged 4 months to 8 years with severe malaria who received quinine intramuscularly; 69 patients received a loading dose of 20 mg quinine dihydrochloride (salt)/kg of body weight. Twenty-one patients had plasma quinine concentrations detectable at baseline. A zero-order absorption model with one-compartment disposition pharmacokinetics described the data adequately. Body weight was the only significant covariate and was implemented as an allometric function on clearance and volume parameters. Population pharmacokinetic parameter estimates (and percent relative standard errors [%RSE]) of elimination clearance, central volume of distribution, and duration of zero-order absorption were 0.977 liters/h (6.50%), 16.7 liters (6.39%), and 1.42 h (21.5%), respectively, for a typical patient weighing 11 kg. Quinine exposure was reduced at lower body weights after standard weight-based dosing; there was 18% less exposure over 24 h in patients weighing 5 kg than in those weighing 25 kg. Maximum plasma concentrations after the loading dose were unaffected by body weight. There was no evidence of dose-related drug toxicity with the loading dosing regimen. Intramuscular quinine is rapidly and reliably absorbed in children with severe falciparum malaria. Based on these pharmacokinetic data, a loading dose of 20 mg salt/kg is recommended, provided that no loading dose was administered within 24 h and no routine dose was administered within 12 h of admission. (This study has been registered with Current Controlled Trials under registration number ISRCTN 50258054.)
- …
