Tropical and geographical medicine

Publications in this journal

• Article: Barriers to acceptance of cataract surgery among patients presenting to district hospitals in rural Malawi.

  P Courtright, S Kanjaloti, S Lewallen
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  ABSTRACT: The objective of this research was to assess the barriers to cataract surgical acceptance by blind rural Malawians recognized and referred for surgical correction at district hospitals. Cataract blind recognized and referred for surgery by the ophthalmic assistants in Chikwawa and Nsanje Districts were interviewed 9-12 months after enrolment to determine if they had undergone cataract surgery and to assess factors associated with surgical acceptance. There were significant gender-specific baseline differences between men and women presenting to the ophthalmic assistants. Patients living near the district hospital were also most likely to present to the ophthalmic assistant. Men with lower socioeconomic status were more likely to accept surgery than men with higher socioeconomic status. Men and women who either talked to someone about cataract surgery or knew another aphakic patients were more likely to accept surgery. The best approaches to improving cataract acceptance given existing resources might be to encourage patients undergoing cataract surgery to educate and motivate others to accept surgery and to train existing village level health staff in cataract recognition and referral. Economic barriers and lack of family support are likely to continue to impede improved cataract surgical acceptance, especially among women.
  Tropical and geographical medicine 02/1995; 47(1):15-8.
• Article: Prevalence of L. loa and M. perstans filariasis in southern Cameroon.

  E C Mommers, H S Dekker, P Richard, A Garica, J P Chippaux
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  ABSTRACT: The prevalence and microfilarial density of Loa loa and Mansonella perstans filariasis have been determined in three successive surveys in one village in the dense rainforest of Southern Cameroon. The prevalence of L. loa microfilaraemia was 30.9% with a geometric mean density of 81.4 microfilariae/30 microliter blood. There was no difference between men and women. The prevalence increased with age from 14.5% at 0-9 years to 52.9% at 40-49 years, whereafter it stablized. The microfilarial density increased until the age of 30-39 years. The highest densities have been found around noon, although the difference was not significant. The prevalence of M. perstans microfilaraemia was 26.6% with a median density of 2.0 microfilariae/30 microliter blood. Both prevalence and density were increasing with age and were higher for men than for women. The time of day that the blood sample was taken had no influence on the microfilarial density of M. perstans.
  Tropical and geographical medicine 02/1995; 47(1):2-5.
• Article: Fenitrothion intoxication during spraying operations in the malaria programme for Afghan refugees in North West Frontier Province of Pakistan.

  M J Bouma, R Nesbit
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  ABSTRACT: During the experimental use of fenitrothion to replace malathion for the control of malaria in North West Frontier Province of Pakistan, serious intoxication of Afghan refugee spraymen occurred. A few weeks after commencement of the spraying operations, cholinesterase levels had fallen to 43.8% in personnel mixing the insecticide, and to 60.7% in spraymen, as measured by tintometry. Most of the personnel reported symptoms of overexposure and the spraying operations had to be discontinued. Intoxication of personnel resulted in poor coverage of the target area. High ambient temperatures during Pakistan's spray season discourage the use of full-protective clothing. Fenitrothion intoxication observed in the Afghan refugee programme, and similar experiences in Pakistan in the past, suggest that this insecticide is too toxic for routine use, when the compliance with safety precautions cannot be effectively supervised.
  Tropical and geographical medicine 02/1995; 47(1):12-4.
• Article: Shellfish-borne illnesses. A Hong Kong perspective.

  T Y Chan
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  ABSTRACT: This article provides an overview of the spectrum of infectious and toxic illnesses that may occur following the consumption of contaminated shellfish in Hong Kong. These include hepatitis A, hepatitis E, infections due to vibrio species, paralytic shellfish poisoning, neurotoxic shellfish poisoning and heavy metal poisoning. Possible preventive measures are discussed.
  Tropical and geographical medicine 02/1995; 47(6):305-7.
• Article: Changes in prevalence, intensity of infection and morbidity due to Schistosoma japonicum infection in a community following a single treatment with praziquantel.

  G Zhao, Q Jiang, A Wasley, S Zhang, Z ljWu, Z Liu, H Yuan
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  ABSTRACT: A repeat survey for schistosomiasis japonica was carried out in Sisan community 1 year after chemotherapy with praziquantel was stopped. Prevalence of infection had fallen from 43.7 to 10.2%, intensity (population geometric mean) had dropped from 6.3 to 0.6 eggs per gram of stool and morbidity decreased significantly.
  Tropical and geographical medicine 02/1995; 47(6):289-92.
• Article: Fulminating strongyloidiasis complicating Indian kala-azar.

  A Nandy, M Addy, P Patra, A K Bandyopashyay
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  ABSTRACT: Infection with Strongyloides stercoralis in an immunocompetent host usually remains unrecognized. Sometimes, however, it may cause serious problems in the immunocompromised host due to its enhanced invasiveness. We present here details of three kala-azar patients with fulminating strongyloidiasis manifested by acute diarrhoea with blood and mucus, severe dehydration, cough and dyspnoea with low peripheral blood eosinophils and filariform larvae of S. stercoralis in faeces. No larvae could be detected in the sputum in spite of radiological evidence of infiltration. The impact of albendazole was dramatic with a disappearance of parasites from the faeces and of pulmonary infiltration and an increase in blood eosinophil count. It is emphasized that S. stercoralis infection in kala-azar patients should be considered a serious infection and treated accordingly.
  Tropical and geographical medicine 02/1995; 47(3):139-41.
• Article: Patterns of infection, incidence and reinfection with Schistosoma mansoni in Nile Delta Governorate: Kafr El Sheikh.

  R Barakat, A Farghaly, H N Morshidy, M K el Sayed, A G Masry, M H Husein, F D Miller
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  ABSTRACT: Two annual follow-up measures of incidence, reinfection after treatment and reversion rates were estimated in a large prospective study of Schistosoma mansoni located in the northern Nile Delta of Kafr El Sheikh. Rates were estimated in a cohort established from a probability sample of the entire rural area of Kafr El Sheikh. Infection was determined by the examination of two Kato stool slides. The weighted first and second annual overall incidence rates were 20.4%, SE +/- 1.4 and 15.9%, SE +/- 1.4, respectively. Geometric mean egg counts in incident cases were 35.6 epg, SE +/- 1.2 and 31.0, SE +/- 1.6 in the first and second follow-ups. Incidence was strongly associated with first round prevalence (r2 = 0.34). Reinfection rates were higher: 33.4%, SE +/- 3.1 and 31.0%, SE +/- 2.1. Reinfection was associated with incidence (r2 = 0.32). Reversion rates were highest in children 0 to 4 years old (61.2%, SE +/- 18.1 and 78.5%, SE +/- 7.0, respectively) and increased from the first to second follow-up: 37.2%, SE +/- 3.4 and 47.0%, SE +/- 3.7, respectively. Patterns of these rates by village community, age and sex are also given over both follow-up examinations and comparison with limited data on rates of S. mansoni infection from previous studies, suggests a stable pattern of transmission over time in the Nile Delta.
  Tropical and geographical medicine 02/1995; 47(6):270-7.
• Article: Tumour necrosis factor alpha in uncomplicated malaria in young adults.

  C Puta, M B Hansen
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  ABSTRACT: The purpose of this study was: 1) to measure tumour necrosis factor alpha (TNF) in the plasma of Plasmodium falciparum infected subjects; and 2) to correlate the presence of TNF to symptomatology. Plasma from 77 malaria infected individuals (with malaria parasites) were assayed for TNF by ELISA. The mean age of the subjects under study was 16.36 +/- 0.80 (mean +/- SEM) years. Thirty-nine (51%) subjects had measurable plasma TNF. Taking symptomatology into account, 10 (59%) of the 17 asymptomatics and 29 (48%) of the 60 symptomatics had measurable plasma TNF. A risk ratio of 0.9 was obtained for the association between the detection of plasma TNF and the presence of symptoms. In plasma from 13 healthy controls no TNF was detected. The results suggest that if TNF plays a negative role in the pathogenesis of malaria, it must be in the presence of other predisposing factors.
  Tropical and geographical medicine 02/1995; 47(3):134-5.
• Article: Severe myoclonus in a patient recovering from falciparum malaria.

  Y Geerts, K Van den Abbeele, R Colebunders, A Van Gompel, W Croughs, J Van den Ende
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  ABSTRACT: Isolated myoclonus has rarely been reported as a complication of Plasmodium falciparum malaria. We describe the development of chaotic myoclonic jerks in an afebrile and conscious patient, the fourth day of treatment with quinine for P. falciparum infection. The myoclonus finally resulted in a generalized tonic-clonic seizure and coma, which resolved without further antimalarial treatment.
  Tropical and geographical medicine 02/1995; 47(5):220.
• Article: Improving the quality of care for persons with HIV infection in sub-Saharan Africa.

  R Colebunders, R Decock, M J Mbeba
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  ABSTRACT: Caring for persons with HIV infection is particularly difficult in resource-poor countries. In order to improve the quality of care we first have to evaluate how such care is presently organized. We need a better assessment of the needs and demands of persons with HIV infection as well as their families. Care for persons with HIV/AIDS should be decentralized and home-based care in a non-stigmatizing way should be promoted. The fight against discrimination of persons with HIV should be intensified. A lot can be achieved by reorganizing and strengthening existing health care systems, by better listening to patients and families and by promoting solidarity among communities.
  Tropical and geographical medicine 02/1995; 47(2):78-81.
• Article: Caesarean birth rates worldwide. A search for determinants.

  J van Roosmalen, C D van der Does
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  ABSTRACT: High caesarean birth rates are an issue of international public health concern. Determinants of caesarean birth are reviewed in order to formulate strategies to reduce these high rates. A strong independent profession of highly qualified midwives, who care for women with low-risk pregnancies, may contribute to a relatively low caesarean birth rate. Different clinical policies which influence the intervention rate, are discussed for the most frequent reasons to perform caesarean section: dystocia, repeat caesarean birth, breech delivery and foetal distress. The risks and safety of caesarean birth differ from place to place in this world. As the relative safety of the procedure is an important factor contributing to the rise of caesarean birth, the fact that this has only been achieved in some parts of the world should restrict the indications to perform the operation in the best interests of pregnant women.
  Tropical and geographical medicine 02/1995; 47(1):19-22.
• Article: Fluoroquinolone antimicrobials.

  R López-Vélez, R Sánchez Mancilla, A García Camacho
  Tropical and geographical medicine 02/1995; 47(4):183.
• Article: Multiple high doses of vitamin A.

  K O'Brien
  Tropical and geographical medicine 02/1995; 47(4):183-4.
• Article: Acute psychosis after mefloquine. Report of six cases.

  A Sowunmi, R A Adio, A M Oduola, O A Ogundahunsi, L A Salako
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  ABSTRACT: A self-limiting psychosis characterized by acute onset of visual and auditory hallucinations and poor sleep developed in six adults between 8 and 24 hours after oral administration of 750-1500 mg of the antimalarial mefloquine. All patients had no personal or family history of psychosis and were neurologically and mentally normal before mefloquine ingestion. These cases illustrate that acute psychotic symptoms may occur in patients treated with mefloquine.
  Tropical and geographical medicine 02/1995; 47(4):179-80.
• Article: The changing pattern of mortality in an African medical ward.

  A D Harries, B Mvula
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  ABSTRACT: The pattern of adult medical deaths in Queen Elizabeth Central Hospital, Blantyre, Malawi was documented over a 12 month period between April 1992 and March 1993. Results were compared with mortality data collected from the same wards in the pre-AIDS era in 1973. Tuberculosis and AIDS together accounted for 49% of all medical deaths in 1992-93. Eighty-two per cent of deaths occurred in the age group 13-49 years; tuberculosis, AIDS, gastroenteritis, pneumonia, pyogenic meningitis and septicaemia were the most important causes of death in these young patients. These findings are very different to those observed in the same wards 20 years previously when tuberculosis was responsible for 13% of deaths and there were no deaths due to AIDS. The predicted upsurge in AIDS-related deaths in sub-Saharan Africa in the 1990s will have grave consequences not only for the health sector, but for the social and economic fabric of the countries concerned.
  Tropical and geographical medicine 02/1995; 47(4):171-4.
• Article: An unusual differential diagnosis of myringitis bullosa haemorrhagica.

  R Indudharan, A S Dharap, Y N Htun
  Tropical and geographical medicine 02/1995; 47(5):227-8.
• Article: Reversal of amenorrhoea after Mectizan treatment.

  J C Anosike, O C Abanobi
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  ABSTRACT: Plausible reversal of secondary amenorrhoea in three women infected with onchocerciasis after Mectizan treatment in Imo State, Nigeria, is presented. The women aged 30, 28, and 32 years with drastic reduction in mean microfilaria scores had reversed amenorrhoea 8, 13 and 10 days post Mectizan treatment, respectively. They had typical manifestation of onchocerciasis including nodules, pruritic rash, body itching and musculo-skeletal pains. The manifestations eased off 4 days post treatment. The plausible link between loss of fertility due to premature menopause in women and onchocerciasis is discussed.
  Tropical and geographical medicine 02/1995; 47(5):222-4.
• Article: Pathways to psychiatric care in Ibadan, Nigeria.

  O Gureje, R A Acha, O A Odejide
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  ABSTRACT: Pathways patients take to psychiatric care will reflect the nature of the services available and the popular beliefs about mental illness. Studying the pathways may help in the identification of sources of delay in the receipt of care and suggest possible improvements. By studying the pathways of 159 patients to a tertiary psychiatric service in Nigeria, we show that traditional and religious healers are consulted at some stage by many patients with mental illness. Such healers are the first carers to a large proportion of the patients. These patients are not different from those who consult orthodox medical practitioners either in demographic features, presenting complaints, or nearness to service. Patients who consult traditional healers first tended to arrive at a tertiary psychiatric service much later than those who consult other carers. Our observations suggest that attempts to incorporate traditional medical care into the health care system must seek to improve their referral skill.
  Tropical and geographical medicine 02/1995; 47(3):125-9.
• Article: The aetiologies of epilepsy in tropical Africa.

  B Adamolekun
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  ABSTRACT: The prevention of epilepsy in tropical Africa is highly desirable because of the morbidity, mortality and social ostracisation that is associated with the disease. Such prevention depends on the identification of the aetiologies of epilepsy endemic to the region. There is a need for prospective epidemiological research to elucidate further the role of filariasis, cysticercosis, cerebral malaria and trypanosomiasis in the aetiology of epilepsy in tropical Africa.
  Tropical and geographical medicine 02/1995; 47(3):115-7.
• Article: Unusual complications in benign tertian malaria.

  N Islam, K Qamruddin
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  ABSTRACT: An unusual case of malaria with Plasmodium vivax is reported which had complications classically seen with Plasmodium falciparum malaria. The complications were cerebral malaria, disseminated intravascular coagulation and adult respiratory distress syndrome.
  Tropical and geographical medicine 02/1995; 47(3):141-3.