[Show abstract][Hide abstract] ABSTRACT: A randomized open-label trial, including 834 pregnant women, examined efficacy and recorded adverse events of ivermectin (ivc) and albendazole (alb) alone and combined (comb) on soil-transmitted helminth infections (STHs) in the second trimester of pregnancy. One abortion occurred in the alb group and 10 stillbirths (1, 5, 3, and 1) in the ivc, alb, comb, and the reference group (ref) with no STHs, respectively. Two babies were born with congenital abnormalities (1 [ivc] and 1 [ref]). The prevalence of anemia at first antenatal care (ANC) visit was 20.6% (23.7% [ivc], 21.1% [alb], 22.2% [comb], and 16.1% [ref]). Anemia was reduced to 8.5% at 36 weeks of gestation with 10.9% (ivc), 11.5% (alb), 7.7% (comb), and 6.9% (ref). Hookworm cure rates were 29.4% (ivc), 95.5% (alb), and 92.6% (comb). No severe adverse events were reported by the women after the administration of ivc, alb, or comb during the second trimester of pregnancy, but long-term pharmacovigillance is needed to assess safety of ivc, alb, or comb in pregnancy.
The American journal of tropical medicine and hygiene 01/2009; 79(6):856-63. · 2.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the effectiveness of 10 years' annual single dose ivermectin treatment on onchocerciasis transmission in hyperendemic areas of Cameroon and Uganda.
Baseline nodule and microfilaria ('skin snip') prevalence data were available from 10 hyperendemic sentinel communities in Cameroon (from 1996) and hyperendemic 20 sentinel communities in Uganda (from 1993). We returned to these villages in 2005, 10 months after the last annual ivermectin distribution, to repeat the cross-sectional surveys. Each sentinel community reported a mean interval treatment coverage of eligible persons of >88% (range 37-100%). Data were analyzed for more than 6200 person examinations. In Cameroon, 719 people >or=10 years were examined at the baseline survey in 1996 and 838 at the follow-up survey in 2005. In Uganda, 1590 people >or=10 years were examined at the baseline survey in 1993 and 2122 people at the follow-up survey in 2005. We also examined children under 10 in Cameroon (1996, n = 185; 2005, n = 448) and Uganda (1993, n = 177; 2005, n = 130). In Uganda, the vitality of worms was judged using standard histological criteria in 80 nodules excised in 2005.
The prevalence of microfilaria carriers among older children and adults (>or=10 years) in Cameroon sentinel communities dropped from 70.1% to 7.04% (P < 0.0001) over the 10-year treatment period; that of nodule carriers from 58% to 9.55% (P < 0.0001). Similarly, in Uganda, the prevalence of microfilaria carriers fell from 71.9% to 7.49% (P < 0.0001) over the 13-year treatment period, and that of nodule carriers from 53.21% to 9.66% (P < 0.0001). The number of microfilaria carriers among children <10 years in Cameroon decreased from 29.73% to 3.8% (P < 0.0001), and in Uganda from 33.89% to 3.1% (P < 0.0001). In 2005, worms excised from nodules in Uganda, 81.4% of males remained alive, and 64% of females, with 24% of them inseminated.
A decade or more of annual single dose ivermectin treatment in hyperendemic areas has reduced onchocerciasis to 'hypoendemicity', but onchocerciasis transmission persists. For now, annual treatment with ivermectin should be continued in formerly mesoendemic and hyperendemic zones.
Tropical Medicine & International Health 09/2008; 13(9):1196-203. · 2.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study examined the predictors of haemoglobin (Hb) concentration and serum ferritin (SF) levels in pregnant women in an area of stable malaria transmission and high prevalence of intestinal helminth infections. In total, 834 women attending antenatal care for the first time were examined. Blood slides for malaria parasites were prepared for 802, of which 154 were primigravidae (PG) and 648 were multigravidae (MG). Malaria parasitaemia rate was 42.6% (66) in PG and 33.3% (216) in MG (P=0.04). The geometric mean parasite density was 1695.8 (95% CI 1005.0-2386.5) in PG and 922.7 (95% CI 626.7-1382.6) in MG (P=0.02). Anaemia (Hb<100g/l) was found in 18.0% (94) of aparasitaemic women compared to 28.5% (80) among parasitaemic women (P<0.001). The prevalence of anaemia was 15.1% (42) in women without hookworm infection compared to 23.3% (129) among infected women (P=0.006). Malaria parasitaemia, hookworm infection, C-reactive protein, gravidity and gestational age were associated with Hb status. Malaria parasitaemia, Ascaris lumbricodes and Trichuris trichiura infections and age were associated with SF. Malaria, hookworm infections and iron deficiency were associated with anaemia in the study population.
Transactions of the Royal Society of Tropical Medicine and Hygiene 02/2008; 102(2):130-6. · 1.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: So-called 'neglected tropical diseases' (NTDs) are becoming less neglected, with increasing political and financial commitments to their control. These recent developments were preceded by substantial advocacy for integrated control of different NTDs, on the premise that integration is both feasible and cost-effective. Although the approach is intuitively attractive, there are few countrywide experiences to confirm or refute this assertion. Using the example of Uganda, this article reviews the geographical and epidemiological bases for integration and assesses the potential opportunities for, and operational challenges of, integrating existing control activities for several of these diseases under an umbrella vertical programme.
Trends in Parasitology 11/2007; 23(10):485-93. · 6.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The national onchocerciasis-control programme in Uganda successfully eliminated Simulium neavei s.s. from the Itwara focus in 1997, by monthly ground spraying with larvicidal temophos (Abate). Since then, no vectors have been caught in the main Itwara focus or two secondary foci in the same area. After 4 years of intervention, S. neavei s.s. has also been nearly eliminated from the Mpamba-Nkusi focus, and the elimination of this vector from two more foci (West Nile and Wambabya-Rwamarongo) appears quite feasible. There are, however, four isolated foci in Uganda (Budongo, Kashoya-Kitomi, Mount Elgon and Kigezi-Bwindi) which are probably too large and inaccessible to make the elimination of S. neavei s.s. by ground spraying a realistic possibility. Encouragingly, >70% of Ugandans have received an annual dose of ivermectin for at least 10 years, and the national programme of community-directed treatment with ivermectin (CDTI) is thought to be progressing towards sustainability. Despite the good treatment coverages, however, many potential vectors are still found infected with Onchocerca volvulus and many Ugandans have O. volvulus in their skin. There is now evidence that adult O. volvulus can be eliminated, within a period of about 6 years, through semiannual treatment with ivermectin. Together, the isolated foci where vector elimination is not considered feasible have a human population of about 700,000, most of whom (595,000) are eligible to receive ivermectin treatment. The estimated cost of each treatment, via the Ugandan CDTI, is U.S.$0.78 if the salaries of the government-employed personnel and the working time lost by the volunteers who act as community-directed drug distributors (CDD) are taken into account. If these 'expenses' are ignored, however, the cost falls to just U.S.$0.17/treatment, and the total costs for the four isolated foci where vector control is not likely to be successful become about U.S.$101,150/year for annual treatment (for an indefinite period of time) or approximately U.S.$202,300/year for semi-annual treatment (for the 6 years needed to eliminate adult O. volvulus), which would be the more cost-effective option. With the necessary financial support and the continued free supply of ivermectin from Merck, the national onchocerciasis-control programme could eliminate human onchocerciasis from Uganda, through a combination of semi-annual treatment with ivermectin in the isolated foci where S. neavei s.s. elimination is not feasible, and vector elimination in all the other foci.
Annals of Tropical Medicine and Parasitology 07/2007; 101(4):323-33. · 1.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Knowledge of malaria and treatment-seeking behaviour was investigated in an area of low transmission in Uganda to help health services to plan for appropriate interventions to control malaria. Although knowledge of malaria symptoms, preventive methods and malaria risks was widespread, few were actually using insecticide-treated nets. Many patients (25%) had received treatment prior to visiting a health facility, with drug shops and general stores being the main sources of treatment. Some shops dispensed quinine, a second-line drug recommended for complicated malaria. Prescription practices of health staff often did not comply with guidelines. Only 30% of patients received treatment at a health facility within 24h of onset of symptoms. Findings indicate a need for community-level information campaigns on prompt treatment and introduction of home-based management of fever. Measures are needed to protect second-line drugs from misuse. Failure to comply with drug policy in both the private and public sectors is of concern in an era of rapidly evolving drug policy changes and highlights the need for reorientation and training of health staff and drug vendors to improve malaria diagnostic and treatment skills.
Transactions of the Royal Society of Tropical Medicine and Hygiene 04/2007; 101(3):209-15. · 1.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Community-based information on the delivery and use of health interventions is important to monitor the effectiveness of the Roll Back Malaria programme. However, community surveys to determine coverage for insecticide-treated bed nets are time-consuming and costly. We wanted to assess whether schoolchildren's reports of household ownership of a bed net and coverage among high-risk groups monitored by schoolteachers through a questionnaire could be used as a proxy of household ownership of bed net and coverage at community level, for routine monitoring of malaria control programmes.
3602 schoolchildren in 39 randomly selected schools and 2798 heads of households in 39 villages were interviewed about their use of either insecticide-treated or untreated bed nets.
The overall household ownership of any kind of bed net was 35% in school surveys and 31% in household surveys (P < 0.001). Household ownership of insecticide-treated nets was 23% and 22%, respectively (P = 0.4); household ownership of untreated nets was 15% and 9%, respectively (P < 0.001). There was significant correlation between estimates of any bed net and treated net ownership based on household surveys and estimates based on school surveys (P < 0.01 for both).
In areas with high school attendance rates, schoolchildren's report of bed net use monitored by schoolteachers through a questionnaire could give a good approximation of household ownership of bed net at community level with about +/-5% difference between community and school surveys. However, further operational research is required to investigate how the feasibility of large-scale implementation might be, by sending the questionnaire to the schools through routine channels and by independent handling by the school administration and teachers.
Tropical Medicine & International Health 03/2007; 12(2):230-7. · 2.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The African Programme for Onchocerciasis Control (APOC) sponsors annual distribution of ivermectin to control onchocerciasis. Ivermectin should be taken annually by 65% of community members for a number of years to eliminate the disease as a public health problem. While many community coverage surveys have been undertaken during project monitoring, individual compliance could not be studied until several annual rounds of distribution had occurred. This paper reports on the efforts to determine whether adequate records could be found to enable a compliance study. A step-down process from project to district to community level was used to identify project sites where continuous ivermectin distribution up through 2004 had occurred. The first step consisted of selecting 17 of 25 projects by APOC. The second step determined adequacy of districts where distribution had occurred on a regular annual basis. Among 121 districts 58.6% undertook distribution in all 7 years. A total 852 villages were visited and community level records were found in all but three. Records showed that distribution had occurred for a minimum of five consecutive times in 429 villages, and ultimately 10 projects. While the feasibility study found an adequate number of villages to study compliance, the large number of projects, districts and villages that did not qualify for the follow-on compliance study should lead National Onchocerciasis Control Programme managers to strengthen the overall coverage and consistency of their efforts.
Tropical Medicine & International Health 03/2007; 12(2):260-8. · 2.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Early recognition of symptoms and signs perceived as malaria are important for effective case management, as few laboratories are available at peripheral health facilities. The validity and reliability of clinical signs and symptoms used by health workers to diagnose malaria were assessed in an area of low transmission in south-western Uganda.
The study had two components: 1) passive case detection where all patients attending the out patient clinic with a febrile illness were included and 2) a longitudinal active malaria case detection survey was conducted in selected villages. A malaria case was defined as any slide-confirmed parasitaemia in a person with an axillary temperature > or = 37.5 degrees C or a history of fever within the last 24 hrs and no signs suggestive of other diseases.
Cases of malaria were significantly more likely to report joint pains, headache, vomiting and abdominal pains. However, due to the low prevalence of malaria, the predictive values of these individual signs alone, or in combination, were poor. Only 24.8% of 1627 patients had malaria according to case definition and > 75% of patients were unnecessarily treated for malaria and few slide negative cases received alternative treatment.
In low-transmission areas, more attention needs to be paid to differential diagnosis of febrile illnesses In view of suggested changes in anti-malarial drug policy, introducing costly artemisinin combination therapy accurate, rapid diagnostic tools are necessary to target treatment to people in need.
[Show abstract][Hide abstract] ABSTRACT: The transmission of Onchocerca volvulus Leuckart (Spirudida: Onchocercidae) and the prospects of Simulium neavei Roubaud (Diptera: Simuliidae) vector elimination through ground larviciding were investigated in the Mpamba-Nkusi focus, western Uganda. Transmission levels and the initiated vector elimination activities were assessed to supplement the ongoing ivermectin mass distribution programme. Searches for breeding sites, adult fly catches, dissection of flies, river treatment with temephos (Abate) and a review of annual ivermectin treatment data were conducted. High levels of crab infestation with S. neavei sensu stricto immature stages were recorded; 57.9% and 100% for the Mpamba and Nyabugando river systems, respectively. The mean numbers of larvae/pupae per crab were 3.6 +/- 0.5 in the Mpamba and 20.6 +/- 1.8 in the Nyabugando systems. Pre-intervention mean biting densities were 39 and 32 flies/(man day) in 2001 and 2002, respectively, and an annual biting rate in 2001 of > 14 000. The bimodal biting pattern of S. neavei s.s. consisted of two peaks; one in the morning (09.00-10.00 hours) and one in the afternoon (14.00-15.00 hours) with a mid-day lull in biting. The infection/infective rates were 13.3%/2.8% and 16.6%/2.9% in the dissected parous flies from the Mpamba and Nyabugando river systems, respectively. Out of approximately 1000 parous flies, 129 and 109 were found to be harbouring infective larvae of Onchocerca volvulus in their heads from the Mpamba and Nyabugando river systems, respectively. In spite of the > 10 years of ivermectin treatment, at a mean coverage of 71.3%, infection remained relatively high. Ground larviciding with temephos (Abate) initiated in June and October 2002 had a significant impact. In the Mpamba river system there was a significant (P < 0.001) reduction in positive crabs from 57.9% in 2001 to 0.06% in 2003 and a decrease in the mean number of larvae/pupae per crab from 3.6 +/- 0.5 in 2001 to 0.0007 +/- 0.0001 (P < 0.002) in 2003. Similarly, in the Nyabugando river system, a significant (P < 0.001) reduction in crab infestation from 100% in 2001 to 0.06% in 2003 and a decrease in the mean number of larvae/pupae per crab from 20.6 +/- 1.8 in 2001 to 0.06 +/- 0.03 in 2003. Drastic reductions were observed in the mean number of biting flies from 3 flies/h in 2001 to 0 flies/h in 2003 and the annual biting rates fell from 14,235 flies/year in 2001 to only 730 flies/year in 2003. These data suggest that substantial progress towards the goal of S. neavei s.s. vector elimination has been made and this will enhance the ongoing ivermectin treatment in this isolated focus.
Medical and Veterinary Entomology 03/2006; 20(1):93-101. · 2.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In order to identify the factors influencing compliance with mass ivermectin treatment for onchocerciasis control, a cross-sectional study was carried out in Bushenyi District, Uganda. Data were collected by interviewing 839 individuals who were randomly selected from 30 clusters where onchocerciasis is endemic. Information was collected on compliance with ivermectin treatment, socio-demographic characteristics, perception of personal susceptibility to onchocerciasis, knowledge about cause/transmission of onchocerciasis, knowledge of signs and symptoms of onchocerciasis, treatment of onchocerciasis, benefits and dangers of taking ivermectin, organization of distribution of ivermectin, work and selections of community drug distributors (CDDs), social influence and support to take ivermectin and on barriers and supports towards compliance with ivermectin treatment. The major factors favouring compliance were: perceiving CDDs as doing their work well, believing that measuring height is the best way to determine one's dose of ivermectin, having social support from one's family, saying that ivermectin treatment costs nothing, perceiving personal risk of onchocerciasis, believing that ivermectin prevents onchocerciasis and perceiving radios as supporting treatment with ivermectin. The strongest predictor of compliance with ivermectin treatment is perceiving CDDs as doing their work well with adjusted odds ratios of 5.54 (95% CI: 3.19-9.62). In order to improve compliance with ivermectin treatment, CDDs need to be well-facilitated and ivermectin distribution should be free. Health education is necessary so that people perceive themselves to be at risk of onchocerciasis and to understand the rationale of using height for dose determination. The health education should target the family and use radios.
Tropical Medicine & International Health 08/2005; 10(7):659-67. · 2.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Community-directed treatment with ivermectin (CDTI), for the control of onchocerciasis, was launched in Uganda in 1997. In East Africa, as in other endemic areas, the refusal to take the drug reduces treatment coverage and therefore poses a serious threat to attempts to eliminate onchocerciasis as a disease of public-health importance. In early 2003, an attempt was therefore made to determine the factors associated with refusal to take ivermectin during mass treatment in 2002, by interviewing the individuals, from three Ugandan villages with CDTI, who had been eligible to receive ivermectin. The subject's socio-demographic characteristics, history of adverse reactions and participation in CDTI-related activities were explored, as potential 'risk' factors for refusing ivermectin in the treatment round in 2002. When odds ratios (OR) for refusal and their associated 95% confidence intervals (CI) were calculated, the villagers aged 18-35 years were found more likely to have received ivermectin in 2002 than their older counterparts (OR = 0.55; CI = 0.33-0.93). Individuals with an inter-current medical condition were also more likely to have received ivermectin in 2002 than the other villagers (OR = 0.56; CI = 0.32-0.99). Worryingly, the ingestion of ivermectin at any time before the 2002 treatment round was strongly associated with refusal to take ivermectin in that round (OR = 7.72; CI = 2.00-29.81), although there was no evidence that the adverse effects of treatment were significantly reducing coverage.
Annals of Tropical Medicine and Parasitology 04/2005; 99(2):165-72. · 1.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: It has recently been suggested that helminth infections may adversely influence susceptibility to other infections, including malaria. To investigate this hypothesis in a sub-Saharan African setting, surveys of helminth infections were conducted in 2003 among individuals who had been under weekly active case detection for clinical malaria during the preceding 18 months in four villages in Kabale District, southwest Uganda. Overall, 47.3% of individuals had at least one intestinal nematode species infection: hookworm, Ascaris lumbricoides and Trichuris trichiura were detected in 32.1, 17.4 and 8.1% of individuals, respectively. We found evidence of significant household clustering of A. lumbricoides, T. trichiura and hookworm, and clustering of heavy infection of each species. The association between helminth infection and clinical malaria was investigated in two villages and no evidence for an association was observed between the presence of infection or heavy infection and risk of malaria.
Transactions of the Royal Society of Tropical Medicine and Hygiene 02/2005; 99(1):18-24. · 1.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The study was conducted in August 2002 in Kigoyera parish in Kyenjojo district, where ivermectin treatment had been the strategy to control onchocerciasis since 1991 and was later supplemented with Simulium neavei control in 1995 and subsequent elimination; and in July 2003 in Kicece parish in Kamwenge district, where ivermectin treatment alone had been the strategy used to control onchocerciasis since 1991. Our objective was to examine and compare the impact of ivermectin treatment alone and when in parallel with S. neavei elimination on nodule and microfilariae carrier rates and on onchocercal dermatitis to provide baseline data that could be used to monitor the trends of microfilariae carrier rates for decision-making on when to discontinue ivermectin treatment. The combined interventions had significantly reduced onchocercal dermatitis from 34% pre-control to 2.9% (P < 0.001), microfilariae carrier rate from 88 to 7.5% (P < 0.001) and nodule prevalence from 49 to 19.2% (P < 0.001). Ivermectin treatment alone had also reduced onchocercal dermatitis prevalence from 34.2% pre-control to 9.5% (P < 0.001), the microfilariae carrier rate from 78 to 27.8% (P < 0.001) and nodule prevalence from 49.1 to 14.2% (P < 0.001). None of the children under 10 years were nodule or microfilariae carriers in both study areas. Histological examination of eight nodules extirpated from patients in Kigoyera identified five male and 12 female adult worms that were all old and alive. Five live and one dead female worms and one live male worm were identified from nodules extirpated from patients in Kicece. There was no female worm with embryogenesis from the nodules obtained from Kigoyera while two female worms from five nodules obtained from Kicece still showed a few embryos. Two female worms in each of the study area had sperms in uteri indicating that male worms were still active. Ivermectin treatment in parallel with vector elimination had a greater impact on onchocercal dermatitis and microfilariae carrier rates than ivermectin treatment alone. It would be worthwhile considering supplementation of ivermectin treatment with vector elimination in all isolated foci with S. neavei transmission to hasten the elimination of onchocerciasis as a public health and socio-economic problem in those foci.
Tropical Medicine & International Health 08/2004; 9(8):882-6. · 2.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A retrospective study based on paediatric ward registers was conducted in the Ugandan districts of Hoima and Kabale, which are areas of stable and unstable malaria transmission, respectively. The records of Hoima hospital from 1990 to 2001 and of Kabale hospital from 1994 to 2000 were reviewed and the initial diagnoses for all young children (i.e. those aged <5 years) were noted. Admissions for malaria and for anaemia were significantly more common among the young children admitted to Hoima hospital than among those admitted to Kabale hospital (P<0.0001 for each). Over the study periods, there were significant linear increases in the numbers of young children admitted with malaria or anaemia, at both Hoima hospital (with chi2 values of 25.6 and 191.5, respectively; P<0.0001 for each) and at Kabale hospital (with chi2 values of 31.6 and 29.0, respectively; P<0.0001 for each). Anaemia was not an important cause of mortality at Kabale hospital during the period reviewed. As in other sites in the East African highlands, the increasing malaria-related morbidity and mortality at Kabale hospital between 1994 and 2000 could be explained by the general increase in air temperatures over the same period. This increase may have made the local climate more conducive to mosquito survival and to parasite development in the vector, leading to increases in the intensity of transmission. At Hoima hospital, however, the increasing numbers of admissions for anaemia or malaria between 1990 and 2001 seem more likely to be the result of increased resistance to chloroquine (CQ) and sulfadoxine-pyrimethamine (SP) in the parasites and to changes in treatment seeking behaviour. With the recent change in the national drug policy, from the use of CQ alone as the first-line treatment of uncomplicated malaria to the use of a combination of CQ with SP, and the abolition of user charges at government health facilities, a reversal of these worrying trends might be anticipated. Although it may be not be appropriate to extrapolate the conclusions of studies based on hospital records to the communities at risk of malaria, such conclusions do allow the health services to monitor general trends in the morbidity and mortality associated with malaria and anaemia.
Annals of Tropical Medicine and Parasitology 06/2004; 98(4):315-27. · 1.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To understand and elicit the factors influencing compliance with mass treatment with ivermectin for onchocerciasis control with a view of suggesting remedial measures.
Qualitative methods using focus group discussion and individual key informant interviews.
Bushenyi district, Uganda.
Fifty key informants who were local council chairpersons and community directed drug distributors (CDDs) for ivermectin. Five focus group discussions with community members.
Explored knowledge about onchocerciasis and its treatment, consequences, benefits and perceived dangers of treatment with ivermectin. In addition the FGDs elicited information regarding social influence towards ivermectin treatment and who the source of social influences are. Perceived barriers and supports towards ivermectin treatment were also explored. The key informant interviews mainly elicited the problems they face in ivermectin distribution and their suggestions for improvement.
Factors that could possibly influence mass treatment with ivermectin that were elicited include consequences of treatment, programme organization, charging for ivermectin distribution and programme/community support to the ivermectin drug distributors.
These results are helpful in redirecting community education and in helping to design further quantitative research.
[Show abstract][Hide abstract] ABSTRACT: We conducted an efficacy study of chloroquine (CQ), sulfadoxine-pyrimethamine (SP) and a combination of both (SP+CQ) for the treatment of uncomplicated malaria in an area of low transmission with low drug pressure. On day 3, fever clearance was 97.4% (95% CI, 86.8-99.9), 100% (95% CI, 87.2-100) and 96.6% (95% CI, 82.2-99.9) in the CQ, SP and SP+CQ groups, respectively, (P=0.65). On day 14, clinical success was 92.5% (95% CI, 79.6-98.4), 100% (95% CI, 87.2-100) and 100% (95% CI, 88.1-100) in the CQ, SP and CQ+SP groups, respectively. Clinical failure was seen in 7.5% with 5% (95% CI, 0.61-16.9) early treatment failure and 2.5% (95% CI, 0.06-13.2) late treatment failure of cases in the CQ group and 0% in the SP and SP+CQ groups. Parasitological resistance was observed at RI level in 10% (95% CI, 2.8-23.7), 18.5% (95% CI, 6.3-38.1) and 6.9% (95% CI, 0.85-22.8) for the CQ, SP and SP+CQ, respectively (P=0.37). There was no age-dependent difference in clinical failure or parasitological resistance in any of the treatment groups and prior CQ use within the last 2 weeks did not affect CQ treatment outcome. The findings of this study suggest that CQ is still effective for the treatment of uncomplicated malaria in this area of low transmission and SP. However, combination therapy of SP+CQ is recommended to delay the development SP resistance, and regular surveillance for emerging CQ and SP resistance is needed to plan for alternative antimalarial drug regimens.
Tropical Medicine & International Health 02/2004; 9(1):47-52. · 2.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Onchocerciasis is co-endemic with schistosomiasis and intestinal helminths infections, which are all diseases of the rural and the poorest communities in Africa. Community-directed treatment (ComDT) for the control of onchocerciasis is the only functional health approach in most of these communities and the strategy has proven to be effective for onchocerciasis control. This study was conducted to assess the feasibility of integrating ComDT with ivermectin for the control of onchocerciasis, and with praziquantel (PZQ) and mebendazole (MBD) for the control of schistosomiasis and intestinal helminths infections in children aged 5-14 years, and to assess advantages and disadvantages of the integrated ComDT over the routine ComDT and the school-based treatment approach. Integrated ComDT achieved higher treatment coverage (85%) for PZQ and MBD than the school-based treatment approach (79%) among children aged 5-14 years (P = 0.03). There were more reported adverse reactions after treatment with a combination of PZQ and MBD in the school-based treatment approach (33%) than for the combination of ivermectin and MBD on day 1 and PZQ on day 2 in the integrated ComDT (18%). However, all adverse reactions were mild (headache, nausea/vomiting and abdominal pain). The integrated ComDT also achieved higher ivermectin treatment coverage for all ages (81.3%) than routine ComDT (77.2%) (P = 0.0003). To achieve even better coverage for PZQ and MBD among the targeted high risk groups, integrated ComDT should treat all age groups in areas where the prevalence of schistosomiasis and intestinal helminths infections is >50%. This would minimize the shortage of the drugs targeted to treat the high risk groups, as the non-targeted groups, will inevitably demand and receive the treatment from the distributors. The results of this study show that PZQ and MBD treatment for the control of schistosomiasis and intestinal helminths, respectively, can be integrated with ivermectin treatment for the control of onchocerciasis without negatively affecting ivermectin treatment coverage.
Tropical Medicine & International Health 12/2003; 8(11):997-1004. · 2.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Community-directed treatment is a relatively new strategy that was adopted in 1997 by the African Programme for Onchocerciasis Control (APOC), for large-scale distribution of ivermectin (Mectizan). Participatory monitoring of 39 of the control projects based on community-directed treatment with ivermectin (CDTI) was undertaken from 1998-2000, with a focus on process implementation of the strategy and the predictors of sustainability. Data from 14,925 household interviews in 2314 villages, 183 complete treatment records, 382 focus-group discussions, and the results of interviews with 669 community leaders, 757 trained community-directed drug distributors (CDD) and 146 health personnel (in 26 projects in four countries) were analysed. The data show that CDD dispensed ivermectin to 65.4% of the total population (71.2% of the eligible population), with no significant gender differences in coverage (P > 0.05). Treatment coverage ranged from 60.2% of the eligible subjects in Cameroon to 76.9% in Uganda. There was no significant relationship between the provision of incentives to CDD and treatment coverage (P > 0.05). The frequency of treatment refusal was highest in Cameroon (29.2%). Although most (72.1%) of the communities investigated selected their CDD on the basis of a community decision at a village meeting, only 37.9% chose their distribution period in the same way. There is clearly a need to improve communication strategies, to address the issues of absentees and refusals, to emphasise community ownership and to de-emphasise incentives for CDD. The investigation of the 'predictor indicators' of sustainability should enable APOC to understand the determinants of project performance and to initiate any appropriate changes in the programme.
Annals of Tropical Medicine and Parasitology 03/2002; 96 Suppl 1:S75-92. · 1.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In the control of onchocerciasis using mass treatment with ivermectin, coverage needs to be monitored regularly so that communities with poor or insufficient coverage can be identified and timely and appropriate interventions then instituted. The aim of the present study was to assess whether ivermectin-treatment coverage in schoolchildren, as monitored by schoolteachers, could be used as a proxy of population coverage. Although the coverages estimated in schoolchildren were found to be significantly correlated with estimates based on household surveys (P=0.01), there was poor correlation between either school and household-survey coverage and the values recorded in community registers. Although the community-register figures are the ones which the district health services normally use to report treatment coverage, they may be unreliable. Ivermectin-treatment coverage in schoolchildren monitored by schoolteachers could give a good and more accurate approximation of total population coverage. Further, large-scale studies, that take into consideration the cost-effectiveness of the various methods available to validate reported treatment coverage, are recommended.
Annals of Tropical Medicine and Parasitology 02/2002; 96(1):53-60. · 1.20 Impact Factor