[show abstract][hide abstract] ABSTRACT: In an earlier study in rural Guatemala, 257 households that received flocculant-disinfectant to treat their drinking water had 39% less diarrhea than 257 control households. Three weeks after completion of the study, national marketing of the flocculant-disinfectant was extended into the study communities. Six months later, we assessed frequency of and characteristics associated with purchase and use of the flocculant-disinfectant by revisiting the original study households and administering a questionnaire. Four hundred sixty-two households (90%) completed the follow-up survey; 22 households (5%) purchased the flocculant-disinfectant within the preceding 2 weeks and used it within the last week. Neither being randomized to the intervention group during the efficacy study nor combined spending on laundry soap, toothpaste, and hand soap in the preceding week was associated with active repeat use. Even after efficacy was demonstrated within their community and an aggressive sophisticated marketing approach, few households purchased flocculant-disinfectant for point-of-use water treatment.
The American journal of tropical medicine and hygiene 04/2008; 78(3):382-7. · 2.53 Impact Factor
[show abstract][hide abstract] ABSTRACT: Endosymbionic Wolbachia bacteria inside adult Onchocerca volvulus worms (causing river blindness) are necessary for female worm fertility. We evaluated whether rifampin and/or azithromycin used in a five-day course could kill Wolbachia. In an open-label trial in Guatemala, 73 patients with 134 palpable onchocercal nodules were randomized into four treatment groups: rifampin, azithromycin, a combination of the two drugs, and controls (multivitamins). After five days of antibiotic treatment, all participants received a single dose of ivermectin on day 6. Nine months after treatment, the nodules were removed and the worms were examined. Skin snips to determine microfilariae were obtained at baseline and nine months. There were no significant differences between any of the treatment groups in the condition of the worms in the nodules, the presence of Wolbachia surface protein, or the number of microfilariae in skin. Short courses with these antibiotics will not clear Wolbachia from O. volvulus.
The American journal of tropical medicine and hygiene 12/2007; 77(5):878-82. · 2.53 Impact Factor
[show abstract][hide abstract] ABSTRACT: World Health Organization certification criteria for onchocerciasis elimination use anterior segment eye lesion prevalence as an indicator of mass ivermectin treatment program success. Lesions either contain visible microfilaria (noninflammatory punctate keratitis [PK] or microfilariae in anterior chamber [MFAC]), or microfilaria obscured by inflammation (inflammatory PK). To assess the utility of these disease indicators, two experienced ophthalmologists independently examined persons from endemic (N = 325) and nonendemic (N = 348) Guatemalan communities. Thirty-six (11.1%) and nine (2.6%) persons from endemic and nonendemic areas respectively had lesions found by either ophthalmologist (prevalence ratio = 4.3, 95% CI 2.1-8.8, P < 0.001). All lesions in nonendemic areas were inflammatory PK in whom no persons were seropositive for onchocerciasis. Overall, observer agreement was moderate (Kappa = 0.49), and most (61%) discordance occurred with inflammatory PK lesions. Our findings suggest that inflammatory punctate keratitis is neither a specific nor a reliable indicator of onchocercal eye disease. Future prevalence surveys should rely upon noninflammatory lesions as disease indicators.
The American journal of tropical medicine and hygiene 01/2007; 75(6):1058-62. · 2.53 Impact Factor
[show abstract][hide abstract] ABSTRACT: An estimated 1 billion persons in low-income countries do not have access to improved drinking water. Chlorine, a useful water treatment agent, is less effective in turbid water, and lacks a visible effect, limiting its acceptability. A product incorporating precipitation, coagulation, flocculation, and chlorination technology (combined product) to reduce microbial, organic and heavy metal contaminants in water was evaluated. The combined product's microbiological efficacy in Guatemalan villagers' households was evaluated. One hundred randomly selected households from four neighboring Guatemalan villages were enrolled. Three groups received the combined product and either the Centers for Disease Control (CDC) water storage vessel, a covered bucket with spigot, or no vessel. One group received chlorine bleach and the CDC water storage vessel, and one group no intervention. Household water samples were collected for 4 weeks and Escherichia coli, chlorine, and turbidity levels were measured. Potable water was defined as having less than one E. coli per 100 ml. Eight (8%) baseline water samples were potable. Follow-up water samples were more likely to be potable than control samples (combined product and traditional vessel 83%; combined product and CDC vessel 92%; combined product and covered bucket with spigot 93%; chlorine and CDC vessel 92%; versus control 5%). Among combined product users, 98% reported improved water clarity compared with 45% of chlorine bleach users (p < 0.0001). The combined product technology improved water potability as effectively as chlorine bleach; improved water clarity could motivate more persons to effectively treat their water.
Journal of Water and Health 04/2003; 1(1):15-22. · 1.22 Impact Factor