Iodine deficiency mitigates growth retardation and osteopenia in selenium-deficient rats.

Selenium deficiency is associated with impaired bone metabolism and osteopenia in rats. However, it is not known how combined selenium and iodine deficiency affects bone metabolism. Therefore, we investigated the effect of selenium and iodine deficiency on bone metabolism in 2nd-generation selenium- and iodine-deficient rats.

Field validity, reproducibility and feasibility of diagnostic tests for visceral leishmaniasis in rural Nepal.

Objectives: To assess the field accuracy, reproducibility and feasibility of the formol gel test (FGT), the urine latex agglutination test (KAtex) and a rK39 antigen-based dipstick for the diagnosis of visceral leishmaniasis (VL) in rural Nepal.

Method: Patients with clinical suspicion of VL were recruited at Rangeli District Hospital (DH), a 15-bed government hospital located in south-eastern Nepal. FGT, KAtex and rK39 dipstick tests were performed on site and later repeated at a reference kala-azar diagnostic laboratory to assess reproducibility.

Diagnostic accuracy of two rK39 antigen-based dipsticks and the formol gel test for rapid diagnosis of visceral leishmaniasis in northeastern Uganda.

The development of an accurate, practical, and affordable diagnostic test is essential to improve the management of visceral leishmaniasis (VL) in remote health centers. We evaluated the Formol Gel test (FGT) and two rK39 antigen-based dipsticks, the DUAL-IT L/M, and the Kalazar Detect for VL diagnosis in Amudat Hospital in Uganda. The DUAL-IT L/M was also evaluated for the diagnosis of malaria.

Trypanosomiasis control, Democratic Republic of Congo, 1993-2003.

In the Democratic Republic of Congo (DRC), human African trypanosomiasis (HAT) reached unprecedented levels in the 1990s. To assess recent trends and evaluate control efforts, we analyzed epidemiologic and financial data collected by all agencies involved in HAT control in DRC from 1993 to 2003. Funds allocated to control populations, as well as to the population screened, doubled from 1993 to 1997 and from 1998 to 2003.

The validity of serologic tests for Trypanosoma cruzi and the effectiveness of transfusional screening strategies in a hyperendemic region.

Background: This study aims at obtaining unbiased estimates of the sensitivity and specificity of existing screening tests for Trypanosoma cruzi and at simulating the effectiveness of alternative screening strategies at different prevalence rates.

Study Design And Methods: A systematic random sample of 400 was taken from 1200 banked serum samples of donors screened between August 1998 and January 1999 in Santa Cruz, Bolivia. Samples were tested with indirect hemagglutination test (IHA), indirect immunofluorescence assay (IFA), and four enzyme-linked immunosorbent assays (ELISAs).

[The efficiency of different detection strategies of human African trypanosomiasis by T. b. gambiense].

Introduction: Population screening for human African trypanosomiasis (HAT) is often based on a combination of two screening tests: lymph node palpation (LN) and card agglutination test for trypanosomiasis (CATT). This decision analysis compared the efficiency of three alternative detection strategies: screening by LN only, CATT only and their combination (LN and CATT).

Method: An HAT detection strategy was defined as the sequence of screening and confirmation.

Street youths are the only high-risk group for HIV in a low-prevalence South American country.

Objectives: To measure HIV prevalence in various subpopulations in Bolivia.

Design: In 2002 in Cochabamba, we offered voluntary counseling and testing to homeless street youths, registered and unregistered commercial sex workers, truck drivers, and prisoners. We examined surveillance data of pregnant women and blood donors.

Infection rates with Leishmania donovani and Mycobacterium tuberculosis in a village in eastern Sudan.

Background: Leishmania-tuberculosis co-infection is not uncommon in clinical practice in East Africa, but little is known about the epidemiology of this problem at population level. A cross-sectional household survey was carried out in an active visceral leishmaniasis (VL) focus in Eastern Sudan in February 2002.

Methods: All inhabitants of Marbata village in Atbara River Area, Gedarif State, who gave informed consent, underwent both a leishmanin skin test (LST) and a tuberculin test for infection with L.

A new PCR-ELISA for diagnosis of visceral leishmaniasis in blood of HIV-negative subjects.

The PCR-ELISA represents a promising advance for diagnosis of visceral leishmaniasis (VL) in blood samples. However, the method has been validated mostly with HIV-positive patients who are known to have high levels of parasitaemia. We developed a new PCR-ELISA assay for specific detection of Leishmania in patients' blood and validated it in Nepalese subjects with clinically suspected VL, almost all of whom were HIV-negative.

Integrating tuberculosis and HIV care in the primary care setting in South Africa.

Background: In many countries including South Africa, the increasing human immunodeficiency virus (HIV) and tuberculosis (TB) epidemics have impacted significantly on already weakened public health services. This paper reviews the scope, process and performance of the HIV and TB services in a primary care setting where antiretroviral therapy is provided, in Khayelitsha, South Africa, in order to assess whether there is a need for some form of integration.

Methods: The scope and process of both services were assessed through observations of the service and individual and group interviews with key persons.

The effectiveness of active population screening and treatment for sleeping sickness control in the Democratic Republic of Congo.

Background: The human African trypanosomiasis (HAT) control programme of the Democratic Republic of Congo (DRC) uses mass screening with the card agglutination test for trypanosomes (CATT). We looked at the contribution of CATT and improved parasitological confirmation to the effectiveness of screening and treatment.

Method: The effectiveness of the screening and treatment process is measured by the percentage of HAT cases that is effectively cured after a single round of screening.

[Community participation in the control of Aedes aegypti: opinions of the population in one section of Havana, Cuba].

Objective: To analyze opinions on community participation held by residents of one section of the city of Havana, Cuba, in order to identify key criteria to use in preparing a participatory strategy for controlling the Aedes aegypti mosquito.

Methods: The study was conducted from September to October 1999 in Playa, one of the 15 municipios (districts) that make up the city of Havana, Cuba. In the first phase of the study, interviews were carried out with key informants, including health brigade members and sanitation activists, who had lived in Playa for more than five years.

A comparative study of the effectiveness of diagnostic tests for visceral leishmaniasis.

We compared the validity of pancytopenia, the formol-gel test (FGT), the indirect fluorescence antibody test (IFAT), the direct agglutination test (DAT), and the rK39 dipstick test as diagnostic criteria for visceral leishmaniasis (VL) in Nepal. Between September 2000 and January 2002, 310 clinical suspects had a bone marrow aspirate, and if negative, a spleen aspirate smear examined for Leishmania donovani. Sensitivity and specificity of all tests were determined compared with parasitology and by latent class analysis (LCA).

Strong general health care systems: a prerequisite to reach global tuberculosis control targets.

We argue that tuberculosis control cannot reach its proposed global targets without investment in an adequate network of accessible, effective and comprehensive health services. Lessons from the past are reviewed. They underscore that passive case-detection and adequate case management is the central technical strategy for tuberculosis control.

Selenium and iodine supplementation of rural Tibetan children affected by Kashin-Beck osteoarthropathy.

Background: Kashin-Beck disease is an osteoarthropathy endemic in selenium- and iodine-deficient areas around Lhasa, Tibet.

Objective: We assessed the efficacy of selenium supplementation on disease progression.

Design: A double-blind, randomized controlled trial of selenium supplementation was carried out in 324 children aged 5-15 y who had Kashin-Beck disease.

Recurrence in tuberculosis: relapse or reinfection?

The importance of reinfection as a cause for recurrence of tuberculosis is unclear and has potential public-health implications. We systematically searched published material for studies using DNA fingerprinting to provide data on the issue. Very few studies were designed for that particular research objective and/or report on a sufficient number of observations.

Incidence of surgical-site infections and the validity of the National Nosocomial Infections Surveillance System risk index in a general surgical ward in Santa Cruz, Bolivia.

Objectives: To estimate the frequency of and risk factors for surgical-site infections (SSIs) in Bolivia, and to study the performance of the National Nosocomial Infections Surveillance (NNIS) System risk index in a developing country.

Design: A prospective study with patient follow-up until the 30th postoperative day.

Setting: A general surgical ward of a public hospital in Santa Cruz, Bolivia.

Visceral leishmaniasis: current status of control, diagnosis, and treatment, and a proposed research and development agenda.

Visceral leishmaniasis is common in less developed countries, with an estimated 500000 new cases each year. Because of the diversity of epidemiological situations, no single diagnosis, treatment, or control will be suitable for all. Control measures through case finding, treatment, and vector control are seldom used, even where they could be useful.

Primary health care vs. emergency medical assistance: a conceptual framework.

Primary health care (PHC) and emergency medical assistance (EMA) are discussed as two fundamentally different strategies of delivering health care. PHC is conceptualized as part of overall development, while EMA is delivered in disaster or emergency situations. The article contrasts the underlying paradigms, and the characteristics of care in PHC and EMA.