Are intestinal parasites fuelling the rise in dual burden households in Venezuela?

BACKGROUND: In developing countries undergoing rapid economic development, the number of dual burden households (i.e. co-existing overweight/obesity and stunting) is increasing. While intestinal parasites are prevalent in these countries, their contribution to dual burden households has so far been neglected. We studied the association between intestinal parasite infection and belonging to a dual burden household in a rural community of Venezuela. METHODS: We examined 225 individuals. A dual burden household was defined as a household with at least one overweight/obese adult (BMI > 25) and at least one stunted child (height -for-age z score <-2). Intestinal parasite (Giardia lamblia and geohelminth) infection was determined by faecal smears. RESULTS: In this community, 47.3% of the individuals were infected with intestinal parasites. Among adults, 65.2% were overweight/obese and 13.8% of the children were stunted. More than one in four households (26.8%) were dual burden households. Being infected with G. lamblia & geohelminths was significantly associated with being in a dual burden household (OR = 4.75, 95% CI: 1.01-22.20, n = 188), indicating a triple burden of disease in this community in Venezuela. CONCLUSION: While the relationship between intestinal parasite infection and stunting has been well established, these results indicate a need to further explore the association of intestinal parasite infection with dual burden households

Bayesian estimation of the true prevalence, sensitivity and specificity of the Rose Bengal and indirect ELISA tests in the diagnosis of bovine brucellosis

Serology is the most convenient method for detecting brucellosis but the efficient use of such tests in disease control requires evaluation of diagnostic performance and discriminative ability. The objective of this study was to assess the performance of the Rose Bengal test (RBT) and an indirect ELISA (iELISA) in diagnosing brucellosis in 995 serum samples collected from cattle in the Ivory Coast between 2005 and 2009. A Bayesian approach was used to evaluate the two tests by estimating their sensitivities and specificities. The correlation-adjusted sensitivity of the iELISA was estimated to be 96.1% (credibility interval [CrI], 92.7-99.8), whereas that of the RBT was 54.9% (CrI, 23.5-95.1). High correlation-adjusted specificities were found for both tests (95.0%; [CrI, 91.1-99.6] for the iELISA and 97.7%; [CrI, 95.3-99.4] for the RBT, respectively). The true prevalence of brucellosis was estimated from the serum samples to be 4.6% (95%; [CrI, 0.6-9.5]). The level of agreement between the two tests was evaluated using indices of agreement (n=995). Good agreement was found for negative results (96.6%; confidence interval [CI], 95.7-97.4), a finding supported by an estimated significant correlation of 0.37 (95%; CI, 0.01-0.73) within the sera testing negative. Agreement was lower for sera testing positive (52.2% CI: 41.9-62.5). The findings highlight the importance of using these two tests in combination as part of any brucellosis control programme

Efficacy of quinine, artemether-lumefantrine and dihydroartemisinin-piperaquine as rescue treatment for uncomplicated malaria in Ugandan children

BACKGROUND: The treatment of falciparum malaria poses unique challenges in settings where malaria transmission intensity is high because recurrent infections are common. These could be new infections, recrudescences, or a combination of the two. Though several African countries continue to use quinine as the second line treatment for patients with recurrent infections, there is little information on its efficacy when used for rescue therapy. Moreover, such practice goes against the World Health Organisation (WHO) recommendation to use combination therapy for uncomplicated malaria. METHODS: We conducted a nested, randomized, open label, three-arm clinical trial of rescue therapy in children 6-59 months old with recurrent malaria infection during 28 days post treatment with artemisinin combination treatment (ACT). Patients were randomly assigned to receive either quinine, artemether-lumefantrine (AL) or dihydroartemisinin-piperaquine (DHAPQ), and actively followed up for 28 days. FINDINGS: Among 220 patients enrolled, 217 (98(.)6 %) were assigned an efficacy outcome and 218 (99(.)1 %) were assessed for safety. The risk of recurrent infection was significantly higher in patients treated with quinine (70 %, 74/110, HR = 3(.)9; 95 % CI: 2(.)4-6(.)7, p<0(.)0001) and AL (60%, 21/35, HR = 3(.)3; 95 % CI: 1(.)8-6(.)3, p<0(.)0002), compared to DHAPQ (25%, 18/72). Recrudescence tended to be lower in the DHAPQ (1%, 1/72) than in the quinine (7%, 8/110) or AL (6 %, 2/35) group, though it was not statistically significant. No serious adverse events were reported. CONCLUSION: Recurrent infections observed after the administration of an ACT can be successfully treated with an alternative ACT rather than with quinine. TRIAL REGISTRATION: Current Controlled Trials ISRCTN99046537