Social and cultural factors affecting rates of regular retreatment of mosquito nets with insecticide in Bagamoyo District, Tanzania

Insecticide-treated mosquito nets have an impact on mortality and morbidity in young children under controlled conditions. When integrated into larger control programs, there is the danger that rates of regular retreatment of the nets with insecticide will drop, greatly limiting their effectiveness as a public health intervention. In Bagamoyo District, Tanzania, rates of retreatment dropped significantly when payment for the insecticide was introduced. A series of neighbourhood (hamlet) meetings were held in all study villages to discuss people\u27s concerns about the insecticide and ways to increase rates of retreatment. Although changes were made in the procedure for retreatment, rates of retreatment remained lower than expected and showed marked variation within as well as between villages. We then conducted unstructured key informant interviews as well as informal discussions in a village with strong variation between different sectors of the village in rates of retreatment. While logistical problems were most frequently cited as reasons not to bring nets for retreatment, political and social divisions within the community provided a better explanation. This is borne out by the low response to rearrangements in logistics which made retreating the nets significantly easier for households, and the higher response when changes were made in the channels of communication as well as the logistic features. It is clearly more difficult for villagers to appreciate the benefits of the insecticide than those of the nets. Great emphasis needs to be placed on the insecticide and its beneficial effects from the outset for any large-scale programme to be sustainable

Comparison of two pancreatic enzyme products for exocrine insufficiency in patients with cystic fibrosis

Background: Zenpep (APT-1008) is a pancreatic enzyme product for the treatment of exocrine pancreatic insufficiency (EPI) associated with cystic fibrosis (CF). Methods: Zenpep and Kreon, both containing 25,000 lipase units, were compared in a randomised, double-blind, crossover, non-inferiority study for CF-associated EPI in patients aged ≥12 years. Patients on a standardised diet and stabilised treatment were randomised to two treatment sequences: Zenpep/Kreon or Kreon/Zenpep. The primary efficacy endpoint was the coefficient of fat absorption over 72 h (CFA-72 h). Results: 96 patients (mean age 19.2 years, 60.4% males) were randomised with 83 completers of both sequences comprising the efficacy population. Zenpep demonstrated non-inferiority and equivalence to Kreon in fat absorption (LS mean CFA-72 h: Zenpep, 84.1% [SE 1.1] vs. Kreon, 85.3% [SE 1.1]; p = 0.297). Safety and tolerability were similar. Conclusions: Zenpep is comparable with Kreon in efficacy and safety for the treatment of adolescents and adults with CF-associated EPI. NCT0164139

The PoroSightR-F test: A simple rapid manual dipstick test to detect Plasmodium falciparum infection

A rapid diagnostic for Plasmodium falciparum based on an antigen capture has been incorporated in a simple, easily interpreted dipstick by Becton Dickinson Advanced Diagnostics. In this article Clive Shiff, Japhet Minjas and Zul Premji discuss its evaluation in rural Tanzania and the implications of such a test in handling malaria cases under field conditions

Laboratory diagnosis of malaria by village health workers using the rapid manual ParaSight™-F test

[No abstract available

The rapid manual ParaSight®-F test. A new diagnostic tool for Plasmodium falciparum infection

A rapid manual test for Plasmodium falciparum, the ParaSight®-F test, has been used on a series of patients in a holoendemic malaria area of coastal Tanzania. The test, which is an antigen capture test detecting trophozoite-derived histidine rich protein-II, is simple to perform and provides a definitive answer in about 10 min. It requires no special equipment and is read using a single drop of blood. When compared with 272 thick blood films examined microscopically by 2 observers and confirmed by the QBC® malaria test, the ParaSight®-F test had 88·9% sensitivity and 87·5% specificity. Detectable antigenaemia in a group of 40 people declined following treatment with Fansidar® and by 10 d after treatment all but 4 individuals were antigen free. The remaining 4, although clear of peripheral parasitaemia, remained antigenaemic for 14 d. The test shows great promise for rapid effective diagnosis of P. falciparum in clinics and village health centres where there is no facility for microscopy. Because of its accuracy and rapid action it may even obviate the need for microscopical examination of blood films to diagnose P. falciparum malaria. © 1993

Chloroquine resistant Plasmodium falciparum in coastal Tanzania. A challenge to the continued strategy of village based chemotherapy for malaria control

An in vivo study to assess Plasmodium falciparum sensitivity to chloroquine was conducted in two villages of the Bagamoyo District, Tanzania in December 1992. The WHO standard field test (7 days) and the extended test (28 days) were carried out on symptom free children. The presence of chloroquine resistance was confirmed with 59% of infections being found resistant. Fifty-three percent were R(I), 2% were at R(II) and 4% at R(III) levels of resistance. Dosage was 25 mg/kg chloroquine base delivered over three days

The use of permethrin-impregnated bednets for malaria control in coastal Tanzania: Preliminary entomological impact on vectors

A community-based malaria control programme, using permethrin-impregnated mosquito nets (IMNs) was carried out in the Bagamoyo District, coastal Tanzania. One of the aims of the programme was to determine whether sufficient protection could be achieved to reduce malaria transmission. We report on the relevant entomological aspects before and after intervention. The study was conducted in an area with high malaria transmission, with estimated entomological inoculation rates (EIR) of 300 infective bites per person per annum. After two and a half years of using IMNs, mosquito densities were not affected but there was a significant reduction in enzyme linked immunosorbent assay (ELISA) sporozoite rates. This led to a reduction of the EIR by 76 % in intervention villages and is mainly due to individual protection. Reduction in EIR was 86 % for Anopheles funestus Giles (Diptera: Culicidae) compared to 66 % for An gambiae s.l. Giles (P \u3c0.001). However, unprotected communities are still at risk from malaria. To realize optimum community protection against malaria, extra effort should be made to maximize net coverage in the community, encourage net use throughout the year and ensure regular and timely re-impregnation of mosquito nets

Local terminology for febrile illnesses in Bagamoyo District, Tanzania and its impact on the design of a community-based malaria control programme

This paper reviews results of several ethnographic studies that have examined the issue of local terminology for malaria in Africa, then presents findings from an on-going study in Bagamoyo District, Tanzania. The study used a mixture of qualitative and quantitative interview methods to examine local perceptions of malaria and malaria treatment practices. Although the local term homa ya malaria or malaria fever appeared on the surface to correspond closely with the biomedical term malaria, significant and often subtle differences were found between the two terms. Of perhaps greatest importance, common consequences of malaria in endemic areas such as cerebral malaria in young children, severe anaemia and malaria in pregnancy were not connected with homa ya malaria by many people. A set of guidelines are described that were used to determine how best to promote acceptance and use of insecticide-impregnated mosquito nets, given these results. It is demonstrated that the position of the term used to denote malaria in the local taxonomy of febrile illnesses has important implications for the design of health education interventions