Randomised primary health center based interventions to improve the diagnosis and treatment of undifferentiated fever and dengue in Vietnam

<p>Abstract</p> <p>Background</p> <p>Fever is a common reason for attending primary health facilities in Vietnam. Response of health care providers to patients with fever commonly consists of making a presumptive diagnosis and proposing corresponding treatment. In Vietnam, where malaria was brought under control, viral infections, notably dengue, are the main causes of undifferentiated fever but they are often misdiagnosed and inappropriately treated with antibiotics.</p> <p>This study investigate if educating primary health center (PHC) staff or introducing rapid diagnostic tests (RDTs) improve diagnostic resolution and accuracy for acute undifferentiated fever (AUF) and reduce prescription of antibiotics and costs for patients.</p> <p>Methods</p> <p>In a PHC randomized intervention study in southern Vietnam, the presumptive diagnoses for AUF patients were recorded and confirmed by serology on paired (acute and convalescence) sera. After one year, PHCs were randomized to four intervention arms: training on infectious diseases (A), the provision of RDTs (B), the combination (AB) and control (C). The intervention lasted from 2002 until 2006.</p> <p>Results</p> <p>The frequency of the non-etiologic diagnosis "undifferentiated fever" decreased in group AB, and - with some delay- also in group B. The diagnosis "dengue" increased in group AB, but only temporarily, although dengue was the most common cause of fever. A correct diagnosis for dengue initially increased in groups AB and B but only for AB this was sustained. Antibiotics prescriptions increased in group C. During intervention it initially declined in AB with a tendency to increase afterwards; in B it gradually declined. There was a substantial increase of patients' costs in B.</p> <p>Conclusions</p> <p>The introduction of RDTs for infectious diseases such as dengue, through free market principles, does improve the quality of the diagnosis and decreases the prescription of antibiotics at the PHC level. However, the effect is more sustainable in combination with training; without it RDTs lead to an excess of costs.</p

Enzyme-linked immunoassay for dengue virus IgM and IgG antibodies in serum and filter paper blood

BACKGROUND: The reproducibilty of dengue IgM and IgG ELISA was studied in serum and filter paper blood spots from Vietnamese febrile patients. METHODS: 781 pairs of acute (t0) and convalescent sera, obtained after three weeks (t3) and 161 corresponding pairs of filter paper blood spots were tested with ELISA for dengue IgG and IgM. 74 serum pairs were tested again in another laboratory with similar methods, after a mean of 252 days. RESULTS: Cases were classified as no dengue (10 %), past dengue (55%) acute primary (7%) or secondary (28%) dengue. Significant differences between the two laboratories' results were found leading to different diagnostic classification (kappa 0.46, p < 0.001). Filter paper results correlated poorly to serum values, being more variable and lower with a mean (95% CI) difference of 0.82 (0.36 to 1.28) for IgMt3, 0.94 (0.51 to 1.37) for IgGt0 and 0.26 (-0.20 to 0.71) for IgGt3. This also led to differences in diagnostic classification (kappa value 0.44, p < 0.001) The duration of storage of frozen serum and dried filter papers, sealed in nylon bags in an air-conditioned room, had no significant effect on the ELISA results. CONCLUSION: Dengue virus IgG antibodies in serum and filter papers was not affected by duration of storage, but was subject to inter-laboratory variability. Dengue virus IgM antibodies measured in serum reconstituted from blood spots on filter papers were lower than in serum, in particular in the acute phase of disease. Therefore this method limits its value for diagnostic confirmation of individual patients with dengue virus infections. However the detection of dengue virus IgG antibodies eluted from filter paper can be used for sero-prevalence cross sectional studies

Anemia, malaria and hookworm infections in a Vietnamese ethnic minority

The aim of this study was to determine the prevalence of anemia and evaluate the relationship of malaria and helminth infections on anemia status in Phan Tien village, a mountainous ethnic minority community in southern Vietnam. This longitudinal study was performed from April 1997 to 2000 by measuring the hemoglobin concentration of 2,767 people who participated in six annual surveys at the end of the rainy seasons. Ferritin concentration was measured in 2000 to evaluate the proportion of iron deficiency anemia. The relation between malaria and intestinal helminth infections with anemia was investigated. Anemia was always over 43% and mainly associated with iron deficiency (80.1%). Using generalized estimating equations, a small but significant decline of the anemia prevalence was detected (OR: 0.805; p < 0.0001). Malaria was significantly associated with anemia (OR: 2.408; p = 0.0006). There was no significant effect of the control of intestinal helminth infections on the time course of anemia (95% CI: -0.1548 to 0.1651

Dengue as a cause of acute undifferentiated fever in Vietnam

BACKGROUND: Dengue is a common cause of fever in the tropics but its contribution to the total burden of febrile illnesses that is presented to primary health facilities in endemic regions such as Vietnam, is largely unknown. We aimed to report the frequency of dengue as a cause of fever in Binh Thuan Province, to describe the characteristics of dengue patients, and analyze the diagnostic accuracy of the health care workers and the determinants of the diagnostic process. METHODS: All patients presenting with acute undifferentiated fever at twelve community health posts and one clinic at the provincial malaria station, Binh Thuan Province, a dengue endemic province in southern Vietnam, were included. Record forms were used to fill in patient and diseases characteristics, pre-referral treatment, signs and symptoms, provisional diagnosis and prescribed treatment, referral and final outcome. Serum samples were collected at first presentation and after 3 weeks for serologic diagnosis. RESULTS: 2096 patients were included from April 2001 to March 2002. All 697 patients with paired serum samples were tested for dengue virus IgM and IgG. Acute dengue was found in 33.6% cases and past dengue virus infections were found in 57.1% cases. Acute primary infections were more common among children under 15 years old than among adults (7.7% vs. 3.5%, p value < 0.001). Younger age significantly predicted acute dengue (RR per increasing year of age (95 % CI): 0.986 (0.975-0.997, p value = 0.014). 48.9% of cases with clinical diagnosis of acute dengue were serologically confirmed and 32.5% of cases without clinical diagnosis of acute dengue were positive by serology after all (OR = 1.981, p value 0.025, 95% CI: 1.079-3.635). Tourniquet test was not a predictor for dengue diagnosis. CONCLUSION: Dengue is responsible for one third of the fevers presented to the public primary health services in Binh Thuan, southern Vietnam. It presents as a highly unspecific illness and is hardly recognized as a clinical entity by primary physician

Control of malaria: a successful experience from Viet Nam

OBJECTIVE: To follow malaria prospectively in an ethnic minority commune in the south of Viet Nam with high malaria transmission and seasonal fluctuation, during malaria control interventions using insecticide-treated bednets (ITBNs) and early diagnosis and treatment (EDT) of symptomatic patients. METHODS: From 1994 onwards the following interventions were used: distribution of ITBNs to all households with biannual reimpregnation; construction of a health post and appointment of staff trained in microscopic diagnosis and treatment of malaria; regular supply of materials and drugs; annual cross-sectional malaria surveys with treatment of all parasitaemic subjects, and a programme of community involvement and health education. Surveys were held yearly at the end of the rainy season. During the surveys, demographic data were updated. Diagnosis and treatment of malaria were free of charge. Plasmodium falciparum infection was treated with artesunate and P. vivax infection with chloroquine plus primaquine. FINDINGS: The baseline survey in 1994 recorded 716inhabitants. Of the children under 2years of age, 37% were parasitaemic; 56% of children aged 2-10 years, and 35% of the remaining population were parasitaemic. P. falciparum accounted for 73-79% of these infections. The respective splenomegaly rates for the above-mentioned age groups were 20%, 56%, and 32%. In 1999, the proportion of parasitaemic subjects was 4%, 7% and 1%, respectively, of which P.falciparum contributed 56%. The splenomegaly rate was 0%, 5% and 2%, respectively. CONCLUSIONS: A combination of ITBNs and EDT, provided free of charge, complemented by annual diagnosis and treatment during malaria surveys and community involvement with health education successfully brought malaria under control. This approach could be applied to other regions in the south of Viet Nam and provides a sound basis for further studies in other areas with different epidemiological patterns of malaria

Simulation of resources for quantum algorithms and quantum communication protocols based on a novel framework

Abstract Recently, Samsung Electronic just released a new type of mobile phone model named Galaxy A71 where the quantum RNG chip is boasted inside for advanced security by capable of generating truly random and unpredictable numbers. It is no doubt that the quantum mechanism-based communication protocols or quantum information technologies are gradually changing the world with its advantages. It promises the new information generation where quantum-based computer can be seen in many living fields. Since the quantum algorithms and quantum communication protocols need to be verified before applying on chip set system, or hardware systems, the verification frameworks need to be done. In this discussion, we first propose a novel framework by MATLAB emulators. Then, we analysis the quantum resources or quantum basic elements such as quantum entanglements, quantum super positions state, quantum Fourier transformation, and quantum Arithmetic in proposed novel framework. The open problems to consider quantum algorithms based on proposed framework is discussed

Control of malaria: a successful experience from Viet Nam.

OBJECTIVE: To follow malaria prospectively in an ethnic minority commune in the south of Viet Nam with high malaria transmission and seasonal fluctuation, during malaria control interventions using insecticide-treated bednets (ITBNs) and early diagnosis and treatment (EDT) of symptomatic patients. METHODS: From 1994 onwards the following interventions were used: distribution of ITBNs to all households with biannual reimpregnation; construction of a health post and appointment of staff trained in microscopic diagnosis and treatment of malaria; regular supply of materials and drugs; annual cross-sectional malaria surveys with treatment of all parasitaemic subjects, and a programme of community involvement and health education. Surveys were held yearly at the end of the rainy season. During the surveys, demographic data were updated. Diagnosis and treatment of malaria were free of charge. Plasmodium falciparum infection was treated with artesunate and P. vivax infection with chloroquine plus primaquine. FINDINGS: The baseline survey in 1994 recorded 716 inhabitants. Of the children under 2 years of age, 37% were parasitaemic; 56% of children aged 2-10 years, and 35% of the remaining population were parasitaemic. P. falciparum accounted for 73-79% of these infections. The respective splenomegaly rates for the above-mentioned age groups were 20%, 56%, and 32%. In 1999, the proportion of parasitaemic subjects was 4%, 7% and 1%, respectively, of which P.falciparum contributed 56%. The splenomegaly rate was 0%, 5% and 2%, respectively. CONCLUSIONS: A combination of ITBNs and EDT, provided free of charge, complemented by annual diagnosis and treatment during malaria surveys and community involvement with health education successfully brought malaria under control. This approach could be applied to other regions in the south of Viet Nam and provides a sound basis for further studies in other areas with different epidemiological patterns of malaria

The haematological consequences of Plasmodium vivax malaria after chloroquine treatment with and without primaquine: a WorldWide Antimalarial Resistance Network systematic review and individual patient data meta-analysis

André M. Siqueira. Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta a informação no documento.André Daher. Fundação Oswaldo Cruz. Instituto de Tecnologia em Fármacos / Fundação Oswaldo Cruz. Presidência. Vice-Presidência de Pesquisa. Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta a informação no documento.Marcus V. G. Lacerda. Fundação Oswaldo Cruz. Instituto Leônidas e Maria Deane. Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta a informação no documento.1 Global Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia. 2 WorldWide Antimalarial Resistance Network (WWARN), Clinical Module, Darwin, Northern Territory, Australia. 3 Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia. 4 Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK. 5 Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand. 6 ICAP, Columbia University Mailman School of Public Health, Addis Ababa, Ethiopia. 7 Addis Ababa University, Addis Ababa, Ethiopia. 8 Armauer Hansen Research Institute, Addis Ababa, Ethiopia. 9 Departamento de Salud Pública, Universidad de Barcelona, Barcelona, Spain. 10Organización Panamericana de Salud, Oficina de País Bolivia, La Paz, Bolivia. 11Malaria and Neglected Tropical Diseases Research Team, Bacterial, Parasitic, Zoonotic Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia. 12Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. 13Nangarhar Medical Faculty, Nangarhar University, Jalalabad, Afghanistan. 14Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia. 15Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia. 16Medicines for Malaria Venture, Geneva, Switzerland. 17Medical Research Council Unit The Gambia at LSTMH, Fajara, The Gambia. 18WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK. 19Institute of Drug Technology (Farmanguinhos), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil. 20Vice-presidency of Research and Reference Laboratories, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil. 21Liverpool School of Tropical Medicine, Liverpool, UK. 22Department of Internal Medicine, Tergooi Hospital, Hilversum, the Netherlands. 23Superintendência de Vigilância em Saúde do Estado do Amapá - SVS/AP, Macapá, Amapá, Brazil. 24Universidade Federal do Amapá – UNIFAP, Macapá, Amapá, Brazil. 25U.S. President’s Malaria Initiative, Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, USA. 26Global Health Group, University of California San Francisco, San Francisco, USA. 27Centre for Infection and Immunity Amsterdam (CINEMA), Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, Amsterdam, the Netherlands. 28Department of Biology, Addis Ababa University, Addis Ababa, Ethiopia. 29Department of Biology, Jimma University, Jimma, Ethiopia. 30International Centre for Diarrheal Diseases and Research, Dhaka, Bangladesh. 31Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil. 32Universidade do Estado do Amazonas, Manaus, Brazil. 33Fundação Oswaldo Cruz, Instituto Leônidas e Maria Deane (FIOCRUZ-Amazonas), Manaus, Brazil. 34Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK. 35HealthNet-TPO, Kabul, Afghanistan. 36The Department of Pharmacology and Therapy, Faculty of Medicine, Nusa Cendana University, Kupang, Indonesia. 37Centro de Pesquisa em Medicina Tropical de Rondônia (CEPEM), Porto Velho, Rondônia, Brazil. 38Universidade Federal de Rondônia (UNIR), Porto Velho, Rondônia, Brazil. 39Division of Infectious Diseases, Tropical Commons et al. BMC Medicine (2019) 17:151 Page 11 of 13 Medicine and AIDS, Academic Medical Center, Amsterdam, the Netherlands. 40Tropical Diseases Clinical Research Center, Cho Ray Hospital, Ho Chi Minh City, Vietnam. 41Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Madhav Nagar, Manipal, Karnataka, India. 42Manipal McGill Center for Infectious Diseases, Manipal Academy of Higher Education, Manipal, Karnataka, India. 43Department of Genome Sciences, University of Washington, Seattle, USA. 44Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil. 45Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. 46Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam. 47Federal University of Pará (Universidade Federal do Pará - UFPA), Belém, Pará, Brazil. 48Public Health Laboratory, Department of Public Health, Ministry of Health, Thimphu, Bhutan. 49Gleneagles Hospital, Kota Kinabalu, Sabah, Malaysia.Submitted by Janaína Nascimento ([email protected]) on 2019-09-11T12:05:30Z No. of bitstreams: 1 ve_Commons_Robert_etal_INI_2019.pdf: 1266198 bytes, checksum: 936f146cdf4941559be88339f3112388 (MD5)Approved for entry into archive by Janaína Nascimento ([email protected]) on 2019-09-11T13:40:33Z (GMT) No. of bitstreams: 1 ve_Commons_Robert_etal_INI_2019.pdf: 1266198 bytes, checksum: 936f146cdf4941559be88339f3112388 (MD5)Made available in DSpace on 2019-09-11T13:40:33Z (GMT). No. of bitstreams: 1 ve_Commons_Robert_etal_INI_2019.pdf: 1266198 bytes, checksum: 936f146cdf4941559be88339f3112388 (MD5) Previous issue date: 2019Múltipla - Ver em Notas.Background: Malaria causes a reduction in haemoglobin that is compounded by primaquine, particularly in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. The aim of this study was to determine the relative contributions to red cell loss of malaria and primaquine in patients with uncomplicated Plasmodium vivax. Methods: A systematic review identified P. vivax efficacy studies of chloroquine with or without primaquine published between January 2000 and March 2017. Individual patient data were pooled using standardised methodology, and the haematological response versus time was quantified using a multivariable linear mixed effects model with non-linear terms for time. Mean differences in haemoglobin between treatment groups at day of nadir and day 42 were estimated from this model. n total, 3421 patients from 29 studies were included: 1692 (49.5%) with normal G6PD status, 1701 (49.7%) with unknown status and 28 (0.8%) deficient or borderline individuals. Of 1975 patients treated with chloroquine alone, the mean haemoglobin fell from 12.22 g/dL [95% CI 11.93, 12.50] on day 0 to a nadir of 11.64 g/dL [11.36,11.93] on day 2, before rising to 12.88 g/dL [12.60, 13.17] on day 42. In comparison to chloroquine alone, the mean haemoglobin in 1446 patients treated with chloroquine plus primaquine was − 0.13 g/dL [− 0.27, 0.01] lower at day of nadir (p = 0.072), but 0.49 g/dL [0.28, 0.69] higher by day 42 (p 25% to 5 g/dL. Conclusions: Primaquine has the potential to reduce malaria-related anaemia at day 42 and beyond by preventing recurrent parasitaemia. Its widespread implementation will require accurate diagnosis of G6PD deficiency to reduce the risk of drug-induced haemolysis in vulnerable individuals