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

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