American Journal of Tropical Medicine and Hygiene, 2017
Background: The African Programme for Onchocerciasis Control (APOC) was created in 1995 to establ... more Background: The African Programme for Onchocerciasis Control (APOC) was created in 1995 to establish community-directed treatment with ivermectin (CDTi) in order to control onchocerciasis as a public health problem in 20 African countries that had 80 % of the global disease burden. When research showed that CDTi may ultimately eliminate onchocerciasis infection, APOC was given in 2008 the additional objective to determine when and where treatment can be safely stopped. We report the results of epidemiological evaluations undertaken from 2008 to 2014 to assess progress towards elimination in CDTi areas with ≥6 years treatment. Methods: Skin snip surveys were undertaken in samples of first-line villages to determine the prevalence of O. volvulus microfilariae. There were two evaluation phases. The decline in prevalence was evaluated in phase 1A. Observed and model-predicted prevalences were compared after correcting for endemicity level and treatment coverage. Bayesian statistics and Monte Carlo simulation were used to classify the decline in prevalence as faster than predicted, on track or delayed. Where the prevalence approached elimination levels, phase 1B was launched to determine if treatment could be safely stopped. Village sampling was extended to the whole CDTi area. Survey data were analysed within a Bayesian framework to determine if stopping criteria (overall prevalence <1.4 % and maximum stratum prevalence <5 %) were met. Results: In phase 1A 127 665 people from 639 villages in 54 areas were examined. The prevalence had fallen dramatically. The decline in prevalence was faster than predicted in 23 areas, on track in another 23 and delayed in eight areas. In phase 1B 108 636 people in 392 villages were examined in 22 areas of which 13 met the epidemiological criteria for stopping treatment. Overall, 32 areas (25.4 million people) had reached or were close to elimination, 18 areas (17.4 million) were on track but required more years treatment, and in eight areas (10.4 million) progress was unsatisfactory. Conclusions: Onchocerciasis has been largely controlled as a public health problem. Great progress has been made towards elimination which already appears to have been achieved for millions of people. For most APOC countries, nationwide onchocerciasis elimination is within reach.
Annals of Tropical Medicine & Parasitology, 2002
Since its inauguration in 1995, the African Programme for Onchocerciasis Control (APOC) has made ... more Since its inauguration in 1995, the African Programme for Onchocerciasis Control (APOC) has made significant progress towards achieving its main objective: to establish sustainable community-directed treatment with ivermectin (CDTI) in onchocerciasis-endemic areas outside of the remit of the Onchocerciasis Control Programme in West Africa (OCP). In the year 2000, the programme, in partnership with governments, non-governmental organizations and the endemic communities themselves, succeeded in treating 20,298,138 individuals in 49,654 communities in 63 projects in 14 countries. Besides the distribution of ivermectin, the programme has strengthened primary healthcare (PHC) through capacity-building, mobilization of resources and empowerment of communities. The community-directed-treatment approach is a model that can be adopted in developing other community-based health programmes. The approach has also made it possible to bring to the poor some measure of intervention in some other healthcare programmes, such as those for malaria control, eye care, maternal and child health, nutrition and immunization. CDTI presents, at all stages of its implementation, a unique window of opportunity for promoting the functional integration of healthcare activities. For this to be done successfully and in a co-ordinated manner, adequate funding of CDTI within PHC is as important as an effective sensitization of the relevant policy-makers, healthworkers and communities on the value of integration (accompanied by appropriate training at all levels). Evaluation of the experiences in integration of health services, particularly at community level, is crucial to the success of the integration.
Annals of Tropical Medicine & Parasitology, 2002
Community-directed treatment is a relatively new strategy that was adopted in 1997 by the African... more Community-directed treatment is a relatively new strategy that was adopted in 1997 by the African Programme for Onchocerciasis Control (APOC), for large-scale distribution of ivermectin (Mectizan). Participatory monitoring of 39 of the control projects based on community-directed treatment with ivermectin (CDTI) was undertaken from 1998-2000, with a focus on process implementation of the strategy and the predictors of sustainability. Data from 14,925 household interviews in 2314 villages, 183 complete treatment records, 382 focus-group discussions, and the results of interviews with 669 community leaders, 757 trained community-directed drug distributors (CDD) and 146 health personnel (in 26 projects in four countries) were analysed. The data show that CDD dispensed ivermectin to 65.4% of the total population (71.2% of the eligible population), with no significant gender differences in coverage (P &gt; 0.05). Treatment coverage ranged from 60.2% of the eligible subjects in Cameroon to 76.9% in Uganda. There was no significant relationship between the provision of incentives to CDD and treatment coverage (P &gt; 0.05). The frequency of treatment refusal was highest in Cameroon (29.2%). Although most (72.1%) of the communities investigated selected their CDD on the basis of a community decision at a village meeting, only 37.9% chose their distribution period in the same way. There is clearly a need to improve communication strategies, to address the issues of absentees and refusals, to emphasise community ownership and to de-emphasise incentives for CDD. The investigation of the &#39;predictor indicators&#39; of sustainability should enable APOC to understand the determinants of project performance and to initiate any appropriate changes in the programme.
Background: Waste disposal and management is a global concern affecting both high-and low-income ... more Background: Waste disposal and management is a global concern affecting both high-and low-income countries. This research assessed the health impact of burning household waste in Khartoum State, Sudan. Methods: An online community-based cross-sectional study was implemented on a sample of 844 participants selected through a stratified random sampling technique across Khartoum State. The data were collected through a standardized pre tested online questionnaire. The data file was georeferenced through Google Earth Pro and analysed with SPSS 23 and ArcGIS 10.3. The data were summarized numerically and graphically. The appropriate frequency tables were used in ArcGIS to generate geographical distribution maps of household waste burning and predictive health risk maps of waste burning in Khartoum State. Statistical tests performed for association carried out were Chi-square and ANOVA. A binary regression analysis established the relationship between burning of household waste and its associated factors. All statistical tests were considered significant when p < 0.05. Results: The practice of burning household waste was performed by 74.5% (619/831) of the participants with 50.8% (311/612) who reported burning the waste weekly. The health conditions related to household waste burning were predominately asthma (57.0%) and respiratory manifestations (38.0%). Of the ten contributing factors of health risks related to burning household waste, the two statistically significant were the frequency of waste collection (OR = 0.720, 95% [CI: 0.593-0.875], p = 0.001) and the place of waste disposal (OR = 0.791, 95% [CI: 0.651-0.961], p = 0.018). Conclusion: The practice of burning household waste in Khartoum State was a public health concern. Sociodemographic and managerial factors exposing residents to health risks appeal political, health authorities and communities to establish a partnership to manage household waste for public safety and good quality of life.
ONCHOCERCA VOLVULUS TRANSMISSION BY SIMULIUM DAMNOSUM S. L. IN TWO REGIONS OF THE CENTRAL AFRICAN... more ONCHOCERCA VOLVULUS TRANSMISSION BY SIMULIUM DAMNOSUM S. L. IN TWO REGIONS OF THE CENTRAL AFRICAN REPUBLIC Entomological baseline data were collected in the villages of Zinga and Boali-Falls in Central African Republic (CAR) in view of the long term impact assessment of community-directed treatment with ivermectin (CDTI). Morphological determinations revealed that flies caught in both sites belong to the subgroup Sou/Sq. In Boali, the nuisance was relatively high with biting rates averaging 243 bites/man/day, with a parous rate of 61.6 % and a crude annual transmission potential (ATP) of 8,259 infective larvae/man/year; and the average number of infective larvae per 1,000 parous flies was 177. In Zinga, the mean biting rate was 191 bites/man/day, with a parous rate of 51.6 %, a crude ATP of 3,422, and 86 infective larvae per 1,000 parous flies. In conclusion, the vectorial capacity and the entomological indices recorded are characteristic of high onchocerciasis transmission zones. However, some of the infective larvae found, maybe of animal origin, need identification to better determine the real level of endemicity. Résumé : Des données entomologiques de base ont été recueillies dans les villages de Zinga et Boali-Chutes, en République Centrafricaine (RCA) en prévision de l'évaluation de l'impact à long terme du traitement par l'ivermectine sous directives communautaires (TIDC). Les déterminations morphologiques révèlent que les simulies capturées dans les deux sites appartiennent au sous-groupe Sou/Sq. À Boali, la nuisance était assez élevée avec une moyenne de 243 piqûres/homme/jour, le taux de parturité moyen de 61,6 % et le potentiel annuel de transmission (PAT) brut de 8 259 larves infectantes d'onchocerques par homme et par an. En outre, le nombre moyen de larves infectantes pour 1 000 pares était de 177. À Zinga, on notait une moyenne de 191 piqûres/ homme/jour, un taux de parturité moyen de 51,6 % et un PAT brut de 3 422 ; quant au nombre moyen de larves infectantes pour 1 000 pares, il était de 86. En conclusion, les capacités vectrices et les indices entomologiques enregistrés sont caractéristiques de zones à forte transmission onchocerquienne. Reste que certaines des larves infectantes récoltées peuvent être d'origine animale, d'où la nécessité de leur identification pour situer le niveau réel de la transmission.
Tropical Medicine & International Health, Oct 30, 2006
As part of a baseline data collection for assessing the impact of the African Programme for Oncho... more As part of a baseline data collection for assessing the impact of the African Programme for Onchocerciasis Control, to evaluate the diethylcarbamazine (DEC) patch test in determining the endemicity of onchocerciasis. A total of 226 untreated children aged 3-5, living in four selected endemic foci, in Cameroon, Gabon and Central African Republic, were tested. Observed graded skin reactions to the patch were analysed and compared with the prevalence of onchocercal nodules and reactive skin disease in the corresponding community. The proportion of children who tested positive ranged from 25.0% to 77.1%. The values were closely correlated with the prevalence of nodules, i.e. the level of endemicity for onchocerciasis. The DEC patch test, which has been so far used only in West African foci of onchocerciasis, can also constitute a valuable tool to evaluate the levels of endemicity of onchocerciasis in Central Africa, and to follow-up the intensity of transmission of Onchocerca volvulus.
Transactions of The Royal Society of Tropical Medicine and Hygiene, Apr 1, 2012
Prevalence of skin and eye disorders in African onchocerciasis (river blindness) is well document... more Prevalence of skin and eye disorders in African onchocerciasis (river blindness) is well documented. However, less is known about their joint occurrence. Information on concurrence may improve our understanding of disease pathogenesis and is required to estimate the disease burden of onchocerciasis. We analysed data from 765 individuals from forest villages in the Kumba and Ngambe Health districts, Cameroon. These data were collected in 1998, as baseline data for the evaluation of the African Programme for Onchocerciasis Control. Concurrence of symptoms was assessed using logistic regression. Onchocerciasis was highly endemic in the study population (63% nodule prevalence among males aged ≥20). Considerable overall prevalences of onchocercal visual impairment (low vision or blindness: 4%), troublesome itch (15%), reactive skin disease (19%), and skin depigmentation (25%) were observed. The association between onchocercal visual impairment and skin depigmentation (OR 9.0, 95% CI 3.9-20.8) was partly explained by age and exposure to infection (OR 3.0, 95% CI 1.2-7.7). The association between troublesome itch and reactive skin disease was hardly affected by adjustment (adjusted OR 6.9, 95% CI 4.2-11.1). Concluding, there is significant concurrence of morbidities within onchocerciasis. Our results suggest a possible role of host characteristics in the pathogenesis of depigmentation and visual impairment. Further, we propose a method to deal with concurrence when estimating the burden of disease.
Annals of Tropical Medicine and Parasitology, Apr 1, 1998
The efficiency of on-going delivery systems and cost recovery in Mectizan (ivermectin, MSD) treat... more The efficiency of on-going delivery systems and cost recovery in Mectizan (ivermectin, MSD) treatment for onchocerciasis are reviewed. The search is on for an effective system of Mectizan delivery, involving drug procurement, delivery from port to districts and distribution to eligible persons, which can be sustained by the endemic countries for many years. The mechanisms for procuring and clearing the drug at the ports, and the drug&#39;s integration into the existing delivery systems of each national health service, need to be improved. Although large-scale treatments by mobile teams or community-based methods evidently achieve high and satisfactory rates of coverage, they also incur high recurrent costs which have to be covered by external partners and are not sustainable by national health services. Cost-sharing is considered an important factor in a sustainable delivery system and community-directed treatment, in which the community shares the cost and ownership of local distribution and is empowered to design and implement it, is likely to be more cost-effective and sustainable.
Tropical Medicine & International Health, Dec 1, 1998
objective To determine the effects of ivermectin in annual, 3-monthly and 6-monthly doses on onch... more objective To determine the effects of ivermectin in annual, 3-monthly and 6-monthly doses on onchocercal skin disease (OSD) and severe itching. method A multicentre, double-blind placebo controlled trial was conducted among 4072 residents of rural communities in Ghana, Nigeria and Uganda. Baseline clinical examination categorized reactive skin lesions as acute papular onchodermatitis, chronic papular onchodermatitis and lichenified onchodermatitis. Presence and severity of itching was determined by open-ended and probing questions. Clinical examination and interview took place at baseline and each of 5 subsequent 3-monthly follow-up visits. results While prevalence and severity of reactive lesions decreased for all 4 arms, those receiving ivermectin maintained a greater decrease in prevalence and severity over time. The difference between ivermectin and placebo groups was significant for prevalence at 9 months and for severity at 3 months. Differences between placebo and ivermectin groups were much more pronounced for itching. From 6 months onward, the prevalence of severe itching was reduced by 40-50% among those receiving ivermectin compared to the trend in the placebo group. conclusion This is an important effect on disease burden as severe itching is for the affected people the most troubling complication of onchocerciasis. The difference among regimens was not significant, and the recommended regimen of annual treatment for the control of ocular onchocerciasis appears also the most appropriate for onchocerciasis control in areas where the skin manifestations predominate. The final determination of the effect on skin lesions requires a longer period of study.
Background: Anti-vascular endothelial growth factor (anti-VEGF) medicines have revolutionized DME... more Background: Anti-vascular endothelial growth factor (anti-VEGF) medicines have revolutionized DME and DR treatment. Despite the worldwide use of anti-VEGFs, their use remains limited in Sudan. This study aimed to assess the impact of anti-VEGF (ranibizumab and bevacizumab) injections in patients with diabetic macular oedema in Khartoum, Sudan. Methods: An analytical comparative cross-sectional study was implemented in Alfaisal referral eye centre. A Standard questionnaire was used to collect the variables related to the research objectives. Thirty-four patients were recruited; 16 patients under ranibizumab (Lucentis) and 18 under bevacizumab (Avastin). Data were analyzed through SPSS 23, best-corrected visual acuity (BCVA) and central retinal thickness (CRT) measurements were considered as main outcomes to evaluate the treatment effectiveness. Results: Among the 34 participants, 64.7% were males and 35.3% were females, with an average age of 62 years and 13 years of long standing diabetes. A total of 54 eyes received an average of 2.3 injections in an average of 7 months' period. The mean BCVA before and after treatment for both drugs respectively 0.19 min and 0.21 min was statistically correlated (p = 0.000). For patients under Lucentis, the mean BCVA before and after medication was 0.20 min-0.24 min and 0.19-0.19 min for those who used Avastin. The mean central retinal thickness (CRT), before and after treatment for both drugs, was 492.22µm-422.89µm, respectively, with a significant correlation (p = 0.003). For patients under Lucentis, the mean CRT decreased from 536.30 µm to 425.19 µm; it dropped from 453.16µm to 421.18µm for patients under Avastin. About 79.4% (27/34) of the participants reported that injections were not affordable and 14.7% (5/34) complained from shortage of one dose, regardless of which type of treatment. Glycaemia control, duration of treatment, type and frequency of injections used were found to be the most contributing factors to the effectiveness of anti-VEGF medications. Conclusion: Both anti-VEGF medications are effective in treating DME, Lucentis showed better improvements in BCVA and macular thickness than Avastin. Policymakers in Sudan require urgent alternative strategies to increase access to these medications.
Objectives: Rheumatoid arthritis is a chronic inflammatory autoimmune disease. This study aimed t... more Objectives: Rheumatoid arthritis is a chronic inflammatory autoimmune disease. This study aimed to determine the association of interleukin-17A-197G/A polymorphism with rheumatoid arthritis in Sudanese patients. Methods: A case–control study was conducted between March and December 2018. Clinical and demographic data of the study participants were collected and analyzed. Polymerase chain reaction restriction fragment length polymorphism molecular technique was done to investigate interleukin-17A-197G/A polymorphisms. All statistical tests were considered statistically significant when p < 0.05. Results: The study population included 266 participants aged between 1 and 85 years, with an average of 40 years, classified into 85 (31.2%) cases (mean age 48.5 ± 11.3 years), and 181 (68.8%) controls (mean age 35.3 ± 15.9 years). The interleukin-17A homozygote AA genotype was more frequent among the control group compared to the case group; 95 (52.5%) and 7 (8.2%), respectively. The homozygote GG and the heterozygote AG genotypes were proportionally not different among the cases and control groups; 13 (54.2%) and 11 (45.8%), and 65 (46.4%) and 75 (53.6%), respectively. According to the distribution of interleukin-17A genotypes, a statistically significant difference was observed among cases with the interleukin-17A AA and AG genotypes, p values 0.001 and 0.004, respectively. For the association interleukin-17A genotypes and family history a negatively significant association was reported (95% confidence interval, –0.219, p value = 0.001). There was also a negatively significant association of interleukin-17A genotypes and anti-cyclic citrullinated peptide (95% confidence interval, −0.141, p value = 0.002). Conclusion: This study is the first study in Sudan established the association between interleukin-17A-197G/A (rs2275913) polymorphisms and susceptibly to rheumatoid arthritis. These findings appeal for further research in Sudan to investigate the exact role of IL-17A in immunopathology and disease severity among Sudanese rheumatoid arthritis
International journal of innovative science and research technology, Sep 1, 2020
Important details of cutaneous abscess management were not covered in the guidelines including an... more Important details of cutaneous abscess management were not covered in the guidelines including anesthesia, operative details and dressing patterns.
<p>The total height of the bars (colored plus blank) represents the estimated number of DAL... more <p>The total height of the bars (colored plus blank) represents the estimated number of DALYs lost in a counterfactual scenario without ivermectin mass treatment (increasing trend due to population growth). The colored part of each bar represents the estimated actual number of DALYs lost (declining trend due to ivermectin mass treatment). The blank part of each bar therefore represents the annual number of DALYs averted by ivermectin mass treatment in the total APOC population.</p
This article analyzes the results of a one-year entomological survey conducted near the Yalala ra... more This article analyzes the results of a one-year entomological survey conducted near the Yalala rapids in the Inga region, Democratic Republic of Congo, prior to the implementation of Community-Directed Treatment with Ivermectin (CDTI). A vector control program had been undertaken from October 1969 to December 1980, 20 kilometers upstream from the study site. The results of the present study show that during 122 collection days, 5,824 females were captured, of which 3,899 were dissected; 2,001 (51.3%) were parous while 44 (2.2%) were infected while 4 (0.2%) were infective. The crude Annual Transmission Potential (ATP) was 65 infective larvae per man and per year at the river as against 12 in Yalala village located two kilometers from the rapids. The average biting rate was 5 flies/man/day during the dry season and 90 during the rainy season. The vector capacity of similium shows that the risk of transmission of Onchocerca volvulus to the human population was not only reduced in time ...
Annals of Tropical Medicine & Parasitology, 2002
This paper reviews the issues relating to compliance and participation among the men and women of... more This paper reviews the issues relating to compliance and participation among the men and women of three countries within the remit of the African Programme for the Control of Onchocerciasis (APOC): Cameroon, Nigeria and Tanzania. Project-monitoring data from 109 focus-group discussions, 6069 household-survey respondents and 89 interviews with ivermectin distributors were analysed to gain an insight into the attitudes and behaviours of men and women in relation to ivermectin treatment and their participation in the programme. Although there are no statistically significant gender differences in coverages for ivermectin treatment, culturally prescribed gender relationships influence the ways in which men and women express and experience treatment-related behaviours. Gender roles also affect participation in the programme. Decision-making in communities on the selection of distributors tends to follow socio-cultural hierarchies based upon patriarchy and gerontocracy. Relatively few ivermectin distributors (21%) are women. Although they receive less support than their male counterparts, the female distributors are just as willing to continue ivermectin distribution in the community, and they perform as well or better than men in this regard. The terms &#39;community-directed&#39;, &#39;community participation&#39; and even &#39;compliance&#39; obfuscate important gender differences that are inherent in the implementation of onchocerciasis control. Development of strategies that recognize these gender differences will have important implications for long-term adherence to treatment and for the overall quality and sustainability of the programme.
Biochemical and Biophysical Research Communications, 1992
Human 5-lipoxygenase contains a non-heme iron essential for its activity. In order to determine w... more Human 5-lipoxygenase contains a non-heme iron essential for its activity. In order to determine which amino acid residues are involved in the iron-binding and the lipoxygenase activity, nine amino acid residues in highly homologous regions among the lipoxygenases were individually replaced by means of site-directed mutagenesis. Mutant 5lipoxygenases in which His-367 or His-550 was replaced by either Asn or Ala, His-372 by either Asn or Ser, or Glu-376 by Gln were completely devoid of the activity. Though mutants containing an alanine residue instead of His-390 or His-399 lacked the activity, the corresponding asparagine substituted mutants exhibited. The other mutants retained the enzyme activity. These results strongly suggest that His-367, His-372, His-550 and Glu-376 are crucial for 5-lipoxygenase activity and coordinate to the essential iron.
American Journal of Tropical Medicine and Hygiene, 2017
Background: The African Programme for Onchocerciasis Control (APOC) was created in 1995 to establ... more Background: The African Programme for Onchocerciasis Control (APOC) was created in 1995 to establish community-directed treatment with ivermectin (CDTi) in order to control onchocerciasis as a public health problem in 20 African countries that had 80 % of the global disease burden. When research showed that CDTi may ultimately eliminate onchocerciasis infection, APOC was given in 2008 the additional objective to determine when and where treatment can be safely stopped. We report the results of epidemiological evaluations undertaken from 2008 to 2014 to assess progress towards elimination in CDTi areas with ≥6 years treatment. Methods: Skin snip surveys were undertaken in samples of first-line villages to determine the prevalence of O. volvulus microfilariae. There were two evaluation phases. The decline in prevalence was evaluated in phase 1A. Observed and model-predicted prevalences were compared after correcting for endemicity level and treatment coverage. Bayesian statistics and Monte Carlo simulation were used to classify the decline in prevalence as faster than predicted, on track or delayed. Where the prevalence approached elimination levels, phase 1B was launched to determine if treatment could be safely stopped. Village sampling was extended to the whole CDTi area. Survey data were analysed within a Bayesian framework to determine if stopping criteria (overall prevalence <1.4 % and maximum stratum prevalence <5 %) were met. Results: In phase 1A 127 665 people from 639 villages in 54 areas were examined. The prevalence had fallen dramatically. The decline in prevalence was faster than predicted in 23 areas, on track in another 23 and delayed in eight areas. In phase 1B 108 636 people in 392 villages were examined in 22 areas of which 13 met the epidemiological criteria for stopping treatment. Overall, 32 areas (25.4 million people) had reached or were close to elimination, 18 areas (17.4 million) were on track but required more years treatment, and in eight areas (10.4 million) progress was unsatisfactory. Conclusions: Onchocerciasis has been largely controlled as a public health problem. Great progress has been made towards elimination which already appears to have been achieved for millions of people. For most APOC countries, nationwide onchocerciasis elimination is within reach.
Annals of Tropical Medicine & Parasitology, 2002
Since its inauguration in 1995, the African Programme for Onchocerciasis Control (APOC) has made ... more Since its inauguration in 1995, the African Programme for Onchocerciasis Control (APOC) has made significant progress towards achieving its main objective: to establish sustainable community-directed treatment with ivermectin (CDTI) in onchocerciasis-endemic areas outside of the remit of the Onchocerciasis Control Programme in West Africa (OCP). In the year 2000, the programme, in partnership with governments, non-governmental organizations and the endemic communities themselves, succeeded in treating 20,298,138 individuals in 49,654 communities in 63 projects in 14 countries. Besides the distribution of ivermectin, the programme has strengthened primary healthcare (PHC) through capacity-building, mobilization of resources and empowerment of communities. The community-directed-treatment approach is a model that can be adopted in developing other community-based health programmes. The approach has also made it possible to bring to the poor some measure of intervention in some other healthcare programmes, such as those for malaria control, eye care, maternal and child health, nutrition and immunization. CDTI presents, at all stages of its implementation, a unique window of opportunity for promoting the functional integration of healthcare activities. For this to be done successfully and in a co-ordinated manner, adequate funding of CDTI within PHC is as important as an effective sensitization of the relevant policy-makers, healthworkers and communities on the value of integration (accompanied by appropriate training at all levels). Evaluation of the experiences in integration of health services, particularly at community level, is crucial to the success of the integration.
Annals of Tropical Medicine & Parasitology, 2002
Community-directed treatment is a relatively new strategy that was adopted in 1997 by the African... more Community-directed treatment is a relatively new strategy that was adopted in 1997 by the African Programme for Onchocerciasis Control (APOC), for large-scale distribution of ivermectin (Mectizan). Participatory monitoring of 39 of the control projects based on community-directed treatment with ivermectin (CDTI) was undertaken from 1998-2000, with a focus on process implementation of the strategy and the predictors of sustainability. Data from 14,925 household interviews in 2314 villages, 183 complete treatment records, 382 focus-group discussions, and the results of interviews with 669 community leaders, 757 trained community-directed drug distributors (CDD) and 146 health personnel (in 26 projects in four countries) were analysed. The data show that CDD dispensed ivermectin to 65.4% of the total population (71.2% of the eligible population), with no significant gender differences in coverage (P &gt; 0.05). Treatment coverage ranged from 60.2% of the eligible subjects in Cameroon to 76.9% in Uganda. There was no significant relationship between the provision of incentives to CDD and treatment coverage (P &gt; 0.05). The frequency of treatment refusal was highest in Cameroon (29.2%). Although most (72.1%) of the communities investigated selected their CDD on the basis of a community decision at a village meeting, only 37.9% chose their distribution period in the same way. There is clearly a need to improve communication strategies, to address the issues of absentees and refusals, to emphasise community ownership and to de-emphasise incentives for CDD. The investigation of the &#39;predictor indicators&#39; of sustainability should enable APOC to understand the determinants of project performance and to initiate any appropriate changes in the programme.
Background: Waste disposal and management is a global concern affecting both high-and low-income ... more Background: Waste disposal and management is a global concern affecting both high-and low-income countries. This research assessed the health impact of burning household waste in Khartoum State, Sudan. Methods: An online community-based cross-sectional study was implemented on a sample of 844 participants selected through a stratified random sampling technique across Khartoum State. The data were collected through a standardized pre tested online questionnaire. The data file was georeferenced through Google Earth Pro and analysed with SPSS 23 and ArcGIS 10.3. The data were summarized numerically and graphically. The appropriate frequency tables were used in ArcGIS to generate geographical distribution maps of household waste burning and predictive health risk maps of waste burning in Khartoum State. Statistical tests performed for association carried out were Chi-square and ANOVA. A binary regression analysis established the relationship between burning of household waste and its associated factors. All statistical tests were considered significant when p < 0.05. Results: The practice of burning household waste was performed by 74.5% (619/831) of the participants with 50.8% (311/612) who reported burning the waste weekly. The health conditions related to household waste burning were predominately asthma (57.0%) and respiratory manifestations (38.0%). Of the ten contributing factors of health risks related to burning household waste, the two statistically significant were the frequency of waste collection (OR = 0.720, 95% [CI: 0.593-0.875], p = 0.001) and the place of waste disposal (OR = 0.791, 95% [CI: 0.651-0.961], p = 0.018). Conclusion: The practice of burning household waste in Khartoum State was a public health concern. Sociodemographic and managerial factors exposing residents to health risks appeal political, health authorities and communities to establish a partnership to manage household waste for public safety and good quality of life.
ONCHOCERCA VOLVULUS TRANSMISSION BY SIMULIUM DAMNOSUM S. L. IN TWO REGIONS OF THE CENTRAL AFRICAN... more ONCHOCERCA VOLVULUS TRANSMISSION BY SIMULIUM DAMNOSUM S. L. IN TWO REGIONS OF THE CENTRAL AFRICAN REPUBLIC Entomological baseline data were collected in the villages of Zinga and Boali-Falls in Central African Republic (CAR) in view of the long term impact assessment of community-directed treatment with ivermectin (CDTI). Morphological determinations revealed that flies caught in both sites belong to the subgroup Sou/Sq. In Boali, the nuisance was relatively high with biting rates averaging 243 bites/man/day, with a parous rate of 61.6 % and a crude annual transmission potential (ATP) of 8,259 infective larvae/man/year; and the average number of infective larvae per 1,000 parous flies was 177. In Zinga, the mean biting rate was 191 bites/man/day, with a parous rate of 51.6 %, a crude ATP of 3,422, and 86 infective larvae per 1,000 parous flies. In conclusion, the vectorial capacity and the entomological indices recorded are characteristic of high onchocerciasis transmission zones. However, some of the infective larvae found, maybe of animal origin, need identification to better determine the real level of endemicity. Résumé : Des données entomologiques de base ont été recueillies dans les villages de Zinga et Boali-Chutes, en République Centrafricaine (RCA) en prévision de l'évaluation de l'impact à long terme du traitement par l'ivermectine sous directives communautaires (TIDC). Les déterminations morphologiques révèlent que les simulies capturées dans les deux sites appartiennent au sous-groupe Sou/Sq. À Boali, la nuisance était assez élevée avec une moyenne de 243 piqûres/homme/jour, le taux de parturité moyen de 61,6 % et le potentiel annuel de transmission (PAT) brut de 8 259 larves infectantes d'onchocerques par homme et par an. En outre, le nombre moyen de larves infectantes pour 1 000 pares était de 177. À Zinga, on notait une moyenne de 191 piqûres/ homme/jour, un taux de parturité moyen de 51,6 % et un PAT brut de 3 422 ; quant au nombre moyen de larves infectantes pour 1 000 pares, il était de 86. En conclusion, les capacités vectrices et les indices entomologiques enregistrés sont caractéristiques de zones à forte transmission onchocerquienne. Reste que certaines des larves infectantes récoltées peuvent être d'origine animale, d'où la nécessité de leur identification pour situer le niveau réel de la transmission.
Tropical Medicine & International Health, Oct 30, 2006
As part of a baseline data collection for assessing the impact of the African Programme for Oncho... more As part of a baseline data collection for assessing the impact of the African Programme for Onchocerciasis Control, to evaluate the diethylcarbamazine (DEC) patch test in determining the endemicity of onchocerciasis. A total of 226 untreated children aged 3-5, living in four selected endemic foci, in Cameroon, Gabon and Central African Republic, were tested. Observed graded skin reactions to the patch were analysed and compared with the prevalence of onchocercal nodules and reactive skin disease in the corresponding community. The proportion of children who tested positive ranged from 25.0% to 77.1%. The values were closely correlated with the prevalence of nodules, i.e. the level of endemicity for onchocerciasis. The DEC patch test, which has been so far used only in West African foci of onchocerciasis, can also constitute a valuable tool to evaluate the levels of endemicity of onchocerciasis in Central Africa, and to follow-up the intensity of transmission of Onchocerca volvulus.
Transactions of The Royal Society of Tropical Medicine and Hygiene, Apr 1, 2012
Prevalence of skin and eye disorders in African onchocerciasis (river blindness) is well document... more Prevalence of skin and eye disorders in African onchocerciasis (river blindness) is well documented. However, less is known about their joint occurrence. Information on concurrence may improve our understanding of disease pathogenesis and is required to estimate the disease burden of onchocerciasis. We analysed data from 765 individuals from forest villages in the Kumba and Ngambe Health districts, Cameroon. These data were collected in 1998, as baseline data for the evaluation of the African Programme for Onchocerciasis Control. Concurrence of symptoms was assessed using logistic regression. Onchocerciasis was highly endemic in the study population (63% nodule prevalence among males aged ≥20). Considerable overall prevalences of onchocercal visual impairment (low vision or blindness: 4%), troublesome itch (15%), reactive skin disease (19%), and skin depigmentation (25%) were observed. The association between onchocercal visual impairment and skin depigmentation (OR 9.0, 95% CI 3.9-20.8) was partly explained by age and exposure to infection (OR 3.0, 95% CI 1.2-7.7). The association between troublesome itch and reactive skin disease was hardly affected by adjustment (adjusted OR 6.9, 95% CI 4.2-11.1). Concluding, there is significant concurrence of morbidities within onchocerciasis. Our results suggest a possible role of host characteristics in the pathogenesis of depigmentation and visual impairment. Further, we propose a method to deal with concurrence when estimating the burden of disease.
Annals of Tropical Medicine and Parasitology, Apr 1, 1998
The efficiency of on-going delivery systems and cost recovery in Mectizan (ivermectin, MSD) treat... more The efficiency of on-going delivery systems and cost recovery in Mectizan (ivermectin, MSD) treatment for onchocerciasis are reviewed. The search is on for an effective system of Mectizan delivery, involving drug procurement, delivery from port to districts and distribution to eligible persons, which can be sustained by the endemic countries for many years. The mechanisms for procuring and clearing the drug at the ports, and the drug&#39;s integration into the existing delivery systems of each national health service, need to be improved. Although large-scale treatments by mobile teams or community-based methods evidently achieve high and satisfactory rates of coverage, they also incur high recurrent costs which have to be covered by external partners and are not sustainable by national health services. Cost-sharing is considered an important factor in a sustainable delivery system and community-directed treatment, in which the community shares the cost and ownership of local distribution and is empowered to design and implement it, is likely to be more cost-effective and sustainable.
Tropical Medicine & International Health, Dec 1, 1998
objective To determine the effects of ivermectin in annual, 3-monthly and 6-monthly doses on onch... more objective To determine the effects of ivermectin in annual, 3-monthly and 6-monthly doses on onchocercal skin disease (OSD) and severe itching. method A multicentre, double-blind placebo controlled trial was conducted among 4072 residents of rural communities in Ghana, Nigeria and Uganda. Baseline clinical examination categorized reactive skin lesions as acute papular onchodermatitis, chronic papular onchodermatitis and lichenified onchodermatitis. Presence and severity of itching was determined by open-ended and probing questions. Clinical examination and interview took place at baseline and each of 5 subsequent 3-monthly follow-up visits. results While prevalence and severity of reactive lesions decreased for all 4 arms, those receiving ivermectin maintained a greater decrease in prevalence and severity over time. The difference between ivermectin and placebo groups was significant for prevalence at 9 months and for severity at 3 months. Differences between placebo and ivermectin groups were much more pronounced for itching. From 6 months onward, the prevalence of severe itching was reduced by 40-50% among those receiving ivermectin compared to the trend in the placebo group. conclusion This is an important effect on disease burden as severe itching is for the affected people the most troubling complication of onchocerciasis. The difference among regimens was not significant, and the recommended regimen of annual treatment for the control of ocular onchocerciasis appears also the most appropriate for onchocerciasis control in areas where the skin manifestations predominate. The final determination of the effect on skin lesions requires a longer period of study.
Background: Anti-vascular endothelial growth factor (anti-VEGF) medicines have revolutionized DME... more Background: Anti-vascular endothelial growth factor (anti-VEGF) medicines have revolutionized DME and DR treatment. Despite the worldwide use of anti-VEGFs, their use remains limited in Sudan. This study aimed to assess the impact of anti-VEGF (ranibizumab and bevacizumab) injections in patients with diabetic macular oedema in Khartoum, Sudan. Methods: An analytical comparative cross-sectional study was implemented in Alfaisal referral eye centre. A Standard questionnaire was used to collect the variables related to the research objectives. Thirty-four patients were recruited; 16 patients under ranibizumab (Lucentis) and 18 under bevacizumab (Avastin). Data were analyzed through SPSS 23, best-corrected visual acuity (BCVA) and central retinal thickness (CRT) measurements were considered as main outcomes to evaluate the treatment effectiveness. Results: Among the 34 participants, 64.7% were males and 35.3% were females, with an average age of 62 years and 13 years of long standing diabetes. A total of 54 eyes received an average of 2.3 injections in an average of 7 months' period. The mean BCVA before and after treatment for both drugs respectively 0.19 min and 0.21 min was statistically correlated (p = 0.000). For patients under Lucentis, the mean BCVA before and after medication was 0.20 min-0.24 min and 0.19-0.19 min for those who used Avastin. The mean central retinal thickness (CRT), before and after treatment for both drugs, was 492.22µm-422.89µm, respectively, with a significant correlation (p = 0.003). For patients under Lucentis, the mean CRT decreased from 536.30 µm to 425.19 µm; it dropped from 453.16µm to 421.18µm for patients under Avastin. About 79.4% (27/34) of the participants reported that injections were not affordable and 14.7% (5/34) complained from shortage of one dose, regardless of which type of treatment. Glycaemia control, duration of treatment, type and frequency of injections used were found to be the most contributing factors to the effectiveness of anti-VEGF medications. Conclusion: Both anti-VEGF medications are effective in treating DME, Lucentis showed better improvements in BCVA and macular thickness than Avastin. Policymakers in Sudan require urgent alternative strategies to increase access to these medications.
Objectives: Rheumatoid arthritis is a chronic inflammatory autoimmune disease. This study aimed t... more Objectives: Rheumatoid arthritis is a chronic inflammatory autoimmune disease. This study aimed to determine the association of interleukin-17A-197G/A polymorphism with rheumatoid arthritis in Sudanese patients. Methods: A case–control study was conducted between March and December 2018. Clinical and demographic data of the study participants were collected and analyzed. Polymerase chain reaction restriction fragment length polymorphism molecular technique was done to investigate interleukin-17A-197G/A polymorphisms. All statistical tests were considered statistically significant when p < 0.05. Results: The study population included 266 participants aged between 1 and 85 years, with an average of 40 years, classified into 85 (31.2%) cases (mean age 48.5 ± 11.3 years), and 181 (68.8%) controls (mean age 35.3 ± 15.9 years). The interleukin-17A homozygote AA genotype was more frequent among the control group compared to the case group; 95 (52.5%) and 7 (8.2%), respectively. The homozygote GG and the heterozygote AG genotypes were proportionally not different among the cases and control groups; 13 (54.2%) and 11 (45.8%), and 65 (46.4%) and 75 (53.6%), respectively. According to the distribution of interleukin-17A genotypes, a statistically significant difference was observed among cases with the interleukin-17A AA and AG genotypes, p values 0.001 and 0.004, respectively. For the association interleukin-17A genotypes and family history a negatively significant association was reported (95% confidence interval, –0.219, p value = 0.001). There was also a negatively significant association of interleukin-17A genotypes and anti-cyclic citrullinated peptide (95% confidence interval, −0.141, p value = 0.002). Conclusion: This study is the first study in Sudan established the association between interleukin-17A-197G/A (rs2275913) polymorphisms and susceptibly to rheumatoid arthritis. These findings appeal for further research in Sudan to investigate the exact role of IL-17A in immunopathology and disease severity among Sudanese rheumatoid arthritis
International journal of innovative science and research technology, Sep 1, 2020
Important details of cutaneous abscess management were not covered in the guidelines including an... more Important details of cutaneous abscess management were not covered in the guidelines including anesthesia, operative details and dressing patterns.
<p>The total height of the bars (colored plus blank) represents the estimated number of DAL... more <p>The total height of the bars (colored plus blank) represents the estimated number of DALYs lost in a counterfactual scenario without ivermectin mass treatment (increasing trend due to population growth). The colored part of each bar represents the estimated actual number of DALYs lost (declining trend due to ivermectin mass treatment). The blank part of each bar therefore represents the annual number of DALYs averted by ivermectin mass treatment in the total APOC population.</p
This article analyzes the results of a one-year entomological survey conducted near the Yalala ra... more This article analyzes the results of a one-year entomological survey conducted near the Yalala rapids in the Inga region, Democratic Republic of Congo, prior to the implementation of Community-Directed Treatment with Ivermectin (CDTI). A vector control program had been undertaken from October 1969 to December 1980, 20 kilometers upstream from the study site. The results of the present study show that during 122 collection days, 5,824 females were captured, of which 3,899 were dissected; 2,001 (51.3%) were parous while 44 (2.2%) were infected while 4 (0.2%) were infective. The crude Annual Transmission Potential (ATP) was 65 infective larvae per man and per year at the river as against 12 in Yalala village located two kilometers from the rapids. The average biting rate was 5 flies/man/day during the dry season and 90 during the rainy season. The vector capacity of similium shows that the risk of transmission of Onchocerca volvulus to the human population was not only reduced in time ...
Annals of Tropical Medicine & Parasitology, 2002
This paper reviews the issues relating to compliance and participation among the men and women of... more This paper reviews the issues relating to compliance and participation among the men and women of three countries within the remit of the African Programme for the Control of Onchocerciasis (APOC): Cameroon, Nigeria and Tanzania. Project-monitoring data from 109 focus-group discussions, 6069 household-survey respondents and 89 interviews with ivermectin distributors were analysed to gain an insight into the attitudes and behaviours of men and women in relation to ivermectin treatment and their participation in the programme. Although there are no statistically significant gender differences in coverages for ivermectin treatment, culturally prescribed gender relationships influence the ways in which men and women express and experience treatment-related behaviours. Gender roles also affect participation in the programme. Decision-making in communities on the selection of distributors tends to follow socio-cultural hierarchies based upon patriarchy and gerontocracy. Relatively few ivermectin distributors (21%) are women. Although they receive less support than their male counterparts, the female distributors are just as willing to continue ivermectin distribution in the community, and they perform as well or better than men in this regard. The terms &#39;community-directed&#39;, &#39;community participation&#39; and even &#39;compliance&#39; obfuscate important gender differences that are inherent in the implementation of onchocerciasis control. Development of strategies that recognize these gender differences will have important implications for long-term adherence to treatment and for the overall quality and sustainability of the programme.
Biochemical and Biophysical Research Communications, 1992
Human 5-lipoxygenase contains a non-heme iron essential for its activity. In order to determine w... more Human 5-lipoxygenase contains a non-heme iron essential for its activity. In order to determine which amino acid residues are involved in the iron-binding and the lipoxygenase activity, nine amino acid residues in highly homologous regions among the lipoxygenases were individually replaced by means of site-directed mutagenesis. Mutant 5lipoxygenases in which His-367 or His-550 was replaced by either Asn or Ala, His-372 by either Asn or Ser, or Glu-376 by Gln were completely devoid of the activity. Though mutants containing an alanine residue instead of His-390 or His-399 lacked the activity, the corresponding asparagine substituted mutants exhibited. The other mutants retained the enzyme activity. These results strongly suggest that His-367, His-372, His-550 and Glu-376 are crucial for 5-lipoxygenase activity and coordinate to the essential iron.
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