(1/50) Survey of blindness and visual impairment in Bioko, Equatorial Guinea.
AIMS: This study was designed to estimate the prevalence of blindness and its main aetiologies in Bioko, an onchocerciasis endemic zone of Equatorial Guinea. METHODS: Random sampling was applied, proportionally to population distribution into urban or rural areas. All the subjects underwent a basic eye examination by trained nurses. In the presence of any ocular affection or a visual acuity of less than 0.3, the subject was visited by the ophthalmologist. This visit included direct and indirect ophthalmoscopy, anterior segment examination with a slit lamp, and intraocular pressure recording. Blindness and visual impairment were defined by using the WHO criteria. RESULTS: 3218 subjects were screened, with a mean age of 34.1 (SD 21.6) years, ranging from 1 month to 102 years (median 34 years). The overall prevalence of blindness was 3.2% (95% CI: 2.6% to 3.9%). Unilateral blindness was present in 4.2%. Visual impairment was diagnosed in 200 patients (6.8%). More than 20% of the acuities inferior to 0.7 improved when explored with a pinhole. The main causes of blindness were cataracts (61.3%); macular affection (25.3%), optic atrophy (16%), and glaucoma (13.3%). Ocular onchocerciasis was detected in 12 cases (0.4%). CONCLUSION: Ocular onchocerciasis was very uncommon in an area of high endemicity. Results also pointed at the lack of basic ophthalmologist eye care and optician resources in the island. (+info)
(2/50) Surveillance of in vivo resistance of Plasmodium falciparum to antimalarial drugs from 1992 to 1999 in Malabo (Equatorial Guinea).
From 1992-1999, we have assessed the therapeutic efficacy of three malaria treatment regimens (chloroquine 25 mg/kg over three days, pyrimethamine/sulfadoxine 1.25/25 mg/kg in one dose, and quinine 25-30 mg/kg daily in three oral doses over a four-, five-, or seven-day period) in 1,189 children under age 10 at Malabo Regional Hospital in Equatorial Guinea. Of those children, 958 were followed up clinically and parasitologically for 14 days. With chloroquine, the failure rate varied from 55% in 1996 to 40% in 1999; the early treatment failure rate increased progressively over the years, from 6% in 1992 to 30% in 1999. With pyrimethamine/sulfadoxine, the failure rate varied from 0% in 1996 to 16% in 1995. The short quinine treatment regimens used in 1992 and 1993 (4 and 5 days, respectively) resulted in significantly higher failure rates (19% and 22%, respectively) than the 7d regimen (3-5.5%). We conclude that: a) failure rates for chloroquine are in the change period (> 25%), and urgent action is needed; b) pyrimethamine/ sulfadoxine failure rates are in the alert period (6-15%), and surveillance must be continued; and c) quinine failure rates are in the grace period (< 6%), so quinine can be recommended. (+info)
(3/50) Importation of seven cases of an unusual helminthic infection into Singapore and assessment of the risk of local transmission.
Singapore remains vulnerable to the introduction of infectious diseases from other countries due to the high traffic of migrant labour and other visitors. We describe seven cases of migrant workers from West Africa who entered Singapore carrying loaisis, a helminthic infection. The clinical presentation, treatment using single dose ivermectin, potential for transmission, and the need for screening of this infection in Singapore are discussed. (+info)
(4/50) Obstructed inguinal hernia: role of technical aid program.
AIM: The purpose of the study was to determine the influence of the presence of a surgeon on the outcome of obstructed inguinal hernia at Mongomo, in Equatorial Guinea. METHODOLOGY: A prospective study of patients with obstructed inguinal hernia seen between June 1997 and May 1999 was carried out. During the same period, all uncomplicated hernias seen at the surgical outpatient clinic were noted. RESULT: Fifteen patients presented with obstructed inguinal hernia, while 138 were uncomplicated. All the 15 patients were males, and one of them died. Death resulted from lack of treatment as he presented on our arrival on a technical aid program from Nigeria. The others (N = 14) were operated upon, and eight of them had resection of the intestine because of gangrene. The duration of obstruction was more than two days among those that had bowel resection. COMMENT: Inguinal hernia is a treatable surgical condition. When done electively, the cost and the risk of treatment are very low. Operative treatment can only be offered to patients with inguinal hernia by a surgeon in the community. CONCLUSION: The study has demonstrated that the presence of a surgeon in a community changes the outcome of obstructed inguinal hernia. Sponsorship of medical aid programs should be encouraged. (+info)
(5/50) Malaria Panel Assay versus PCR: detection of naturally infected Anopheles melas in a coastal village of Equatorial Guinea.
BACKGROUND: A study was carried out in a village of the mainland region of Equatorial Guinea in order to ascertain a) which members of Anopheles gambiae complex could be involved in malaria transmission and b) the rate of infectivity for Anopheles melas comparing two different methods, a PCR able to detect sporozoite-DNA and an immunochromatographic assay MPR (Malaria Rapid Dipstick Panel Assay). METHODS: Mosquitoes were sampled at night by indoor captures in two houses of a coastal village in Equatorial Guinea (Ayantang). Collected mosquitoes were identified as An. gambiae s.l. These were individually dried into silica-gel. The head-thorax of the An. gambiae s.l. mosquitoes were analysed by PCR to verify that the species was of the gambiae complex. Individual head-thorax and pools (5 pools) of homogenized mosquitoes employed in Malaria Rapid Panel assay (MRP assay) were lysed and DNA was extracted. PCR was designed from the 753 base pair insert of pBRKl-14 and DNA was amplified. The relationship between dipstick and PCR to detect Plasmodium falciparum sporozoites was measured in terms of sensitivity, specificity and test association (Cohen's kappa value). RESULTS: Two hundred and sixty-four An. gambiae s.l. females were studied (214 individually and five pools with 10 mosquitoes in each). PCR analysis showed that 207 mosquitoes were An. melas, 3 An. gambiae s.s. and 4 could not be identified. By using PCR as the gold standard method when dipstick assay was compared, matching results were obtained for 6 mosquitoes and, in one case MRP was positive while PCR was not reactive. MRP assay showed a low sensitivity (3.3%) when compared with falciparum-DNA detection (17,7% and 14,3%, series A and B respectively). Agreement between the two test formats was low (kappa = 0,224). CONCLUSION: It was determined that An. melas is the main anopheline vector involved in malaria transmission in Ayantang, a coastal village in mainland Equatorial Guinea. A comparison of PCR and Vec-Test Assay, concluded that the PCR method proved to be a more sensitive and useful tool than the dipstick assay to determine the malarial infection rate in mosquitoes in an area of stable and high malaria transmission like Equatorial Guinea. (+info)
(6/50) Impact of different strategies to control Plasmodium infection and anaemia on the island of Bioko (Equatorial Guinea).
BACKGROUND: On the island of Bioko (Equatorial Guinea), insecticide-treated nets (ITNs) have been the main tool used to control malaria over the last 13 years. In 2004, started an indoor residual spraying (IRS) campaign to control malaria. The purpose of this study is to asses the impact of the two control strategies on the island of Bioko (Equatorial Guinea), with regards to Plasmodium infection and anaemia in the children under five years of age. METHODS: Two transversal studies, the first one prior to the start of the IRS campaign and the second one year later. Sampling was carried out by stratified clusters. Malaria infection was measured by means of thick and thin film, and the packed cell volume (PCV) percentage. Data related to ITN use and information regarding IRS were collected. The Pearson's chi-square and logistic regression statistical tests were used to calculate odds ratios (OR). RESULTS: In the first survey, 168 children were sampled and 433 children in the second one. The prevalence of infection was 40% in 2004, and significantly lower at 21.7% in 2005. PCV was 41% and 39%, respectively. 58% of the children surveyed in 2004 and 44.3% in 2005 had slept under an ITN. 78% of the dwellings studied in 2005 had been sprayed. In the 2005 survey, sleeping without a mosquito net meant a risk of infection 3 times greater than sleeping protected with a net hanged correctly and with no holes (p < 0.05). CONCLUSION: IRS and ITNs have proven to be effective control strategies on the island of Bioko. The choice of one or other strategy is, above all, a question of operational feasibility and availability of local resources. (+info)
(7/50) Spatial variability in the density, distribution and vectorial capacity of anopheline species in a high transmission village (Equatorial Guinea).
BACKGROUND: Malaria transmission varies from one country to another and there are also local differences in time and space. An important variable when explaining the variability in transmission is the breeding behaviour of the different vector species and the availability of breeding sites. The aim of this study was to determine the geographical variability of certain entomological parameters: human biting rate (HBR), sporozoitic index (SI) for Plasmodium falciparum and entomological inoculation rate (EIR). METHODS: The study was carried out in a small village in the mainland region of Equatorial Guinea. Adult mosquitoes were collected by CDC light traps. Polymerase Chain Reaction was employed to identify the species within the Anopheles gambiae complex and to detect P. falciparum sporozoites. The geographical position of all the dwellings in the village were taken using a global positioning system receiver unit. Data relating to the dwelling, occupants, use of bednets and the mosquitoes collection data were used to generate a geographical information system (GIS). This GIS allowed the minimum distance of the dwellings to the closest water point (potential breeding sites) to be determined. RESULTS: A total of 1,173 anophelines were caught: 279 A. gambiae s.l. (217 A. gambiae s.s. and one Anopheles melas), 777 Anopheles moucheti and 117 Anopheles carnevalei. A. moucheti proved to be the main vector species and was responsible for 52.38 [95% IC: 33.7-71] night infective bites during this period. The highest SI was found in A. carnevalei (24%), even though the HBR was the lowest for this species. A significant association was found between the distance from the dwellings to the closest water point (River Ntem or secondary streams) and the total HBR. CONCLUSION: A clear association has been observed between the distance to potential breeding sites and the variability in the anopheline density, while the other parameters measured do not seem to condition this spatial variability. The application of GIS to the study of vector-transmitted diseases considerably improves the management of the information obtained from field surveys and facilitates the study of the distribution patterns of the vector species. (+info)
(8/50) The elimination of Trypanosoma brucei gambiense sleeping sickness in the focus of Luba, Bioko Island, Equatorial Guinea.
After the resurgence of sleeping sickness in Luba, Equatorial Guinea, a major campaign to control the disease was established in 1985. The campaign comprised no vector control, but intensive active and passive surveillance using serology for screening, and treatment of all parasitological and suspected serological cases. Total prevalence was used to classify villages as endemic, at risk, anecdotal and non-endemic which also allowed defining the geographic extent of the focus. Active case-finding was implemented from 1985 to 2004. The frequency of surveys was based on parasitological prevalence: twice a year during intensified control, once a year during ordinary control and once every 2 years during the control consolidation phase, when the parasitological prevalence in the whole focus fell to 0.1%. From 1985 to 1999, the indirect immunofluorescent antibody test (IFAT) was used as an initial screening tool, followed by parasitological confirmation of IFAT positive cases, and the Card Agglutination Trypanosomiasis Test (CATT) if necessary. In 2000, the IFAT was replaced by the CATT. Serum-positive individuals without parasitological confirmation were subsequently tested on serial dilution. All cases underwent lumbar puncture to determine the stage of the disease. First-stage cases were treated with pentamidine and second-stage cases with melarsoprol. A few relapses and very advanced cases were treated with eflornithine. The last sleeping sickness case was identified and treated in 1995. (+info)