Maintaining compliance to ivermectin in communities in two West African countries.
We have investigated various aspects related to managing wide-scale ivermectin distribution schemes within randomized controlled trials in communities where onchocerciasis is endemic. Multiple logistic regression analysis of determinants of compliance to five doses of ivermectin in 589 people in Sierra Leone showed independent significant associations with leopard skin depigmentation, the severity of side effects of treatment, fulfilling the exclusion criteria for treatment, and long-term residence in the community. These results are useful for tailoring health promotion messages in Sierra Leone, but the associations may differ in other West African societies. In Nigeria 1847 people were interviewed about various subjective responses, including itching. None of these showed clear improvement after three years of ivermectin treatment. Positive comments about treatment were generally non-specific and similar in the placebo and ivermectin groups. Negative comments were usually related to adverse reactions, especially itching and rash, and were more common after ivermectin. The lack of any benefit attributable to ivermectin that is discernible to its recipients may make it difficult to maintain the high compliance rates needed for long periods if mass dosing programmes are to have a lasting impact on onchocerciasis. In addition, no consistent effects of ivermectin were found by measuring visual acuity, height, weight or haematocrit in comparison with placebo. This may indicate that evidence of clinical impact is very slow to develop and is hard to measure using simple objective methods after only three doses of treatment. At present it seems that parasitological, entomological and detailed ophthalmological or dermatological methods are required to demonstrate the impact of ivermectin treatment in the medium-term. (+info)
Phenotypic and genotypic characterization of Mycobacterium africanum isolates from West Africa.
The Mycobacterium tuberculosis complex includes M. tuberculosis, M. bovis, M. africanum, and M. microti. Most clinical isolates are M. tuberculosis or M. bovis. These species can be distinguished by phenotypes and genotypes. However, there is no simple definition of M. africanum, and some authors question the validity of this species. We analyzed 17 human isolates from Sierra Leone, identified as M. africanum by biochemical and growth characteristics. We sequenced polymorphic genes and intergenic regions. We amplified DNA from six loci with variable numbers of tandem repeats (VNTRs) and determined the exact number of repeats at each locus in each strain. All M. africanum isolates had the ancestral CTG Leu at katG codon 463. Drug-resistant M. africanum isolates had katG and rpoB mutations similar to those found in drug-resistant M. bovis and M. tuberculosis. Fourteen Sierra Leone M. africanum isolates (designated group A) had katG codon 203 ACC Thr, also found in M. africanumT (the T indicates type strain) from Senegal. Group A isolates clustered with M. africanumT by VNTR analysis. Three M. africanum isolates (group B) had katG codon 203 ACT Thr, found in M. tuberculosisT, and clustered with M. tuberculosisT by VNTR analysis. Phenotypic identification of M. africanum yielded a heterogeneous collection of strains. Genotypic analyses identified a cluster (M. africanum group A) which included M. africanumT and was distinct from the rest of the M. tuberculosis complex. Future studies of M. africanum should include both phenotypic and genotypic analyses. (+info)
Use of the complement fixation (CF) test in Lassa fever surveillance. Evidence for persistent CF antibodies.
A survey to detect individuals with antibodies to Lassa virus was undertaken among hospital personnel in the eastern and southern provinces of Sierra Leone late in 1974. Sera were evaluated by the complement fixation test. The data obtained showed that some contacts of Lassa fever patients in the 1972 epidemic had developed antibodies to the virus; individuals who had never reported being sick also showed evidence of infection, with significant CF antibody titres in their sera. Surviving Lassa fever patients from the 1972 epidemic still had easily measurable levels of persisting CF antibodies. The significance of these data is discussed; in addition it is recommended that the CF test should continue to be the method of choice in mass surveys for this virus disease until other tests can be developed. (+info)
Lassa virus infection in Mastomys natalensis in Sierra Leone. Gross and microscopic findings in infected and uninfected animals.
Pathological examinations of 28 wild-caught Mastomys natalensis from Sierra Leone, 14 of which were positive for Lassa virus by tissue culture, are reported. The high frequency of neoplastic and degenerative diseases observed among older animals in closed colonies of M. natalensis were not observed in the wild animals studied. This is probably a reflection of the age distribution of the study population, since the life expectancy of wild Mastomys is less than a year. Inflammatory lesions were nonetheless identified, some of which were similar to those described in laboratory colonies. Frequent lesions were myocarditis (54%), myositis (32%), interstitial pneumonitis (50%), intercapillary glomerulosclerosis (36%), and acute nephrosis (14%). Follicular and nodular lymphoid hyperplasia were evident in the spleen (74%) and Peyer's patches (64%). Lymphoid cell accumulations were prominent in the salivary glands (36%), periportal hepatic region (25%), lungs (32%), perivascular regions (36%), and kidney (21%). Cytomegalic inclusion body sialoadenitis was common (25%). Coccidiosis was evident in the intestinal tract (25%), kidney (25%), and muscle (21%). One neoplasm, a parahepatic haemangioma, was observed histologically.Mean body weights and lengths for virus-positive animals (33 g and 9.2 cm) and virus-negative animals (54 g and 12.2 cm) showed that virus-positive animals were smaller in weight and shorter in length. Since the age of the animals could not be determined, these differences remain unexplained.In comparison with virus-negative animals, virus-positive Mastomys had higher frequencies of splenic follicular hyperplasia (82% against 50%), myocarditis (79% against 29%), perivascular lymphoid cell accumulation (57% against 7%), myositis (50% against 14%), and cytomegalic inclusion body sialoadenitis (36% against 14%). The frequency of lymphoid hyperplasia of Peyer's patches was high in both groups of animals (71% and 57%).The presence of Lassa virus, small size, myocarditis, and lymphoid perivasculitis appeared to be interrelated, but larger and better controlled studies are required to elucidate the relationship. (+info)
Genetic characterization of wild-type genotype VII hepatitis A virus.
The complete genome sequence of the only identified genotype VII hepatitis A virus (HAV), strain SLF88, was obtained from PCR amplicons generated by a modified long PCR approach. There was 90% nucleotide identity in the 5' untranslated region compared to other known HAV sequences. In the remainder of the genome containing the long open reading frame, there was about 85% nucleotide identity to human HAV genotypes IA and IB and 80% identity to simian HAV genotype V. Compared to HAV strain HM-175, the capsid amino acids were highly conserved, with only four homologous amino acid changes, while an increasing number of amino acid differences was seen in the P2 and P3 genome regions. While nucleotide variability within the three functional coding regions did not differ, the P3D region was found to have the largest number of amino acid changes compared to HM-175. (+info)
Behcet's disease in patients of west African and Afro-Caribbean origin.
AIM: To report the presence of Behcet's disease with ocular involvement in patients of west African or Afro-Caribbean origin. METHODS: Case series of eight patients reporting to a tertiary uveitis service. RESULTS: Eight patients with typical features of the disease are presented. Six of the eight patients were tested and found to be HLA-B51 negative. CONCLUSION: Behcet's disease has only been reported in sporadic case reports in the indigenous west African and Afro-Caribbean populations, in whom the incidence of HLA B51 is also very low. A series of patients from the London region presented with the typical symptoms and signs of disease, most of whom were also HLA B51 negative. The presence of disease in this population, when absent in the indigenous population, suggests either that ascertainment of disease is poor in the indigenous population or that acquired factors may be important in the aetiology of the disease. (+info)
The food of Near East, North West and Western African regions.
Among the countries that can be classified as Near East Africa, North West Africa, and Western Africa, there is a great diversity of foods and dietary patterns. Prevalence of undernourishment as defined by FAO using dietary energy supply data, varies dramatically among these countries, with Tunisia in the lowest prevalence category (<2.5%), and Sierra Leone in the highest prevalence category (>35%). Throughout the 1960's, the dietary energy supply of North West African and Western African countries was similar. However, since the 1970s a great and consistent improvement has been seen in North and North West African countries. Both the proportion and number of undernourished in North Africa is now very similar to that of North America. Oil use, energy from fat, and protein from plant versus animal sources account for a large part of the food pattern differences between countries in these regions. Using Tunisia and Sierra Leone as examples again, dietary diversity as measured by the percentage of energy from foods other than starchy staples, is about 50% in the former, while in the latter, it is only 36%. Fatty fruits such as olives, cocoa and palm fruit have a special role in both the diet and the economies of the region. (+info)
Evidence basis for antimalarial policy change in Sierra Leone: five in vivo efficacy studies of chloroquine, sulphadoxine-pyrimethamine and amodiaquine.
OBJECTIVES: To provide nationally relevant information on the antimalarial efficacy of chloroquine (CQ), sulphadoxine-pyrimethamine (SP) and amodiaquine (AQ) in Sierra Leone, with a view to updating antimalarial policy in the country. METHODS: Between October 2002 and May 2003, standard WHO methodology for in vivo efficacy assessment was used in five sites to study the therapeutic response of 6-59 months old uncomplicated Plasmodium falciparum malaria cases treated with CQ (n = 247), SP (n = 353) or AQ (n = 434). Follow-up was of 28 days, with polymerase chain reaction genotyping to distinguish late recrudescences from re-infections. RESULTS: Overall 85.3% of patients reached an analysable endpoint. CQ failure proportions were very high, ranging from 39.5% (95% CI: 25.0-55.6) in Kabala to 78.8% (65.3-88.9) in Kailahun. Early failures under CQ were frequent. SP efficacy was also disappointing, with failure from 23.2% (13.9-34.9) in Kabala to 46.1% (35.4-57.0) in Kailahun. AQ resistance was more moderate, ranging from 5.4% (1.8-12.1) in Makeni to 29.8% (20.3-40.8) in Kailahun, with almost no early failures. AQ also provided more rapid fever and parasite clearance. CONCLUSION: In a consensus meeting organized by the Ministry of Health and Sanitation, and based on these findings, artesunate (AS) + AQ and artemether-lumefantrine (Coartemtrade mark) were identified as the only options to rapidly replace CQ. The choice fell on AS + AQ because of expected high efficacy, lower cost in a blister presentation, and the absence of safety data on artemether-lumefantrine in pregnancy. Donor support is required to support this policy change. Throughout Africa, as SP resistance increases, these two regimens are probably the only options available while newer combinations are developed. Efficacy studies should focus on testing AQ and AS + AQ. (+info)