Treatment of pre-school children under 6 years of age for schistosomiasis: safety, efficacy and acceptability of praziquantel

The World Health Organization [WHO] recommends praziquantel for the control and treatment of schistosomiasis, with no real alternative. Pre-school children are excluded from population treatment programs mainly due to paucity of safety data on this age group. This study investigated safety, efficacy and acceptability of praziquantel for the treatment of S. haematobium and S. mansoni infections among pre-school children aged <6years. The study also investigated the burden of schistosomiasis in this age group. Pre-school children [n=188] from Sudan were included in the study. The children were treated with praziquantel tablets at a single dose of 40 mg/kg body weight. Adverse events were assessed at 24 hours and 7 days later, via questionnaire administration to parents and guardians. Efficacy of treatment was assessed at 1, 3 and 6 months by examining stool and urine samples for schistosome eggs. Acceptability was determined by the number of children spitting or vomiting during administration of the drug. The burden of schistosomiasis among pre-school children aged <6 years was high [31.1%], and this was comparable to that observed among school children-aged 6 years [32%]. Praziquantel treatment achieved high cure rates [egg negative] for both S. haematobium and S. mansoni infections when assessed at 1 month after treatment [89.6-92.1%] and remained high for S. haematobium [89.6-100%] up to 6 months. However, cure rate dropped from 90.5% at one month to 58.8% and 69.2% at 3 and 6 months among S. mansoni-treated children. Praziquantel treatment decreased egg counts considerably with post-treatment geometric mean egg reductions rates ranging from 96.4% to 99.4% at 1 month. Acceptability of praziquantel treatment was high, only for one child the dose had to be repeated after initial spitting. Treatment resolved haematuria and improved weight of the children. There were no drug-related adverse events in all the treated children during follow-up at 24 hours and 7 days. Praziquantel is safe, effective and acceptable among children aged <6 years. Preschool children represent a high risk group for schistosomiasis and should be included in population treatment programs

risk of venus thromboembolism among sudanese women using contraceptives

Contraceptives are known family planning tool and their side effects are well understood except on the coagulation system reactions. The study intended to identify the effect of the use of contraceptives on coagulation reactions in order to find out the risk of Venus Thromboembolism [VTE] among those who use these tools. A descriptive cross-sectional study designed and conducted between April 2008 and January 2009 in Al Taif, Abo-Hamama and Al maygoma family planning centers. Sixty venous blood samples from healthy non-pregnant women using contraceptives and 30 venous blood samples were collected from healthy women without contraception as control group. Citrated blood samples were then subjected for measurement of PT, APTT, TT and Fibrinogen concentration, using the conventional manual methods. The results of the study showed a shortening of PT [T:12.9/C:15.4] and TT [T:14.4/C:16.3] accompanied by an increase of Fibrinogen concentration [T:3.8/C:3.1] in females using contraceptives compared to control group. Also, age of tested women was significantly associated with the lowered TT as well as elevated Fibrinogen. Body weight was significantly correlated to the increased Fibrinogen; while, the injection method significantly shortened PT [Tab:15.2/Inj:13] and TT [Tab:13.7/Inj:12.2] more than tablet method. It was concluded that the use of contraceptives is significantly affect the coagulation system specially the Extrinsic pathway, increases the risk of VTE; thus, could lead to serious complications. The study recommended the use of tablets method and for separated short intervals as well as females using contraceptives should be subjected for regular and continuous coagulation screen

Coagulation disturbances in pregnancy and post delivery period in Sudan

Coagulation problems during pregnancy and after delivery are major health problems leading to fatal complications. Coagulation complications in pregnancy are related to hypertension [PIH], placenta previa or gestational diabetes as well as some chronic problems that effect pregnancy like heart disease and asthma. The study was intended to measure the coagulation profiles, prior and post delivery, to find out coagulation hazards among those ladies compared to non-pregnant ladies as control group. A descriptive comparative study was conducted from Jan to June 2007 using 70 blood samples obtained from non-pregnant ladies [control] and 140 blood samples obtained from 70 ladies during pregnancy and after delivery. The coagulation tests [prothrombin time, activated partial thromboplastin time, thrombin time and platelets count] were performed on all samples by the same manner. Results showed that prothrombin time, activated partial thromboplastin time, thrombin time and platelets count prior and post delivery were significantly decreased compared to control, unlike platelets which were increased rather than in control without statistical significance. Also the coagulation profiles were significantly affected by the type of delivery [cesarean section and normal], while not affected by mothers' age, circumcision, history of abortion and diabetes mellitus. There is observable effect of weight and contraceptive. It is concluded that the coagulation profile prior and post delivery were significantly decreased compared to control, while platelets were increased more than that counted in control. It is recommended to investigate pregnant ladies for coagulation profile before and after delivery and treatment should be offered to ladies with high risk

Frequency of intestinal parasites among food-handlers in Khartoum, Sudan

Food-handlers [n = 1500] attending the public health laboratory in Khartoum, Sudan, for annual check-ups were screened for intestinal parasites by 3 different techniques [direct faecal examination, formol-ether concentration and floatation] to evaluate the adequacy of annual screening. Results showed that 29.4% of food-handlers were harbouring intestinal protozoa in stool samples: Entamoeba coli in 15.3%, Giardia lamblia in 9.7%, and Enta. histolytica in 4.3%. Moreover, 2.7% of food-handlers harboured intestinal helminths: Hymenolepis nana [1.6%], Schistosoma mansoni [0.7%], Taenia saginata [0.3%] and Strongyloides stercoralis [0.1%]. We recommend more frequent screening of food-handlers and that the direct faecal smear technique is efficient for the detection of such parasites

Enhancement of chloroquine activity against resistant parasites by co-administration of cimetidine

In vivo studies on reversal of chloroquine [CQ] resistance by cimetidine [CIM] were carried out in thirty five patients infected with Plasmodium falciparum in Omdurman Hospital for Tropical Diseases and Elhaj Yousif area, Khartoum Sudan. Parasites were considered resistant if still present in peripheral blood circulation, three days after the start of standard dose of CQ treatment. Patients with CQ resistant parasites were admitted to the hospital and given CIM [800 mg in two divided doses], 48 hours after the start of standard dose of chloroquine treatment. They were followed clinically and microscopically, daily for one week and then discharged. Treatment in the dose used was found to reverse CQ resistance in [70%] of the patients studied within three days of CIM treatment. No side effects were reported by any of the patients. Glutamicoxaloacetic transaminase [GOT] content in the treated group was found to be 31.57 I.U/L [ +/- 0.85], protein content 6.5 g/dl [ +/- 0.85] and the uric acid 6.5 mg /dl [ +/- 0.71]. The values of GOT, protein and uric acid in the resistant group were found to be slightly higher than those in by the sensitive one

Evaluation of laboratory procedures used for screening food handlers in the Sudan

The objective of this study was to find a suitable laboratory procedure for screening Sudanese food handlers for Intestinal parasites. Routine direct smear, formal ether and floatation techniques were compared. A total of 1500 food handlers who presented for annual checkups were screened for Intestinal parasites by direct faecal examination, formal ether concentration technique and floatation technique. The sensitivity of both the direct smear and the floatation technique was 64.2%, while the specificity of both methods was 100% when using the formal ether technique as the standard technique. There was a statistically significant difference of a p-value < 0.05. When regarding the direct smear as the standard technique, the sensitivity of the floatation technique was 39.8% while the specificity was 94%. In conclusion the formal ether concentration technique is the more suitable technique for a high sensitivity and feasible application in different regions of Sudanconcluded that the clinical presentation and MRI findings did not differ much from what is reported worldwide

Coagulation disturbances in pregnancy and post delivery period in Sudan

Coagulation problems during pregnancy and after delivery are major health problems leading to fatal complications. Coagulation complications in pregnancy are related to hypertension [PIH], placenta previa or gestational diabetes as well as some chronic problems that effect pregnancy like heart disease and asthma. The study was intended to measure the coagulation profiles, prior and post delivery, to find out coagulation hazards among those ladies compared to non-pregnant ladies as control group. A descriptive comparative study was conducted from Jan to June 2007 using 70 blood samples obtained from non-pregnant ladies [control] and 140 blood samples obtained from 70 ladies during pregnancy and after delivery. The coagulation tests [prothrombin time, activated partial thromboplastin time, thrombin time and platelets count] were performed on all samples by the same manner. Results showed that prothrombin time, activated partial thromboplastin time, thrombin time and platelets count prior and post delivery were significantly decreased compared to control, unlike platelets which were Increased rather than in control without statistical significance. Also the coagulation profiles were significantly affected by the type of delivery [cesarean section and normal], while not affected by mothers> age, circumcision, history of abortion and diabetes mellitus. There is observable effect of weight and contraceptive. It is concluded that the coagulation profile prior and post delivery were significantly decreased compared to control, while platelets were increased more than that counted in control. It is recommended to investigate pregnant ladies for coagulation profile before and after delivery and treatment should be offered to ladies with high risk

Evaluation of laboratory procedures applied for counting platelets

Accurate platelets count has an important role in the diagnosis of many haematological disorders such as thrombocytopenia, thrombocytosis as well as for prophylactic platelets transfusion. Therefore, it is necessary to select the most reliable method for such use. These methods include haemocytometry [Manual 1% ammonium oxalate technique], assessment of platelets from well prepared and stained thin blood film and automated analyzer system using KX-21 counter [Sysmex]. Out of 100 blood samples recruited for the study, 31 showed low platelets count, 61 showed normal platelets level and only 8 blood sample showed high platelets concentration. Result showed that the numbers of platelets counted by automated machine were significantly lower than that obtained by both manual methods in samples with less than 150000 platelets/micro L and more than 450000 platelets/micro L. Among normal blood samples, platelets count between 150000 and 450000 platelets/micro L no significant statistical difference detected between the counts obtained by the three techniques. It was concluded that automated blood analyzer systems, which have worldwide distribution, may have problems distinguishing large platelets, or aggregates from other blood cells. The assessment of platelets number using automated counters can reveal the accurate status in samples with normal platelet levels whereas it could not replace the manual ammonium oxalate method particularly in persons with high or low platelets count

Economic cost of malaria on households during a transmission season in Khartoum State, Sudan

This study was conducted in 2004 among 1200 households in Khartoum to estimate the direct and indirect economic costs of malaria for households. Information on the household and the malaria episodes was collected [care-seeking behaviour, working days lost and expenditure on malaria treatment]. There were 327 episodes of malaria; 25.2% of the households reported at least 1 malaria episode during the month preceding the survey. In only 18.0% of malaria episodes was the individual economically active. The average treatment expenditure per fully cured case was US$ 6.3 [SD 5.9]. The average indirect cost per fully cured case was US$ 3.2 [SD 9.2]; it was higher for individuals working in the informal sector than those employed in the formal sector