Cyclosporiasis: an Emerging Public Health Concern around the World and in Africa

Background: Cyclosporiasis is an emerging gastro-enteric disease caused by the coccidia protozoan Cyclospora cayetanensis. It isassociated with diarrhoea among children in developing countries; in the Americas where C. cayetanensis is endemic; traveller's diarrhoea and/or food and waterborne outbreaks in the developed countries. Objectives: The aim of this review is to highlight cyclosporiasis and its relevance to public health in East Africa and Africa at large. Methods: All literature on Cyclospora; C. cayetanensis; cyclosporiasis in Africa; and endemic cyclosporiasis was searched from libraries;colleagues and internet but only literature on its history; clinical presentation; epidemiology in endemic settings; and occurrence inAfrica were scrutinised. Results: In Sub Saharan Africa; cyclosporiasis has been reported in at least 3 countries; including Tanzania; in East Africa; occurring inboth immunocompromised and immunocompetent patients. Zoonotic species of Cyclospora have also been identified in East African primates; indicating likely endemicity of this little reported disease in the region. This can be attributed to lack of awareness in thepublic and medical profession concerning the disease; and therefore not routinely checked at the health centres. Cyclosporiasis ischaracterized by intermittent diarrhoea; and secondary conditions or sequelae such as reactive arthritis syndrome (Reiter's syndrome); have been associated with progression of the disease. Its management is based on antibiotics; an unusual scenario for a protozoa. Conclusions: Although many aspects of this disease and its transmission remain an enigma; the situation has been rapidly changing since the disease first came to medical attention in the 1970s

Community-directed Treatment of Lymphatic Filariasis in Kenya and its Role in the National Programmes for Elimination of Lymphatic Filariasis

We conducted a prospective; cross-sectional study to examine and compare treatment coverage of lymphatic filariasis by the health system (HST) and a health system implemented; community-directed treatment for the control of lymphatic filariasis (ComDT/HS) in 44 randomly selected villages in coastal Kenya. Demographic information on the villages and peripheral health facilities to guide design and implementation was obtained from a situation analysis phase of this study. A series of interactive training sessions on basic biology of lymphatic filariasis; concept and philosophy of ComDT/HS were given to members of the District Health Management Team (DHMT); peripheral health staff; community leaders and community drug distributors (CDDs) prior to ivermectin distribution. An intensive sensitization process of the community by the trained peripheral health staff and community leaders followed before selection of the CDDs. Quantitative and qualitative data for evaluation of the study were collected by coverage surveys of randomly selected households; focus group discussions and interviews; immediately after the drug distribution. Treatment coverage of all eligible persons was 46.5 and 88in HST and ComDT/HS villages; respectively; P 0.001. In comparing treatment coverage by the two study arms in relationship to the distance from a health facility; coverage among HST and not ComDT/HS villages was influenced by distance. In Kenya; ComDT/HS can effectively be implemented by the regular health system and can attain coverage levels compatible with the global filariasis elimination goal