First Record of Paramphistomes Fischoederius cobboldi and Paramphistomum epiclitum Detected in Bovine Rumen from a Local Market of Savannakhet Province, Lao PDR

In the present study, we report on the occurrence of paramphistomes, Fischoederius cobboldi and Paramphistomum epiclitum, in Lao PDR with the basis of molecular data. Parasite materials were collected from bovines bred in Ban Lahanam area, Savannakhet Province, Lao PDR at Lahanam public market. Morphological observations indicated 2 different species of paramphistomes. The mitochondrial gene cox1 of the specimens was successfully amplified by PCR and DNA sequencing was carried out for diagnosis of 11 specimens. Pairwise alignment of cox1 sequences were performed and confirmed F. cobboldi and P. epiclitum infecting bovines in Laos. Although there were many limiting points, as the small number of worm samples, and the restricted access of the animal host materials, we confirmed for the first time that 2 species of paramphistomes, F. cobboldi and P. epiclitum, are distributed in Lao PDR. More studies are needed to confirm the paramphistome species present in Savannakhet and its hosts to clear the natural history of these parasites of ruminants in the region and measure the impact of this parasite infection in the life and health of the local people.

Households with insufficient bednets in a village with sufficient bednets: evaluation of household bednet coverage using bednet distribution index in Xepon district, Lao PDR

InLao PDR, the National Malaria Control Program (NMCP) evaluates bednet coverage,often at the village level, using a coverage target of one net per 2.5 (or fewer)persons in a given population. However, in villages that meet the target, notall households necessarily meet the target or utilize all available bednets. Thisstudy explored households that fell short of the target and household utilizationof bednets in villages that met the target of bednet coverage set by the NMCP. Thepersons per net ratio (PPNR), which is defined as the population divided by thenumber of available bednets in a household/village, was used to determine whethera household/village met the NMCP target. Using a household survey, we collectedand analyzed the data of 635 households in 17 villages in Xepon district in2012. Households that fell short of the target (households with a PPNR of >2.5 or no bednet) existed in every village. The proportion of these households differedgreatly among the villages, ranging from 3.4–50%, with some households fallingfar short. Of the 635 households, 275 (43.5%) had at least one bednet that wasnot being used on the night preceding the survey and 131 (20.6%) had at leasttwo. In conclusion, in villages that met the NMCP target, a considerable numberof households fell short of the target. Available bednets were not fullyutilized in many of the surveyed households.

Households with Insufficient Bednets in a Village with Sufficient Bednets: Evaluation of Household Bednet Coverage Using Bednet Distribution Index in Xepon District, Lao PDR

In Lao PDR, the National Malaria Control Program (NMCP) evaluates bednet coverage, often at the village level, using a coverage target of one net per 2.5 (or fewer) persons in a given population. However, in villages that meet the target, not all households necessarily meet the target or utilize all available bednets. This study explored households that fell short of the target and household utilization of bednets in villages that met the target of bednet coverage set by the NMCP. The person per net ratio (PPNR), which is defined as the population divided by the number of available bednets in a household/village, was used to determine whether a household/village met the NMCP target. Using a household survey, we collected and analyzed the data of 635 households in 17 villages in Xepon district in 2012. Households that fell short of the target (households with a PPNR of > 2.5 or no bednet) existed in every village. The proportion of these households differed greatly among the villages, ranging from 3.4–50%, with some households falling far short. Of the 635 households, 275 (43.5%) had at least one bednet that was not being used on the night preceding the survey and 131 (20.6%) had at least two. In conclusion, in villages that met the NMCP target, a considerable number of households fell short of the target, and the available bednets were not fully utilized in many of the surveyed households.

Nodding Syndrome in Uganda: Field Observations, Challenges and Research Agenda

This article summarizes observations made in Northern Uganda and a lecture given at the Nodding Syndrome Workshop in Nagasaki September 2013. The objective of the manuscript is to summarize the current knowledge on nodding syndrome and to provide an agenda for investigations into the epidemiology, pathophysiology, diagnosis and care management of nodding syndrome in Uganda.

Nodding Syndrome in Uganda: Field observations, challenges and research agenda

This article summarizes observations made in Northern Uganda and a lecture given at the Nodding Syndrome Workshop in Nagasaki September 2013. The objective of the manuscript is to summarize the current knowledge on nodding syndrome and to provide an agenda for investigations into the epidemiology, pathophysiology, diagnosis and care management of nodding syndrome in Uganda.

Anemia and Related Factors in Preschool Children in the Southern Rural Lao People's Democratic Republic

Anemia is a severe public health problem in the Lao People’s Democratic Republic (PDR). Consequently, a new control strategy to reduce the burden of anemia has been introduced for preschool children (aged 6–52 months). The objective of this study was to assess the current prevalence of anemia and related factors in preschool children in southern rural Lao PDR. A population-based cross-sectional study was carried out in six communities in Songkhone district, Savannakheth province, in February 2009. As a result, the prevalence of anemia was found to be 48.9% (95% confidence interval (CI), 43.5–54.3), although most cases were mild. A multiple logistic regression analysis indicated that there was no protective effect of breastfeeding against anemia. The anemia prevalence was higher in 1) children aged 6–23 months (Odds Ratio (OR) = 1.73, 95% CI, 1.02–2.90) than in older children, 2) children in large families (6 or more members) (OR = 1.96, 95% CI, 1.17–3.29), and 3) children in three remote villages with relatively difficult access to markets (OR = 3.01, 95% CI, 1.25–7.47).<br />In Lao PDR, improvement of food practices and home-fortified food supplementation interventions are essential. High-risk groups should be targeted and a long-term health education program that aims to modify food habits implemented. Furthermore, in settings where iron deficiency is not the only cause of anemia, combining an iron supplement with other measures is necessary.

Effect of communal piped water supply on pattern of water use and transmission of schistosomiasis haematobia in an endemic area of Kenya

An attempt was made to examine the long-term impact of the introduction of communal piped water supply on pattern of water use and transmission of schistosomiasis haematobia in an endemic area of Kenya. In the study area, Mtsangatamu, a control program based on repeated selective mass-chemotherapy had been carried out for 6 years from 1987 to 1993. The pre-treatment overall prevalence and intensity of infection in 1987 were 59.2% and 10.9 eggs⁄10 ml of urine (Muhoho <I>et al</I>., 1997). During the control program, the prevalence was kept at a low range of 20 to 40% (Muhoho <I>et al</I>., 1994). At the end of the program, in 1994, gravity-fed water supply was provided to the village. Although the water facilities were damaged by flooding in 1998, new and further expanded gravity-fed water supply facilities consisting of 7 standpipes were introduced in 2000. The follow-up survey done in 1999 revealed reduced prevalence and intensity of infection, I.e. 23.0% and 1.2 eggs⁄ 10 ml of urine (unpublished data). The present study was carried out in 2006, 6 years after the last mass-chemotherapy. Urine examination showed that the prevalence and intensity of infection had return to 52.2% and 7.4 eggs⁄10 ml, nearly the same level as the pre-treatment level. The results of our study demonstrated that, over the long-term, the gravity-fed water supply facilities had little impact on the overall prevalence and intensity of infection in this village. However, analysis of the spatial pattern of infection, observation of human water contact at the river and a questionnaire on water use shed light on the possible impact of water supply on human water contact. The younger people (5-19 years old) with easy access to the standpipes showed a lower prevalence and intensity of infection, while the relationship was not clear in other age groups.<br>The result of the questionnaire indicated that the long distance from household to standpipe was the major factor limiting the use of the communal tap water. Most of the villagers who used piped water as the main source of water lived within 800 m of the nearest standpipe, and villagers who used river water exclusively lived beyond that distance. Observation of water-related activities at the communal water facilities also indicated that the residents who lived near standpipes used the piped water more frequently.<br>The frequency of total visits to river water sites did not differ between residents who lived near and far from the standpipe. However, water contact in the form of playing, the highest risk behavior, was observed exclusively among children who lived far (>250m) from standpipes, although the number of observations was small.<br>The present study demonstrated that the water facilities had little effect on the dispersed population but might have a beneficial effect on some villagers given easy access to standpipes.

Knowledge, attitudes, beliefs, and practices of Chinese migrants in Nairobi, Kenya and Dar es Salaam, Tanzania toward HIV/AIDS

To investigate AIDS-related knowledge, attitudes, beliefs and practices (KABPs) among Chinese migrant laborers in east African cities, and to examine the current status of access to AIDS-related healthcare services, we conducted a cross-sectional study in Nairobi, Kenya, and Dar es Salaam, Tanzania. Of 121 male laborer participants who spoke neither English nor Swahili, 109 (90.9%) had an education level of high school or less. The survey revealed that migrants‘ AIDS-related knowledge was poor, e.g., very few (n=4, 3.3%) were aware of the epidemiologic status of HIV in these two cities. Negative attitudes toward people living with HIV⁄AIDS (PLWHA) were widespread, and the majority (n=94, 77.7%) did not make use of AIDS-related healthcare services or education. Although the main information resources on HIV⁄AIDS in China include television (n=94, 77.7%), books and newspapers (n=78, 64.5%) and radio (n=51, 42.1%), these sources were much less common in Nairobi and Dar es Salaam (p&It;0.001 for each). One third (n=44, 36.4%) did not have any information resources in these two cities. These results indicate that Chinese migrant laborers are at risk of HIV infection in the two African cities. Appropriate education for the general population in China and for migrants in these two cities regarding HIV⁄AIDS, along with relevant information resources that are more accessible and useful for migrants in East Africa are therefore needed to minimize the risk of infection.

PREBIOTIC EFFECT OF DAILY FRUCTOOLIGOSACCHARIDE INTAKE ON WEIGHT GAIN AND REDUCTION OF ACUTE DIARRHEA AMONG CHILDREN IN A BANGLADESH URBAN SLUM: A Randomized Double-masked Placebo-controlled Study

Fructooligosaccharide (FOS) is a typical prebiotic agent. A randomized, double-masked, placebo-controlled study was performed to evaluate the prebiotic effect of daily intake of an isotonic solution containing FOS on body weight gain and the reduction of diarrhea in children in an urban slum in Bangladesh over six consecutive months. We enrolled a total of 150 children, aged 25-59 months. Sixty-four children in the FOS group received 50 mL of isotonic solution with 2 g of FOS added, and 69 children in the placebo group were given an identical solution with 1 g of glucose added, once a day. The measurement of body weight was carried out every other day; height and arm circumference were measured once a month; and the children‘s mothers were interviewed to obtain data about diarrhea, the consistency and constitution of stool, other symptoms, and antibiotic treatment. As a result, the body weight gain during the six-month period was 0.86±0.55 kg in the FOS group and 0.89±0.48 kg in the placebo group, while the increase in height and arm circumference were not significantly different between the two groups. The number of diarrhea episodes during the six-month period was not significantly different. A significant reduction in the duration of diarrhea days and of duration per episode was observed in the FOS group (<i>p</i>=0.039 and <i>p</i>=0.008, respectively). In conclusion, daily intake of FOS was associated neither with the children‘s growth nor with the number of diarrhea episodes, but a significant reduction in the duration of diarrhea days was observed. Further studies are needed to confirm the effects of FOS by changing the doses and eliminating the influence of antibiotics.

A SIMULATION SHEDS A LIGHT ON THE PRESENT HIV EPIDEMIC

A hypothetical community of one million people where birth rate and death rate are equal was applied to the modified deferential equations Lipsitch and Nowak published in 1995 in order to examine the impact of partner acquisition change on the HIV epidemic over a relatively short term. The results showed that if the partner exchange rate increases from two to three per year in the population, the epidemic caused by a more virulent strain would overweigh that caused by a less virulent strain within a century. This result reveals that an increase in the rate of partner acquisition gives the more virulent strain an advantage in terms of propagating the virus in a given population, at least over a relatively short term of several decades. The partner acquisition rate also exerts an influence on the magnitude of the HIV epidemic and the time it needs to reach a peak in the hypothetical community.<BR>These results indicate that increased sexual contact may be even more important than expected and thus shed a new light on the present HIV epidemic.

INCIDENCE OF TRAVELERS' DIARRHEA AMONG JAPANESE VISITING THAILAND

A cross-sectional survey of 327 Japanese short-term travelers (≤3 weeks) arriving in Bangkok, Thailand was conducted to assess the incidence of travelers’ diarrhea (TD) as well as their symptoms and treatment-seeking behaviors. The incidence of the first episode of TD (FTD) was ascertained retrospectively by questionnaire. Reported by 69 travelers, FTD clustered within the first 8 days of arrival in Thailand, and the incidence rate varied from 2% to 8% with the highest incidence on the third day.<BR> Cumulative probability of FTD was 19% for those arriving in Thai directly from Japan, 42 % for those arriving via Southeast Asia, and 25% for those arriving via other regions at Day 7 by the Kaplan-Meier survival analysis. Log rank test revealed a higher FTD risk for travelers arriving via other Southeast Asian countries than for those arriving directly from Japan (<I>P</I> < 0.005). Of all the 69 FTD episodes, 33% had classic TD defined as ≥3 unformed stools per 24 hours with at least one accompanying symptom, 49% had moderate TD defined as ≤2 unformed stools with at least one additional symptom or more unformed stools without additional symptoms, and 17% had mild TD defined as with ≤ 2 unformed stools without additional symptoms. Cumulative probability of FTD at Day 7 was 12% for classic TD, 25% for classic plus moderate TD and 30% for all the TD. More than 38% of travelers with diarrhea took medicine brought from Japan. Among travelers with classic TD, 35% bought medicine in Thailand, whereas 47-50% of travelers with moderate and mild TD took only rest without any treatment.