RESUMO
Introduction: Although there are many methods in malaria diagnoses e.g., quatitative buffy coat (QBC), rapid diagnosis tests (RDTs), serological tests and molecular diagnosis methods such as PCR, but microscopy still remains the gold standard for malaria diagnosis. Estimation of malaria parasite density can be carried out by using assumed white blood cells (WBC) and red blood cells (RBC) counts. Objective: The aims of this study were to determine malaria parasite densities calculated by Original Research Article assumed WBC and RBC counts; and to compare their reliability with absolute WBC and RBC counts. Methods: The clinical presentations and laboratoryfindings of specimens collectedfrom 512 uncomplicated falciparum and vivax malaria patients admitted to Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand were utilized and analysed for estimation of malaria parasite densities by using different formulas.Results: Parasite densities calculated by WHO recommended assumed WBC of 8,000 /μL, and assumed RBC counts of 4.7x106-6.1x106/μL and 4.2x106-5.4x106 /μL for males and females respectively led to overestimation, and resulted in low reliability when compared to the absolute WBC and RBC counts.Parasite densities calculated by assumed WBC of 5,900/μL in thick blood; by assumed RBC of 4.8x106/μL for malesand 4.3x106/μLfor femalesin thin blood film respectively gave more precise estimation.Conclusion: Assumed WBC and RBC counts for calculating malaria parasite densities haveto be adjusted to use in Thailand for more precise estimation. Parasite densities calculated by assumed WBC and RBC used in other malaria endemic countries might need further re-evaluation
RESUMO
Background: In Myanmar a large proportion of antenatal and intrapartum care in rural areas is provided by skilled birth attendants (SBAs), this study assessed the coverage by these health workers of all births, their adherence to service guidelines, and community opinion on the antenatal and delivery care they give in two rural health centres in Pathein Township, Ayeyarwaddy Region to identify the challenges and improve antenatal and intrapartum service delivery provided by the SBAs. Method: A structured questionnaire was used to interview 304 women who had infants under one year of age, and in-depth interviews were held with 12 SBAs and 10 community members. Results: Of the 304 pregnancies, 93% had received antenatal care (ANC); 97% of these were covered by SBAs at an average 15 weeks’ gestation. The average frequency of ANC visits was 9. Rates of home and hospital deliveries were 84.5% and 13.8% respectively. Among home deliveries, use rate of SBA was 51.4%, while for postnatal care, 31.3% was given by unskilled providers (traditional birth attendants (TBAs) 17.5%, auxiliary midwives (AMWs),13.8%). Multivariate analysis showed that interviewees aged 30 years and below (OR=0.468, P=0.046), with an education at primary level and below that of husband (OR=0.391, P=0.007) or not residing in the village of the rural/station health centre (OR=0.457, P=0.011) were significantly less likely to use SBAs. The categories of supervision, referral, and health education activities of SBAs were not in line with service guidelines. The main reasons were lack of access and community acceptance of TBAs. Conclusion: Heavy workload, geographical location, transportation and financial concerns were major challenges for SBAs, along with community compliance and mutual coordination. Good communication and service management skills were important to overcome these challenges.