ABSTRACT
AIMS: To determine if macrolide resistant Streptococcus pneumoniae will be a major concern in areas that receive annual mass azithromycin distributions for trachoma. METHODS: A cross sectional survey was conducted of nasopharyngeal S pneumoniae isolates for susceptibility to azithromycin 1 year after administering a single dose of azithromycin to treat trachoma in a village in Nepal. RESULTS: S pneumoniae was isolated from 50 (86%) of 57 nasopharyngeal cultures and no resistance to azithromycin was detected. CONCLUSION: The authors were unable to demonstrate that mass azithromycin therapy for trachoma produced macrolide resistant S pneumoniae that persists until the next scheduled annual treatment.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Azithromycin/therapeutic use , Streptococcus pneumoniae/drug effects , Trachoma/drug therapy , Child , Child, Preschool , Cross-Sectional Studies , Drug Resistance, Bacterial , Female , Humans , Infant , Male , Nepal/epidemiology , Prevalence , Rural Health , Streptococcal Infections/epidemiology , Trachoma/epidemiologyABSTRACT
OBJECTIVE: The study compares the effectiveness of two strategies for distributing azithromycin in an area with mild-to-moderate active trachoma in Nepal. METHODS: The two strategies investigated were the use of azithromycin for 1) mass treatment of all children, or 2) targeted treatment of only those children who were found to be clinically active, as well as all members of their household. FINDINGS: Mass treatment of children was slightly more effective in terms of decreasing the prevalence of clinically active trachoma (estimated by clinical examination) and of chlamydial infection (estimated by DNA amplification tests), although neither result was statistically significant. CONCLUSION: Both strategies appeared to be effective in reducing the prevalence of clinically active trachoma and infection six months after the treatment. Antibiotic treatment reduced the prevalence of chlamydial infection more than it did the level of clinically active trachoma.
Subject(s)
Anti-Bacterial Agents/supply & distribution , Anti-Bacterial Agents/therapeutic use , Azithromycin/supply & distribution , Azithromycin/therapeutic use , Trachoma/drug therapy , Child , Child Health Services/organization & administration , Child, Preschool , Humans , Infant , Nepal/epidemiology , Trachoma/epidemiology , Trachoma/prevention & controlABSTRACT
OBJECTIVE: The present study compares the cost-effectiveness of targeted household treatment and mass treatment of children in the most westerly part of Nepal. METHODS: Effectiveness was measured as the percentage point change in the prevalence of trachoma. Resource measures included personnel time required for treatment, transportation, the time that study subjects had to wait to receive treatment, and the quantity of azithromycin used. The costs of the programme were calculated from the perspectives of the public health programme sponsor, the study subjects, and the society as a whole. FINDINGS: Previous studies have indicated no statistically significant differences in effectiveness, and the present work showed no significant differences in total personnel and transportation costs per child aged 1-10 years, the total time that adults spent waiting, or the quantity of azithromycin per child. However, the mass treatment of children was slightly more effective and used less of each resource per child aged 1-10 years than the targeted treatment of households. CONCLUSION: From all perspectives, the mass treatment of children is at least as effective and no more expensive than targeted household treatment, notwithstanding the absence of statistically significant differences. Less expensive targeting methods are required in order to make targeted household treatment more cost-effective.
Subject(s)
Anti-Bacterial Agents/economics , Azithromycin/economics , Child Health Services/organization & administration , Cost-Benefit Analysis , Trachoma/drug therapy , Anti-Bacterial Agents/supply & distribution , Anti-Bacterial Agents/therapeutic use , Azithromycin/supply & distribution , Azithromycin/therapeutic use , Child , Child Health Services/economics , Child, Preschool , Female , Health Care Costs , Humans , Infant , Male , Nepal/epidemiology , Outcome Assessment, Health Care , Trachoma/economicsABSTRACT
The aim of this study was to test the hypothesis that increased pollination enhances the probability of'pollen competition'in Betula pubescent. In an in vitro test, the germination of pollen from three B. pubescens trees, increased with increasing pollen density (r2 = 0·82, 0·81 and 0·82, respectively). Pollen tubes grew at different rates in styles when testing different paternal/maternal combinations. Evidence was obtained to suggest that these differences might be attributed to both maternal and paternal effects. Further, increasing the number of tubes per style tended to increase the length of the longest tube per style, but had no significant effect on the mean length of the tubes. The r values, for the correlations of lengths with numbers of pollen tubes per style, were lower in two natural B pubescens populations than in the data from a controlled pollination experiment, is concluded that selection among male gametes may occur after supplementary pollination in B. pubescens, but in natural situations, pollen deposition is usually too low for pollen Selection to be a common occurrence.
