ABSTRACT
This paper examines household and community-level influences on diarrhoeal prevalence in southern Malawi. A Bayesian multi-level modelling technique is used in the estimation of hierarchically built data from a survey of individuals nested within households nested within communities. Households have strong unobserved influence on diarrhoeal illness (sigma(2)(u) = 4.476; 95% CI: 2.081, 6.871). A joint Wald test of significance shows that an individual's age [chi(2)(4) = 55.921, p = 0.000] and school [chi(2)(2) = 18.203, p = 0.000] have strong influence on an individual's diarrhoeal prevalence. An individual's history of malarial-like illness also has a strong positive relationship with diarrhoeal prevalence [beta = 0.606, p = 0.000]. Household factors that influence diarrhoea include employment status of head of household [beta = -0.619, p < 0.021], maternal age [beta = -0.013, p < 0.003], and size of household [beta = -0.669, p = 0.000]. The positive relationship between diarrhoea and malaria-like episodes highlights common risk factors hence the need for common approaches to combat the diseases. Significant household effects underline the importance of household considerations in policy issues.
Subject(s)
Diarrhea/epidemiology , Family Characteristics , Logistic Models , Residence Characteristics/statistics & numerical data , Adolescent , Adult , Bayes Theorem , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Malawi/epidemiology , Middle Aged , Regression Analysis , Risk Factors , Young AdultABSTRACT
Abstract:Although malaria is a controllable and preventable disease; it remains among the leading causes of mortality and morbidity in southern Malawi. The importance of early diagnosis and prompt treatment with hospital prescribed drugs and effective home management to control malaria is well established; however; these in part depend on how households make their decisions when family members have suffered from malaria. This study examines the behaviour of households with regard to decisions they make in managing malaria illness. Using hierarchically built data from a survey of 1;400 mothers nested within 33 communities; a series of two-level logistic regression models with Bayesian estimation was used to determine predictors of care-seeking behaviour towards malaria when a family member or a child was perceived to have malaria. The results show that most families normally visit or use medication prescribed at health facilities for both adult (80) and child (86) members when they are perceived to have malaria. The main obstacle to accessing the nearest health facility was distance and transport costs (73) and the main problems encountered at health facilities were long waiting time or absence of health workers (73) and shortage of drugs (35). Among the main predictor variables for choices of treatment for childhood malaria was the absence of a health surveillance assistant for those that visited hospitals [?=0.56; 95 CI:-0.86;-0.26]; bought medication from open markets [?=0.51; 95 CI:0.20;0.82]; and those that used other traditional methods or did nothing [?=0.70; 95
Subject(s)
Behavior , Family Characteristics , Malaria/diagnosis , Morbidity , Therapeutics/mortalityABSTRACT
We determined the incidence of cryptosporidiosis in children aged <5 years presenting with diarrhoea in an urban and rural hospital-based setting in Malawi. Stools were collected over a 22-month period during both rainy and dry seasons. A range of microscopic methods were used to determine the presence of Cryptosporidium spp. oocysts. Species determination was by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) of oocyst-extracted DNA using 18S rRNA and COWP gene loci. Cryptosporidium spp. oocysts were seen in 5.9% (50/848) of samples, of which 43 amplified by PCR-RFLP indicated the following species: C. hominis, C. parvum, C. hominis/C. parvum, C. meleagridis and C. andersoni. Seven samples could not be amplified by PCR. Wider species diversity was found in the rural setting, and may be a result of increased malnutrition and zoonotic exposure in this area. Improvements in water, sanitation, household hygiene and animal control are required to reduce the incidence of infection in this population.
Subject(s)
Cryptosporidiosis/epidemiology , Cryptosporidiosis/parasitology , Cryptosporidium/classification , Animals , Child, Preschool , Cryptosporidium/genetics , Cryptosporidium/isolation & purification , DNA, Bacterial/genetics , Diarrhea/microbiology , Feces/microbiology , Hospitals , Humans , Incidence , Infant , Infant, Newborn , Malawi/epidemiology , Microscopy , Parasite Egg Count , Polymerase Chain Reaction , Polymorphism, Restriction Fragment Length , Protozoan Proteins/genetics , RNA, Ribosomal, 18S/genetics , Rural Population , Urban PopulationABSTRACT
Potentially lethal damage repair (PLDR) was investigated in two normal and three ataxia telangiectasia (AT) human-skin fibroblast cell lines cultured in vitro. Using plateau-phase cells, both the time kinetics and the amount of repair were measured after irradiation. PLDR depended on both dose and survival level, as previously seen in rodent cells. Human cells differed from rodent cells in PLDR speed and the ability to discern two components within the repair response. Fast repair had a t1/2 of approximately 5-7 min while the slow response occurred over hours. AT cells had demonstrable PLDR in contrast to previous studies. Quantitatively, the proportion of fast and slow repair was similar for each dose in either normal or AT cells. However, AT cells had lower levels of both types of repair. When analyzing PLDR in human cells, differences in the rate of repair between human and rodent cells must be taken into account.
