Therapeutic efficacy of antimalarial drugs along the eastern Indo-Nepal border: a cross-border collaborative study.

This collaborative cross-border study was performed to determine the therapeutic efficacy of antimalarial drugs used by the National Programmes for falciparum malaria along the eastern Indo-Nepal border where there is unregulated population movement across the border. The study was conducted at sites in Jhapa District, Nepal and Darjeeling District, India. The study was conducted from August 2003 to February 2004, following the WHO 28 day treatment protocol. The efficacy of chloroquine was tested in India among 91 subjects and of sulfadoxine-pyrimethamine in Nepal among 107 subjects with laboratory-confirmed Plasmodium falciparum malaria. Of the 102 subjects who completed the study in Nepal, there were 21 (20.6%) treatment failures comprising 7 (6.9%) early treatment failures (ETF) and 14 (14.7%) late treatment failures (LTF) (5 late clinical failures [LCF] and 9 late parasitological failures [LPF]). Of the 89 subjects who completed the study in India, there were 46 (51.7%) treatment failures comprising 7 (7.9%) ETFs and 39 (43.8%) LTFs (13 LCFs and 26 LPFs). Based on WHO guidelines both countries need to review their drug policy urgently and make appropriate changes, taking into account aspects of cross-border collaboration in the control of drug-resistant malaria.

Endemic disease and development: the leishmaniases.

Health and sustainable development are intricately interwoven. Communities under pressure from a barrage of endemic diseases face tremendous obstacles in achieving an improved quality of life. The leishmaniases are examples of hitherto underestimated parasitic zoonoses which place those communities affected at significant risk of morbidity, debility and mortality. This article summarizes the experience of community-based applied research projects on leishmaniasis supported by the Canadian International Development Research Centre, in Lebanon, Jordan, Ethiopia, Kenya, Tunisia, Mexico, Costa Rica, Colombia, Peru, and Brazil. The article examines the role of leishmaniasis-associated morbidity versus mortality, and the impact of these diseases on a community's capacity to develop. It further analyzes the various determinants of leishmaniasis infection, disease and outcomes, and their interactions at the individual as well as the community level. Adverse health implications as a result of external and intervening factors are examined. Such factors include ecological/environmental changes such as those arising from developmental projects, unplanned urbanization, and continuous movements of populations. The paper views strategies for prevention and control of leishmaniases in the context of socio-political and economic constraints of the affected countries. Particularly emphasized is the need to take into account the knowledge base, beliefs, perceptions and practices of the population by incorporating active community participation in preventive and intervention practices. Leishmaniasis poses a particular challenge to classical health systems that tend to resist innovative change needed to address socio-political and economic realities of the present and future decades.

Evaluation of the diethylcarbamazine provocative test in the diagnosis of Wuchereria bancrofti infections in the Nigerian savanna and the effects on Dipetalonema perstans.

Large scale filariasis surveys in rural areas for microfilaraemia, especially of periodic types such as Wuchereria bancrofti are known to cause considerable administrative, technical and social problems. The present investigation was carried out in the population of two villages in the Malumfashi district of the Northern Nigerian savanna. From the survey results, the sensitivity and specificity of two techniques-day-time diethylcarbamazine (DEC) provocative test by blood smear and concentration, and night-blood examination by smear and concentration especially for W. bancrofti-were assessed. Day-time DEC provocative test proved to be efficient in terms of sensitivity and specificity, compared with the night-blood method, for W. bancrofti detection but less so for Dipetalonema perstans, the other blood microfilaria found in this population during these studies. A regression line between night-blood survey results for W. bancrofti and the results from day-time DEC provocative test was calculated. With the help of this regression line it is possible to estimate W. bancrofti microfilarial prevalence for night surveys, using the DEC provocative test results of day-time surveys. This can be done with minimal, but known, loss of accuracy and incurs fewer administrative, technical and social difficulties.