Vodou's role in Haitian mental health.

This paper gives an overview of Vodou's history in Haiti and how Vodou informs Haitian mental health interventions.

Evaluation of chemotherapy in the control of Schistosoma mansoni in Marquis Valley, Saint Lucia. I. Results in humans.

Hycanthone at a dose of 2.5 mg kg body weight was given in 1973 and 1974 to persons found by a sedimentation concentration technique to be excreting Schistosoma mansoni eggs. In a further two campaigns oxamniquine was used (15 mg/kg body weight). The last treatment was given after the 1976 survey and stools of children were re-examined annually but not further treatment was planned. In six villages prevalence remained low, at 4%, 4 years later, in two it increased to 10%, and in two others after 3 years it was 23% and further treatment was offered. Factors affecting renewed transmission and the rate prevalence builds up were investigated and found to be low attendance rate for treatment, greater use of the river water and, possibly, infected immigrants. But if prevalence builds up slowly, retreatment may be necessary only every 3-4 years at an estimated annual cost of 40 cents per person protected.

Schistosoma mansoni control in Cul de Sac Valley, Saint Lucia. II. Chemotherapy as a supplement to a focal mollusciciding programme.

After an intensive area-wide mollusciciding campaign, over four and a half years, transmission of Schistosoma mansoni was reduced. A cheaper scheme suitable for the follow-up or consolidation stage of control was evaluated and two selective population chemotherapy campaigns using hycanthone (2 mg/kg b.w.) and oxamniquine (15 mg/kg b.w.) were mounted. Prevalence dropped to 6% and 3% in areas with previously high and low levels of transmission respectively. Calculations suggested that these figures were falsely low and that perhaps 20% of the population were still excreting S. mansoni ova in small numbers. The unco-operative groups in the population are probably more important in maintaining a reservoir of infection in the community than persons with light infections undetected by the sedimentation concentration stool examination technique used. The benefit of more sensitive but more costly examination techniques is not clear since the importance of very light infections in transmission is uncertain. Case detection absorbs an increasing proportion of the total cost of chemotherapy programmes with fewer cases being found amongst the same number screened. Using hycanthone (649 treated) the cost per person protected was $0.74 and using oxamniquine (264 treated) $0.94. The need to develop low cost consolidation or follow-up procedures for preventing a resurgence of transmission after successful control, when the infection is no longer of public health importance, is stressed.

Schistosoma mansoni control in Cul de Sac Valley Saint Lucia. II Chemotherapy as a supplement to a focal mollusciciding programme

After an intensive area-wide mollusciciding campaign, over four and a half years, transmission of Schistosoma mansoni was reduced. A cheaper scheme suitable for the follow-up or consolidation stage of control was evaluated and two selective population chemotherapy campaigns using hycanthone (2 mg/kg b.w.) and oxamniquine (15mg/kg b.w.) were mounted. Prevalence dropped to 6 percent and 3 percent in areas with previously high and low levels of transmission respectively. Calculations suggested that these figures were falsely low and that perhaps 20 percent of the population were still excreting S. mansoni ova in small numbers. The unco-operative groups in the population are probably more important in maintaining a reservoir of infection in the community than persons with light infections undetected by the sedimentation concentration stool examination technique used. The benefit of more sensitive but more costly examination techniques is not clear since the importance of very light infections in transmission is uncertain. Case detection absorbs an increasing proportion of the total cost of chemotherapy programmes with fewer cases being found amongst the same number screened. Using hycanthone (649 treated) the cost per person protected was $0.74 and using oxamniquine (264 treated) $0.94. The need to develop low cost consolidation or follow-up procedures for preventing a resurgence of transmission after successful control, when the infection is no longer of public health importance, is stressed. (AU)