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Biomedical subjects

A D Hopkins

Publications and source records attributed to A D Hopkins.

6 recordsLinked to original sources
PubMed2005

Ivermectin and onchocerciasis: is it all solved?

The donation of ivermectin by Merck and Co. Inc. has led to one of the most effective private-public partnerships controlling a disease of major public health importance particularly in Africa. The up scaling of ivermectin distribution during the last 15 years has been remarkable with almost 40 million people treated in 2003, many already on their regular annual dose. The tools that have been developed particularly by the APOC programme have been instrumental in this increase. However, ivermectin is a microfilaricide and does not kill the adult worms. Distribution will be needed for at least 25 years and latest estimates indicate that 90 million people need annual treatment if onchocerciasis is to be eliminated as a public health problem. In spite of this incredible progress it is difficult to see how the programme will be sustained, especially after the closure of APOC in 2010. A macrofilaricide destroying adult worms and safe for mass distribution would solve the problem of onchocerciasis.

Community Health Services↗
PubMed2002

The effect of 5 years of annual treatment with ivermectin (Mectizan) on the prevalence and morbidity of onchocerciasis in the village of Gami in the Central African Republic.

To assess the impact of 5 years of annual community treatment with ivermectin (Mectizan) on the prevalence of onchocerciasis and onchocerciasis-associated morbidity, data collected, before and after such treatment, in the village of Gami, in a hyper-endemic area of the Central African Republic, were analysed. Skin snips from all the villagers treated in 1990 and/or 1995 were used to assess the prevalence and intensity of infection with Onchocerca volvulus. Ocular and dermatological morbidity was assessed by ophthalmological and clinical examinations of the same subjects. Following the five annual treatments, there was a reduction in the prevalence of infection and a dramatic decrease in the microfilarial load of the community. The prevalences of pruritus, onchocercal nodules and impaired vision were all significantly reduced. The results emphasise the long-term benefits of the mass-treatment programmes, particularly for children aged <10 years.

Adolescent↗
PubMed1998

A method to determine the coverage of ivermectin distribution in onchocerciasis-control programmes.

Onchocerciasis is a human filarial infection responsible for an estimated 750,000 blind and severely visually disabled people. In some African countries, this disease represents the main cause of blindness, with considerable socio-economic impact on the affected communities. Since the introduction of ivermectin as a microfilaricidal agent, there is hope that visual loss from onchocerciasis can be eliminated through community-based ivermectin-distribution programmes. The African Programme for Onchocerciasis Control (APOC) has now been initiated, by the World Health Organization and World Bank, to distribute ivermectin in 19 African countries where onchocerciasis is endemic. Estimates of ivermectin coverage in distribution programmes for onchocerciasis control have so far been based on the number of treatments given, in any one year, to a target population. There is a need for a standardized method to evaluate, measure and monitor coverage over time. In April 1996, a cluster random-sampling method was used to calculate coverage with ivermectin in an urban population of 30,000 people in the Central African Republic. The method was adapted from that used to determine coverage by the WHO Expanded Programme on Immunization. It proved to be inexpensive and easy to perform, requiring only local equipment and personnel. The method used and results obtained in Bossangoa and the potential use of the technique in other distribution programmes are discussed.

Adult↗
PubMed1998

Mectizan delivery systems and cost recovery in the Central African Republic.

The Central African Republic (CAR) has a serious onchocerciasis problem. The disease is endemic in three quarters of the country and there is considerable onchocercal blindness in the north-west. The low population density and extreme poverty (the CAR being one of the 20 poorest countries in the world) combine to make mass treatment with Mectizan (ivermectin, MSD) a challenge. Although planned, primary health care (PHC) is not widely developed in the country. Mectizan distribution was carried out in 1993-1994 by mobile teams in order to address the most urgent need, particularly in the north-west. Since then, the strategy has been one of community involvement, using village health workers, chosen by their own communities, to do the treatment. The system has been a stimulus to the development of PHC in some areas, as the co-ordinators of the Mectizan programme are often the only health personnel to visit every village. The long distances between health centres, with a mean of 45 km, are likely to be an obstacle to the population collecting their own Mectizan, within the self-treatment system otherwise in place. Operational research is planned to examine ways in which the population can contribute to cost recovery without there being a reduction in treatment coverage.

Central African Republic↗
PubMed1979

Therapeutic trial of four amoebicide regimes in rural Zaire.

A prospective comparative trial of four amoebicide regimes was carried out with protozoological control using 300 patients presenting with symptomatic intestinal amoebiasis at a tropical rural hospital during a five month period. 195 (76.2%) of 256 treated supplied three follow-up stools. Of those treated with Metronidazole and Oxytetracycline 10.9 per cent continued to excrete Entamoeba histolytica while with Di-iodohydroxyquinoline and Oxytetracycline the figure was 25.5 per cent falling to 20.0 per cent when Dehydroemetine was added and with Clioquinol and Oxytetracycline 27.5 per cent continued to excrete Entamoeba histolytica. These figures with the absolute numbers of patients involved do not show any one of the regimes used to be significantly more effective than the others in unclassified symptomatic intestinal amoebiasis. We conclude therefore that in the rural situation the cheapest regime should be preferred as the standard one, namely Clioquinol and Oxytetracycline. However, in view of the reported serious side-effects of Clioquinol, Di-iodomydroxyquinoline and Oxytetracycline could be considered as the second cheapest and with slightly better results.

Clinical Trials as Topic↗