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Biomedical subjects

A Kroeger

Publications and source records attributed to A Kroeger.

At least 19 recordsLinked to original sources
PubMed2006

What do community-based dengue control programmes achieve? A systematic review of published evaluations.

Owing to increased epidemic activity and difficulties in controlling the insect vector, dengue has become a major public health problem in many parts of the tropics. The objective of this review is to analyse evidence regarding the achievements of community-based dengue control programmes. Medline, EMBASE, WHOLIS and the Cochrane Database of Systematic Reviews were searched (all to March 2005) to identify potentially relevant articles using keywords such as 'Aedes', 'dengue', 'breeding habits', 'housing' and 'community intervention'. According to the evaluation criteria recommended by the Cochrane Effective Practice and Organisation of Care Review Group, only studies that met the inclusion criteria of randomised controlled trials (RCT), controlled clinical trials (CCT), controlled before and after trials (CBA) or interrupted time series (ITS) were included. Eleven of 1091 studies met the inclusion criteria. Of these, two were RCTs, six were CBAs and three were ITS. The selected studies varied widely with respect to target groups, intervention procedures and outcome measurements. Six studies combined community participation programmes with dengue control tools. Methodological weaknesses were found in all studies: only two papers reported confidence intervals (95% CI); five studies reported P-values; two studies recognised the importance of water container productivity as a measure for vector density; in no study was cluster randomisation attempted; and in no study were costs and sustainability assessed. Evidence that community-based dengue control programmes alone and in combination with other control activities can enhance the effectiveness of dengue control programmes is weak.

Community Health Services↗
PubMed2006

Dengue research and training supported through the World Health Organization.

The rapidly increasing burden of dengue, the varied and often poorly understood factors contributing to its global spread, and the challenges of preventing and controlling it have led to a renewed call for more research and training on the disease. The main aims are to improve vector control, case management, and primary prevention through vaccine development. The World Health Organization (WHO), through its inter-departmental working group on dengue, is actively engaged in supporting and co-ordinating the major research activities. The dengue research initiatives of the Special Programme for Research and Training in Tropical Diseases (TDR), other departments at the WHO's Geneva headquarters, the WHO's regional and country offices, and the organization's dengue-affected member states are summarized in this article. This intensified effort, in close collaboration with other stakeholders, is contributing towards the goals of reversing the current epidemiological trends and of reducing the global burden posed by dengue in all of its forms.

Aedes↗
PubMed2004

Combined field and laboratory evaluation of a long-term impregnated bednet, PermaNet.

For how long does the insecticidal effect of long-lasting nets achieve high Anopheles mortality? Four PermaNets tested previously in Colombia for wash resistance were bioassayed again after 3 years of use and 23 washes. The tests were done both in Colombia and a reference laboratory in Indonesia. Additionally the residual concentration of deltamethrin on the nets was chemically analysed. The results showed high Anopheles mortality and a mean deltamethrin concentration of 9.6 mg/m2. Discrepancies with other studies are discussed.

Animals↗
PubMed2004

Dengue.

Explore the source record for details and available documents.

Animals↗
PubMed2003

Economic costs associated with inadequate drug prescribing: an exploratory study in Chiapas, Mexico.

An exploratory study assessing the economic consequences of inadequate prescribing by health-care providers was carried out in two cities of Chiapas State, South Mexico. Two research methods were used: (a) an exit survey with pharmacy users (1190 interviews) and (b) in-depth individual interviews with patients at hospital level (19 interviews). For comparative purposes, three tracer conditions were selected: acute respiratory infection (ARI), diarrhoeal disease (DD) and hypertension. The main findings were that doctors, drug vendors at pharmacies, traditional healers, users of health-care services themselves (through self-prescription) and other health staff are all sources of inadequate prescribing and impose a substantial economic burden of unnecessary cost on health-care users. In general, treatment costs were high compared with standard treatments, and prescriptions included a high proportion of non-essential drugs (50-64%). Additional costs to the standard treatment were particularly high when the prescription was by a medical doctor (US$ 3.57 per ARI prescription and US$ 8.37 for DD). Losses attributable to inadequate prescribing averaged US$ 47 per patient. The study concludes that training programmes on rational drug use aimed exclusively at medical doctors can only have a limited effect in reducing economic losses due to inadequate prescribing. Such efforts should be extended to other providers who are very active in prescribing drugs and providing health advice. The main challenge that the Mexican health system will be facing in the foreseeable future is not only to improve equity of access to essential drugs, but also to improve quality of drug advice and prescription and rational use of drugs by the population.

Adult↗
PubMed2002

Unit costs for house spraying and bednet impregnation with residual insecticides in Colombia: a management tool for the control of vector-borne disease.

A study of unit costs and cost components of two malaria-control strategies (house spraying and bednet impregnation with residual insecticides) was undertaken in 11 malaria-endemic states (departamentos) of Colombia, using data provided by control staff on self-administered questionnaires. The accuracy of the data was verified by personal visits, telephone conversations and complementary information from 10 other states. Allthe financial-cost components of the malaria-control operations carried out in the previous 6 months and the results of the control operations themselves (including the numbers of houses sprayed and numbers of bednets impregnated/day) were recorded. The information was stratified according to whether the target communities were 'near' or 'far away' from an operational base, the far-away communities being those that needed overnight stays by the control staff. The main variables analysed were unit costs/house treated, and annual cost/person protected. The results show that house spraying was generally more expensive for the health services than bednet impregnation. This is particularly the case in 'nearby' communities, where most of those at-risk live. In such communities, spraying one house was 7.2 times more expensive than impregnating one bednet. Even if only those sleeping under an impregnated net were assumed to be protected, the unit costs/person protected in a 'nearby' community were twice as high for house spraying than for bednet impregnation. In 'nearby' communities, where technicians could return to the operational base each evening, insecticides made up 80% of the total spraying costs and 42% of the costs of bednet impregnation. In 'far-away' communities, however, salaries and 'per diems' were the most important cost components, representing, respectively, 23% and 22% of the costs of spraying, and 34% plus 27% of the costs of impregnation. Insecticide wastage and non-use of discounts on insecticide prices (available through the national Ministry of Health) increased the overall costs considerably. The multiple uses of these cost calculations for district health managers are presented.

Animals↗
PubMed2001

Inadequate drug advice in the pharmacies of Guatemala and Mexico: the scale of the problem and explanatory factors.

A study of urban pharmacies in Guatemala and in Chiapas, southern Mexico, was undertaken to analyse the scale of the inadequate drug advice provided, and to identify the contributing factors. The estimate of the scale of the problem was based on the results of 969 approaches to 191 pharmacies by 'magic clients' (i.e. researchers pretending to be looking for treatment for relatives who had one of three 'tracer' diseases), interviews with 4469 pharmacy users as they left the same 191 pharmacies, and a comparison of the quality of advice offered by public and private pharmacies in Guatemala (based on exit interviews with 150 users). The contributing factors were explored using a provider survey (interviews with 166 pharmacy supervisors and 371 drug vendors), an in-depth study analysing large-chain and independent Mexican pharmacies, and a review of the national drug policies in both countries. Although only about 11% of all drug treatments were recommended in pharmacies (the rest being prescribed by physicians or recommended by kin-groups), this still represents large numbers of treatments. Overall, 501 individuals who visited the 191 study pharmacies over 2 days of observation received drugs recommended by pharmacy staff. Much of the pharmacy advice was revealed to be poor: > 80% of the treatments recommended to the 'magic clients' for diarrhoeal disease or acute respiratory infection included unnecessary or dangerous drugs. Few of those who worked in the pharmacies based their advice on careful case histories. Drug advice in pharmacies was much more likely to be of poor quality than that from physicians or even kin-groups. The factors behind this poor advice were identified as a lack of knowledge about standard treatments and legal regulations, incompetence among pharmacy staff, commercial pressures (particularly in the large-chain pharmacies of Mexico), and a failure to implement the existing regulations covering the drug market and its retail practices. It is recommended that: (1) pharmacy owners and drug vendors be made more aware that the selling of drugs should involve provision of healthcare (as well as reasonable profit-making); (2) existing drug-related legislation be reinforced (through consensus-building rather than coercion); and (3) mass training of pharmacy supervisors and drug vendors, in the standard treatment of common diseases, be undertaken. This process will be challenging and slow.

Clinical Competence↗
PubMed2001

Randomized, controlled, double-blind trial of topical treatment of cutaneous leishmaniasis with paromomycin plus methylbenzethonium chloride ointment in Guatemala.

A double-blind, randomized trial was undertaken in Guatemala to determine the therapeutic efficacy of an ointment for the treatment of cutaneous leishmaniasis that contained 15% paromomycin and 12% methylbenzethonium chloride and that was applied twice a day for 20 days. The treatment group included 35 patients, and the placebo group included 33 patients. The initial clinical response rate (13 weeks after completing the treatment) was 91.4% in the treatment group and 39.4% in the placebo group. The final clinical response rate at the 12-month follow-up examination was 85.7% (31 of 35) in the treatment group and 39.4% (13 of 33) in the placebo group (P < or = 0.001). In general, the treatment was well tolerated and was never interrupted because of adverse effects. The number of adverse effects reported in the placebo group was lower than in the treatment group (16 events versus 30 events). All adverse effects reported by patients disappeared within 1 week of completing the treatment. Our findings show that the combination of paromomycin with methylbenzethonium chloride for 20 days is a good alternative for antimonial treatments of cutaneous leishmaniasis in Guatemala.

Adolescent↗
PubMed2000

Cutaneous leishmaniasis in Guatemala: people's knowledge, concepts and practices.

Ten rural communities in the northern area of Guatemala where cutaneous leishmaniasis (CL) is endemic were investigated to determine the residents' knowledge of the disease, their related concepts and practices, and their treatment preferences, and to identify the communication channels they use to acquire information. Of 425 heads of household interviewed, 96.7% could accurately describe a typical CL lesion. CL was found to be the fourth most frequently mentioned disease (in studies based on a free list format) and to be considered the sixth most serious (in studies based on paired comparisons). A series of three-way comparisons, used to analyse the subjects' concepts about the similarities of various discases, indicated that CL was considered to be most closely related to skin problems and to be different from any other group of diseases. All interviewees believed that it was necessary to receive treatment for CL, because without treatment the disease would progress, reach the bone, and take years to heal. More than half (55%) of the respondents knew about meglumine antimonate (Glucantime), the most commonly prescribed drug for treating CL in Guatemala. Only a few communication channels that were used by respondents to receive information were identified; the use of radio broadcasts and direct communication via the community leaders appeared to be the most effective.

Adolescent↗
PubMed1999

Bednet impregnation for Chagas disease control: a new perspective.

BACKGROUND: To determine the efficacy and acceptability of deltamethrin-impregnated bednets in controlling Chagas disease in South America. METHODS: In three endemic departments of Colombia, a qualitative study on people's knowledge about Chagas disease, vectors, preventive measures and their willingness for collaboration in control operations was undertaken. Additionally, in an entomological study with 100 laboratory-bred Chagas vectors (Rhodnius prolixus), vectors were released for 5 nights (20 each night) in an experimental room, with the human bait protected for one night by an unimpregnated and for four nights by a deltamethrin-impregnated bednet (13 mg/m2). Vectors were stained with fluorescent powder for observation, collected after 10 h exposure in the experimental room and observed for a further 72 h. RESULTS: The study population did not know anything about Chagas disease, but believed the vector to transmit cutaneous leishmaniasis. Therefore willingness to take part in control operations was high. The experimental hut study showed a vector mortality rate of 95% in a room with impregnated nets and of 10% in a room with unimpregnated nets. CONCLUSION: This study opens a new perspective for Chagas disease control in integrated vector borne disease prevention programmes.

Animals↗
PubMed1998

Personality correlates of +/- pindolol induced decreases in prolactin.

The present study was conducted to investigate if personality traits can be usefully related to serotonergic vs. dopaminergic action of the 5-HT1a-antagonist +/- pindolol. Forty healthy male volunteers (aged between 20 and 30 years) were randomly assigned to a placebo or a +/- pindolol (30 mg, oral dose) group in a double blind trial. Blood samples were drawn and analyzed for PRL concentrations. In addition, the subjects completed questionnaires on personality. The results indicated that +/- pindolol decreases PRL concentrations depending on personality. While subjects high on impulsivity and related traits (aggression and disinhibition) show lower PRL decreases, well-being and personality traits frequently related to dopaminergic activity were not correlated with changes in PRL. Since reduced (blunted) PRL-responses after 5-HT challenge tests have been reported for impulsives, the present results favor the involvement of primarily serotonergic and probably only secondarily dopaminergic control of +/- pindolol induced PRL decreases.

Adrenergic beta-Antagonists↗
PubMed1997

Operational aspects of bednet impregnation for community-based malaria control in Nicaragua, Ecuador, Peru and Colombia.

Community intervention projects with pyrethroid (permethrin and lambdacyhalothrin) impregnated bednets and an accompanying community education programme were carried out in 6 malaria endemic areas on the Pacific coast of Nicaragua, Ecuador, Peru and Colombia as well as in the Peruvian Amazon basin. In this paper the operational aspects are analysed: bednet coverage, results of promotional activities for increased bednet use, the sale of low-cost bednets, techniques and difficulties with impregnation, acceptance of the programme (including washing of impregnated nets), side-effects, residual concentrations of the chemical in the nets, costs of the impregnation programme and insecticide resistance of the malaria vectors. We found that the local manufacture of bednets and their sale through village health workers, even in communities with low cash income, is a viable way of increasing bednet coverage; the impregnation of bednets is well accepted if villagers perceive a direct benefit; pretesting of the soaking capacity of different net materials should be done at central level; the instructions for the impregnation procedures of different net materials (cotton and synthetic) should be simple and unambiguous; very cheap thin net materials should be avoided, particularly in the case of lambdacyhalothrin impregnation; educational methods and/or promotion of dark-colour nets should be further tested in order to decrease the washing frequency of bednets at household level; in areas with early-biting mosquitoes further studies on the protective efficacy of bednets are necessary; careful monitoring of side-effects, particularly those of last-generation pyrethroids, is necessary; and the community-based impregnation programme is a powerful tool for strengthening community involvement in health actions.

Bedding and Linens↗
PubMed1997

The contribution of repellent soap to malaria control.

A study about the acceptability, protective efficacy, effectiveness, and cost of a repellent soap containing 20% diethyltoluamide and 0.5% permethrin was carried out on the Pacific coast of Ecuador and Peru, where malaria is endemic and the transmission is seasonal. The malaria vectors were Anopheles albimanus, An. punctimacula, and An. pseudopunctipennis in Ecuador and An. albimanus in Peru. Comparing the hourly mosquito bites on human subjects with and without the protection of the repellent soap, it showed that inactive, protected subjects were bitten 94.2% less than unprotected controls 2 hr after application of the soap. This protective efficacy was reduced to 81% after 6 hr. In persons physically active for 3 hr after application, the efficacy of the soap was 67% in the fourth hour after application and 52% in the sixth hour after application. Sweating decreased the protective efficacy of the soap even more. In a community-based malaria control program, the soap was introduced by community health promoters. Acceptance was good when it was given free of charge but reduced dramatically when it was sold. People used the soap mainly because of the nuisance of mosquitoes. The application was generally done correctly. However, no significant impact on the incidence of malaria episodes could be shown when comparing intervention communities with control communities, either in Ecuador, where the proportion of Plasmodium falciparum cases was high, or in Peru, where P. vivax was the only species of Plasmodium seen. This can probably be explained by the limited use of soap and the shift of mosquito bites from users to nonusers of the repellent soap. The cost of a soap program would be $4.60 (USA) per person per year, which seems to be quite high in terms of cost of soap and its distribution related to people's low cash income. The implications of the introduction of repellent soap into a control program are discussed.

Animals↗
PubMed1996

Health education for community-based malaria control: an intervention study in Ecuador, Colombia and Nicaragua.

A malaria study was undertaken in 98 rural communities of the Pacific coast of Ecuador (n = 14), Colombia (n = 22) and Nicaragua (n = 62). In-depth interviews on people's knowledge and practice regarding malaria aetiology, symptoms and treatment were conducted and complemented by formal household interviews. On the basis of this information, an educational programme was set up which included the training of village health promoters and community workshops organized by the health workers and used a set of methods of interactive learning. After the baseline survey the communities were paired and randomly allocated to the intervention and control groups. Malaria education took place only in the intervention communities. At the start of the project people's knowledge about malaria-transmitting mosquitoes and malaria symptoms was correct and widespread in those areas where the community exposure to formal health services was pronounced. However, knowledge of the recommended dose of chloroquine was poor everywhere, and self-treatment of malaria episodes deficient. The educational intervention achieved a high level of participant satisfaction which was expressed in a high and continuous attendance rate at the monthly workshops. The knowledge of malaria aetiology and symptoms was 33-61% better in the intervention group than in the control group. Knowledge of the recommended doses of chloroquine increased significantly (34% in Ecuador, 93% in Colombia but not in Nicaragua) and correct use of chloroquine in the treatment of malaria episodes also improved (26% in Ecuador, 85% in Colombia). In Nicaragua the results were less satisfactory due to the short period of promotional activities and the health services' policy of delivering only supervised treatment to the population. It is concluded that health education should play a major role in malaria control.

Colombia↗
PubMed1995

The potential for malaria control with the biological larvicide Bacillus thuringiensis israelensis (Bti) in Peru and Ecuador.

A study on the efficacy of Bti spraying in mosquito breeding places was undertaken in the Pacific coast of Peru and Ecuador and in the Amazon area of Peru. It was shown that Bti is a powerful larvicide for Anopheles larvae, although it sinks quickly, whereas Anopheles larvae feed at the water surface. The duration of its effect was less than 7 days with the exception of the Amazon area of Peru, where it was approximately 10 days. In two study areas, Bti was sprayed weekly over periods of 10 and 7 weeks, respectively, and the adult mosquito densities were monitored. The Anopheles adult density (bites per person per hour on human baits) was reduced by an average of 70% in one area and by up to 50% in the other. This means that Bti spraying can potentially be an important component of a modified malaria control strategy.

Animals↗