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Biomedical subjects

C C Campbell

Publications and source records attributed to C C Campbell.

At least 19 recordsLinked to original sources
PubMed1995

Malaria surveillance--United States, 1992.

PROBLEM/CONDITION: Malaria is caused by one of four species of Plasmodium (i.e., P. falciparum, P. vivax, P. ovale, or P. malariae) and is transmitted by the bite of an infective female Anopheles sp. mosquito. Most malaria cases in the United States occur among persons who have traveled to areas that have ongoing transmission. However, cases are transmitted occasionally through exposure to infected blood products, by congenital transmission, or by local mosquito-borne transmission. Malaria surveillance is conducted to identify episodes of local transmission and to guide prevention recommendations. REPORTING PERIOD COVERED: Cases with onset of illness during 1992. DESCRIPTION OF SYSTEM: Malaria cases were identified at the local level (i.e., by healthcare providers or through laboratory-based surveillance). All suspected cases were confirmed by slide diagnosis and then reported to the respective state health department and to CDC. RESULTS: CDC received reports of 910 cases of malaria that had onset of symptoms during 1992 among persons in the United States and its territories. In comparison, 1,046 cases were reported for 1991, representing a decrease of 13% in 1992. P. vivax, P. falciparum, P. malariae, and P. ovale were identified in 51%, 33%, 4%, and 3% of cases, respectively. The species was not identified in the remaining 9% of cases. The number of reported malaria cases that had been acquired in Africa by U.S. civilians decreased 38%, primarily because the number of P. falciparum cases declined. Of U.S. civilians whose illnesses were diagnosed as malaria, 81% had not taken a chemoprophylactic regimen recommended by CDC. Seven patients had acquired their infections in the United States. Seven deaths were attributed to malaria. INTERPRETATION: The decrease in the number of P. falciparum cases in U.S. civilians could have resulted from a change in travel patterns, reporting errors, or increased use of more effective chemoprophylaxis regimens. ACTIONS TAKEN: Additional information was obtained concerning the seven fatal cases and the seven cases acquired in the United States. Malaria prevention guidelines were updated and disseminated to health-care providers. Persons traveling to a malaria-endemic area should take the recommended chemoprophylaxis regimen and use personal protection measures to prevent mosquito bites. Any person who has been to a malarious area and who subsequently develops a fever or influenza-like symptoms should seek medical care, which should include a blood smear for malaria. The disease can be fatal if not diagnosed and treated at an early stage of infection. Recommendations concerning prevention and treatment of malaria can be obtained from CDC.

Female↗
PubMed1995

Mosquito-transmitted malaria in New York City, 1993.

In August, 1993, 3 cases of Plasmodium falciparum malaria in people without recent travel histories or bloodborne exposure were reported in New York City. An epidemiological investigation confirmed the absence of risk factors for acquisition of malaria in two cases. The third case could not be definitively classified as locally acquired malaria because the patient had travelled to Thailand two years before malaria was diagnosed. The 3 individuals lived in separate houses in the same neighbourhood of Queens, New York and had onset of illness within a day of each other. The investigation consisted of patient interviews, active case finding, reviewing recent New York flight and shipping arrivals, and an entomological survey for anopheline mosquitoes and breeding sites. No other cases were identified. The 3 patients lived several miles from air and sea ports and prevailing winds would have carried any mosquitoes at those sites away from the patient's homes. By the time of the environmental investigation (September, 1993), the area was dry and neither adult nor larval anophelines were found. However, weather conditions at the probable time of infection (July, 1993) were very different. Malaria was probably transmitted to these 2 patients by local anopheline mosquitoes that had fed on infected human hosts. Mosquito-control measures were not implemented because there was no evidence of ongoing transmission. The occurrence of mosquito-transmitted malaria in New York City demonstrates the potential for reintroduction of malaria transmission into areas that are no longer endemic and emphasises the need for continued surveillance and prompt investigations, if cases without risk factors are reported.

Adult↗
PubMed1995

Malaria in east African refugees resettling to the United States: development of strategies to reduce the risk of imported malaria.

Resettlement to the United States of malaria-infected refugees can pose problems for both the refugees and their resettlement communities. To formulate malaria management strategies for East African refugees before resettlement to the United States, epidemiologic data were reviewed and malaria prevalence surveys were conducted among refugees awaiting resettlement in Mombasa, Kenya, and Khartoum, Sudan, in 1993. Overall, 279 Somali (Mombasa) and 127 Ethiopian (Khartoum) refugees were surveyed. Malaria contributed significantly to morbidity in Mombasa: 15% (43/279) of Somalis were parasitemic; 39 infections (91%) were due to Plasmodium falciparum. Sulfadoxine-pyrimethamine was effective treatment. In Khartoum, only 0.8% (1/127) were parasitemic; recent fever or antimalarial use were uncommon. Presumptive sulfadoxine-pyrimethamine treatment before departure was recommended for all resettling refugees from Mombasa; in Khartoum, individual assessment of febrile illness was recommended. Prevention of malaria parasitemia by mass drug administration or individual therapy can minimize the burden of malarial illness to refugees and their resettlement communities.

Africa, Eastern↗
PubMed1995

Self-treatment of malaria in a rural area of western Kenya.

Reported are the results of a study of residents' knowledge about malaria and antimalarial drugs and of their treatment-seeking behaviour in a rural area of western Kenya. The study subjects were generally well-informed about the symptoms of the disease. Malaria was perceived as a relatively mild illness, much less severe than acquired immunodeficiency syndrome (AIDS), measles, difficulty in breathing, and diarrhoea. Self-treatment was extremely common: of 138 episodes of febrile illness, 60% were treated at home with herbal remedies or medicines purchased at local shops, and only 18% received treatment at a health centre or hospital; no treatment was sought by the remainder. Commercially available chloroquine preparations were perceived as more effective than either antipyretics or herbal remedies for the treatment of malaria, and injections were regarded as more effective than oral medications. 4-Amino-quinolines were used to treat 58% of febrile illnesses but in only 12% of the cases was a curative dose of > or = 25 mg/kg body weight employed. Even attendance at a health centre did not ensure adequate treatment because of the common practice of sharing medication among family members. Greatly increased attention should be paid to the role of home treatment of malaria when policies are being developed for the management of febrile illnesses in sub-Saharan Africa.

Adolescent↗
PubMed1992

Usefulness of clinical case-definitions in guiding therapy for African children with malaria or pneumonia.

The World Health Organisation has developed disease-specific clinical case-definitions to guide management of children with fever or cough, the cardinal signs of malaria and pneumonia. To assess the usefulness of the case-definitions and to investigate their interaction, we studied children with fever or cough brought to a hospital in Lilongwe, Malawi. For all children, a thick blood smear was examined for Plasmodium falciparum parasites. Chest radiography was done only for children with parasitaemia and those who satisfied the clinical case-definition for pneumonia; others were assumed to have normal chest radiographs. Of 1599 enrolled children, 566 (35%) had parasitaemia and 116 had radiographic evidence of pneumonia; 43 had both pneumonia and parasitaemia. Of the 471 children who met the clinical definition for pneumonia, 449 (95%) also met the malaria clinical definition. Among children with radiographic evidence of pneumonia, the clinical definition for malaria was not predictive of parasitaemia (sensitivity 93%, specificity 5%). Whether malaria parasitaemia was present or absent, the pneumonia clinical definition distinguished children with and without radiographic evidence of pneumonia (sensitivity and specificity > 60%). Children who satisfied the pneumonia clinical definition were more likely to have radiographic evidence of pneumonia (odds ratio 10.4, 95% confidence interval 5.2-20.7), parasitaemia (1.6, 1.2-2.2), or both at the same time (4.2, 2.1-8.4) than were children who did not meet the definition. Children who satisfy the malaria and pneumonia clinical definitions need treatment for both disorders. Scarce diagnostic methods, especially microscopy, are needed for more specific treatment of children with fever and cough.

Algorithms↗
PubMed1992

Effect of blood transfusion on survival among children in a Kenyan hospital.

In Africa, blood transfusions are frequently given to treat severe paediatric anaemia. Because of the risk of HIV transmission, identification of when transfusion will reduce the risk of death for severely anaemic children has become increasingly important. For all children admitted to a Kenyan hospital from October, 1989, to October, 1990, we collected data on clinical presentation, haemoglobin (Hb), receipt of transfusion, and in-hospital survival. Of 2433 admissions, 29% (684) had severe anaemia (Hb less than 5.0 g/dl), and 20% (483) received blood transfusions. Based on laboratory criteria only, children with Hb less than 3.9 g/dl who were transfused had lower mortality than those with Hb less than 3.9 g/dl who were not transfused, but this finding applied only to children transfused on the day of admission (odds ratio [OR] 0.30; 95% Cl 0.14, 0.61) or the day after admission (OR 0.37; 95% Cl 0.14, 1.00). Based on a combination of laboratory and clinical criteria, children with clinical signs of respiratory distress and Hb less than 4.7 g/dl who were transfused had lower morality than those who were not (OR 0.19; 95% Cl 0.09, 0.41). Among children without respiratory distress, there was no association between receipt of transfusion and mortality, irrespective of admission Hb. The frequency of blood transfusion can be reduced and survival enhanced by targeting blood to those children with severe anaemia and clinical signs of respiratory distress, and by using transfusion early in the course of hospitalisation.

Anemia↗
PubMed1992

Malaria and pregnancy in Cameroonian women. Effect of pregnancy on Plasmodium falciparum parasitemia and the response to chloroquine.

The interaction between malaria and pregnancy was investigated in an epidemiologic study conducted in Mfou, a rural community in Cameroon. The study consisted of both cross-sectional and longitudinal analyses involving 225 pregnant women and 75 nonpregnant controls. Information was obtained by a standardized questionnaire to determine the pattern of antimalarial drug use. The parasitologic response to chloroquine was also determined. A dosage of chloroquine base (25 mg/kg of body weight) was given to women over a 3-day period, followed by 5 mg/kg doses administered weekly for 4 weeks. The results showed that Plasmodium falciparum infections occurred more frequently in pregnant (45%) than in nonpregnant (31%) women in terms of parasite rates (p = 0.03) and density (p less than 0.003), especially in primigravidae as compared with multigravidae matched for parity and age. Levels of parasitemia were also higher in the second trimester than in the first trimester of pregnancy (p less than 0.01). Failure to clear parasitemia after a chloroquine regimen was more frequent in pregnant than in nonpregnant women (p less than 0.01), particularly in primigravidae. Higher parasitemia and a lower parasitologic response to chloroquine in pregnant women, especially in primigravidae, suggest a relatively low level of clinical immunity and emphasize the need to target this group of women for malaria control strategies.

Cameroon↗
PubMed1992

Excision of the radial head for congenital dislocation.

Eight elbows in six patients who had had excision of the radial head for congenital dislocation were evaluated an average of seven years postoperatively. The average age of the patients at the time of the excision was thirteen years (range, ten to 15.5 years). The dislocation was posterior in five elbows and posterolateral in three. The over-all increase in the arc of flexion-extension postoperatively compared with preoperatively was 11 degrees (p greater than 0.1): The over-all increase in the arc of rotation was significant at 53 degrees (p less than 0.002). Pain in the elbow had decreased compared with preoperatively, but all patients had minor pain in the wrist. The result was rated good in five elbows, fair in two, and poor in one. One patient had a repeat excision of the radial head after it re-formed, and this was the reason for the poor result. All patients were satisfied with the outcome of the operation. Contrary to previously published data, excision of the radial head for congenital dislocation resulted in an increased range of motion and a decrease in pain in the elbow in our patients.

Adolescent↗
PubMed1991

Co-trimoxazole for childhood febrile illness in malaria-endemic regions.

The efficacy of co-trimoxazole for the treatment of Plasmodium falciparum parasitaemia in children younger than 5 years of age was evaluated in Malawi. 46 children with P falciparum parasitaemia, 37% of whom also met clinical criteria for a diagnosis of acute lower respiratory tract infection, were treated with 20 mg/kg co-trimoxazole twice daily for five days. Parasitaemia (mean clearance time 2.7 days) and symptoms were rapidly abolished and improvement was maintained during follow-up for 14 days. Co-trimoxazole may be an effective single treatment for febrile illness in young children in areas where malaria is endemic, resources are few, and diagnosis must rely on clinical findings alone.

Acute Disease↗
PubMed1991

Effectiveness and tolerance of long-term malaria prophylaxis with mefloquine. Need for a better dosing regimen.

To measure the effectiveness and tolerance of long-term malaria prophylaxis with mefloquine, the incidence of Plasmodium falciparum malaria and of adverse reactions was compared in Peace Corps volunteers in West Africa who took mefloquine every 2 weeks and in volunteers who took chloroquine phosphate weekly. Mefloquine was only 63% more effective than chloroquine; the monthly incidence of P falciparum infections was one case per 100 volunteers who took mefloquine and 2.7 cases per 100 volunteers who took chloroquine. Using daily proguanil (chloroguanide) hydrochloride in addition to chloroquine did not provide additional protection. All mefloquine prophylaxis failures occurred during the second week of the every-2-weeks dosing regimen in volunteers who had used mefloquine for more than 2 months. Blood concentrations of mefloquine were lower during the second week of the alternate-week regimen than during the first week, suggesting that blood levels are too low during the second week to suppress parasitemia. No serious adverse reactions were observed. The results indicate that a dosing regimen of 250 mg of mefloquine weekly should be considered for travelers to areas with chloroquine-resistant P falciparum malaria.

Adult↗
PubMed1991

Imported Plasmodium falciparum malaria in American travelers to Africa. Implications for prevention strategies.

Data from the US National Malaria Surveillance System were analyzed to assess characteristics of travelers who acquired Plasmodium falciparum infections in Africa and evaluate the impact of chloroquine resistance on the incidence of imported malaria. Although the number of cases acquired in East Africa has stabilized, the number of imported P falciparum infections acquired in West Africa increased threefold from 1985 to 1988, and the proportion of travelers who reported failure of chloroquine prophylaxis increased from 10% to 48%. Fifty-eight percent of patients who acquired malaria in West Africa had not used chemoprophylaxis. To curb the rising incidence of P falciparum infections in American travelers, the Centers for Disease Control revised malaria prophylaxis recommendations to include the use of mefloquine in areas of chloroquine resistance. Use of malaria protection measures by travelers to West Africa must also be improved.

Africa, Eastern↗
PubMed1991

Food insecurity: a nutritional outcome or a predictor variable?

The phenomenon loosely labeled hunger in the 1980s is now being discussed as food security or insecurity. Food security is defined as access by all people at all times to enough food for an active, healthy life, and at a minimum includes the following: 1) the ready availability of nutritionally adequate and safe foods and 2) the assured ability to acquire personally acceptable foods in a socially acceptable way. Food insecurity exists whenever food security is limited or uncertain. The measurement of food insecurity at the household or individual level involves the measurement of those quantitative, qualitative, psychological and social or normative constructs that are central to the experience of food insecurity, qualified by their involuntariness and periodicity. Risk factors for food insecurity include any factors that affect household resources and the proportion of those resources available for food acquisition. Potential consequences of food insecurity include hunger, malnutrition and (either directly or indirectly) negative effects on health and quality of life. The precise relationships between food insecurity and its risk factors and potential consequences need much more research now that there is an emerging consensus on the definition and measurement of food insecurity. Indicators of food security or insecurity are proposed as a necessary component of the core measures of the nutritional state of individuals, communities or nations.

Anxiety↗
PubMed1990

In vivo efficacy of quinine treatment for Plasmodium falciparum malaria in Malawian children.

Twenty-five Malwaian children with Plasmodium falciparum infection were studied for response to quinine in an eight-hourly dosage of 10 mg salt kg-1 body weight. The mean parasite clearance time, defined as the time after initiation of treatment when the first of two consecutive 12-hourly smears was negative for P. falciparum parasites, was 67 hours. The mean fever clearance time, defined as the time after initiation of treatment when the axillary temperature first fell below 37.5 degrees C and remained below this level for 48 hours, was 36 hours. Twenty-four hours after the first dose of quinine, the geometric mean parasite density among the children studied had decreased by 84%, from 41 357-6586 parasites mm-3, and all children cleared their parasitaemia within 108 hours. Results of this study confirm that quinine remains effective in rapidly controlling P. falciparum parasitaemias in Malawi, where resistance to the 4-aminoquinolines is highly prevalent.

Administration, Oral↗
PubMed1990

Development of indicators to assess hunger.

Despite widespread concern about hunger in America, efforts to monitor and assess the extent of hunger have been hampered by lack of consensus on an appropriate meaning for the term hunger and by the lack of valid indicators to assess it. The first phase of the research used qualitative methods to derive a socially-appropriate definition of hunger. Thirty-two women in Upstate New York were interviewed regarding their experience with food problems and hunger. The interviews were analyzed using the constant comparative method. Results indicated that women had a narrow and a broad concept of hunger. The narrow concept focused on going without food for a specified period of time and the physical sensation of hunger. The broad one included two dimensions: household and individual hunger. Each had quantitative, qualitative, psychological, and social components. The second phase of the research used survey methodology to examine the validity and reliability of items designed to measure the conceptual definition of hunger. The survey was administered to 189 women in Upstate New York who participated in programs designed for low-income households or households in need of food. The second phase confirmed the conceptualization of hunger developed in the first phase. A subset of valid and reliable items that represented each of the major dimensions and components of hunger was identified as being useful for monitoring and assessing hunger.

Adult↗
PubMed1990

Transmission of Plasmodium vivax malaria in San Diego County, California, 1986.

Between 18 June and 20 September 1986, 28 cases of Plasmodium vivax malaria were documented in Carlsbad, California, a coastal town north of San Diego. Malaria occurred in 1 local resident who had no risk factors, a second local resident who had traveled to a malarious area 9 months earlier, and 26 Mexican migrant workers (MWs). Among the 28 cases, 27 lived in a square mile marshy area where Anopheles hermsi, a newly described American species of the Anopheles maculipennis group, was known to be breeding. An investigation of MWs residing in the affected area was done to determine the extent of the outbreak and to identify risk factors for acquiring malaria. We interviewed and drew blood from 304 healthy MWs and 17 (65%) of the MWs with malaria. Fluorescent antibody titers to P. vivax greater than or equal to 1:256 occurred in 14 (82%) of the 17 MWs with malaria tested and 9 (3%) of the healthy MWs. The principal risk factor identified for contracting malaria was sleeping outside on a hillside adjacent to the marshy area. Malaria in a local resident with no malaria risk factors and the clustering in time and place of 26 cases suggest that P. vivax malaria was introduced and local transmission was sustained through several generations, producing the largest outbreak of introduced malaria in the United States since 1952.

Adolescent↗