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D Engels

Publications and source records attributed to D Engels.

At least 37 records · Page 2Linked to original sources
PubMed1996

Day-to-day egg count fluctuation in Schistosoma mansoni infection and its operational implications.

In a study group of 183 people in a Schistosoma mansoni-endemic area in Burundi, stool examinations were performed with duplicate 25-mg Kato-Katz slides on seven occasions (days 1, 3, 5, 8, 10, 32, and 37). Point prevalences detected by single examinations of 25 mg and 50 mg of stool varied from 41.0% to 57.9% and from 55.7% to 63.9%, respectively. The cumulative prevalence for all seven measurements was 82.0%. The individual day-to-day variation in egg output was important. The majority of infections missed by the examination of single slides and specimens were light ones. The Kato-Katz method applied on a single stool specimen is more suitable for morbidity control, but less suitable for control of infection. When a precise quantitative diagnosis on the individual level is required, several measurements on different days are necessary. The data presented validate recently developed statistical models and charts predicting true prevalences.

Adolescent↗
PubMed1996

Fluctuation of schistosome circulating antigen levels in urine of individuals with Schistosoma mansoni infection in Burundi.

We studied the fluctuations of schistosome circulating antigens in urine as compared with fecal egg counts in 60 Burundese individuals infected with Schistosoma mansoni. Levels of circulating anodic antigen (CAA) and circulating cathodic antigen (CCA) in the urine were determined by quantitative enzyme-linked immunosorbent assays. Fecal samples were simultaneously collected and examined with duplicate Kato-Katz slides. Significant correlations were consistently found between circulating antigen levels in urine and fecal egg counts. Although both antigen levels and egg output fluctuated, there was less fluctuation of CCA levels in urine than of fecal egg counts. All individuals had CCA in at least one urine sample and 82% were at least once positive for egg counts. Positive CCA levels were found in at least one urine sample in 75% of all individuals, but levels were low. Our results show that detection of CCA in urine is a sensitive, quantitative, and reliable method for noninvasive diagnosis and screening of S. mansoni infections, due to the relatively low fluctuations.

Adolescent↗
PubMed1995

Epidemic dysentery caused by Shigella dysenteriae type 1: a sentinel site surveillance of antimicrobial resistance patterns in Burundi.

Annual epidemics of bacillary dysentery have been a public health problem in Burundi for the last 14 years. Recent civil unrest, resulting in the displacement of large numbers of people into refugee settlements, has aggravated the situation. We report the results of a nationwide, health-centre based, sentinel site survey to check the drug resistance of Shigella dysenteriae type 1 (Sd1), the causal organism of such epidemics. Shigella spp. (of which 97% were Sd1) were isolated from 73% of the 126 specimens collected from six main sites around the country. There was no difference in culture results from fresh and frozen stool specimens. Overall Sd1 resistance to commonly available antibiotics (sulfamethoxazole + trimethoprim, ampicillin, tetracycline, and chloramphenicol) varied from 77% to 99% and was fairly uniformly distributed over the country. All Sd1 isolates were susceptible to newer drugs, such as ciprofloxacin and ceftriaxone. Resistance to nalidixic acid, the current first line of treatment for bacillary dysentery in Burundi, varied from 8% to 83% in the different sentinel sites; global resistance was 57%.

Anti-Infective Agents↗
PubMed1994

Control of Schistosoma mansoni and intestinal helminths: 8-year follow-up of an urban school programme in Bujumbura, Burundi.

Annual selective chemotherapy with praziquantel was implemented in primary schools in the endemic suburbs of Bujumbura from 1984 to 1992. During the first 6-year period, the overall prevalence among pupils decreased from 23.3% to 9.1%, a reduction of 61%. During the following 2-year period, in which only children from the 1st, 4th and 6th grade were examined in two of the four endemic suburbs (maintenance strategy), the prevalence decreased further to 6.4% or a 73% reduction from the beginning of the programme. The impact of annually repeated selective chemotherapy was more important on the intensity than on the prevalence of infection. It was also more pronounced in the senior grades of primary school. Its cumulative effect tended to decline over the years. The prevalence of infection in new entrants to the programme also decreased over the years, indicating a reduction of transmission. This change in transmission was different in each suburb and related to changes in the sanitary situation, the degree of urbanization and the accessibility to rural transmission sites. The results of helminth control, a secondary aspect of the school programme, were proportionately less pronounced than those obtained for schistosomiasis. The improvement in hygienic conditions has also contributed much to the outcome of this latter type of control. The cost, per person protected, of the programme was comparable with what has been reported by other, similar programmes. Application of a maintenance strategy to 57% of the target population has reduced the cost by 40%.

Adolescent↗
PubMed1994

Impact of repeated community-based selective chemotherapy on morbidity due to schistosomiasis mansoni.

The impact of repeated chemotherapy on morbidity due to schistosomiasis mansoni was evaluated in Gihungwe (initial prevalence 58%) and Buhandagaza/Kizina (33%), two village clusters in Burundi. Surveys were carried out with reference to the first treatment (month 0) at months -6, -3, 0, 3, 6, 9, 12, 24, and 36. Praziquantel (40 mg/kg) was given at months 0, 12, 24, and 36 to those showing eggs in the feces with a single 28-mg Kato slide. At each survey, duplicate Kato smears were examined, and all participants responded to a standardized medical history interview and underwent a clinical examination. In the three preintervention surveys, spleen and liver rates remained stable at the community and the individual level. The frequencies of diarrhea and abdominal pain varied to some extent, but they were consistently higher in the most heavily infected villages and age groups and remained relatively stable at the individual level. At the final survey, the prevalence of infection had decreased to 25%, and the frequency of diarrhea from 19-26% to 10% in both village clusters. This impact was strongest in the younger age groups. The frequency of abdominal pain was reduced only at the short term and in selected age groups. Organomegaly decreased only to a limited extent in those treated, and increased in those not treated, possibly due to the impact of malaria. The net result was that no measurable impact of the treatments on organomegaly at the community level could be demonstrated. In the light of these results, the relevance of community-based chemotherapy in moderate foci is questioned.

Abdominal Pain↗
PubMed1993

[Medical and occupational rehabilitation of psychiatric patients. Results of concomitant research of rehabilitation facilities for psychiatric and handicapped patients].

The Rehabilitation facilities for mentally ill and disabled (RPK) are designed to enable clients with chronic mental illness to (re)acquire the skills needed for their reintegration in occupational and/or social respects. The peculiar feature of the RPKs is their holistic approach integrating medical-psychiatric care, vocational preparation and training services, as well as sociotherapeutic measures. Accompanying research findings clearly prove that, once they have gained a firm foothold in the RPK, the great majority of the rehabilitees will achieve successful and lasting rehabilitation. The medical phase is completed by some two thirds of the clients admitted. Drop-out usually occurs in the initial three months period. The medical phase is followed by medical-vocational services in approx. 60% of the rehabilitees, and the majority of these achieve successful reintegration, with a drop-out rate of 15-20% in this phase clearly below the rate during the medical service provision phase. RPKs operating along a cooperative model have proven their worth within a dense service provider network, while the advantages of the integrative model lie in its concentration of services under one roof. Recommendations given in particular pertain to simplification of admission procedures and to ensuring follow-up services after programme completion.

Adult↗
PubMed1993

Schistosomiasis mansoni in Burundi: progress in its control since 1985.

Described is the evolution of the schistosomiasis control programme in Burundi since 1985. A single round of selective population chemotherapy was carried out in the Rusizi Plain and the Bugesera focus from 1985 to 1990. The prevalences and intensities of infection as well as the number of symptomatic cases detected in general health services decreased considerably. Annual sample surveys in the treated areas showed, however, that these improvements were rapidly reversed by reinfection of the demographically changing population. Since repeated selective population chemotherapy was not sustainable in the long term, a primary health care approach was adopted. In areas with good access to basic health services, approximately 10% of all schistosomiasis cases now receive treatment annually through this approach. Yearly selective chemotherapy in primary schools in suburban Bujumbura reduced the prevalence of schistosomal infection among pupils from 23% to 9% over the period 1984-90, and this programme has now been extended to highly endemic areas in Imbo-Sud. Focal snail control produced disappointing results, and emphasis has therefore shifted towards health education and environmental control of transmission.

Adolescent↗
PubMed1992

Experiences with the control of schistosomiasis mansoni in two foci in central Africa.

Experiences with population-based chemotherapy and other methods for the control of schistosomiasis mansoni in two subsaharan foci are described. In the forest area of Maniema (Zaire), intense transmission of Schistosoma mansoni, high prevalences and intensities of infection, and important morbidity have been documented. Taking into account the limited financial means and the poor logistic conditions, the control strategy has been based mainly on targeted chemotherapy of heavily infected people (> 600 epg). After ten years of intervention, prevalences and intensities have hardly been affected, but the initial severe hepatosplenic morbidity has almost disappeared. In Burundi, a national research and control programme has been initiated in 1982. Prevalences, intensities and morbidity were moderate, transmission was focal and erratic in time and space. A more structural control strategy was developed, based on screening and selective therapy, health education, sanitation and domestic water supply. Prevalences and intensities have been considerably reduced, though the results show focal and unpredictable variations. Transmission and reinfection were not significantly affected by chemotherapy alone, and the eventual outcome of repeated selective treatment appears to be limited by the sensitivity of the screening method. Intestinal morbidity was strongly reduced by community-based selective treatment, but hepatosplenic enlargement was hardly affected; this is possibly due to the confounding impact of increasing malaria morbidity. The experiences show the importance of local structures and conditions for the development of an adapted control strategy. It is further concluded that population-based chemotherapy is a highly valid tool for the rapid control of morbidity, but should in most operational conditions not be considered as a tool for transmission control.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Repeated community-based chemotherapy for the control of Schistosoma mansoni: effect of screening and selective treatment on prevalences and intensities of infection.

The impact of repeated selective chemotherapy on prevalences and intensities of infection with Schistosoma mansoni was evaluated in Gihungwe Transversals 1 and 2 (initial prevalence 60%) and Buhandagaza/Kizina (initial prevalence 35%), two village clusters in Burundi. Surveys were carried out at months -6, -3, 0, 3, 6, 9, 12, 24, and 36, with reference to the first intervention; treatment with praziquantel (40 mg/kg) was given at months 0, 12, 24, and 36 to subjects showing parasite eggs on a single 28-mg Kato slide. A second slide was examined for monitoring purposes only. Over the pre-intervention period, the overall prevalences and intensities remained relatively stable, but important increases were observed in specific groups. The cure rate three months after the first treatment in those treated was 73% (Gihungwe) and 83% (Buhandagaza/Kizina), but the prevalence at the community level was reduced only by 50% and 46%, respectively. Fifty-six percent and 79%, respectively, of the remaining positive cases had not been treated, largely because they were (falsely) negative at the screening. Reinfection occurred mainly in Gihungwe and in younger age groups. One year after the second treatment, prevalences and intensities were further reduced in Gihungwe only; one year after the third treatment prevalences were not reduced further in either village group. The final prevalence of infection was approximately 25%, with infections with an intensity of over 100 eggs per gram of feces approximately 5%, in all four villages. Over 80% of the remaining cases had not been treated at the previous intervention; the sensitivity of the screening method appears to be a major determinant of the outcome of repeated selective treatment.

Adolescent↗
PubMed1987

Treatment of gram-positive peritonitis with two intraperitoneal doses of vancomycin in continuous ambulatory peritoneal dialysis patients.

Eight patients with end-stage renal failure on continuous ambulatory peritoneal dialysis (CAPD), who developed peritonitis, received an intraperitoneal dose of vancomycin (30 mg/kg body weight) with 6 h of peritoneal dwell and then resumed their routine CAPD schedule. Vancomycin concentration in serum, peritoneal dialysate (PD) from an overnight dwell and 1, 2 and 3 h after a new exchange was measured at 48 h (in 5 patients) and 7 days (in 6 patients). Except for an occasional 1-hour peritoneal fluid sample on the 7th day, all samples had satisfactory vancomycin levels. Five of the 8 patients who had gram-positive peritonitis and 1 with 'sterile' peritonitis received another similar intraperitoneal dose of vancomycin at the 7th day. All of these patients had good therapeutic response with a negative PD culture 3 weeks after the cessation of therapy and no relapse of infection in at least 1 month of follow-up. We conclude that 2 intraperitoneal doses of vancomycin (30 mg/kg body weight) given 1 week apart with 6 h of intraperitoneal dwell is an effective and adequate treatment for gram-positive and 'sterile' peritonitis in CAPD patients.

Bacterial Infections↗
PubMedDate not supplied

Field test of the 'dose pole' for praziquantel in Zanzibar.

A graduated pole for height measurement, estimating the number of praziquantel tablets needed for treatment, was field-tested on 1289 children in Zanzibar. A bathroom-type scale performed better than the dose pole in delivering the optimal dose (40-60 mg/kg) and the 2 methods performed similarly in delivering a dose considered appropriate (30-60 mg/kg).

Anthelmintics↗
PubMedDate not supplied

Comparison of the direct faecal smear and two thick smear techniques for the diagnosis of intestinal parasitic infections.

Among 547 health centre patients in Burundi, the diagnostic performance of a glass coverslip modification of the Kato thick smear technique was compared with the combination of direct slide examination and the quick Kato-Katz method, currently recommended in basic health services, for the diagnosis of intestinal parasitic infections. The classical Kato-Katz method performed best for the diagnosis of common helminth infections, especially in combination with direct examination. For the diagnosis of protozoa, both trophozoites and cysts, the direct slide examination was superior to the glass coverslip technique. Despite its being a single and easy procedure, the glass coverslip technique could not be recommended as the method of choice for the diagnosis of intestinal parasites in basic health services.

Feces↗