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Biomedical subjects

H J Diesfeld

Publications and source records attributed to H J Diesfeld.

At least 19 recordsLinked to original sources
PubMed1991

Estimating the direct and indirect economic costs of malaria in a rural district of Burkina Faso.

Comprehensive estimates of the direct economic costs of malaria should include not only the costs of care at established health facilities, but also other expenditures, such as travel and out-of-pocket costs of drugs. They should include all episodes of illness, whether or not the patient attended a health facility. Also, the indirect economic costs, which are based on the value of time lost due to illness, consider seasonal variations in the marginal product of labor according to the agricultural season. A 1985 representative survey of 626 households in Solenzo medical district, Burkina Faso, provided household data on health service utilization, expenditures, and agricultural production with which to implement these refinements. Numbers of malaria deaths and cases were estimated by adjusting survey totals according to monthly patterns of reported malaria deaths. The marginal product of labor was valued according to typical activities in each of three agricultural seasons: brewing millet beer during the maintenance period (January-February), growing cotton during the cash crop season (March-April), and growing millet and sorghum during the food crop season (May-December). The resulting values were $0.28, $1.09, and $0.55 per day, respectively. Cost per case averaged $5.96 and cost per capita $1.15. Indirect cost due to mortality was the largest cost component ($0.79 per capita), followed by direct costs incurred by the user (e.g. transportation costs and drug purchases, $0.22 per capita). Direct costs paid by providers were small, only $0.04 per capita. A household survey provides the necessary data for more comprehensive population-based estimates of costs of malaria.

Adult↗
PubMed1989

Low utilization of community health workers: results from a household interview survey in Burkina Faso.

A representative household survey was carried out in order to study the utilization of community health workers (CHW) in relation to other sources of health care. We found three main results: (1) For mild diseases, villagers consulted their CHW only in 8.8% of mild diseases, in 69% the family remained the main provider of primary care. (2) In the case of serious diseases, which the CHW was supposed to identify and refer, the villagers bypassed the CHW in 96.5%. The professional health worker were consulted directly in the majority of serious disease. (3) Sick infants were not taken to the CHW for treatment. (4) No pattern of referral between professional and CHWs could be traced. Severity of disease and perceived effectiveness of the treatment were the most important determinants of health seeking behavior. Availability, distance, and cost of travel and drugs were important service related determinants. Individual and household characteristics such as income, ethnicity, and household size were only weakly associated with choice of curative care. Reasons for the low utilization of CHWs are outlined and policy implications discussed.

Attitude to Health↗
PubMed1989

Assessment of MCH services in the district of Solenzo, Burkina Faso. II. Acceptability.

Acceptability of professional MCH services in the district of Solenzo was assessed using the techniques of time and motion study combined with a user survey of attending mothers. A large proportion of mothers said to have difficulty in using the services. Three types of problems were identified and their relevance discussed: (i) wasting mothers' time through inappropriate opening hours, long waiting time in contrast with short contact time; (ii) organizational features, i.e. fragmentation of clinics offering single MCH components at different times; and (iii) staff behaviour, i.e. poor communication with users. While services do little to help mothers to utilize them, mothers were shown to receive little support in their work at home from their families while attending the clinic. Possible ways to increase acceptability of MCH care are outlined.

Appointments and Schedules↗
PubMed1989

Assessment of MCH services in the district of Solenzo, Burkina Faso. III. Effectiveness of MCH services in detecting of and caring for mothers and children at risk.

A time and motion study was carried out in all five professional MCH-facilities in the study area. The chain of decision making process--from (i) collecting information, (ii) interpreting it as indicating risk to (iii) action--was followed while taking care not to interfere with it. At each step specific shortcomings were identified: a great number of commonly accepted risk factors was not looked for (e.g. outcome of previous pregnancies in a woman in labour). On the other hand, information indicating risk was collected, but not recognized as such (e.g. weight loss). The most striking feature of both under fives' (UFC), antenatal clinics (ANC) and maternity care was the consistent lack of any action taken as a consequence of a recognized risk factor. The possible underlying causes for the poor functioning of the risk approach in the studied peripheral services are discussed: (i) implementation failure, (ii) inappropriateness of cut-off points for risk definition leading to an unmanageably great proportion of risk clients, and (iii) a conceptual problem, i.e. the reluctance of the auxiliary staff as well as the patients to act on the basis of risk prediction, i.e. something that has not yet happened.

Burkina Faso↗
PubMed1989

Assessment of MCH services offered by professional and community health workers in the district of Solenzo, Burkina Faso. I. Utilization of MCH services.

A representative household survey of a district of Burkina Faso was carried out in order to study the utilization of trained birth attendants (TBA) versus professional health workers as providers of under fives' (UFC), antenatal (ANC), and maternity care (MC). Overall utilization by the target groups varied between 13 per cent (UFC), 31 per cent (ANC), and 32 per cent (MC). The presence of a village health post did not increase utilization of MCH care. Furthermore, those who did utilize, preferred to choose another source of care: the professional midwife for ANC, the traditional 'old woman' for delivery. Sick infants were generally not taken to the village health worker (VHW), but rather treated by the family itself. The determinants of utilization were assessed by means of multivariate analysis. The level of care offered in the village (health post, dispensary, and medical centre), educational level of both the mother and the husband, and ethnic group were identified as major factors influencing health seeking behaviour in MCH. A strong case is made for improvement of quality of care before extension of geographical coverage. The importance of involving husbands in sensitization for the utilization of MCH-care is stressed and the implications are discussed for the role of the community health workers in caring for mothers and children.

Burkina Faso↗
PubMed1988

Characterization of an immunodominant Onchocerca volvulus antigen with patient sera and a monoclonal antibody.

Adult Onchocerca voluvlus and infective larvae, but not microfilariae contain an immunodominant antigen (33,000 and 21,000 Mr in females, 39,000, 33,000, and 21,000 Mr in males, 133,000 Mr in infective larvae) which is recognized by an Onchocerca-specific mAb. The component is part of the reproductive organs and muscles. 96.2% of onchocerciasis sera contained antibodies detectable by immunoblotting against it. Antigen purified by immunoaffinity chromatography was specifically recognized in immunoblots by onchocerciasis sera, but not by sera from other filarial infections. The high immunogenicity, the specificity, and the occurrence in infective larvae of this antigen indicate an immunodiagnostic potential and a possible role in the immunobiology of the parasite.

Animals↗
PubMed1987

Specificity of routine parasite serological tests in autoimmune disorders, neoplastic disease, EBV-induced mononucleosis, and HIV infection.

Sera from 120 patients with rheumatological disorders, neoplastic disease, infectious mononucleosis, and HIV infection, and from 30 healthy blood donors were tested for nonspecific reactivity in 13 routinely used parasite serological tests. Responses were detected in 3/30 healthy blood donors (10%) vs 25/120 patients (21%). Of 40 responses in these 28 responders most were weakly reactive, and 25 out of 40 responses were only at borderline level. Response rates were highest in patients with mononucleosis presumably due to heterophile antibodies. Only four patients had responses in at least two different serodiagnostic tests for the same parasitic infection. Response patterns indicative of a possible underlying, concurring, or superimposed parasitic infection, thus, were rare. Especially susceptible to nonspecific reactivity seemed to be immunofluorescent antibody tests for filariasis, schistosomiasis, and amebiasis. In conclusion, compared to healthy controls, false-positive serological responses seem to be more frequent in certain disease groups dependent on the test methods used. Second, the use of more than one serodiagnostic test for the same parasitic disease will substantially facilitate the identification of nonspecific reactivity. Third, for better defining the specificity of parasitological serodiagnosis, more studies should include control sera from patients with nonparasitic diseases that frequently show immunological abnormalities.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Dipetalonema viteae infection in three species of rodents: species specific patterns of the antibody response.

Groups of jirds (Meriones unguiculatus), multimammate rats (Mastomys natalensis) and golden hamsters (Mesocricetus auratus) were infected with third stage larvae (L3) of Dipetaloneam viteae and the course of infection was followed until 20 weeks post infection. Worm growth was best and microfilaraemia was high and long lasting in jirds and in multimammate rats, whereas golden hamsters were poor hosts as measured by these parameters. The IgG and IgM antibody responses of the species were compared by immunoblotting and ELISA using proteins of D. viteae, separated by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). The levels of antibodies against most proteins of high molecular weight declined during infection in jirds and in multimammate rats, whereas an increase was observed in golden hamsters. In contrast, several antigens of low molecular weight induced increasing antibody levels in all species. Species specific antigen recognition was observed for a number of protein bands of L3, microfilariae and female worms. The data suggest that susceptibility to immunesuppression and the species specific pattern of antigen recognition might determine the qualities of a rodent species as host for D. viteae.

Animals↗
PubMed1987

Antibody responses in forest and savanna onchocerciasis in Ivory Coast.

Three foci of onchocerciasis transmission (two forest and one savanna, respectively) in the Republic of Ivory Coast were chosen for a comparative analysis of Onchocerca volvulus antigens and of patients' antibody responses. Clear differences between frequency and intensity of ocular pathology existed between the forest foci and the savanna focus. We found heterogeneity of SDS-PAGE-separated components of female worms with respect to the mobility of three protein bands of the 100 KD region and to the ability of an 80 KD band to bind horseradish peroxidase. These variations were clearly not associated with the degree of ocular pathology. No differences in the composition of worm antigens were detected by immunoblotting. A variable with a possible relation to ocular pathology was the antibody response of patients: individuals from the savanna focus, where a high degree of ocular pathology is observed, tended to have a stronger and more differentiated IgG antibody response against O. volvulus antigens than patients from the forest foci. However, no antigens specifically recognized by patients from either forest or savanna were detected.

Adolescent↗
PubMed1987

Sera of Schistosoma japonicum-infected patients cross-react with diagnostic 31/32 kD proteins of S. mansoni.

Schistosoma mansoni adult worm antigens were tested for cross-reactions with sera obtained from patients infected with S. japonicum. The sera consistently recognized a doublet of bands, in immunoblots, which had molecular weights of approximately 31 and 32 kilodaltons (kD). This reaction was found to be markedly reduced with sera of patients who had received chemotherapy and who had a low risk of reinfection. Sera obtained from uninfected persons or from patients infected with other parasites never reacted with the antigen doublet. Schistosoma japonicum-infected mice produced antibodies during prepatency which predominantly recognized antigens of this molecular weight range in immunoblots performed with S. mansoni or S. japonicum proteins. Sera from S. mansoni-infected patients with a high specificity for the diagnostic S. mansoni-antigen cross-reacted with a corresponding component also in S. japonicum worms. Immunofluorescence assays performed with sera of schistosomiasis japonica patients confirmed earlier results localizing the diagnostic 31/32 kD antigens in the gut of S. mansoni. These cross-reacting 31/32 kD S. mansoni protein antigens may be applied for the immunodiagnosis of schistosomiasis japonica.

Adolescent↗
PubMed1986

Dipetalonema viteae: resistance in Meriones unguiculatus with multiple infections of stage-3 larvae.

The jird, Meriones unguiculatus, infected with 80 normal infective larvae of Dipetalonema viteae, revealed a recovery rate of 27.9% 12 weeks after infection. A pretreatment by three injections of 50 normal larvae each and challenge by 80 larvae resulted in a recovery rate of 10.7%. The recovered worms were longer than those from the challenge control animals. When three times 50 irradiated larvae (35 krad) were inoculated, the recovery rate of the challenge decreased to 2.6%, representing a protection of 90.7%. The surviving adult worms were stunted and derived exclusively from the 80 normal larvae given for challenge, since absolutely no adult worms were recovered in eight animals inoculated three times with 50 irradiated larvae only. Sera of all pretreated jirds contained IgG and IgM antibodies which bound in immunoblotting experiments bound predominantly to three proteins of larvae with molecular masses of 68,140, and 165 kDa, respectively. Enzymatic surface iodination revealed that the three antigens were exposed on the larval surface. The coincidence of a partial resistance to a challenge infection and of an antibody response against surface proteins of infective larvae suggests an importance of these antigens for the rejection of D. viteae mediated by an acquired immunological resistance of M. unguiculatus.

Animals↗
PubMed1986

A study on antigen recognition by onchocerciasis patients with different clinical forms of disease.

Sera from 40 onchocerciasis patients from the Yemen Arab Republic with either mild localized forms of onchocerciasis, intermediate or severe localized forms of the disease or generalized forms of infection were studied with respect to their IgG and IgM response against Onchocerca volvulus antigens. Immunoblotting, performed with SDS-PAGE-separated proteins of female O. volvulus and quantified by densitometric scanning, revealed IgG and IgM antibodies against worm components in sera of all patients. Persons with intermediate or severe localized forms of onchocerciasis had a stronger IgG response against more proteins than individuals of the other groups. However, some antigens (Mr 21, 23, 30, 33 kDa) induced comparable quantities of IgG in all groups. The IgM response of patients with mild localized forms of onchocerciasis was more intensive and directed against more antigens than in the other groups. No antigens were detected that were recognized only by individuals with low levels of microfilaridermia. In all groups, varying concentrations of antibodies against cuticle, muscle/hypodermis layer and/or uterus of female O. volvulus were detected by the indirect immunofluorescence test using frozen worm sections as antigen. The highest mean antibody titres were found in patients with intermediate and severe localized forms of disease.

Adult↗
PubMed1986

Seroepidemiological study on kala-azar in Baringo District, Kenya.

This paper reports on 164 cases of kala-azar observed in the Baringo District of Kenya between February 1981 and February 1983. All were confirmed serologically by enzyme-linked immunosorbent assay (ELISA) and all but 20 by parasitological examination as well. Following the standard treatment with a 30 day course of sodium stibogluconate (Pentostam) two non-responders and four relapses were observed. Children between 2 and 15 years old were found to be the most affected age group; male patients predominated slightly at 57%. All cases occurred in the semi-arid and arid parts of the district below 1500 m, where pastoralism predominates. Besides scattered cases, certain kala-azar foci could be identified. Two of these--Endao with 49 households, 228 inhabitants and 13 cases of kala-azar, and Koriema with 22 households, 93 inhabitants and 11 cases--were subject to a house to house survey. People were examined physically, their weight and height recorded and fingerprick blood collected on blotting paper for later serological testing. Each household was mapped and the relevant environmental factors recorded. A positive correlation could be demonstrated between kala-azar cases and the vicinity of their homesteads to seasonal rivers and also between kala-azar cases and people living in timber houses, rather than mud and wattle houses. Eroded termite hills were not found to be of epidemiological importance. No satisfying explanation could be found for the striking temporal and local clustering of cases. The homestead was identified as an important site of transmission with optimum conditions for transmission occurring during supper in the evening. Based on spleen rates, Endao was classified as hyperendemic for malaria and Koriema as mesoendemic. Diagnostic ELISA values above 0.2 were observed in all cases of active kala-azar. However, ELISA values above 0.04, taken as the borderline non-specific reaction, could be found in about half of the study areas population. Therefore we conclude that asymptomatic infection must be common. Observations demonstrated that spontaneous recovery may follow clinical illness and visceralization of the parasite. Comparison of parasitological and serological data suggest that this may be expected in more than 15% of cases.

Adolescent↗
PubMed1985

Schistosoma mansoni: immunoblot analysis of adult worm proteins.

Proteins of adult Schistosoma mansoni were separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and assayed in immunoblots for reactions with individual mouse sera. Four weeks after a heavy infection with a few hundred cercariae, IgG antibodies directed predominantly against a protein of 31 kDa were detected. The protein was only weakly recognized by antibodies of mice harboring a 4-week-old light infection with about 60 cercariae. After 6 weeks or more, mice infected with either dose formed antibodies, not only against the 31-kDa protein and a 67-kDa protein, but also against a number of other components. While reactions with the 31- and 67-kDa proteins occurred with sera of all individual mice of four different strains, the reactions with other components were less consistently observed. Mice vaccinated with a heavy or light dose of 20,000-rad-irradiated cercariae did not form antibodies detectable in the blotting system. However, in immunofluorescence assays with living skin schistosomula, but not lung schistosomula, antibodies against the larval surface were detected with all sera obtained 4 weeks after infection or vaccination. In addition, immunofluorescence studies using the same sera and sectioned adult parasites demonstrated the presence of antibodies against the parasite surface in all sera except those obtained from mice exposed to a light infection with normal cercariae. Mice infected in this latter way were the only animals that did not develop a significant resistance against a challenge infection 4 weeks after exposure to normal or irradiated cercariae. The presence of an immunofluorescent reaction against the schistosome gut always coincided with a reaction of the sera with the 31-kDa protein in the immunoblots. Although a role in immune resistance could not be ascribed to any of the proteins reacting in the immunoblots, the data demonstrate important differences in the antibody specificities induced by various infection schemes.

Animals↗