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Biomedical subjects

K Cham

Publications and source records attributed to K Cham.

14 recordsLinked to original sources
PubMed1997

The Gambian National Impregnated Bednet Programme: evaluation of the 1994 cost recovery trial.

Following the success of a controlled trial of insecticide-impregnated bednets in reducing mortality in children. The Gambia started a National Impregnated Bednet Programme (NIBP) in 1992. The objectives of this programme were to introduce impregnated bednets into all primary health care (PHC) villages and to establish a system of cost recovery over a three-year period. During the initial phase of the programme, when insecticide was given out free, a high uptake was achieved. However, after small user charges were introduced in 1993, coverage dropped to a low level. In 1994, different systems of insecticide distribution and permethrin formulations were tried in an attempt to improve coverage. A nationwide cross-sectional survey carried out during the 1994 rainy season measured coverage by distribution channel, as well as the knowledge, attitudes and practices of health workers and villagers during the intervention. Overall, only 16% of bednets were impregnated in 1994, compared to 80% when the insecticide was offered free of charge in previous years. Lack of money was the major reason given by villagers for not impregnating their bednets in 1994. Use of impregnated bednets was higher in areas where the sale of permethrin emulsion by village health workers was supplemented by the sale of insecticide in individual packages through shops. In villages where insecticide was distributed free to women with small children through governmental mother and child health (MCH) services, higher levels of coverage were achieved among women and young children than in villages where other distribution systems were used. We conclude that the sale of insecticide through the private sector may increase bednet impregnation rates in African communities, and that the free distribution of insecticide through MCH services may be an effective way of targeting young children, the group most at risk of malaria.

Adolescent↗
PubMed1994

Financing mechanisms for village activities in The Gambia and their implications for financing insecticide for bednet impregnation.

The recent enthusiasm for impregnated bednets as a malaria control measure leaves unresolved the question of how to finance them. The National Impregnated Bednet Programme in The Gambia faced the question of how to obtain funds from villages to finance the cost of insecticide, but knew very little about current village fundraising for development purposes. A survey was conducted of such fundraising, and questions also asked about willingness to pay for insecticide and preferred means of paying. All 53 villages surveyed paid taxes/rates, but 34% of villages reported no voluntary fundraising. The most common reason for collecting money was for the maintenance of wells (40% of villages). Collective farming was used as a means of raising money in 32% of villages. There was some variation in the type and extent of fundraising by region and also by the predominant ethnic groups of the village. Villages with voluntary fundraising activities seemed to have well established collective mechanisms for agreeing on sums to be collected and their use, and for collecting and recording income and expenditure. Non-payment was rare, and misuse of funds was not reported. Respondents were asked how much compounds might be willing to pay for insecticide impregnantion: the most frequently cited maximum amounts were D5 and 10, and minimum D1 and 5 (D15 = 1 pound). The paper discusses payment options for insecticide, such as whether the village should be allowed to decide itself how to raise funds, and whether the payment should be made only by households with nets or by a village-wide mechanism such as collective farming.(ABSTRACT TRUNCATED AT 250 WORDS)

Agriculture↗
PubMed1994

Comparison of mortality between villages with and without Primary Health Care workers in Upper River Division, The Gambia.

Health services utilization was analysed in a rural area of the The Gambia. In general, health workers were consulted frequently. However, verbal autopsies showed that children who died had rarely consulted health workers, particularly if they came from villages where such workers were not posted. Traditional healers were consulted frequently, independently of the presence of a village health worker. The relationship between cause specific mortality and the utilization of health services is discussed. Childhood mortality was similar in villages with or without a primary health care worker at the time of the study.

Cause of Death↗
PubMed1993

A malaria control trial using insecticide-treated bed nets and targeted chemoprophylaxis in a rural area of The Gambia, west Africa. 2. Mortality and morbidity from malaria in the study area.

Background data on child mortality and morbidity from malaria were obtained in a new study area in the centre of The Gambia, south of the river, chosen as the site for a malaria intervention trial. Infant and child mortality rates were 120 and 41 per 1000 respectively. Results obtained using post-mortem questionnaires suggested that malaria was an uncommon cause of death in children under the age of one year but responsible for about 40% of deaths in children aged 1-4 years. Ninety-two percent of deaths attributed to malaria occurred during or immediately after the rainy season. Parasite and spleen rates in children aged 1-5 years at the end of the malaria transmission season were 66% and 64% respectively. Malariometric indices were similar in primary health care (PHC) villages, selected as sites for an intervention with insecticide-treated bed nets and targeted chemoprophylaxis, and in smaller, non-PHC, control villages.

Cause of Death↗
PubMed1993

A malaria control trial using insecticide-treated bed nets and targeted chemoprophylaxis in a rural area of The Gambia, west Africa. 5. Design and implementation of the trial.

A large-scale malaria intervention programme using insecticide-treated bed nets and chemoprophylaxis administered to children was introduced into a rural area of The Gambia. The operation was carried out using the existing primary health care (PHC) service in the region. Training of the village health workers, sensitization of the communities, and implementation of net impregnation and the drug delivery programme are described. This delivery system resulted in over 90% of nets being treated with insecticide and 80% of children receiving over 90% of their tablets during the rainy season. There was considerable variation in the distribution of permethrin on a bed net and between individual nets, which is likely to facilitate the spread of insecticide resistance in the local mosquito populations. Bed nets made from heavier fabrics tended to absorb more insecticide than those made from lighter materials. Four months after dipping, 89% of the insecticide had been lost from treated nets. This was probably due mainly to women washing their nets, an activity carried out on average once every 2 months during the rainy season. The high number of insecticide-treated bed nets in the study area demonstrated that a malaria control programme operated through a PHC system can be implemented successfully.

Antimalarials↗
PubMed1993

A malaria control trial using insecticide-treated bed nets and targeted chemoprophylaxis in a rural area of The Gambia, west Africa. 6. The impact of the interventions on mortality and morbidity from malaria.

The effects of insecticide-impregnated bed nets on mortality and morbidity from malaria have been investigated during one malaria transmission season in a group of rural Gambian children aged 6 months to 5 years. Sleeping under impregnated nets was associated with an overall reduction in mortality of about 60% in children aged 1-4 years. Mortality was not reduced further by chemoprophylaxis with Maloprim given weekly by village health workers throughout the rainy season. Episodes of fever associated with malaria parasitaemia were reduced by 45% among children who slept under impregnated nets. The addition of chemoprophylaxis provided substantial additional benefit against clinical attacks of malaria; 158 episodes were recorded among 946 children who slept under impregnated nets but who also received chemoprophylaxis. Chemoprophylaxis reduced the prevalence of splenomegaly and parasitaemia at the end of the malaria transmission season by 63% and 83% respectively. Thus, insecticide-impregnated bed nets provided significant protection in children against overall mortality, mortality attributed to malaria, clinical attacks of malaria, and malaria infection. The addition of chemoprophylaxis provided substantial additional protection against clinical attacks of malaria and malaria infection but not against death.

Antimalarials↗
PubMed1993

Decline in meningococcal antibody levels in African children 5 years after vaccination and the lack of an effect of booster immunization.

Antibodies to group A meningococcal polysaccharide were measured by hemagglutination (HA) and by ELISA in sera obtained from Gambian children before vaccination and 3 weeks, 2 years, and 5 years after vaccination with a group A + group C meningococcal capsular polysaccharide vaccine. Children were 1-4 years old at the time of vaccination. Most showed a good initial response to vaccination, including those aged 1-2 years. However, antibody titers declined progressively during follow-up, and 5 years after vaccination, antibody titers measured by both HA and ELISA had returned to prevaccination levels. This decline was not influenced significantly by a booster dose of vaccine given 2 years after initial immunization. Administration of malaria chemoprophylaxis reduced the rate at which antibody levels fell after initial immunization. Sustained protection of children against group A meningococcal disease will require the development of vaccines that are immunogenic in infants and that can induce T cell memory.

Antibodies, Bacterial↗
PubMed1991

Risk factors for HIV-2 infection in The Gambia.

A serosurvey was carried out to assess the prevalence of HIV infection in The Gambia and the importance of possible risk factors. The overall prevalence of HIV-2 infection among the 4228 adults studied was 1.7% while that of HIV-1 was 0.1%. The prevalence of HIV-2 was similar in both sexes but higher among those greater than 25 years of age and those who lived in two small towns along a main transport route. Among men, multivariate analysis showed prevalence of HIV-2 infection was significantly greater among those in the more affluent occupations, those without a secondary education and those with a history of urethral discharge. Among women, infection was more frequent in divorcees and widows and those who had been married several times. The prevalence was also higher in individuals born in Guinea-Bissau and in an ethnic group which originated there.

Adolescent↗
PubMed1989

Outbreak of beri-beri in The Gambia.

In 1988, an outbreak of beri-beri occurred in The Gambia during the rainy season. At least 140 people were affected, and 22 died. A clear response to thiamine was observed in 8 patients who were in hospital, and the outbreak resolved after distribution of thiamine in the community. Gradual replacement of traditional cereals with imported milled rice may have increased susceptibility to beri-beri.

Adolescent↗
PubMed1980

Yellow fever in the Gambia, 1978--1979: epidemiologic aspects with observations on the occurrence of orungo virus infections.

An epidemic of yellow fever (YF) occurred in the Gambia between May 1978 and January 1979. Retrospective case-finding methods and active surveillance led to the identification of 271 clinically suspected cases. A confirmatory or presumptive laboratory diagnosis was established in 94 cases. The earliest serologically documented case occurred in June 1978, at the extreme east of the Gambia. Small numbers of cases occurred in August and September. The epidemic peaked in October, and cases continued to occur at a diminishing rate through January, when a mass vaccination campaign was completed. The outbreak was largely confined to the eastern half of the country (MacCarthy Island and Upper River Divisions). In nine survey villages in this area (total population 1,531) the attack rate was 2.6--4.4%, with a mortality rate of 0.8%, and a case fatality rate of 19.4%. If these villages are representative of the total affected region, there may have been as many as 8,400 cases and 1,600 deaths during the outbreak. The disease incidence was highest in the 0- to 9-year age group (6.7%) and decreased with advancing age to 1.7% in persons over 40 years. Overall, 32.6% of survey village inhabitants had YF complement-fixing (CF) antibodies. The prevalence of antibody patterns indicating primary YF infection decreased with age, in concert with disease incidence. The overall inapparent:apparent infection ratio was 12:1. In persons with serological responses indicating flaviviral superinfection, the inapparent:apparent infection ratio was 10 times higher than in persons with primary YF infection. Sylvatic vectors of YF virus, principally Aedes furcifer-taylori and Ae. luteocephalus are believed to have been responsible for transmission, at least at the beginning of the outbreak. Eighty-four percent of wild monkeys shot in January 1979 had YF neutralizing antibodies, and 32% had CF antibodies. Domestic Aedes aegypti were absent or present at very low indices in many severely affected villages (see companion paper). In January, however, aegypti-borne YF 2.5 months into the dry season was documented by isolation of YF virus from a sick man and from this vector species in the absence of sylvatic vectors. Thus, in villages where the classical urban vector was abundant, interhuman transmission by Ae. aegypti occurred and continued into the dry season. A mass vaccination campaign, begun in December, was completed on 25 January, with over 95% coverage of the Gambian population. A seroconversion rate of 93% was determined in a group of vaccinees. This outbreak emphasizes the continuing public health importance of YF in West Africa and points out the need for inclusion of 17D YF vaccination in future programs of multiple immunication.

Adolescent↗
PubMedDate not supplied

Urban beri-beri in The Gambia, west Africa.

Thirty-eight patients with beri-beri (13 dry, 14 wet and 11 mixed type) were seen at the Royal Victoria Hospital, Banjul, The Gambia, in 1990-1991, with a peak in September-October (25 cases) during the latter half of the rainy season. They were all non-confined residents of urban areas. Overt risk factors were pregnancy (6), alcohol (5), fevers (4), chronic disability (4), and exercise (2). Four patients (10.5%) died. The potential for large outbreaks of beri-beri exist in many urban areas of West Africa where polished rice is the staple diet.

Adolescent↗
PubMedDate not supplied

The impact of a national impregnated bed net programme on the outcome of pregnancy in primigravidae in The Gambia.

In 1992, the Gambian national impregnated bed net programme (NIBP) introduced insecticide treatment of bed nets into half of the primary health care villages in The Gambia. One component of the evaluation of this programme was the determination of whether it had any impact on the outcome of pregnancy in primigravidae. From February 1992, 651 primigravidae were recruited into the study. Less than 50% of them used an insecticide-treated bednet. During the rainy season the prevalence of Plasmodium falciparum among primigravidae was lower, fewer babies were classified as premature, and the mean birth weight was higher in villages where treated bed nets were used than in control villages. Therefore, during the rainy season, despite the low use of insecticide-treated bed nets by Gambian primigravidae, the NIBP had some impact on the outcome of pregnancy, particularly on the percentage of premature babies, and this was probably due to the decreased risk of malaria infection achieved during this period.

Adolescent↗