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Biomedical subjects

Lorenzo Savioli

Publications and source records attributed to Lorenzo Savioli.

At least 19 recordsLinked to original sources
PubMed2006

Comparative study of the quality and efficacy of originator and generic albendazole for mass treatment of soil-transmitted nematode infections in Nepal.

The quality and efficacy of two locally manufactured generic albendazole (ABZ) products (Curex and Royal Drug) used for deworming children in Nepal since 1999 were tested against the originator product (GlaxoSmithKline (GSK)). The study included disintegration and dissolution testing according to the Indian Pharmacopoeia (IP) and the United States Pharmacopeia (USP), respectively, as well as a randomised controlled clinical trial comparing cure rates (CR) and egg reduction rates (ERR) for Ascaris lumbricoides, Trichuris trichiura and hookworm infections. Stool samples from 1277 children were examined before and 21 days after treatment. For A. lumbricoides, GSK (97.0%) and Royal Drug (95.0%) ABZ achieved significantly higher CRs than Curex ABZ (82.6%); however, all products achieved ERRs >90%. For T. trichiura, Curex ABZ showed significantly lower ERRs (63.2%). For hookworms, GSK ABZ performed significantly better (CR 74.3%, ERR 87.1%) than Royal Drug ABZ (CR 53.3%, ERR 80.8%) and Curex ABZ (CR 50.7%, ERR 73.1%). Only the GSK product passed both disintegration and dissolution tests according to the IP and USP. Both generic products failed the dissolution tests. Curex ABZ showed poor disintegration. Despite its lower efficacy, the cheaper Curex product achieved good results in controlling morbidity due to soil-transmitted helminth infections. This study shows that the cost effectiveness of drugs used in mass deworming campaigns should not be inferred on the basis of a single quality testing parameter.

Adolescent↗
PubMed2006

Reconsidering the underestimated burden caused by neglected tropical diseases.

It is generally acknowledged that the burden caused by neglected tropical diseases needs to be reassessed. Not only are there several important diseases unaccounted for, but new information suggests they have a more substantial impact on health than initially thought. Looking at the tropical diseases as a group makes sense: they tend to cluster in the same poor populations and, to make progress with their control, they will have to be dealt with in an integrated manner. Measuring the effect of such integrated control is likely to reveal the real impact of tropical diseases on human health and wellbeing.

Cluster Analysis↗
PubMed2006

Intervention for the control of soil-transmitted helminthiasis in the community.

The global strategy for the control of soil-transmitted helminthiasis, based on regular anthelminthic treatment, health education and improved sanitation standards, is reviewed. The reasons for the development of a control strategy based on population intervention rather than on individual treatment are explained. The evidence and experience from control programmes that created the basis for (i) the definition of the intervention package, (ii) the identification of the groups at risk, (iii) the standardization of the community diagnosis and (iv) the selection of the appropriate intervention for each category in the community are discussed. How to best deliver the appropriate intervention, the impact of the control measures on morbidity and on indicators such as school attendance, cognitive development and productivity are presented. The factors influencing the cost-benefits of helminth control are also considered. The recent progress on the control of soil-transmitted helminth infections is illustrated. Research needs are analysed in relation to the most recent perceptions from private-public partnerships involved in helminth control. The way forward for the control of soil-transmitted helminth infections is described as a multi-disease approach that goes beyond deworming and fosters a pro-poor strategy that supports the aims of the Millennium Development Goals.

Animals↗
PubMed2005

Development of the egg hatch assay for detection of anthelminthic resistance in human hookworms.

Evidence of development and rapid spread of anthelminthic resistance in veterinary nematodes raises concern that the increasingly frequent treatments used in chemotherapy-based programmes to control human soil-transmitted helminths may select resistant worms. The aim of this study was to adapt, refine, and evaluate the Egg Hatch Assay (EHA) test, which has been used for veterinary nematodes, for field testing of benzimidazole (BZ) susceptibility/resistance in human hookworms. A second objective was to use this EHA to assess whether a population of worms resistant to mebendazole (MBZ) has built up in a sub-population of frequently treated children in Pemba Island. Stools from 470 school children enrolled in the first (Standard 1) and in the fifth (Standard 5) class were examined at baseline and at 21 days after treatment with 500 mg MBZ or placebo tablets. Standard 1 children had never received any MBZ treatment whilst Standard 5 children had received a total of 13 rounds of treatment. The EHA, involving culture of purified eggs with increasing drug concentrations showed that, for thiabendazole (TBZ), the mean ED(50)s (concentrations required to prevent 50% of the viable eggs from hatching) for all children at baseline were 0.079 microg/ml at 48h and 0.120 microg/ml at 72h (P<0.001). For MBZ, the mean ED(50)s for all children at baseline were 0.895 microg/ml at 48h and 1.50 microg/ml at 72h (P<0.001). For TBZ and for MBZ the ED(50) from Standard 1 were similar to those from Standard 5 children both at 48 and at 72h. At the follow-up for TBZ and for MBZ, there was no significant difference between the ED(50) from children who had received MBZ and children treated with placebo. In Pemba, TBZ ED(50) values of children non-exposed (Standard 1) and of children exposed (Standard 5) to MBZ treatment, and data from children treated with MBZ and placebo indicate that a drug-resistant worm population has not built up within treated individuals, and that periodic treatment has not yet selected for widespread BZ resistance, at least at the threshold detectable by the EHA in this study. However, ED(50) values for strains isolated from Mafia island, an area never exposed to BZ treatment were lower than for Pemba, suggesting lowered sensitivity of hookworm eggs recovered from Pembian children towards BZ.

Ancylostomatoidea↗
PubMed2005

Control of human fascioliasis by selective chemotherapy: design, cost and effect of the first public health, school-based intervention implemented in endemic areas of the Nile Delta, Egypt.

Human fascioliasis is becoming a serious public health problem with a number of endemic areas identified in different countries. The viability of humans as definitive hosts has been experimentally demonstrated, and there is now a need to control the human infection along with the veterinary infection. In 1998, following reports on high prevalence among children in the Nile Delta, the Egyptian Ministry of Health and Population launched the first public health, school-based intervention to control human fascioliasis. An innovative selective treatment approach, with chemotherapy targeted to specific high risk age groups and villages, was adopted. First, high prevalence districts were identified by a regional baseline survey, then screening and selective treatment of all schoolchildren took place in high prevalence villages within those districts. From 1998 to 2002 the programme screened almost 36000 schoolchildren, in six districts, treating 1280 cases of human fascioliasis. Prevalence in the endemic area was reduced from 5.6 to 1.2%. The control intervention is described in detail, including data on cost. The targeted, selective chemotherapy approach was appropriate in addressing low prevalence infection, effective in reducing prevalence rates and transmission of the disease, and in the present situation, more cost-effective than mass distribution.

Anthelmintics↗
PubMed2004

Monitoring drug efficacy and early detection of drug resistance in human soil-transmitted nematodes: a pressing public health agenda for helminth control.

Control of soil-transmitted helminth infection and elimination of lymphatic filariasis by periodic chemotherapy increase drug pressure for possible occurrence of resistance against single dose anthelminthics. In veterinary practice, frequent treatment of closed populations has led to a serious problem of anthelminthic drug resistance which is now largely irreversible. Reduced efficacy of single dose drugs against nematodes of humans should be taken as early warnings to tackle the issue in due time. Research and development of sensitive tools for monitoring and early detection of drug resistance is urgently needed to sustain the benefits of helminth control programs gained so far. A concerted action with international partners and the creation of a network of scientists to address this issue is the next pressing public health issue for helminth control.

Animal Diseases↗
PubMed2004

Low-dose daily iron supplementation for 12 months does not increase the prevalence of malarial infection or density of parasites in young Zanzibari children.

Conflicting evidence exists on the possible role of iron supplementation in the predisposition to malaria infection or the enhancement of its clinical severity. Where anemia prevalence is >40%, current guidelines are to provide low-dose daily iron to young children for up to 18 mo. Earlier studies used doses higher than the current guidelines, intermittent doses, or have supplemented for durations < or = 4 mo. We aimed to assess the effect of low-dose, long-term iron supplementation on malaria infection using a double-blind, placebo-controlled, randomized design, and to examine possible subgroup effects by season and child age. The study was conducted in Pemba Island, Zanzibar, where Plasmodium falciparum malaria has year-round high transmission. A community-based sample of 614 children 4-71 mo old was randomly allocated to 10 mg/d iron or placebo for 12 mo. Outcome measures were the prevalence and density of malaria infection, which was assessed by blood films at monthly intervals. At baseline, 94.4% were anemic (hemoglobin < 110 g/L), 48.1% were stunted (height-for-age Z-score less than -2) and >80% had malaria-positive blood films. No significant differences in malariometric indices were observed between children in the iron-supplemented and placebo groups. Parasite density was higher in certain months and in younger children, but iron supplementation was not associated with any malarial infection outcome in any season or age subgroup. We conclude that in this environment of high malaria transmission, daily oral low-dose supplementation of iron for 12 mo did not affect the prevalence of malaria infection or parasite density.

Age Factors↗
PubMed2004

Low dose daily iron supplementation improves iron status and appetite but not anemia, whereas quarterly anthelminthic treatment improves growth, appetite and anemia in Zanzibari preschool children.

Iron deficiency and helminth infections are two common conditions of children in developing countries. The consequences of helminth infection in young children are not well described, and the efficacy of low dose iron supplementation is not well documented in malaria-endemic settings. A 12-mo randomized, placebo controlled, double-blind trial of 10 mg daily iron and/or mebendazole (500 mg) every 3 mo was conducted in a community-based sample of 459 Zanzibari children age 6-71 mo with hemoglobin > 70 g/L at baseline. The trial was designed to examine treatment effects on growth, anemia and appetite in two age subgroups. Iron did not affect growth retardation, hemoglobin concentration or mild or moderate anemia (hemoglobin < 110 g/L or < 90 g/L, respectively), but iron significantly improved serum ferritin and erythrocyte protoporphyrin. Mebendazole significantly reduced wasting malnutrition. but only in children <30 mo old. The adjusted odds ratios (AORs) for mebendazole in this age group were 0.38 (95% CI: 0.16, 0.90) for weight-for-height less than -1 Z-score and 0.29 (0.09, 0.91) for small arm circumference. In children <24 mo old, mebendazole also reduced moderate anemia (AOR: 0.41, 0.18, 0.94). Both iron and mebendazole improved children's appetite, according to mothers' report. In this study, iron's effect on anemia was limited, likely constrained by infection, inflammation and perhaps other nutrient deficiencies. Mebendazole treatment caused unexpected and significant reductions in wasting malnutrition and anemia in very young children with light infections. We hypothesize that incident helminth infections may stimulate inflammatory immune responses in young children, with deleterious effects on protein metabolism and erythropoiesis.

Anemia, Iron-Deficiency↗
PubMed2004

Soil-transmitted helminthiasis in Myanmar and approximate costs for countrywide control.

Previous surveys in Myanmar indicate that soil-transmitted helminths (STH) are a significant public health problem. However the majority of these surveys are small scale or hospital based. To date there has been no countrywide assessment of the prevalence and intensity of STH infection. We conducted a survey (June 2002-June 2003) to assess the magnitude of STH infection in school age children in each of the different ecological areas of the country. In each area, five schools were selected and from each one, 50 children were randomly chosen. Parasitological and nutritional data were collected from each child. We found an overall prevalence of infection of 69%: 18% had a moderate-heavy intensity of infection, 22% were anaemic. A pilot exercise to treat 25,000 school age children in the 200 schools of Nyangdone Township tested the strategy before scaling up and to generate some rough costings. A crude calculation of the expenditure to buy and deliver the drugs, including the costs incurred in the teacher training, concluded that the cost per child was approximately 0.05 USD.

Adolescent↗
PubMed2003

The School Health Programme in Behera: an integrated helminth control programme at Governorate level in Egypt.

School Health Programmes offer the opportunity to deliver public health interventions to a great number of beneficiaries at a relatively low cost and are seen with growing interest by policy makers in developing countries and the donors' communities. In Egypt a pilot School Health Programme has been implemented for the past 6 years in Behera, the largest and most populous Governorate of the Nile Delta. The Programme integrated additional activities for the control of soil-transmitted helminthiasis, human fascioliasis and anaemia in the National Schistosomiasis Control Programme (NSCP), implemented in Egypt since 1988 by the Ministry of Health and Population (MoHP). To facilitate planning and direct actions, a strong monitoring system was also developed, that generated useful information for the schistosomiasis control programme. The practical steps adopted to develop the programme are presented and discussed. Results from three rounds of monitoring (2000, 2001, 2002) are analysed and compared with baseline data conducted in 1996, together with the cost of each activity. On the basis of the experience gained by the Behera School Health Programme a number of operational recommendations are formulated.

Adolescent↗
PubMed2003

The control of human (neuro)cysticercosis: which way forward?

Taenia solium cysticercosis, and its public health and economic consequences, appears to be a growing problem in poor areas of Africa, Asia and Latin America where people eat pork and traditional pig husbandry is practiced (and expanding). Its burden is counted in terms of human disease (mainly neurocysticercosis related epilepsy) and economic losses, in a context of both commercial and traditional subsistence pig farming. Although substantial fragmentary information seems to be available from local settings, national and global burdens due to T. solium cysticercosis are still to be comprehensively assessed. With regard to control, several strategies have been checked out at a small or medium scale and have proven to be successful. Yet, no intervention programmes have been implemented so far at the national level with proven success. Although T. solium cysticercosis is considered to be a potentially eradicable disease, there is no evidence yet that it is feasible and recommendable to envisage this within a reasonable time frame. However, it appears realistic to aim for the rapid definition of a simple package of interventions, which can routinely be carried out by existing services and structures, and will give an optimal, long-term return in terms of burden relief. Also, a number of international initiatives and opportunities currently exist in which a more pro-active attitude towards the control of T. solium cysticercosis can be integrated and promoted. Commitment of both national and local authorities to control the disease needs to be convincingly solicited and, as for most zoonotic diseases, an interdisciplinary approach is essential.

Animal Husbandry↗