Biomedical subjects

S Hewitt

Publications and source records attributed to S Hewitt.

At least 19 recordsLinked to original sources

PubMed2001

Birt-Hogg-Dubé syndrome, a genodermatosis associated with spontaneous pneumothorax and kidney neoplasia, maps to chromosome 17p11.2.

Birt-Hogg-Dubé syndrome (BHD), an inherited autosomal genodermatosis characterized by benign tumors of the hair follicle, has been associated with renal neoplasia, lung cysts, and spontaneous pneumothorax. To identify the BHD locus, we recruited families with cutaneous lesions and associated phenotypic features of the BHD syndrome. We performed a genomewide scan in one large kindred with BHD and, by linkage analysis, localized the gene locus to the pericentromeric region of chromosome 17p, with a LOD score of 4.98 at D17S740 (recombination fraction 0). Two-point linkage analysis of eight additional families with BHD produced a maximum LOD score of 16.06 at D17S2196. Haplotype analysis identified critical recombinants and defined the minimal region of nonrecombination as being within a <4-cM distance between D17S1857 and D17S805. One additional family, which had histologically proved fibrofolliculomas, did not show evidence of linkage to chromosome 17p, suggesting genetic heterogeneity for BHD. The BHD locus lies within chromosomal band 17p11.2, a genomic region that, because of the presence of low-copy-number repeat elements, is unstable and that is associated with a number of diseases. Identification of the gene for BHD may reveal a new genetic locus responsible for renal neoplasia and for lung and hair-follicle developmental defects.

Abnormalities, Multiple↗

PubMed2001

Control of malaria in Pakistan by applying deltamethrin insecticide to cattle: a community-randomised trial.

BACKGROUND: The standard method of malaria control in south Asia, indoor spraying of houses with residual insecticide, is becoming prohibitively expensive to implement and new approaches are needed. Since the region's vector mosquitoes feed predominantly on domestic animals and only secondarily on human beings, to apply insecticide to surfaces of cattle instead might be more costeffective. We aimed to investigate whether domestic livestock treated with deltamethrin (applied by a sponging method) would prove toxic to mosquitoes and therefore aid in malaria control. METHODS: Six Afghan refugee settlements in Pakistan were randomly assigned to one of two groups. In one group livestock were treated with deltamethrin during the malaria transmission seasons of 1995 and 1997, whereas in the other group livestock were treated during the 1996 season. Malaria was monitored by passive case detection at village clinics and by cross-sectional surveillance. Mosquitoes were also monitored. FINDINGS: According to clinic records the incidence of malaria caused by Plasmodium falciparum decreased by 56% (95% CI 14-78%) and P vivax by 31% (5-50%) in livestock-treated villages. Cross-sectional surveys showed comparable decreases in parasite prevalence. The density and life expectancy of Anopheles stephensi and A culicifacies populations were reduced in treated villages. The efficacy of livestock treatment was similar to that of indoor spraying but campaign costs were 80% less. When applied in a highly endemic settlement, the incidence of falciparum malaria decreased from 280 episodes per 1000 person-years to nine episodes per 1000 person-years. INTERPRETATIONS: Insecticide treatment of livestock is a cost-effective and promising alternative for south Asia and other regions where primary vectors are zoophilic.

Animals↗

PubMed2001

Molecular cytogenetic characterization of early and late renal cell carcinomas in von Hippel-Lindau disease.

Deletions of 3p25, gains of chromosomes 7 and 10, and isochromosome 17q are known cytogenetic aberrations in sporadic renal cell carcinoma (RCC). In addition, a majority of RCCs have loss of heterozygosity (LOH) of the Von Hippel-Lindau (VHL) gene located at chromosome band 3p25. Patients who inherit a germline mutation of the VHL gene can develop multifocal RCCs and other solid tumors, including malignancies of the pancreas, adrenal medulla, and brain. VHL tumors follow the two-hit model of tumorigenesis, as LOH of VHL, a classic tumor suppressor gene, is the critical event in the development of the neoplastic phenotype. In an attempt to define the cytogenetic aberrations from early tumors to late RCC further, we applied spectral karyotyping (SKY) to 23 renal tumors harvested from 6 unrelated VHL patients undergoing surgery. Cysts and low-grade solid lesions were near-diploid and contained 1-2 reciprocal translocations, dicentric chromosomes, and/or isochromosomes. A variety of sole numerical aberrations included gains of chromosomes 1, 2, 4, 7, 10, 13, 21, and the X chromosome, although no tumors had sole numerical losses. Three patients shared a breakpoint at 2p21-22, and three others shared a dicentric chromosome 9 or an isochromosome 9q. In contrast to the near-diploidy of the low-grade lesions, a high-grade lesion and its nodal metastasis were markedly aneuploid, revealed loss of VHL by fluorescence in situ hybridization (FISH), and contained recurrent unbalanced translocations and losses of chromosome arms 2q, 3p, 4q, 9p, 14q, and 19p as demonstrated by comparative genomic hybridization (CGH). By combining SKY, CGH, and FISH of multiple tumors from the same VHL kidney, we have begun to identify chromosomal aberrations in the earliest stages of VHL-related renal cell tumors. Our current findings illustrate the cytogenetic heterogeneity of different VHL lesions from the same kidney, which supports the multiclonal origins of hereditary RCCs. Published 2001 Wiley-Liss, Inc.

Adult↗

PubMed2001

Dementia.

Alzheimer's disease is the most common cause of dementia, but often several other conditions causing dementia are present on brain autopsies. Palliative care medical issues are similar in all late stage progressive degenerative dementias and include; cardiopulmonary resuscitation, transfer to acute care setting, antibiotic therapy, and tube feeding. Behavioral symptoms of dementia include agitation and resistiveness to care. Quality of life of individuals suffering from dementia is enhanced by availability of meaningful activities and by avoidance of restraints. Family support and involvement are crucial for optimal care. Formulation of advanced directives or an advance proxy plan is important for assuring the patient's previous wishes or best interests are considered when decisions about treatment strategies are made.

Dementia↗

PubMed2001

Treatment of falciparum malaria in Vietnamese children: the need for combination therapy and optimized dosage regimens.

To assess the in vivo sensitivity of Plasmodium falciparum to mefloquine and artesunate in a hyperendemic area of southern Viet Nam, we studied 41 children and 21 adults from a remote commune who had uncomplicated falciparum malaria without previous treatment. Patients were randomly allocated to artesunate (4 mg/kg on day 0 and 2 mg/kg on days 1-4) or mefloquine (10 mg/kg followed by 5 mg/kg at 6 h). Serial assessments were performed over 28 days. Of 31 patients allocated artesunate, nine (29%) redeveloped parasitaemia during follow-up compared with 23% (seven of 30) who received mefloquine. Of the 41 children, 15 (37%) had recrudescence/re-infection compared with only one of 20 adults (5%; p < 0.001). Significantly more children than adults failed on mefloquine treatment (37% vs 0%; p = 0.021) and one case showed RIII resistance. There was no significant difference in the case of artesunate. In regression analysis, parasitaemia was an independent predictor of recrudescence/re-infection after mefloquine (p = 0.02). These data support the use of combination therapy such as artesunate plus mefloquine for falciparum malaria in a hyperendemic area of Viet Nam. Primarily because of their greater parasite densities, children should be given higher doses of mefloquine (e.g. 25 mg/kg).

Adolescent↗

PubMed2000

The angiogenesis inhibitor, endostatin, does not affect murine cutaneous wound healing.

BACKGROUND: Endostatin is a potent angiogenesis inhibitor, which is currently being used in Phase I trials as an antitumor agent. The purpose of this study was to determine whether endostatin has an effect on wound healing in a murine model. MATERIALS AND METHODS: The function of endostatin was confirmed using a human microvascular endothelial cell (HMVEC) proliferation assay in which cells are treated for 4 days with growth media plus or minus endostatin. Full-thickness incisions were made on the dorsum of athymic nude mice and closed primarily with skin staples. PVA sponges were implanted in some wounds to determine vascular ingrowth. Subsequently, mice were treated with recombinant human endostatin at 20 mg/kg/day or 50 mg/kg/dose BID versus control for a total of 14 days. On Days 2, 4, 8, 12, and 16, three mice per group had serum samples drawn and were sacrificed. Perpendicular breaking strength (N) was determined using an Instron 5540 tensometer. Wound strength was determined by dividing breaking strength by wound area (N/cm(2)). Vascular density in sponges was determined using CD31 immunohistochemistry. Serum endostatin concentrations were determined using a commercially available ELISA kit. RESULTS: Endostatin caused a significant reduction of endothelial cell proliferation after 4 days compared to media alone (72%, P = 0.031). At all time points tested, there was no statistical difference in the wound-breaking strength between endostatin and control-treated mice at either the low or high dose. Serum endostatin levels were consistently 10-fold higher in endostatin-treated mice than in controls. No differences in vascular density were seen in endostatin versus control-treated mice as determined by CD31 immunohistochemistry of PVA sponges. CONCLUSION: Therapy with human endostatin does not induce a significant decrease in breaking strength of cutaneous wounds in mice.

Animals↗

PubMed2000

Event-related potential indices of semantic priming using masked and unmasked words: evidence that the N400 does not reflect a post-lexical process.

Several authors have contended that the N400 is a reflection of a post-lexical event such as that proposed by Neely and Keefe [J.H. Neely, D.E. Keefe, Semantic context effects on visual word processing: a hybrid prospective/retrospective processing theory, in: G.H. Bower (Ed.), The Psychology of Learning and Motivation: Advances in Research and Theory, Vol. 23, Academic Press, New York, 1989, pp. 207-248.], whereby the subject compares the word on the current trial to the "context" provided by the word on the preceding trial [M. Besson, M. Kutas, The many facets of repetition: A cued-recall and event-related potential analysis of repeating words in same versus different sentence contexts, Journal of Experimental Psychology: Learning, Memory and Cognition, 19 (5) (1993), 1115-1133; C. Brown, P. Hagoort, The processing nature of the N400: Evidence from masked priming. Journal of Cognitive Neuroscience, 5(1) (1993), 34-44; P.J. Holcomb, Semantic priming and stimulus degradation: Implications for the role of the N400 in language processing, Psychophysiology 30 (1993), 47-61; M.D. Rugg, M.C. Doyle, Event-related potentials and stimulus repetition in indirect and direct tests of memory, in: H. Heinze, T. Munte, G.R. Mangun (Eds), Cognitive Electrophysiology, Birkhauser Boston, Cambridge, MA, 1994]. A study which used masked primes to directly test this possibility has been reported by Brown and Hagoort [C. Brown, P. Hagoort, The processing nature of the N400: evidence from masked priming. Journal of Cognitive Neuroscience, 5(1) (1993), 34-44]. When the primes were masked, no priming effect was observed on the N400. When behavioral data were collected in the same paradigm, from another group of subjects, the usual priming effect on RT was obtained. Considered together, the data from the two groups of subjects indicated that activation of semantic representations had occurred without conscious awareness. As no N400 priming effect was observed, it was suggested that N400 must reflect a post-lexical process. This interpretation, however, is at odds with the findings of other studies which have reported N400 priming effects under conditions where post-lexical processes would not be thought to operate[J. Anderson, P. Holcomb, Auditory and visual semantic priming using different stimulus onset asynchronies: an event-related brain potential study. Psychophysiology 32 (1995), 177-190; J. Boddy, Event-related potentials in chronometric analysis of primed word recognition with different stimulus onset asynchronies, Psychophysiology 23 (1986), 232-245; D. Deacon, T. Uhm, W. Ritter, S. Hewitt, The lifetime of automatic priming effects may exceed two seconds, Cognitive Brain Research 7 (1999), 465-472; P.J. Holcomb, Automatic and attentional process: an event-related brain potential analysis of semantic priming. Brain and Language 35 (1998) 66-85]. The present study replicated Brown and Hagoort using a repeated measures design, a shorter SOA (stimulus onset asynchrony), and a slightly different threshold setting procedure. Significant priming effects were obtained on the mean amplitude of the N400 regardless of whether the words were masked or unmasked. The findings imply that the processing subserving the N400 is not postlexical, since the N400 was manipulated without the subjects being aware of the identity of the words.

Adolescent↗

PubMed2000

Pain in young children attending an accident and emergency department.

OBJECTIVES: To assess pain in young children presenting to an accident and emergency (A&E) department. To evaluate the use of the toddler-preschooler postoperative pain scale (TPPPS) and the use of analgesia in these children. METHODS: 100 children aged 1-5 years presenting to an A&E department were assessed for pain. Pain assessments were carried out using a modified form of the TPPPS; a visual analogue scale by parents and a numerical scale by nursing staff. RESULTS: The majority of children were assessed as having pain: 60 by the TPPPS, 58 by the nurses and 63 by parents. Only 30 children, however, received analgesia. Children with the highest pain scores as assessed by nursing staff or using the TPPPS all received analgesia. CONCLUSIONS: The pain scale appears suitable for use in young children in A&E departments. The subsequent management of pain in young children could be improved.

Child, Preschool↗

PubMed2000

Effect of Norwegian fish powder on risk factors for coronary heart disease among hypercholesterolemic individuals.

BACKGROUND AND AIM: Numerous studies suggest an association between high intake of fatty fish and reduced risk of coronary heart disease. Very long-chain omega-3 fatty acids are thought to be responsible for the benefits observed, though other fatty fish components may act in concert with them. Norwegian fish powder is a dry herring product that contains essential amino acids, marine omega-3 fatty acids, vitamins and minerals. The aim of the present study was to determine whether it has beneficial effects on risk factors for coronary heart disease in man. METHODS AND RESULTS: A single center, randomized, double-blind, parallel-treatment study was carried out for 12 weeks. Subjects with primary hypercholesterolemia were randomly allocated to 10 g fish powder or placebo (20 tablets/day). Participants were instructed to follow National Cholesterol Education Program (NCEP) Step I Diet during a 4-week diet run-in phase and during the study. Concentrations of lipids, lipoproteins, hemostatic variables and endothelial cell markers were determined before and after supplementation. Our data showed that the fish powder supplement was well tolerated. A significant decrease and increase respectively were observed in plasma alpha-linolenic acid (p = 0.03) and docosahexaenoic acid (DHA) (p = 0.03). Concentrations of lipids, lipoproteins, homocysteine, factor VII, fibrinogen, tissue plasminogen activator (tPA), plasminogen activator inhibitor (PAI)-1, soluble intercellular adhesion molecule (ICAM)-1, P-selectin and interleukin (IL)-8 were not beneficially affected. CONCLUSIONS: Fish powder supplementation does not seem an effective approach to improve risk factors for coronary heart disease in hypercholesterolemic subjects following the NCEP Step I Diet.

Adult↗

PubMed1999

The lifetime of automatic semantic priming effects may exceed two seconds.

The N400 component of event-related potentials (ERPs) was obtained in a modified version of the Neely [J.H. Neely, Semantic priming and retrieval from lexical memory: Roles of inhibitionless spreading activation and limited-capacity attention, Journal of Experimental Psychology: General, Vol. 106 (1977), pp. 226-254.] paradigm which permits unconfounding of semantic priming effects due to automatic and attentional processes. It was found that a short stimulus onset asynchrony (SOA) of 250 ms between the prime and the target was associated with automatic but not expectancy effects on the amplitude of N400. At a long SOA of 2000 ms between prime and target, semantic priming effects on N400 were obtained associated with both automatic and expectancy processes. Moreover, there was no significance difference in the magnitude of the automatic effects at the two SOAs, suggesting that automatic processing had not decayed within the 2000 ms interval between the prime and target. The results support the two-processing interpretation of semantic priming advanced by Posner and Synder [M.I. Posner, C.R.R. Snyder, Attention and cognitive control, in: R.L. Solso (Ed.), Information Processing and Cognition: The Loyola Symposium, Erlbaum, Hillsdale, NJ (1975).] and concur with the results of Neely [J.H. Neely, Semantic priming and retrieval from lexical memory: Roles of inhibitionless spreading activation and limited-capacity attention, Journal of Experimental Psychology: General, Vol. 106 (1977), pp. 226-254], with the exception of indicating a longer persistence of automatic processes.

Adult↗

PubMed1999

Malignant ascites as only manifestation of metastatic prostate cancer.

Prostate cancer is the most common malignancy in men in the US. Both at diagnosis and throughout the disease progression it can metastasize to multiple organs (bone and lymph being the most common). Effusions (either pleural or abdominal) are relatively uncommon, but usually occur as a result of soft tissue lesions. Herein we report on a patient with androgen independent prostate cancer and an elevated PSA with disease confined to ascites of the abdomen.

Journal Article↗

PubMed1999

Control of zoophilic malaria vectors by applying pyrethroid insecticides to cattle.

The principal method of malaria control in South and West Asia--indoor residual spraying--is extravagant with insecticide. A more efficient way of deploying insecticide might be to apply it on livestock since the malaria vectors in the region are highly zoophilic. A series of investigations assessed the potential of cattle treated with pyrethroid to control zoophilic mosquitoes. Permethrin, deltamethrin, and lambdacyhalothrin were applied to cattle using a sponge at concentrations of 0.5 g/m2, 0.025 g/m2, and 0.025 g/m2, respectively. 'Whole animal' insecticide bioassays that simulated natural mosquito-host contact were used to measure insecticidal and behavioural effects on wild host-seeking mosquitoes. The bioassays were performed on both sheltered and outdoor grazing animals for up to 45 days post-treatment. The possibility that treatments might cause diversion of host-seeking vectors from cattle to people nearby was also investigated. At the doses tested deltamethrin had the most pronounced and longest-lasting effect, reducing the proportion of bloodfed survivors by over 50% for the first two weeks. The majority of mosquitoes affected by the insecticide were killed before feeding. Insecticidal impact was generally lower on grazing than on sheltered animals. There was no diversion of host-seeking mosquitoes from treated cattle to nearby humans at any stage after treatment. The application of insecticide to livestock using a campaign approach may prove an effective means of controlling malaria in the region. At the doses tested deltamethrin is the most appropriate insecticide for this purpose.

Administration, Topical↗

PubMed1998

Assessing the performance of anti-vibration gloves--a possible alternative to ISO 10819, 1996.

Special gloves (commonly referred to as anti-vibration gloves) have been offered for many years as personal protection against hand-arm vibration generated, for example, by powered hand tools. An internationally agreed means of quantifying the vibration-reducing performance of such gloves was not available until the publication of International Standard ISO 10819, 1996. The evaluation of the Standard reported here has led to the conclusion that the test could be improved to give more information to the potential glove user about how the glove might perform. Investigations of the main factors which can influence the results of glove transmissibility tests have formed the basis for a proposal to develop the Standard. The proposed alternative test measures the performance of a glove in octave bands and the resultant data can be used to estimate the potential that the glove has to protect against any given vibration source. Examples of the application of the proposed alternative test for selection of anti-vibration gloves matched to particular vibration sources (powered hand tools) are given. The advantages and disadvantages of the two test methods are discussed. The evaluation of the Standard and proposals for its development are under discussion with members of the committee which developed ISO 10819, 1996.

Gloves, Protective↗

PubMed1998

Event-related potential indices of semantic priming following an unrelated intervening item.

Interposing an unrelated word between related primes and targets often disrupts priming. This finding has been used to support the view that semantic information is represented in a distributed fashion, rather than locally. In some studies where unrelated items intervened between the prime and target, however, significant priming was nevertheless obtained. The discrepant results of these studies has been attributed to differences in speed-accuracy tradeoff, post-lexical checking, conscious rehearsal of the prime and differences in the depth to which the prime and target were processed. The present study was designed in such a way as to minimize variability associated with post-lexical influences. The N400 component of the human event-related potential was used as a physiological index of the extent to which priming occurred with and without the interposition of an unrelated item. Priming effects on both the amplitude and latency of the N400 were rendered non-significant by the presence of an intervening unrelated word. The results are interpreted as tentative evidence that semantic representations are distributed.

Adolescent↗

PubMed1997

[Cardiovascular risk factors in persons aged 40-42 years in the county of Hedmark 1988-94].

We present the results from three surveys conducted in 1988, 1991 and 1994 in Hedmark comparing risk factors for cardiovascular disease among men and women age 40-42 years. The data are compared with the results for persons in the same age group from the counties Vestfold, Rogaland and Nordland, and examined in the same periods. In 1991 the average levels of total cholesterol and infarction risk score were the same in Hedmark and the three other counties, but in 1994 Hedmark compared less favourably. While the mean levels of total cholesterol showed minimal difference between rural and urban municipalities in Hedmark, triglycerides and systolic blood pressure were higher in the rural areas. Adjustment of the results in Hedmark for lower attendance rate among unmarried, divorced and widowed persons in 1991 and 1994 than in 1988 does not affect other risk factors than smoking. We discuss possible explanations of the less favourable results and the implications for primary prevention of cardiovascular diseases.

Adult↗

PubMed1997

Resistance of falciparum malaria to chloroquine and sulfadoxine-pyrimethamine in Afghan refugee settlements in western Pakistan: surveys by the general health services using a simplified in vivo test.

Surveys of drug resistant falciparum malaria were conducted in several Afghan refugee settlements, distributed over a 700 km range in western Pakistan, during the transmission seasons of 1994 and 1995. Symptomatic malaria patients were recruited by a process of passive case detection at the refugees' basic health units. To facilitate follow-up by local health workers, a modified version of the WHO extended in vivo test was adopted in which blood smears were taken from each subject, and clinical symptoms recorded, at weekly intervals. Resistance to chloroquine and sulfadoxine-pyrimethamine was identified in every settlement. The frequency of chloroquine resistance ranged from 18% to 62%. Resistance occurred mostly as RI, with RII resistance never exceeding 11%. Resistance to sulfadoxine-pyrimethamine occurred at much lower frequencies, ranging from 4% to 25%. There was a resumption of clinical symptoms at the onset of parasite recrudescence in over 90% of cases. The policy of using chloroquine as first-line treatment might be changed in favour of sulfadoxine-pyrimethamine in most camps and areas of western Pakistan. The modified in vivo test was almost as accurate as the normal WHO in vivo test in identifying the grade of resistance, and should prove a useful tool for the monitoring of resistance to common antimalarials by district health services.

Adolescent↗

PubMed1997

Chloroquine resistance in Pakistan and the upsurge of falciparum malaria in Pakistani and Afghan refugee populations.

Surveys conducted in Pakistan during the last decade show that falciparum malaria has become resistant to chloroquine in Pakistani and Afghan refugee populations throughout the country. Although RI resistance is common everywhere (with a frequency of 30%-84%), RII is rarer (2%-36%), and RIII resistance has yet to be detected. The national policy is to prescribe chloroquine as first-line treatment of malaria. A repeated in-vivo survey in a sentinel village indicated that prescription of chloroquine can lead to a 15% increase in the frequency of resistance in a single year, and similar trends were observed in other districts. Coinciding with the spread of resistance is a 6-fold increase in the number of falciparum cases recorded nationally between 1982 and 1992 and a parallel, 5-fold increase in the number of cases recorded in the Afghan refugee population. Resistance contributes to this trend in various ways. Firstly, patients with resistant malaria make repeated visits to health centres. In the sentinel village, for example, where resistance was measured at 71%, recrudescent infections inflated by 66% the genuine incidence of new infections recorded at the health centre. Secondly, owing to ineffective treatment, resistant infections are often still patent during the post-transmission season. This may enlarge the 'overwintering' parasite reservoir, leading to a surge of new cases when transmission resumes. Other factors potentially contributing to the upsurge in falciparum include the decrease availability of insecticide for indoor spraying. Despite the problems posed by resistance for case management, the evidence from the vector-control programme among the refugees is that malaria control through well-targeted campaigns of insecticide spraying is still able to reduce the incidence of falciparum malaria to a level that existed before the advent of resistance.

Afghanistan↗

PubMed1997

Sustainability of pyrethroid-impregnated bednets for malaria control in Afghan communities.

Between 1992 and 1995 a series of studies was undertaken to assess the long-term suitability of pyrethroid-impregnated bednets (PIBs) for malaria control in Afghan refugee communities in two villages in North-West Frontier Province, Pakistan. During 1992, 86% of bednet owners volunteered to have their bednets re-impregnated, and a further 15% of families purchased nets at two-thirds of cost price. From 1992 onwards, 27% of the villagers returned to Afghanistan, and annual house spraying campaigns were introduced to protect those still resident but sleeping without bednets. Within 3 years, these campaigns, together with PIBs, reduced the annual incidence of malaria by 87%, from 597 to 78 cases per 1000 population. Nevertheless, 65% of resident families continued to re-impregnate their nets annually with permethrin. To assess whether PIBs were still being used and were still protective, in view of these reduced transmission rates, we carried out a case--control study in 1994 on febrile or otherwise symptomatic patients presenting at village health centres. Comparison of the slide-positivity rates of PIB users and those without bednets showed that regular usage reduced the odds of contracting falciparum and vivax malaria to 0.22 (95% confidence interval (CI): 0.09-0.55) and 0.31 (95% CI: 0.19-0.51), respectively. There was no evidence of a sex- or age-bias in bednet use or in protective effect. The results indicate that a community-based PIB programme is an appropriate malaria control measure in areas where management or security problems make traditional house-spraying campaigns impossible. A relevant finding for those involved in the monitoring of bednet distribution projects is that the local coverage of bednets and the local impact on malaria, even when introduced to remote areas, can be estimated very cheaply by health centre microscopists who simply catalogue blood film diagnoses according to patients' bednet use practices.

Afghanistan↗