Disease Control Strategy Group

Liverpool, United Kingdom

Disease Control Strategy Group

Liverpool, United Kingdom
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Ravichandran K.,King Faisal Specialist Hospital And Research Center | Mohamed G.,Disease Control Strategy Group | Al-Hamdan N.A.,University of Sfax
Asian Pacific Journal of Cancer Prevention | Year: 2010

Background: Earlier studies on cancer knowledge/awareness from Saudi Arabia have been few and mostly limited to knowledge of and attitude towards breast cancer. The objectives of the present cross sectional study were to determine the levels of knowledge concerning cancer and to identify associated factors. Methods: This study was carried out among 1,407 Saudis who were either patients or their escorts, attending selected hospitals in Riyadh region and aged 15 years or more. Required information was obtained by interview using a piloted Arabic questionnaire. Associations between different variables and respondents knowledge were evaluated by Chi square test. Multiple logistic regression analyses were performed to examine the potential impact of the variables. Results: This study population consisted of 688 males and 719 females. Approximately two thirds of participants (67.6%) had never heard of any cancer warning signals, but 80.7% believed some cancers can be cured if detected early, 27.1% believed cancer means end of life and 74.2% believed cancer will appear overnight. The majority of the respondents (65.1%) received information about cancer from television/radio. Although 1,159 had high level knowledge (scored 50.0% and more), only 233 individuals scored 75.0% and more. Significant differences in the knowledge level across age groups, educational levels and marital status were observed. Females had higher level knowledge than males. Odds of having high level knowledge about cancer was 5.27 times higher among those who had undergone any of the tests (breast self examination, mammography, occult blood, Papanicolau smear) compared to those who had none of those tests (95% CI: 1.87-14.84). Those who had heard about any cancer warning signal were more knowledgeable (OR=1.55; 95% CI: 1.10-2.19) than those who hadn't. The other most important determinants of knowledge level included age, and attending a primary health care centre. Conclusions: Our results suggest that the knowledge of cancer is poor among the public and greater attempts should be made to increase public awareness.


Levitz S.,Natural History Museum in London | Standley C.J.,Natural History Museum in London | Adriko M.,Ministry of Health | Kabatereine N.B.,Ministry of Health | Stothard J.R.,Disease Control Strategy Group
Acta Tropica | Year: 2013

Intestinal schistosomiasis continues to be hyper-endemic in the fishing community of Bugoigo located on the eastern shore of Lake Albert, Uganda. Our study aimed to identify the factors that determine the local distribution and abundance of Biomphalaria, as well as infection(s) with Schistosoma mansoni inclusive of their genetic diversity. In addition, a DNA barcoding approach was taken to genotype schistosome cercariae, exploring the micro-epidemiology of infections. Over a 3-week period in June-July 2010, several hundred Biomphalaria spp. were collected, together with environmental information, from 10 selected sites, representive of both putative wave-exposed (n= 5) and wave-sheltered shorelines (n= 5). A Mann-Whitney U-test and a generalized linear model were used to assess associations with snail abundance and parasite infections across the shoreline. Levels of local wave action were recorded over the 19-day period using digital accelerometers. The general absence of wave action on the sheltered shoreline likely helped to raise and focalize other environmental parameters, such as water conductivity by lack of mixing, that foster transmission of intestinal schistosomiasis. Over the study period, a total of 10 infected snails were encountered and a selection of schistosome cercariae from each infected snail was harvested for analysis by DNA barcoding. In total, 91 DNA barcodes were generated with 15 unique barcode types identified. Of these, 4 barcodes had been found previously in Lake Albert and (or) Victoria, the remaining 11 were newly encountered here and described. The distribution of DNA barcodes across infected snails and sampled locations revealed a complicated spatial sub-structuring. By shedding new light on the fine-scale patterning of infections, DNA barcoding has revealed a rather heterogeneous landscape of cercariae, likely inclusive of multi-miracidial infections within the snail, which will in turn interplay with human water contact activities to shape the genetic diversity of worm populations within infected people. © 2012 Elsevier B.V.


Sousa-Figueiredo J.C.,Disease Control Strategy Group | Sousa-Figueiredo J.C.,London School of Hygiene and Tropical Medicine | Betson M.,Disease Control Strategy Group | Atuhaire A.,Ministry of Health | And 5 more authors.
PLoS Neglected Tropical Diseases | Year: 2012

Background: In 2012 the WHO formally recognised that infants and preschool children are at significant risk of schistosomiasis and qualify for treatment with praziquantel (PZQ). Targeted surveys determining both the performance and safety of this drug are now needed in endemic areas. We have formally assessed parasitological cure and putative side-effects in a prospective cohort of Schistosoma mansoni-infected children (aged 5 months-7 years old) in lakeshore settings of Uganda. Methodology/Principal Findings: From a total of 369 children found to be egg-patent for intestinal schistosomiasis, 305 were followed-up three to four weeks after PZQ treatment and infection status re-assessed. Separately, a previously tested side-effect questionnaire was employed before and 24 hours after PZQ treatment to assess incidence and amelioration of symptoms in young children and their mothers. While the overall observed parasitological cure was 56.4%, a significant difference was found between a sub-set of children who had a history of multiple PZQ treatments (between one and four in an 18 month period), where cure rate was 41.7%, and those who had never received treatment (cure rate was 77·6%). PZQ proved to be safe, with only mild reported side effects which cleared within a month after treatment. Prevalence of reported symptoms was significantly lower in children than in mothers, and fewer side-effects were reported upon subsequent rounds of PZQ treatment. Conclusion/Significance: Our findings show that PZQ treatment of young children resulted in satisfactory cure rates, and marked reduction in egg-output, with only mild and transient reported side-effects. However, the cure rate is clearly lower in younger children and those with history of previous treatment. Cure rate, but not egg reduction rate, was also lower in children with heavier pre-intervention infection intensity. With chemotherapy now recommended as a long-term strategy for disease control in young children, research into optimising the periodicity of targeted treatment strategies is now crucial. © 2012 Sousa-Figueiredo et al.


Betson M.,Disease Control Strategy Group | Sousa-Figueiredo J.C.,Disease Control Strategy Group | Sousa-Figueiredo J.C.,London School of Hygiene and Tropical Medicine | Kabatereine N.B.,Ministry of Health | Stothard J.R.,Disease Control Strategy Group
American Journal of Tropical Medicine and Hygiene | Year: 2012

There is a need for field-applicable markers to assess morbidity associated with intestinal schistosomiasis, especially in the context of preventive chemotherapy in young children. We investigated whether fecal occult blood (FOB) point-of-care tests could be used to assess intestinal pathology over a 12-month period in a cohort of 382 children (< 5 years of age). We found a strong association between egg-patent schistosomiasis and FOB at baseline (odds ratio [OR] = 3.1, P < 0.0001), 6 months (OR = 3.4, P < 0.0001), and 12 months (OR = 3.5, P < 0.0001), despite repeated chemotherapy. There were tendencies for prevalence of FOB to decrease in children who became egg negative and increase in those who became egg positive. Our results demonstrate overt disease in children less than five years of age. We therefore propose that FOB is useful for assessing dynamics of intestinal morbidity in young children at the community level and monitoring changes in morbidity after mass chemotherapy. Copyright © 2012 by The American Society of Tropical Medicine and Hygiene.


Sousa-Figueiredo J.C.,Disease Control Strategy Group | Sousa-Figueiredo J.C.,London School of Hygiene and Tropical Medicine | Betson M.,Disease Control Strategy Group | Kabatereine N.B.,Ministry of Health | Stothard J.R.,Disease Control Strategy Group
PLoS Neglected Tropical Diseases | Year: 2013

Background: The World Health Organization now recommends the provision of praziquantel treatment to preschool-aged children infected with schistosomiasis. For intestinal schistosomiasis the current operational field diagnostic standard is examination of a thick Kato-Katz smear by microscopy prepared from a single stool specimen, and although pragmatic, this methodology has well-known shortcomings. Here, as a potential alternative, the performance of the urine circulating cathodic antigen (CCA) dipstick test was assessed in terms of disease-mapping and point-of-care diagnosis for intestinal schistosomiasis in preschool-aged children. Our manuscript reports on findings at baseline and at the end of a one-year longitudinal treatment study. Methodology/Principal Findings: A total of 925 children (mean age 2.8 years) were initially recruited from six lakeshore villages representative of high, moderate and low levels of disease transmission. At baseline, all children were tested for intestinal schistosomiasis by microscopic examination of duplicate Kato-Katz smears prepared from a single stool faecal, by antigen detection with the urine CCA dipstick test and by serology with a commercially available ELISA test (as 'gold-standard') that measures host antibody titres to soluble egg antigens. As a point-of-care diagnosis, the urine CCA dipstick test achieved sensitivity and specificity values ranging from 52.5-63.2% and 57.7-75.6%, respectively, with faecal microscopy achieving very high specificities (>87%) but sensitivities as low as 16.7% in the low transmission setting. Conclusion/Significance: The urine CCA test was shown to be more effective than faecal microscopy especially in lower transmission settings. The diagnostic performance of this test was not significantly impacted by treatment history or co-infections with other intestinal helminths. © 2013 Sousa-Figueiredo et al.


Stothard J.R.,Disease Control Strategy Group | Mugisha L.,Makerere University | Mugisha L.,Conservation and Ecosystem Health Alliance CEHA | Standley C.J.,Princeton University
Trends in Parasitology | Year: 2012

Ngamba Island Chimpanzee Sanctuary (NICS) in Lake Victoria, Uganda is currently home to 44 wild-borne, semi-captive chimpanzees. Despite regular veterinary health checks, it only came to light recently that many animals, and sanctuary staff, were naturally infected with Schistosoma mansoni. Indeed, local schistosome transmission appears firmly engrained for intermediate snail hosts can be found along almost the entirety of Ngamba's shoreline. Here, the epidemiology of infection is a dynamic interplay between human and chimpanzee populations, as revealed by genetic analyses of S. mansoni. In this review, our present understanding of this complex and evolving situation is discussed, alongside general disease control activities in Uganda, to highlight future interventions towards stopping schistosome morbidity and transmission within this conservation sanctuary setting. © 2012.


Owusu-Ofori A.K.,Komfo Anokye Teaching Hospital | Owusu-Ofori A.K.,Disease Control Strategy Group | Bates I.,Disease Control Strategy Group
PLoS ONE | Year: 2012

Background: Policies concerning the prevention of transfusion transmitted malaria (TTM) are the responsibility of blood transfusion services and malaria control programmes. To prevent spreading drug resistance due to over-use of malaria drugs, recent malaria treatment guidelines recommend prompt parasitological confirmation before treatment is started. In contrast, blood safety policies from the World Health Organisation (WHO) recommend presumptive malaria treatment for recipients of blood in endemic countries but evidence supporting this approach is lacking. Our study documented how these conflicting policies relating to malaria transmission through blood transfusion impact on clinical practice in a teaching hospital in West Africa. Methods/Principal Findings: We randomly selected and reviewed case notes of 151 patients within 24 hours of their receiving a blood transfusion. Transfusion practices including the confirmation of diagnosis and anti-malarial treatment given were compared across three departments; Obstetrics and Gynaecology (O&G), Paediatrics and Medicine. Overall, 66 (44%) of patients received malaria treatment within 24 hrs of their blood transfusion; of which only 2 (3%) received anti-malarials based on a laboratory confirmation of malaria. Paediatric patients (87%) received the most anti-malarials and only 7% and 24% of recipients in medicine and O&G respectively received anti malarials. In 51 patients (78%), the anti-malarials were prescribed at the same time as the blood transfusion and anti-malarials prescriptions exceeded the number of patients with a presumptive diagnosis of malaria. Conclusions: It is common practice in paediatrics to prescribe anti-malarials routinely with blood transfusions. This contravenes the malaria treatment guidelines of laboratory confirmation before treatment but is in accordance with the less-well evidenced blood safety guidelines. There is an urgent need for more evidence about the clinical impact of transfusion transmitted malaria to enable malaria and blood transfusion programmes to harmonize their policies and give clear guidance to clinicians who prescribe blood transfusions in malaria-endemic areas. © 2012 Owusu-Ofori, Bates.


Standley C.J.,Princeton University | Stothard J.R.,Disease Control Strategy Group
Journal of Parasitology | Year: 2012

Abstract: While Schistosoma rodhaini is typically considered a parasite of small mammals and is very scantly distributed in the Lake Victoria basin, it is known to hybridize with the more widespread Schistosoma mansoni, the causative agent of intestinal schistosomiasis. As part of broader parasitological and malacological surveys for S. mansoni across Lake Victoria, schistosome cercariae were harvested from a field-caught Biomphalaria choanomphala taken on Ngamba Island Chimpanzee Sanctuary, Uganda. Upon DNA barcoding, these cercariae were found to be a mixture of both S. rodhaini and S. mansoni, with further phylogenetic analysis revealing a hitherto unknown sub-lineage within S. rodhaini. Despite repeated sampling for eggs and miracidia from both chimpanzees and staff on Ngamba Island Sanctuary, detection of S. rodhaini within local definitive hosts awaits additional efforts, which should be mindful of a potential host role of spotted-necked otters. © American Society of Parasitologists 2012.


Owusu-Ofori A.K.,Komfo Anokye Teaching Hospital | Parry C.,University of Oxford | Bates I.,Disease Control Strategy Group
Clinical Infectious Diseases | Year: 2010

Although international policies recommend that blood for transfusion should be screened for transfusion-transmitted infections, malaria screening is not performed in most malaria-endemic countries in sub-Saharan Africa. Our literature review identified 17 relevant studies from the period 1980-2009 and indicated that the median prevalence of malaria among 33,029 blood donors was 10.2% (range, 0.7% in Kenya to 55.0% in Nigeria). Malaria screening methods, including microscopy (used in 16 of 17 studies), are either insensitive or impractical for donor screening in resource-poor countries. Even if a suitable screening method were available, rejection of malaria-positive donors would jeopardize the blood supply. Only 1 study established the prevalence of parasitemia among transfusion recipients. This review highlights the need for more evidence about the clinical impact of transfusion-transmitted malaria to justify the policy of screening for blood for malaria in areas of endemicity and for a critical analysis of the feasibility of implementing such a policy and its effect on blood supply. © 2010 by the Infectious Diseases Society of America. All rights reserved.


Sousa-Figueiredo J.C.,Disease Control Strategy Group | Sousa-Figueiredo J.C.,London School of Hygiene and Tropical Medicine | Betson M.,Disease Control Strategy Group | Stothard J.R.,Disease Control Strategy Group
International Health | Year: 2012

To facilitate administration of praziquantel (PZQ) to African infants and preschool-aged children using a dose pole, the performance of two downwardly extended versions (the first created in 2010 using biometric data from Uganda alone and the second version created here using data from 36 countries) was assessed against height/weight data from a total of 166. 210 preschool-aged children (≤6 year olds) from 36 African countries. New and optimized thresholds for PZQ tablet administration at one tablet (600. mg), 3/4 and 1/2 tablet divisions are suggested here. Both dose poles investigated estimated an acceptable PZQ dosage (30-60. mg/Kg) for more than 95% of children. Extension and optimization of the current PZQ dose pole, followed by theoretical validation using biometric data from preschool-aged children (0-6 years of age, 60-110. cm in height) from 36 African countries will help future mass drug administration campaigns incorporate younger children. This newly optimized dose pole with single 600. mg (height: 99-110. cm), 3/4 (height: 83-99. cm) and 1/2 (height: 66-83. cm) tablet divisions, also reduces drug waste and facilitates inclusion of preschool-aged children. Our findings also have bearings on the use of other dose poles for treatment of young children. © 2012 Royal Society of Tropical Medicine and Hygiene.

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