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Risk factors assessment for T. b. rhodesiense sleeping sickness acquisition in S.E. Uganda. A case-control study. 乌干达东南部感染罗得西亚锥虫昏睡病的危险因素评估。病例对照研究。
M Okia, D B Mbulamberi, A De Muynck

The major risk factors associated with acquisition of T. b. rhodesiense sleeping sickness in the Busoga focus, S.E. Uganda were investigated using a case-control study. 122 cases and 244 matched controls were used in the study. For each case two age-, sex- and resistance controls (1 matched nearest neighbour control and 1 village control) were selected. Patients and controls answered the same questionnaire which had been developed and field tested before the field study started. A logistic regression model for a 1:2 matched case control design was fit to the data. The following factors were found significant: cases spent more time outside their village of residence than controls and visited more SS high risk areas than controls, more cases than controls collected firewood in the forests. Generally, cases had less domestic animals grazing near the places of man-fly contact, especially near water and firewood collecting and bathing points, and near farms and gardens, than controls. Cases had more antecedents of sleeping sickness in the family. Generally cases had a less well developed information network than controls, and belonged economically to a less powerful group. Based on these results we may conclude that the risk to develop T.b. rhodesiense sleeping sickness depends upon a multitude of economical, cultural and human behaviour factors. These factors should be taken into account in the planning and monitoring of sleeping sickness control programmes.

采用病例对照研究调查了乌干达东南部布索加疫区与感染罗得西亚锥虫昏睡病相关的主要危险因素。122例病例和244例匹配对照纳入研究。对每个病例选择两个年龄、性别和耐药性对照(1个匹配的近邻对照和1个村庄对照)。患者和对照组都回答了同样的调查问卷,调查问卷在实地研究开始前已经编制并进行了实地测试。采用1:2匹配病例对照设计的logistic回归模型对数据进行拟合。以下因素被发现具有显著性:病例比对照组在居住地外停留的时间更长,访问SS高危地区的次数比对照组多,在森林中收集柴火的次数比对照组多。一般而言,与对照相比,病例中在人蝇接触地点附近放牧的家畜较少,特别是在取水和柴火和洗澡点附近,以及在农场和花园附近。家族中有更多昏睡病的先例。一般来说,病例的信息网络不如对照组发达,在经济上属于一个权力较小的群体。根据这些结果,我们可以得出结论,发生布氏罗得西亚锥虫昏睡病的风险取决于多种经济、文化和人类行为因素。在规划和监测昏睡病控制规划时应考虑到这些因素。
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引用次数: 0
[Onchocerciasis control program in West Africa: socioeconomic development and risk of recrudescence of transmission. 2. Experimental study of the transmission of Onchocerca volvulus strains from Southwestern Sierra Leone by Simulium yahense and Simulium squamosum]. 西非盘尾丝虫病控制规划:社会经济发展和传播复发风险。2. 塞拉利昂西南部盘尾丝虫病传播的实验研究[j]。
Y Bissan, K Doucouré, C Back, J M Hougard, H Agoua, P Guillet, M Konaré, P Harding, J Musa, F Dumbuya

The movements of human populations towards the mining wealth of the northern parts of Sierra Leone are favorable to a high contact rate between onchocerciasis patients coming from the south-western area of this country and the vector species Simulium yahense and Simulium squamosum which assume the essential of onchocerciasis transmission in the above-mentioned mining area. In fact, the Onchocerca volvulus strains concerned by this contact seem to be more pathogenic than those locally transmitted. In order to assess the danger it could represent for the Onchocerciasis Control Programme in West Africa, we carried out the experimental study of transmission which may result from this contact when more or less infected onchocerciasis patients are involved. The results indicated that this transmission by S. yahense may reach high proportions only when heavily infected onchocerciasis patients are implicated. We took also notice of the low capacity of S. squamosum to transmit the O. volvulus strains from the south-western Sierra Leone, irrespective of the microfilarial load of patients. Thus, in the most favorable conditions of a high parasite-vector contact of the study, involvement of S. yahense and onchocerciasis patients with high skin microfilarial loads is the only occurrence to which a high risk of intensive transmission may be related. The authors consider that the probability of such a risk occurring will be drastically reduced, due to the considerable decrease of skin microfilarial loads in human communities which regularly have the advantage of ivermectin (Mectizan) mass treatments.

人口向塞拉利昂北部矿区的迁移,使得来自该国西南部地区的盘尾丝虫病患者与上述矿区盘尾丝虫病传播的主要媒介——绵螺和棘螺之间的接触率很高。事实上,这次接触所涉及的盘尾丝虫病株似乎比当地传播的盘尾丝虫病株更具致病性。为了评估它可能对西非盘尾丝虫病控制规划构成的危险,我们对涉及或多或少感染盘尾丝虫病患者时这种接触可能导致的传播进行了实验性研究。结果表明,只有当涉及重度感染盘尾丝虫病患者时,这种传播才可能达到高比例。我们还注意到,无论患者的微丝虫负荷如何,鳞状棘球绦虫从塞拉利昂西南部传播扭转棘球绦虫菌株的能力很低。因此,在本研究中高度寄生虫媒介接触的最有利条件下,皮肤微丝虫负荷高的雅氏葡萄球菌和盘尾丝虫病患者是唯一可能与高度密集传播风险相关的事件。作者认为,由于经常使用伊维菌素(Mectizan)大规模治疗的人群中皮肤微丝虫负荷显著减少,这种风险发生的可能性将大大降低。
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引用次数: 0
[ Onchocerciasis control program in West Africa: socioeconomic development and risk of recrudescence of transmission. 1. Experimental study of the transmission of Onchocerca volvulus strains from Southwestern Sierra Leone by Simulium sirbanum]. 西非盘尾丝虫病控制规划:社会经济发展和传播复发风险。1. 塞拉利昂西南部盘尾丝虫病传播的实验研究[j]。
K Doucouré, Y Bissan, C Back, J M Hougard, H Agoua, P Guillet, M Konaré, D Quillévéré

As part of the return of savanna migrants installed since a long time in forest regions, in the south of Sierra Leone, we carried out an experimental study about a cross-transmission between Simulium sirbanum from Missira (West-Mali) and the forest strain of Onchocerca volvulus in the south-west of Sierra Leone. This study will allow to know if there is a risk of onchocerciasis transmission recrudescence in relation to the reinstallation of these migrants in their native region. Because of the very high limitation to the forest strain of O. volvulus microfilariae output of the peritrophic membrane reduction with savanna black-flies and according to the very low mature parasite out put of S. sirbanum with this strain observed along this experimentation, the forest strain of O. volvulus from the south Sierra Leone appears maladjusted to S. sirbanum, the main vector of onchocerciasis in savanna regions. This observation implicates a very low intensity of transmission for this forest strain by savanna onchocerciasis vectors. The return of savanna migrants in their native region, installed in the south Sierra Leone since several decades, could not be, in a short time, an origin of onchocerciasis recrudescence in savanna regions of the Onchocerciasis Control Programme area cleaned by an effective vector control carried out since 1975 sustained now by a chemotherapeutic treatment reducing the human parasite reservoir. However, the preservation of this acquired necessitates an epidemiological supervision increased, because the interactions between the vector and the parasite for a long time could carry away a mutual adaptation and a sickness recrudescence.

作为长期安置在塞拉利昂南部森林地区的热带草原移民返回的一部分,我们开展了一项关于来自密西拉(马里西部)的siulium sirbanum与塞拉利昂西南部盘尾盘尾虫(Onchocerca volvulus)森林菌株交叉传播的实验研究。这项研究将有助于了解将这些移民重新安置在其原籍地区是否存在盘尾丝虫病传播复发的风险。由于涡旋丝虫森林菌株对稀树草原黑蝇的周营养膜减少产量的限制非常高,并且根据本实验中观察到的S. sirbanum成熟寄生虫产量非常低,来自塞拉利昂南部的涡旋丝虫森林菌株似乎不适应S. sirbanum,稀树草原地区盘尾丝虫病的主要媒介。这一观察结果表明,热带草原盘尾丝虫病媒介对这一森林毒株的传播强度非常低。几十年来定居在塞拉利昂南部的热带稀树草原移徙者返回其原籍地区,在短期内不可能成为盘尾丝虫病在盘尾丝虫病控制方案地区的热带稀树草原地区复发的根源,该方案自1975年以来进行了有效的病媒控制,现已由减少人类寄生虫储存库的化学疗法维持。然而,这种获得性的保存需要加强流行病学监督,因为病媒和寄生虫之间的长期相互作用可能导致相互适应和疾病复发。
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引用次数: 0
[Influence of mosquito nets impregnated with deltamethrin on the aggressivity cycle of Anopheles gambiae in Djoumouna, Congo]. [溴氰菊酯浸渍蚊帐对刚果乔穆纳地区冈比亚按蚊侵袭周期的影响]。
A Zoulani, P Carnevale, L Penchenier

Several studies recently done in Africa south of the Sahara have clearly demonstrated that pyrethroid impregnated bednets should actually reduce malaria inoculation rate due to Anopheles gambiae and therefore high Plasmodium falciparum parasitaemia and malaria morbidity, even mortality. Nevertheless some concerns were recently raised on an eventual shift in the usual behavior of this species induced by the presence inside the house of bednets treated with pyrethroid insecticide known to have a deterrent or excito-repellent effect, and which could therefore lead to a biting behavior earlier than usual. The current limited study, done in Djoumouna, a place well known for the very high density of An. gambiae, has shown that the temporary presence inside a house of a bednet impregnated with deltamethrin (12.5 or 25 ma a.i./m2) has not induced any shift in the biting cycle of this species, but it actually reduced by some 50% its biting rate noticed on human beings. It is worth underlining that all sporozoite infected specimens were actually caught after midnight. This biting behavior of An. gambiae could explain why impregnated bednets are so efficient in reducing man-vector contact and malaria transmission.

最近在撒哈拉以南非洲进行的几项研究清楚地表明,浸渍了拟除虫菊酯的蚊帐实际上应该降低由于冈比亚按蚊引起的疟疾接种率,从而降低恶性疟原虫寄生虫病和疟疾发病率,甚至死亡率。然而,最近有人提出了一些担忧,即这种物种的通常行为最终会发生变化,因为在房屋内使用了经拟除虫菊酯杀虫剂处理过的蚊帐,这种杀虫剂已知具有威慑或兴奋驱避作用,因此可能导致咬人行为比平时更早发生。目前这项有限的研究是在朱莫纳进行的,这是一个以安族高密度而闻名的地方。冈比亚的研究表明,在一所房子里暂时放置一顶浸渍了溴氰菊酯(12.5或25 ma a.i./m2)的蚊帐,并没有导致该物种的叮咬周期发生任何变化,但实际上它在人类身上发现的叮咬率降低了约50%。值得强调的是,所有孢子虫感染的标本实际上都是在午夜之后捕获的。安的这种咬人行为。冈比亚可以解释为什么浸渍蚊帐在减少人类媒介接触和疟疾传播方面如此有效。
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引用次数: 0
Population dynamics of anophelines in a malathion treated village in the intermediate zone of Sri Lanka. 斯里兰卡中间地带马拉硫磷处理村庄按蚊种群动态。
I Dewit, M Coosemans, K Srikrishnaraj, M Wery

As part of research programme on malaria transmission in Sri Lanka, a study was made of man-biting anophelines at Nikawehera, a village on the border of the intermediate and dry rainfall zones. Weekly mosquito collections by night human bait (NHB) were performed inside and outside four fixed stations from October 1992 till March 1993. Houses in the village were treated with malathion by the Anti-Malaria Campaign in October and at the end of January 1993. An. culicifacies and An. tesselatus were the most abundant species. An. culicifacies was probably the only species responsible for malaria transmission. An. culicifacies densities varied between stations and reflected differences in availability of breeding places. An. culicifacies aggressivity is closely related to the rainfall pattern, increasing after the first monsoon rains in November and reaching a peak in late December--early January. Vectorial capacity, however, decreased during the first weeks of the rainy season. The maximum vectorial capacity was found in January. The night biting cycle of An. culicifacies showed a peak between 20.00 and 23.00 h. Since the introduction of electricity in the village, people go to bed later. This might reduce the impact of impregnated bednets on malaria transmission. The results show that malathion spraying as performed now is not very effective. The timing of the spray rounds should be improved. In order to limit malaria transmission, we suggest to advance the malathion spraying campaign of January with one month.

作为斯里兰卡疟疾传播研究方案的一部分,在Nikawehera(一个位于中雨区和干雨区交界处的村庄)对叮人疟蚊进行了一项研究。1992年10月至1993年3月,每周在4个固定站点内外进行夜间人饵捕蚊。1993年10月和1月底,防治疟疾运动用马拉硫磷治疗了村里的房屋。一个。文化相与文化。Tesselatus是最丰富的种类。一个。Culicifacies可能是唯一负责疟疾传播的物种。一个。不同站点间的种群相密度不同,反映了繁殖场所可用性的差异。一个。相侵略性与降雨模式密切相关,在11月第一次季风雨后增加,在12月下旬至1月初达到峰值。然而,在雨季的头几个星期,病媒能力下降。最大的病媒传播能力出现在1月份。安的夜间咬人循环。culicifacies在20点到23点之间出现高峰。由于村里引入了电力,人们睡得更晚了。这可能会减少浸渍蚊帐对疟疾传播的影响。结果表明,目前采用的马拉硫磷喷洒方法效果不佳。喷弹的时机应该改进。为限制疟疾传播,建议将1月份的马拉硫磷喷洒活动提前1个月。
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引用次数: 0
Health seeking behaviour and self-treatment for common childhood symptoms in rural Guatemala. 危地马拉农村儿童常见症状的求医行为和自我治疗。
E Delgado, S C Sorensen, P Van der Stuyft

This study was conducted in the Guatemalan highland department of Sacatepequez, in a sample of 146 rural women insured by the Social Security system. It examined their health care behaviour when their children presented common childhood symptoms such as diarrhoea, fever, cough and worms. The mothers generally sought help and treatment advice from an older woman in the family, and did so more often for diarrhoea (82%) and fever (64%) than for cough (43%) or worms (28%). Obtaining advice in a pharmacy or from a drug seller ranked second (range: 8%-38%, depending on the symptom), before the procurement of professional help at a medical service (range: 8%-23%). Traditional healers were hardly consulted (range: 0%-3%). In the case of self-treatment the women predominantly relied on Western drugs: around 80% in diarrhoea and fever, and above 50% in cough. Herbs and traditional external remedies were little used, except in cough (27% herbs) and worms (58% external remedies). None of the mothers reported ORS as home treatment for diarrhoea. Problems of geographical or financial accessibility could not explain the low utilisation of the Western health care system. The acceptability of public services, however, was poor. Largely because the Social Security clinic did not prescribe the "potent" modern drugs mothers preferred for the treatment of childhood symptoms--at least, not for uncomplicated illness episodes. Women hence turned to the--partially informal--private sector, which unabashedly responds to their demands. Clear away the discrepancy between the "rational" needs perceived by the official health sector and the demands of the population is one of the bigger challenges to health care planning in transitional communities such as the one studied.

这项研究是在危地马拉的萨卡特佩克斯高地进行的,样本是146名参加社会保障制度的农村妇女。调查调查了他们的孩子出现腹泻、发烧、咳嗽和寄生虫等常见儿童症状时的保健行为。这些母亲通常会向家中的一位年长妇女寻求帮助和治疗建议,并且腹泻(82%)和发烧(64%)比咳嗽(43%)或蠕虫(28%)更常这样做。在获得医疗服务专业帮助(范围:8%-23%)之前,在药房或药品销售商处获得建议排在第二位(范围:8%-38%,取决于症状)。很少咨询传统治疗师(范围:0%-3%)。在自我治疗方面,妇女主要依靠西药:腹泻和发烧约占80%,咳嗽超过50%。草药和传统的外药很少使用,除了咳嗽(27%的草药)和蠕虫(58%的外药)。没有母亲报告口服补液疗法是治疗腹泻的家庭疗法。地理或经济可及性的问题不能解释西方医疗保健系统使用率低的原因。然而,公共服务的可接受性很差。很大程度上是因为社会保障诊所没有开出母亲们喜欢的治疗儿童症状的“强效”现代药物——至少不是治疗无并发症的疾病发作。因此,妇女转向部分非正式的私营部门,这些部门毫不掩饰地回应她们的要求。消除官方卫生部门认为的"合理"需求与人口需求之间的差异,是所研究的这类转型社区保健规划面临的更大挑战之一。
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引用次数: 0
Paying for health care instead of buying drugs. An experience from western Mali. 支付医疗费用而不是购买药品。来自马里西部的经验。
G Kegels

This paper gives an overview of what happened when a flat fee cost recovery system for pre-school children was introduced in a rural town hospital in western Mali: the preceding analysis, the implementation of the new scheme, the results and the problems. The most probable explanations for the problems are discussed. It is concluded that, in order to be successful and to attain its objectives, an initiative of this kind--in this environment--requires very careful preparation and commitment, management-wise as well as socially, in order to achieve a sufficient level of common understanding and consensus.

本文概述了在马里西部的一家农村城镇医院引入学前儿童固定费用成本回收系统时发生的情况:之前的分析,新方案的实施,结果和问题。对这些问题最可能的解释进行了讨论。结论是,为了取得成功和实现其目标,在这种环境下的这类倡议需要非常仔细的准备和承诺,在管理方面和社会方面都需要,以便达到足够程度的共同理解和协商一致意见。
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引用次数: 0
[Leishmaniasis in Ecuador. 6. Epidemiological and entomological note on the focus of leishmaniasis in Zumba]. [厄瓜多尔的利什曼病]。尊巴地区利什曼病流行病学和昆虫学要点[j]。
F Le Pont, C Barrera, A L Caceres, E A Galati, O Jarra, A R Riofrio, J Mouchet, R Echeverria, R H Guderian

The Zumba focus of tegumentary leishmaniasis lies in the southwards Amazonian region of Ecuador. A clinico-epidemiological study has been carried out in the area on 83 patients attending health centers. All the biotopes suitable for sandflies, including dwellings, have been sampled from February to September 1992 by light trap and human bait catches. The number of sandflies caught amounts to 2,547. Anthropophilic sandfly fauna is poor and only three species have been recorded. Lutzomyia serrana abounds inside dwellings where it bites men even during daytime. The parasite was identified as an intermediate form between Leishmania panamensis and L. braziliensis. It will be described elsewhere. The high proportion of facial lesions suggests a domiciliary transmission for which Lu. serrana could be a good vector candidate.

晚期利什曼病的尊巴中心位于厄瓜多尔的亚马逊南部地区。在该地区对83名在保健中心就诊的病人进行了临床流行病学研究。1992年2月至9月,用灯诱法和人饵法对所有适合白蛉生存的生物群落,包括住所进行了取样。捕获的白蛉达2547只。亲人类的白蛉区系很少,仅记录了3种。瑟拉纳Lutzomyia serrana在住宅内大量存在,即使在白天也会叮咬人类。该寄生虫被鉴定为巴拿马利什曼原虫和巴西利什曼原虫之间的中间形态。它将在其他地方描述。面部病变的高比例表明,这是一种家属性传播。塞拉纳可能是一个很好的载体候选人。
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引用次数: 0
Antiparasitic activity of diallyl trisulfide (Dasuansu) on human and animal pathogenic protozoa (Trypanosoma sp., Entamoeba histolytica and Giardia lamblia) in vitro. 二烯丙基三硫醚对人畜致病性原生动物(锥虫、溶组织内阿米巴和鞭毛虫)体外抗寄生活性的研究。
Z R Lun, C Burri, M Menzinger, R Kaminsky

Garlic (Allium sativum L.) and one of its major components, allicin, have been known to have antibacterial and antifungal activity for a long time. Diallyl trisulfide is a chemically stable final transformation product of allicin which was synthesized in 1981 in China and used for treatment of bacterial, fungal and parasitic infections in man. The activity of diallyl trisulfide was investigated in several important protozoan parasites in vitro. The IC50 (concentration which inhibits metabolism or growth of parasites by 50%) for Trypanosoma brucei brucei, T.b. rhodesiense, T.b. gambiense, T. evansi, T. congolense and T. equiperdum was in the range of 0.8-5.5 micrograms/ml. IC50 values were 59 micrograms/ml for Entamoeba histolytica and 14 micrograms/ml for Giardia lamblia. The cytotoxicity of the compound was evaluated on two fibroblast cell lines (MASEF, Mastomys natalensis embryo fibroblast and HEFL-12, human embryo fibroblast) in vitro. The maximum tolerated concentration for both cell lines was 25 micrograms/ml. The results indicate that the compound has potential to be used for treatment of several human and animal parasitic diseases.

大蒜(Allium sativum L.)及其主要成分之一大蒜素(allicin)长期以来一直被认为具有抗菌和抗真菌活性。二烯丙基三硫醚是大蒜素化学性质稳定的最终转化产物,于1981年在中国合成,用于治疗人体细菌、真菌和寄生虫感染。研究了二烯丙基三硫醚在几种重要原生动物寄生虫体内的体外活性。布氏锥虫、罗得西亚锥虫、冈比亚锥虫、伊瓦西锥虫、刚果锥虫和装备锥虫的IC50(抑制寄生虫代谢或生长50%的浓度)在0.8 ~ 5.5微克/ml。溶组织内阿米巴的IC50值为59微克/毫升,贾第鞭毛虫的IC50值为14微克/毫升。体外对两种成纤维细胞系(MASEF, Mastomys natalensis胚胎成纤维细胞和HEFL-12,人胚胎成纤维细胞)进行了细胞毒性评价。两种细胞系的最大耐受浓度均为25微克/毫升。结果表明,该化合物具有治疗多种人畜寄生虫病的潜力。
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引用次数: 0
Development of hyperreactive malarious splenomegaly in an 8 year-old Caucasian boy, 18 months after residence in Africa. 在非洲居住18个月后,一名8岁高加索男孩出现高反应性疟疾性脾肿大。
J Van den Ende, A Van Gompel, E Van den Enden, R Colebunders

Hyperreactive malarial splenomegaly (the former tropical splenomegaly syndrome) refers to a combination of splenomegaly, high antimalarial antibodies and high serum IgM content, a condition resulting from an aberrant immunological response to malaria. It has rarely been described in expatriates. We report the case of an 8 year-old Dutch boy who developed this syndrome 18 months after returning from Zaire. Treatment with mefloquine resulted in gradual improvement of all laboratory abnormalities. The spleen did not decrease in size, but became normal for age as height increased.

高反应性疟疾性脾肿大(原热带脾肿大综合征)是指脾肿大、高抗疟抗体和高血清IgM含量的结合,这是一种由对疟疾的异常免疫反应引起的疾病。这种情况很少发生在外籍人士身上。我们报告一例8岁的荷兰男孩,他从扎伊尔返回18个月后出现这种综合征。甲氟喹治疗导致所有实验室异常逐渐改善。脾脏的大小没有减小,但随着年龄的增长,随着身高的增加而恢复正常。
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引用次数: 0
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Annales de la Societe belge de medecine tropicale
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