Bassinet use and sudden unexpected death in infancy

OBJECTIVE

To analyze risk factors in infants who die suddenly and unexpectedly in bassinets.

STUDY DESIGN

A retrospective review of all deaths of infants involving bassinets reported to the Consumer Product Safety Commission (CPSC) between 1990 and 2004.

RESULTS

For the 53 deaths analyzed, the mean age at death was 84 days. The cause of death was recorded as anoxia, asphyxiation, or suffocation in 85% and sudden infant death syndrome (SIDS) in 9.4%. In terms of position, 37% were placed prone for sleep, and 50% were prone when found dead. Additional items in the bassinet, including soft bedding, were noted in 74% of cases. Specific mechanical problems with the bassinets were noted in 17% of cases.

CONCLUSIONS

The risk of sudden unexpected death in infants who sleep in bassinets can be reduced by following American Academy of Pediatrics guidelines, including positioning infants supine and avoiding soft bedding in bassinets. In addition, parents must ensure that the bassinet is mechanically sound and that no objects that can lead to suffocation are in or near the bassinet.

Malaria prevalence and mosquito net coverage in Oromia and SNNPR regions of Ethiopia

BACKGROUND

Malaria transmission in Ethiopia is unstable and seasonal, with the majority of the country's population living in malaria-prone areas. Results from DHS 2005 indicate that the coverage of key malaria interventions was low. The government of Ethiopia has set the national goal of full population coverage with a mean of 2 long-lasting insecticidal nets (LLINs) per household through distribution of about 20 million LLIN by the end of 2007. The aim of this study was to generate baseline information on malaria parasite prevalence and coverage of key malaria control interventions in Oromia and SNNPR and to relate the prevalence survey findings to routine surveillance data just before further mass distribution of LLINs.

METHODS

A 64 cluster malaria survey was conducted in January 2007 using a multi-stage cluster random sampling design. Using Malaria Indicator Survey Household Questionnaire modified for the local conditions as well as peripheral blood microscopy and rapid diagnostic tests, the survey assessed net ownership and use and malaria parasite prevalence in Oromia and SNNPR regions of Ethiopia. Routine surveillance data on malaria for the survey time period was obtained for comparison with prevalence survey results.

RESULTS

Overall, 47.5% (95% confidence interval (CI) 33.5-61.9%) of households had at least one net, and 35.1% (95% CI 23.1-49.4%) had at least one LLIN. There was no difference in net ownership or net utilization between the regions. Malaria parasite prevalence was 2.4% (95% CI 1.6-3.5%) overall, but differed markedly between the two regions: Oromia, 0.9% (95% CI 0.5-1.6); SNNPR, 5.4% (95% CI 3.4-8.5), p < 0.001. This difference between the two regions was also reflected in the routine surveillance data.

CONCLUSION

Household net ownership exhibited nearly ten-fold increase compared to the results of Demographic and Health Survey 2005 when fewer than 5% of households in these two regions owned any nets. The results of the survey as well as the routine surveillance data demonstrated that malaria continues to be a significant public health challenge in these regions-and more prevalent in SNNPR than in Oromia.

Distribution systems of insecticide-treated bed nets for malaria control in rural Burkina Faso: cluster-randomized controlled trial

BACKGROUND

Insecticide-impregnated bed nets (ITNs) have been shown to be a highly effective tool against malaria in the endemic regions of sub-Saharan Africa (SSA). There are however different opinions about the role of ITN social marketing and ITN free distribution in the roll-out of ITN programmes. The objective of this study was to evaluate the effects of free ITN distribution through antenatal care services in addition to an ITN social marketing programme in an area typical for rural SSA.

METHODS

A cluster-randomised controlled ITN trial took place in the whole Kossi Province in north-western Burkina Faso, an area highly endemic for malaria. Twelve clusters were assigned to long-term ITN (Serena brand) social marketing plus free ITN (Serena brand) distribution to all pregnant women attending governmental antenatal care services (group A), and 13 clusters to ITN social marketing only (group B). The intervention took place during the rainy season of 2006 and thereafter. The trial was evaluated through a representative household survey at baseline and after one year. Serena ITN household ownership was the primary outcome measure.

FINDINGS

A total of 1052 households were visited at baseline in February 2006 and 1050 at follow-up in February 2007. Overall Serena ITN household ownership increased from 16% to 28% over the study period, with a significantly higher increase in group A (13% to 35%) than in group B (18% to 23%) (p<0.001).

INTERPRETATION

The free distribution of ITNs to pregnant women through governmental antenatal care services in addition to ITN social marketing substantially improved ITN household ownership in rural Burkina Faso.

TRIAL REGISTRATION

Controlled-Trials.com ISRCTN07985309.

Spatial targeted vector control is able to reduce malaria prevalence in the highlands of Burundi

In a highland province of Burundi, indoor residual spraying and long-lasting insecticidal net distribution were targeted in the valley, aiming also to protect the population living on the hilltops. The impact on malaria indicators was assessed, and the potential additional effect of nets evaluated. After the intervention--and compared with the control valleys--children 1-9 years old in the treated valleys had lower risks of malaria infection (odds ratio, OR: 0.55), high parasite density (OR: 0.48), and clinical malaria (OR: 0.57). The impact on malaria prevalence was even higher in infants (OR: 0.14). Using nets did not confer an additional protective effect to spraying. Targeted vector control had a major impact on malaria in the high-risk valleys but not in the less-exposed hilltops. Investment in targeted and regular control measures associated with effective case management should be able to control malaria in the highlands.

Homicidal smothering: vital histological confirmation of orofacial injury despite a prolonged post-mortem interval

Homicidal smothering is the deliberate occlusion of the external airways, usually using the hands, pillows, or bedding. Victims are often those who are unable to resist, such as the young or the old. The limited resistance offered by these individuals may result in a comparative lack of injury. We present a case of a 72-year-old female, found deceased on her bed. The case was initially not considered suspicious and a coronial autopsy was performed. Concerns were subsequently raised and the body remained refrigerated. Six months after the initial examination, an opinion was requested as to whether further examination would be worthwhile to consider allegations of deliberate smothering. Review of the scene photographs showed deviation of the nose, eversion of the upper lip, and suspected intra-oral bruising. A bloodstained pillow was adjacent to the face. At the later autopsy, the body was found to show significant post-mortem deterioration and the facial tissues were mummified. The upper lip was excised and routinely processed for histology, sections showing remarkably good tissue preservation and extensive recent bruising, allowing the suspicious lip injuries in the scene photographs to be safely interpreted. This report illustrates the subtle pathological findings apparent in many of these cases and reinforces the need for thorough external examination and correlation with forensic scene investigation. Histological sampling of suspected injuries can be rewarding, even in the presence of severe post-mortem deterioration.

House dust mite control measures for asthma: systematic review

The major allergen in house dust comes from mites. We performed a systematic review of the randomized trials that had assessed the effects of reducing exposure to house dust mite antigens in the homes of people with mite-sensitive asthma, and had compared active interventions with placebo or no treatment. Fifty-four trials (3002 patients) were included. Thirty-six trials assessed physical methods (26 mattress covers), 10 chemical methods and eight a combination of chemical and physical methods. Despite the fact that many trials were of poor quality and would be expected to exaggerate the reported effect, we did not find an effect of the interventions. For the most frequently reported outcome, peak flow in the morning (1565 patients), the standardized mean difference was 0.00 (95% confidence interval (CI) -0.10 to 0.10). There were no statistically significant differences in number of patients improved (relative risk 1.01, 95% CI 0.80-1.27), asthma symptom scores (standardized mean difference -0.04, 95% CI -0.15 to 0.07) or in medication usage (standardized mean difference -0.06, 95% CI -0.18 to 0.07). Chemical and physical methods aimed at reducing exposure to house dust mite allergens cannot be recommended.

Effect of washing on the bioefficacy of insecticide-treated nets (ITNs) and long-lasting insecticidal nets (LLINs) against main malaria vector Anopheles stephensi by three bioassay methods

BACKGROUND & OBJECTIVES

The use of pyrethoid impregnated bednets is one of the main malaria vector control strategies worldwide. The objective of the present study was to evaluate the bioefficacy of bednets impregnated with various pyrethroids after repeated washings.

METHODS

The effectiveness of bednets impregnated with permethrin, deltamethrin, bifenthrin, etofenprox and long-lasting bednets like OlysetNet and PermaNet which were provided by WHOPES was evaluated. The tests were carried out according to the WHO-recommended methods. Malaria vector, Anopheles stephensi was exposed to impregnated bednets for 3 min and the mortality was measured after 24 h recovery period. Knockdown was measured as well.

RESULTS

Results of three methods of bioassay tests showed that between two LLINs, PermaNet was more efficient than OlysetNet. Results of ITNs exhibited that deltamethrin and permethrin were more effective than etofenprox and bifenthrin as impregnants.

INTERPRETATION & CONCLUSION

Findings of this study will be useful for WHO, local authorities and people who wish to use different pyrethroid-impregnated bednets for malaria vector control.

Knowledge, use and promotion of insecticide treated nets by health workers in a suburban town in south western Nigeria

BACKGROUND

Morbidity and mortality associated with malaria can be significantly reduced by widespread use of insecticide treated nets. Health workers can increase acceptability of ITN by promoting its use and serving as role model.

OBJECTIVE

To assess the knowledge, use and promotion of insecticide treated bed-net by health workers.

METHOD

This descriptive, cross sectional study was carried out among health care workers in Sagamu (Ogun State) between November 2004 and January 2005. Data was collected from 263 health workers using a pretested, structured questionnaire.

RESULT

Two hundred and forty six (93.5%) were aware of insecticide treated bednets (ITN) but many did not have adequate knowledge about it, only 52 (20.9%) knew that ITN should be retreated every 6 months. Sixty (22.8%) were currently using ITN. In the homes where they were currently using ITN, children were the main users (59%). The major reasons given for not using an ITN were that it had not occurred to them (23.2%), 13.3% were satisfied with the method they were using and 12.1% felt it was not convenient to use. Less than one-third (32.3%) indicated that ITN was available in their health facility. Fifty-seven percent (56.7%) had recommended it for patients before. The main reasons given by those who had not recommended it before were: lack of knowledge about it (52.5%), while 20% indicated that they were not familiar with it.

CONCLUSION

Awareness about ITN is high among the health workers but the knowledge about it is inadequate. The major challenges to use and promotion of ITN by health workers are lack of conviction about the unique benefits of ITN, inadequate knowledge and poor access to the nets.

The use of mosquito nets and the prevalence of Plasmodium falciparum infection in rural South Central Somalia

BACKGROUND

There have been resurgent efforts in Africa to estimate the public health impact of malaria control interventions such as insecticide treated nets (ITNs) following substantial investments in scaling-up coverage in the last five years. Little is known, however, on the effectiveness of ITN in areas of Africa that support low transmission. This hinders the accurate estimation of impact of ITN use on disease burden and its cost-effectiveness in low transmission settings.

METHODS AND PRINCIPAL FINDINGS

Using a stratified two-stage cluster sample design, four cross-sectional studies were undertaken between March-June 2007 across three livelihood groups in an area of low intensity malaria transmission in South Central Somalia. Information on bed net use; age; and sex of all participants were recorded. A finger prick blood sample was taken from participants to examine for parasitaemia. Mantel-Haenzel methods were used to measure the effect of net use on parasitaemia adjusting for livelihood; age; and sex. A total of 10,587 individuals of all ages were seen of which 10,359 provided full information. Overall net use and parasite prevalence were 12.4% and 15.7% respectively. Age-specific protective effectiveness (PE) of bed net ranged from 39% among <5 years to 72% among 5-14 years old. Overall PE of bed nets was 54% (95% confidence interval 44%-63%) after adjusting for livelihood; sex; and age.

CONCLUSIONS AND SIGNIFICANCE

Bed nets confer high protection against parasite infection in South Central Somalia. In such areas where baseline transmission is low, however, the absolute reductions in parasitaemia due to wide-scale net use will be relatively small raising questions on the cost-effectiveness of covering millions of people living in such settings in Africa with nets. Further understanding of the progress of disease upon infection against the cost of averting its consequent burden in low transmission areas of Africa is therefore required.

Fire/burn risk with electrosurgical devices and endoscopy fiberoptic cables

PURPOSE

The purpose of the study was to systematically explore the fire and burn risk associated with fiberoptic cables and electrosurgical devices.

MATERIALS AND METHODS

A 300-W light source was connected to a standard gray fiberoptic light cable. The end of the cable was either rested atop or buried within a cotton towel or polypropylene drape in the presence or absence of 100% oxygen for up to 10 minutes. A monopolar electrosurgical device set at 1 W, 10 W, or 30 W was tested on a cotton towel or polypropylene drape for a period of 30 seconds. All trials were repeated.

RESULTS

Resting the light cable on top of the cotton towel or polypropylene drape with or without oxygen produced no result. Burying the end of the cable within the drape produced a hole in the drape within 15 seconds both with and without oxygen. Burying the end of the cable within the cotton towel produced a yellow discoloration after 2 minutes both with and without oxygen. The monopolar electrosurgical device set at 30 W burned immediately through the polypropylene drape, producing a skin burn. All other trials with monopolar electrocautery produced no result. No flame or fire was produced in any trial.

CONCLUSIONS

Fiberoptic cables and electrosurgical generators represent a serious burn risk for surgical patients, with operating room drapes and towels affording only limited protection. Otolaryngologists should be keenly aware of the risks that these devices represent because our specialty uses them frequently.

Curtains help keep programme on track

The use of disposable curtains is one of the key infection prevention measures adopted by a major Trust in London, reports Health Estate Journal.

Bedbug infestations in the news: a picture of an emerging public health problem in the United States

Bedbug (Cimex lectularis) infestations have become a major complaint in all but three states in the United States. Increasing infestations have also been reported in Asia, Australia, Europe, and Canada. Newspaper articles often herald the onset of a new health issue for the public, and they can be used for epidemiological tracking of increasing populations of irritating and potentially serious vectoring pests. This news coverage model is useful in validating the typical spread of a new contagious entity, or in predicting the waves of public reaction to the spread of a new pest or health problem. The authors' analysis covers the years 2001 to 2006, showing the incidence of bedbug news coverage from the East Coast, the Midwest, the South, and the West in the United States. Rural and urban examples are included in a four-year time frame starting with news in the Northeast and ending with an attempt to eradicate the pest from the state of Hawaii.

A randomized placebo-controlled trial of intermittent preventive treatment in pregnant women in the context of insecticide treated nets delivered through the antenatal clinic

BACKGROUND

Current recommendations to prevent malaria in African pregnant women rely on insecticide treated nets (ITNs) and intermittent preventive treatment (IPTp). However, there is no information on the safety and efficacy of their combined use.

METHODS

1030 pregnant Mozambican women of all gravidities received a long-lasting ITN during antenatal clinic (ANC) visits and, irrespective of HIV status, were enrolled in a randomised, double blind, placebo-controlled trial, to assess the safety and efficacy of 2-dose sulphadoxine-pyrimethamine (SP). The main outcome was the reduction in low birth weight.

FINDINGS

Two-dose SP was safe and well tolerated, but was not associated with reductions in anaemia prevalence at delivery (RR, 0.92 [95% CI, 0.79-1.08]), low birth weight (RR, 0.99 [95% CI, 0.70-1.39]), or overall placental infection (p = 0.964). However, the SP group showed a 40% reduction (95% CI, 7.40-61.20]; p = 0.020) in the incidence of clinical malaria during pregnancy, and reductions in the prevalence of peripheral parasitaemia (7.10% vs 15.15%) (p<0.001), and of actively infected placentas (7.04% vs 13.60%) (p = 0.002). There was a reduction in severe anaemia at delivery of borderline statistical significance (p = 0.055). These effects were not modified by gravidity or HIV status. Reported ITN's use was more than 90% in both groups.

CONCLUSIONS

Two-dose SP was associated with a reduction in some indicators, but these were not translated to significant improvement in other maternal or birth outcomes. The use of ITNs during pregnancy may reduce the need to administer IPTp. ITNs should be part of the ANC package in sub-Saharan Africa.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00209781.

Grouped comparisons of sleep quality for new and personal bedding systems

The purpose of this study was to compare sleep comfort and quality between personal and new bedding systems. A convenience sample (women, n=33; men, n=29) with no clinical history of disturbed sleep participated in the study. Subjects recorded back and shoulder pain, sleep quality, comfort, and efficiency for 28 days each in their personal beds (pre) and in new medium-firm bedding systems (post). Repeated measures ANOVAs revealed significant improvement between pre- and post-test means for all dependent variables. Furthermore, reduction of pain and stiffness and improvement of sleep comfort and quality became more prominent over time. No significant differences were found for the groupings of age, weight, height, or body mass index. It was found that for the cheapest category of beds, lower back pain was significantly (p<0.01) more prominent than for the medium and higher priced beds. Average bed age was 9.5yrs. It was concluded that new bedding systems can significantly improve selected sleep variables and that continuous sleep quality may be dependent on timely replacement of bedding systems.

Wash resistance of PermaNets in comparison to hand-treated nets

The wash resistance of factory produced PermaNets (with deltamethrin bonded to the netting with a resin) was studied by bioassays with Anopheles stephensi. Commercial detergent powders were used to wash the nets. For comparison, conventionally treated nets were washed and bio-assayed. Nets were washed under laboratory conditions using a Rotary shaker for 10min. Mosquito bioassays used standard WHO plastic cones with an exposure time of 3min. The PermaNet caused almost a 100% mortality of An. stephensi after up to 18 washes and >80% mortality up to 26 washes but after 30 washes mortality declined. The differences between the mortality of An. stephensi on treated nets washed with detergent or soap (uncoloured, non-perfumed) were not significant. When conventional nets dipped in deltamethrin (25mg/m(2)) or lambdacyhalothrin (10mg/m(2)) were washed under similar laboratory conditions, the wash resistance was markedly less than that of the PermaNet. In the case of deltamethrin, mosquito mortality remained >80% up to 12 washes and with lambdacyhalothrin mortality remained above 80% up to 11 washes. The relationship of 80% mortality from a 3min bioassay to effectiveness against free flying mosquitoes remains to be determined.

Cost-effectiveness of the Australian Medical Sheepskin for the prevention of pressure ulcers in somatic nursing home patients: study protocol for a prospective multi-centre randomised controlled trial (ISRCTN17553857)

BACKGROUND

Pressure ulcers are a major problem, especially in nursing home patients, although they are regarded as preventable and there are many pressure relieving methods and materials. One such pressure relieving material is the recently developed Australian Medical Sheepskin, which has been shown in two randomized controlled trials 12 to be an effective intervention in the prevention of sacral pressure ulcers in hospital patients. However, the use of sheepskins has been debated and in general discouraged by most pressure ulcer working groups and pressure ulcer guidelines, but these debates were based on old forms of sheepskins. Furthermore, nothing is yet known about the (cost-)effectiveness of the Australian Medical sheepskin in nursing home patients. The objective of this study is to assess the effects and costs of the use of the Australian Medical Sheepskin combined with usual care with regard to the prevention of sacral pressure ulcers in somatic nursing home patients, versus usual care only.

METHODS/DESIGN

In a multi-centre randomised controlled trial 750 patients admitted for a primarily somatic reason to one of the five participating nursing homes, and not having pressure ulcers on the sacrum at admission, will be randomized to either usual care only or usual care plus the use of the Australian Medical Sheepskin as an overlay on the mattress. Outcome measures are: incidence of sacral pressure ulcers in the first month after admission; sacrum pressure ulcer free days; costs; patient comfort; and ease of use. The skin of all the patients will be observed once a day from admission on for 30 days. Patient characteristics and pressure risk scores are assessed at admission and at day 30 after it. Additional to the empirical phase, systematic reviews will be performed in order to obtain data for economic weighting and modelling. The protocol is registered in the Controlled Trial Register as ISRCTN17553857.

[Control of phlebotomine sandflies and the latest development in this field]

Phlebotomine sandflies make people uncomfortable because of biting and because they transmit various diseases. Especially, leishmaniasis is a serious public health problem in a number of countries, and requires control management. No effective control methods have been found for immature sandflies. On the contrary, the studies on destruction and modification of their habitats have found to be suitable for mature sandflies. Barrier spraying method recommended for exophilic sandflies are generally unsustainable and uneconomical. Although residual insecticide spraying of dwellings is successful in urban areas with high concentrations of endophilic sandflies, it may be both impractical and ineffective in rural areas where dwellings are more dispersed and surrounded by a large, untargeted reservoir of sandflies. Therefore, insecticide impregnated bed nets and curtains may be the best choice in rural areas. However, these applications do not replace other methods. Control of zoonotic cutaneous leishmaniasis would be control with insecticide-impregnated dog collars. In addition, alternative control methods such as avermectin or microbial agents spraying of the sandflies' sugar supplying vegetation and the use of pheromone baits are still under investigation. Moreover, antibodies produced by the host against the salivary glands of sandflies shown promise in the development of vaccination in the control of both sandflies and leishmaniasis.

Malaria: prevention in travellers

INTRODUCTION

Malaria transmission occurs most frequently in environments with humidity over 60% and ambient temperature of 25-30 degrees C. Risks increase with longer visits and depend on activity. Infection can follow a single mosquito bite. Incubation is usually 10-14 days but can be up to 18 months depending on the strain of parasite.

METHODS AND OUTCOMES

We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of non-drug preventive interventions in adult travellers? What are the effects of drug prophylaxis in adult travellers? What are the effects of antimalaria vaccines in travellers? What are the effects of antimalaria interventions in child travellers, pregnant travellers, and in airline pilots? We searched: Medline, Embase, The Cochrane Library and other important databases up to February 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

RESULTS

We found 69 systematic reviews, RCTs, or observational studies that met our inclusion criteria.

CONCLUSIONS

In this systematic review we present information relating to the effectiveness and safety of the following interventions: acoustic buzzers, aerosol insecticides, amodiaquine, air conditioning and electric fans, atovaquone-proguanil, biological control measures, chloroquine (alone or with proguanil), diethyltoluamide (DEET), doxycycline, full-length and light-coloured clothing, insecticide-treated clothing/nets, mefloquine, mosquito coils and vaporising mats, primaquine, pyrimethamine-dapsone, pyrimethamine-sulfadoxine, smoke, topical (skin-applied) insect repellents, and vaccines.

Plant based insect repellent and insecticide treated bed nets to protect against malaria in areas of early evening biting vectors: double blind randomised placebo controlled clinical trial in the Bolivian Amazon

OBJECTIVE

To determine the effectiveness in reducing malaria of combining an insect repellent with insecticide treated bed nets compared with the nets alone in an area where vector mosquitoes feed in the early evening.

DESIGN

A double blind, placebo controlled cluster-randomised clinical study.

SETTING

Rural villages and peri-urban districts in the Bolivian Amazon.

PARTICIPANTS

4008 individuals in 860 households.

INTERVENTIONS

All individuals slept under treated nets; one group also used a plant based insect repellent each evening, a second group used placebo.

MAIN OUTCOME MEASURE

Episodes of Plasmodium falciparum or P vivax malaria confirmed by rapid diagnostic test or blood slide, respectively.

RESULTS

We analysed 15,174 person months at risk and found a highly significant 80% reduction in episodes of P vivax in the group that used treated nets and repellent (incidence rate ratio 0.20, 95% confidence interval 0.11 to 0.38, P<0.001). Numbers of P falciparum cases during the study were small and, after adjustment for age, an 82% protective effect was observed, although this was not significant (0.18, 0.02 to 1.40, P=0.10). Reported episodes of fever with any cause were reduced by 58% in the group that used repellent (0.42, 0.31 to 0.56, P<0.001).

CONCLUSIONS

Insect repellents can provide protection against malaria. In areas where vectors feed in the early evening, effectiveness of treated nets can be significantly increased by using repellent between dusk and bedtime. This has important implications in malaria vector control programmes outside Africa and shows that the combined use of treated nets and insect repellents, as advocated for most tourists travelling to high risk areas, is fully justified.

REGISTRATION

NCT 00144716.

Risk of wheezing associated with house-dust mite allergens and indoor air quality among three-year-old children. Kraków inner city study

OBJECTIVES

The aim of the study was to describe the distribution of house-dust mite (HDM) allergens in homes of three-year-old children and to test the hypothesis whether the content of HDM allergens exceeding 2 microg/g of dust may be regarded as a risk level possibly affecting respiratory health in early childhood.

MATERIALS AND METHODS

House-dust samples were collected in 275 dwellings from mattresses, children's bedrooms and kitchen floors. In the laboratory, dust samples were analyzed for Der f 1 and Der p 1 using monoclonal antibody enzyme-linked immunosorbent assays (ELISA). At the time of the house-dust collection, mothers were interviewed on the household characteristics and their children's respiratory health. Respiratory outcome variables included wheezing or whistling in the chest irrespective of respiratory infections. The number of the wheezing episodes and their duration in days over the last 6 months were recorded in the questionnaire. In the multivariate Poisson regression analysis on the association between the occurrence of wheezing and exposure, a set of potential confounders, such as child's gender, maternal education, maternal allergy, older siblings, presence of moulds, house dampness, and environmental tobacco smoke (ETS) was taken into account.

RESULTS

The adjusted incidence rate ratios (IRR) of wheezing ascribed to a higher HDM level (> 2.0 microg/g dust) were 1.84 (95% CI: 1.45-2.34) for duration of wheezing and 1.56 (95% CI: 0.88-2.75) for episodes. Of the confounders taken into consideration, the presence of moulds had the strongest impact on the risk of wheezing (IRR = 4.24; 95% CI: 3.08-5.84).

CONCLUSION

The data support the view that exposure to a higher level of HDM allergens increases the burden of respiratory diseases in the early childhood and the effect is independent of maternal atopy, ETS, and moulds in homes.

Impact of artemisinin-based combination therapy and insecticide-treated nets on malaria burden in Zanzibar

BACKGROUND

The Roll Back Malaria strategy recommends a combination of interventions for malaria control. Zanzibar implemented artemisinin-based combination therapy (ACT) for uncomplicated malaria in late 2003 and long-lasting insecticidal nets (LLINs) from early 2006. ACT is provided free of charge to all malaria patients, while LLINs are distributed free to children under age 5 y ("under five") and pregnant women. We investigated temporal trends in Plasmodium falciparum prevalence and malaria-related health parameters following the implementation of these two malaria control interventions in Zanzibar.

METHODS AND FINDINGS

Cross-sectional clinical and parasitological surveys in children under the age of 14 y were conducted in North A District in May 2003, 2005, and 2006. Survey data were analyzed in a logistic regression model and adjusted for complex sampling design and potential confounders. Records from all 13 public health facilities in North A District were analyzed for malaria-related outpatient visits and admissions. Mortality and demographic data were obtained from District Commissioner's Office. P. falciparum prevalence decreased in children under five between 2003 and 2006; using 2003 as the reference year, odds ratios (ORs) and 95% confidence intervals (CIs) were, for 2005, 0.55 (0.28-1.08), and for 2006, 0.03 (0.00-0.27); p for trend < 0.001. Between 2002 and 2005 crude under-five, infant (under age 1 y), and child (aged 1-4 y) mortality decreased by 52%, 33%, and 71%, respectively. Similarly, malaria-related admissions, blood transfusions, and malaria-attributed mortality decreased significantly by 77%, 67% and 75%, respectively, between 2002 and 2005 in children under five. Climatic conditions favorable for malaria transmission persisted throughout the observational period.

CONCLUSIONS

Following deployment of ACT in Zanzibar 2003, malaria-associated morbidity and mortality decreased dramatically within two years. Additional distribution of LLINs in early 2006 resulted in a 10-fold reduction of malaria parasite prevalence. The results indicate that the Millennium Development Goals of reducing mortality in children under five and alleviating the burden of malaria are achievable in tropical Africa with high coverage of combined malaria control interventions.

Efficacy of pyrethroid-treated nets against malaria vectors and nuisance-biting mosquitoes in Tanzania in areas with long-term insecticide-treated net use

OBJECTIVE

To measure pyrethroid susceptibility in populations of malaria vectors and nuisance-biting mosquitoes in Tanzania and to test the biological efficacy of current insecticide formulations used for net treatment.

METHODS

Anopheles gambiae Giles s.l., An. funestus Giles s.l. and Culex quinquefasciatus Say were collected during three national surveys and two insecticide-treated net (ITN) studies in Tanzania. Knockdown effect and mortality were measured in standard WHO susceptibility tests and ball-frame bio-efficacy tests. Test results from 1999 to 2004 were compared to determine trends in resistance development.

RESULTS

Anopheles gambiae s.l. and An. funestus s.l. were highly susceptible to permethrin (range 87-100%) and deltamethrin (consistently 100%) in WHO tests in 1999 and 2004, while Culex quinquefasciatus susceptibility to these pyrethroids was much lower (range 7-100% and 0-84% respectively). Efficacy of pyrethroid-treated nets was similarly high against An. gambiae s.l. and An. funestus s.l. (range 82-100%) while efficacy against Cx. quinquefasciatus was considerably lower (range 2-100%). There was no indication of development of resistance in populations of An. gambiae s.l. or An. funestus s.l. where ITNs have been extensively used; however, susceptibility of nuisance-biting Cx. quinquefasciatus mosquitoes declined in some areas between 1999 and 2004.

CONCLUSION

The sustained pyrethroid susceptibility of malaria vectors in Tanzania is encouraging for successful malaria control with ITNs. Continued monitoring is essential to ensure early resistance detection, particularly in areas with heavy agricultural or public health use of insecticides where resistance is likely to develop. Widespread low susceptibility of nuisance-biting Culex mosquitoes to ITNs raises concern for user acceptance of nets.

Use of plastic adhesive drapes during surgery for preventing surgical site infection

BACKGROUND

Surgical site infection has been estimated to occur in about 15% of clean surgery and 30% of contaminated surgery. Using plastic adhesive drapes to protect the wound from organisms that may be present on the surrounding skin during surgery is one strategy used to prevent surgical site infection. Results from non-randomised studies have produced conflicting results about the efficacy of this approach but no systematic review has been conducted to date to guide clinical practice.

OBJECTIVES

To assess the effect of adhesive drapes used during surgery on surgical site infection, cost, mortality and morbidity.

SEARCH STRATEGY

We searched the Cochrane Wounds Group Specialised Register (last searched 24/4/07), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2,2007), Ovid MEDLINE (1950 to April Week 2, 2007), Ovid EMBASE (1980 to 2007 Week 16), and Ovid CINAHL (1982 to 1980 to April Week 2 2007).

SELECTION CRITERIA

Randomised controlled trials comparing any plastic adhesive drape with no adhesive drape, used alone or in combination with woven (material) drapes or disposable (paper) drapes in patients undergoing any type of surgery.

DATA COLLECTION AND ANALYSIS

Two authors independently selected and assessed studies for trial quality and both independently extracted data. Study authors were contacted for additional information.

MAIN RESULTS

This review includes five studies involving 3,082 participants comparing adhesive drapes with no drape and two studies involving 1,113 participants comparing iodine-impregnated adhesive drapes with no drape. A significantly higher proportion of patients in the adhesive drape group developed a surgical site infection when compared with no drape. (Relative Risk (RR) 1.23, 95% Confidence Intervals (CI) 1.02 to 1.48, p=0.03). Iodine-impregnated adhesive drapes had no effect on the surgical site infection rate (RR 1.03, 95% CI 0.064 to 1.66, p=0.89). Length of hospital stay was similar in adhesive drape and non-adhesive drape groups.

AUTHORS' CONCLUSIONS

There was no evidence from the seven trials that plastic adhesive drapes reduces surgical site infection rate and some evidence that they increase infection rates. Further trials may be justified using blinded outcome assessment to examine the effect of adhesive drapes on surgical site infection based on different wound classifications.

[Summary of the practice guideline 'allergic and non-allergic rhinitis' (first revision) from the Dutch College of General Practitioners]

The practice guideline 'Allergic and non-allergic rhinitis' of the Dutch College ofGeneral Practitioners has been revised based on developments that have occurred in recent years. The most important modifications are: Impermeable covers for beddings are advised only for patients with serious complaints despite the use of medication and other mite-avoidance measures, and patients with allergic rhinitis with asthma. The indication for the use ofa corticosteroid nasal spray is broadened. There is more evidence for the efficacy ofa nasal spray with antihistamines. The indication for cromoglycate has been restricted. Two major unsolved points of discussion concerned the effectiveness of sublingual immunotherapy and the link between asthma and allergic rhinitis.

Households willingness to pay for long-lasting insecticide treated nets in three urban communities of Assosa Zone, western Ethiopia

BACKGROUND

Achieving the target coverage of insecticide treated nets (ITNs) has to be preceded by understanding their demands, willingness to pay (WTP) and determinants of WTP for those who could not get free of charge.

OBJECTIVE

To assess WTP for long lasting ITN using contingent valuation method and determinants of maximum WTP for long lasting ITN among households in Assosa Zone, Western Ethiopia.

METHODS

The contingent valuation method was used to assess WTP for long-lasting ITN among households selected from the three urban communities. univariate and multivariate regression analyses were carried out. The adjusted effect (beta), F-ratios, adjusted odds ratios (AOR) and 95% CI were used to interpret results. The criterion for statistical significance was set at 0.05.

RESULTS

Ninety six percent of the respondents reported that long-lasting ITN are important for their family fbr prevention of malaria and demanded for long lasting ITN. Sixty seven percent of the respondents were willing to pay for long-lasting ITN at the starting bid amount of 25 Birr. The mean, maximum WTP amount was 27.84 Birr. The mean WTP amount varied with the respondents' wealth status, which was 19.09 and 35.26 Birr foir poorest and well-off wealth quintiles respectively. Wealth status and knowledge of the respondents about its preventive effects against boring insects were significantly associated with their WTP (adjusted beta = +3.76, 95% CI: 2.3, 4.6 and adjusted beta = 10.15, 95% CI: 2.7, 17.6 respectively).

CONCLUSION

The poor have shown their WTP for reduced cost of ITN, thus the regional health bureau should develop a price discrimination mechanism for those economically vulnerable groups.

Effects of trimethoprim-sulfamethoxazole and insecticide-treated bednets on malaria among HIV-infected Ugandan children

BACKGROUND

Trimethoprim-sulfamethoxazole (TMP/SMX) prophylaxis and insecticide-treated bednets reduce malaria risk among HIV-infected adults. The efficacy of TMP/SMX may be diminished where antifolate resistance to malaria is high. We evaluated the efficacy of these interventions for malaria prevention among Ugandan children.

METHODS

We concurrently followed 300 HIV-infected children aged 1-10 years and a community-based cohort of 561 healthy children aged 1-11 years over 11 months in Kampala, Uganda. The HIV-infected children received TMP/SMX prophylaxis and insecticide treated bednets. In the community cohort, insecticide-treated bednets were introduced during the observation period. Children from both cohorts were followed using a standardized protocol to measure the incidence of malaria.

RESULTS

Only nine episodes of malaria were diagnosed among HIV-infected children (incidence = 0.07/person-year) in comparison with 440 episodes among children from the community (incidence = 0.90/person-year; P < 0.0001). The use of insecticide-treated bednets was associated with a 43% reduction in malaria incidence (P < 0.001), and a combination of TMP/SMX and use of insecticide-treated bednets with a 97% reduction in malaria incidence (P < 0.001). The prevalence of five mutations associated with antifolate resistance was high among malaria cases detected in both the HIV (100%) and community cohorts (75%). Malaria accounted for only 4% of febrile episodes in the HIV cohort in comparison with 33% in the community-based cohort (P < 0.0001).

CONCLUSION

In a malaria endemic area with a high level of molecular markers of antifolate resistance, the combined use of TMP/SMX prophylaxis and insecticide-treated bednets was associated with a dramatic reduction in malaria incidence among HIV-infected children.

[Current situation and future perspectives for malaria prophylaxis among travellers and military personnel]

Malaria remains a major public health problem, both for travellers and for the 40,000 French soldiers deployed each year to endemic areas. Epidemiological data show that imported malaria (IM) is on the increase, and that migrants account for more than 60% of malaria cases notified each year in France. The increase in IM among French military personnel is explained by prematurely terminated chemoprophylaxis on return, repeated short missions, and more cases of P. vivax and P. ovale infection. The choice of chemoprophylaxis depends mainly on the level of chloroquine resistance in the country visited. The atovaquone-proguanil combination is well tolerated and only requires 7 days of intake on return from the endemic area. Doxycycline monohydrate is cheaper and better-tolerated than mefloquine, and is thus preferred for French military personnel. However, its short half-life necessitates very good compliance. Chemoprophylaxis should be combined with vector control measures and with personal protection (impregnated bednets, protective clothing, repellents, and indoor insecticide spraying). The need for these measures should be clearly explained before departure, during the stay, and after return.

Swaddling: a systematic review

Swaddling was an almost universal child-care practice before the 18th century. It is still tradition in certain parts of the Middle East and is gaining popularity in the United Kingdom, the United States, and The Netherlands to curb excessive crying. We have systematically reviewed all articles on swaddling to evaluate its possible benefits and disadvantages. In general, swaddled infants arouse less and sleep longer. Preterm infants have shown improved neuromuscular development, less physiologic distress, better motor organization, and more self-regulatory ability when they are swaddled. When compared with massage, excessively crying infants cried less when swaddled, and swaddling can soothe pain in infants. It is supportive in cases of neonatal abstinence syndrome and infants with neonatal cerebral lesions. It can be helpful in regulating temperature but can also cause hyperthermia when misapplied. Another possible adverse effect is an increased risk of the development of hip dysplasia, which is related to swaddling with the legs in extension and adduction. Although swaddling promotes the favorable supine position, the combination of swaddling with prone position increases the risk of sudden infant death syndrome, which makes it necessary to warn parents to stop swaddling if infants attempt to turn. There is some evidence that there is a higher risk of respiratory infections related to the tightness of swaddling. Furthermore, swaddling does not influence rickets onset or bone properties. Swaddling immediately after birth can cause delayed postnatal weight gain under certain conditions, but does not seem to influence breastfeeding parameters.

Risk factors for moderate to severe anemia among children in Benin and Mali: insights from a multilevel analysis

BACKGROUND

Anemia currently affects 2 billion people throughout the world. Although the immediate causes of anemia among children are known (including malnutrition and infections), the importance of contextual determinants and their relationships with individual effects have rarely been explored.

OBJECTIVE

To identify anemia risk factors at the individual, household, and community levels among Beninese and Malian children, using simple and multilevel regression methods.

METHODS

An analysis was undertaken of nationally representative data collected in 2001 in Benin (n = 2,284) and Mali (n = 2,826) by the Demographic and Health Surveys. Sixteen potential risk factors for anemia were considered at the individual, household, and community levels. Comparative analyses were carried out using simple and multilevel logistic regression models.

RESULTS

Simple and multilevel logistic regression analyses yielded broadly similar results. Risk factors for moderate to severe anemia included incomplete immunization, stunted growth, recent infection, absence of bednet, low household living standard, rural residency (Mali), low maternal education, and low community development index (Benin). In addition, multilevel analysis indicated a clustering level of anemia in communities (intraclass correlation) of 14% and 19% in Benin and Mali, respectively.

CONCLUSIONS

Risk factors for child anemia appeared at all three levels (individual, household and community). Community-level clustering seemed to be low. Therefore, interventions to address anemia need not be village- or region-specific. Identifying a successful and replicable program is now a priority in child survival endeavors. It is likely that such a program would include a focus on improving immunization coverage, increased bednet usage, and reduced protein-energy malnutrition.

Varying efficacy of intermittent preventive treatment for malaria in infants in two similar trials: public health implications

Background

Intermittent preventive treatment (IPTi) with sulphadoxine-pyrimethamine (SP) in infants resulted in different estimates of clinical malaria protection in two trials that used the same protocol in Ifakara, Tanzania, and Manhiça, Mozambique. Understanding the reasons for the discrepant results will help to elucidate the action mechanism of this intervention, which is essential for rational policy formulation.

Methods

A comparative analysis of two IPTi trials that used the same study design, follow-up, intervention, procedures and assessment of outcomes, in Tanzania and Mozambique was undertaken. Children were randomised to receive either SP or placebo administered 3 times alongside routine vaccinations delivered through the Expanded Program on Immunisation (EPI). Characteristics of the two areas and efficacy on clinical malaria after each dose were compared.

Results

The most relevant difference was in ITN's use ; 68% in Ifakara and zero in Manhiça. In Ifakara, IPTi was associated with a 53% (95% CI 14.0; 74.1) reduction in the risk of clinical malaria between the second and the third dose; during the same period there was no significant effect in Manhiça. Similarly, protection against malaria episodes was maintained in Ifakara during 6 months after dose 3, but no effect of IPTi was observed in Manhiça.

Conclusion

The high ITN coverage in Ifakara is the most likely explanation for the difference in IPTi efficacy on clinical malaria. Combination of IPTi and ITNs may be the most cost-effective tool for malaria control currently available, and needs to be explored in current and future studies.

Trial Registration

Manhiça study registration number: NCT00209795

Ifakara study registration number: NCT88523834

Natural cellulose fibers from switchgrass with tensile properties similar to cotton and linen

We report the production and characteristics of natural cellulose fibers obtained from the leaves and stems of switchgrass. In this paper, the composition, structure and properties of fibers obtained from the leaves and stem of switchgrass have been studied in comparison to the common natural cellulose fibers, such as cotton, linen and kenaf. The leaves and stems of switchgrass have tensile properties intriguingly similar to that of linen and cotton, respectively. Fibers were obtained from the leaves and stems of switchgrass using a simple alkaline extraction and the structure and properties of the fibers were studied. Fibers obtained from switchgrass leaves have crystallinity of 51%, breaking tenacity of 5.5 g per denier (715 MPa) and breaking elongation of 2.2% whereas the corresponding values for fibers obtained from switchgrass stems are 46%, 2.7 g per denier and 6.8%, respectively. Switchgrass is a relatively easy to grow and high yield biomass crop that can be source to partially substitute the natural and synthetic fibers currently in use. We hope that this research will stimulate interests in using switchgrass as a novel fiber crop in addition to being promoted as a potential source for biofuels.

Sociocultural factors and malaria in the desert part of Rajasthan, India

BACKGROUND & OBJECTIVES

Malaria is a new emerging problem of Indian Thar Desert. The study was attempted to find out some sociocultural factors associated with malaria transmission in this region and to supplement social solutions to ongoing malaria control efforts in the desert part of Rajasthan.

METHODS

Interview technique was used for data collection on pre-tested schedules. In all 30 households (15 from low socioeconomic group and the same number of households from the high socioeconomic group) in a village were selected following systematic random sampling technique. A total of 450 respondents were selected randomly in 15 villages of Jaisalmer district, Rajasthan.

RESULTS

One-third of the respondents had neither taken treatment for malaria nor took part in the vector control operations because they did not consider mosquito bites to be harmful and took malaria as a mild disease. Outdoor sleeping habits, sharing bed with children, uneasy and suffocation feeling in using mosquito bednets or any other protective device also contributed to the spread of malaria in the study villages.

INTERPRETATION & CONCLUSION

Community should be educated as a whole particularly the low socioeconomic group of people to bring changes in their beliefs, sociocultural and health practices to protect themselves from mosquito bites by using bednets, repellents and other devices, such as wire mesh screening of house doors and windows.

[Detection of mite allergens in the dust of filter-net and air of air-conditioned room]

OBJECTIVE

To detect mite allergens in the dust of air conditioner filter-net and floating air in room.

METHODS

Samples were collected from rooms of asthma patient and normal families with or without air conditioner. Der p1, Der f1 and Der 2 were determined by two monoclonal antibody-based ELISA.

RESULTS

In asthma patient families, the concentration of airborne Der p1, Der f1 and Der 2 was (0.23 +/- 0.13), (2.62 +/- 1.08), (0.93 +/- 0.41) ng/m3, and (0.56 +/- 0.25), (4.74 +/- 1.22), (2.33 +/- 0.64) ng/m3 respectively before and after the air conditioner switched on, all showing a significant difference (P < 0.05). In families without asthma patient, the concentration of Der p1, Der f1 and Der 2 was (0.33 +/- 0.11), (11.50 +/- 3.08) and (2.10 +/- 0.80) ng/m3, and (0.63 +/- 0.23), (19.80 +/- 4.30) and (3.60 +/- 1.00) ng/m3 respectively before and after the air conditioner switched on, also showing a significant difference (P < 0.05). From the filter-net dust of air conditioner in family with allergic asthma patient, the concentration of Der p1, Der f1 and Der 2 was (0.52 +/- 0.19), (3.34 +/- 0.63), (2.53 +/- 0.65) microg/g dust, while that of normal families was (1.30 +/- 0.35), (5.16 +/- 0.92), (3.47 +/- 1.13) microg/g dust respectively. The concentration of Der f1 and Der 2 at both asthma families and normal families was higher than 2 microg/g, an allergen concentration threshold.

CONCLUSION

Mite allergens exist in the filter-net dust of air conditioner, which may be an important source of indoor allergens and a cause of the increasing prevalence of allergic asthma.