Immunoprophylactic potential of filarial glutathione-s-transferase in lymphatic filariaisis

ObjectiveTo elucidates the immunoprophylactic potential of glutathion-s-transferase (GST) from cattle filarial parasite Setaria digitata (S. digitata) against lymphatic filariasis.MethodsGST was purified through affinity chromatography (SdGST) and chacterized by SDS-PAGE and Nano-LC MS/MS analysis. Antibody isotypes to SdGST were measured by ELISA. Antibody dependant cellular cytotoxicity (ADCC) was performed in vitro using sera from immunized animals and immune individuals. T-cell proliferation and cytokine response to SdGST in different groups of filariasis were measured. Immunoprophylactic potential of SdGST was evaluate in animal model.ResultsSdGST exhibited 30-fold enhancement of enzyme activity over crude parasitic extract. It was found to be 26 kDa by SDS-PAGE. Nano LC-MS/MS analysis followed by blast search showed 100% homology with Dirofilaria immitis (D. immitis) and only 43% with Homo sapiens (H. sapiens). Immunoblotting analysis showed putatively immune individuals carry significant level of antibodies to SdGST as compared with microfilaraemics. Immunized sera and sera endemic normal could neutralize the enzymatic activity of SdGST and inducing in vitro cytotoxicity of microfilariae. Peripheral blood mononuclear cells (PBMC) from endemic normals upon stimulation with SdGST showed a mixed type of Th1/Th2 response. SdGST immunization clear microfilariae from circulation in S. digitata implanted mastomys.ConclusionsThe heterologous GST could be potentially developed as a vaccine candidate against lymphatic filarial parasite.     

Syndromic management of sexually transmitted diseases in Botswana's primary health care: quality of care aspects

OBJECTIVES: To evaluate the quality of care of the syndromic management of sexually transmitted diseases (STDs) in Botswana's primary health care. METHODS: Participative observations of 224 consecutive consultations of patients with STDs (135 females and 89 males) by nurses. Twenty-one cases were excluded because no STD checklist was filled in. Criteria for acceptable history taking, physical examination and correct treatment were agreed upon. RESULTS: The quality of history taking and physical examination was acceptable for 25% and 23% of the women and for 54% and 57% of the men, respectively. Approximately, 65% of the women and 81% of the men received appropriate treatment. On average, consultations took 5.4 min for women and 4.6 min for men. STD contacts comprised 11% of STD cases. Advice on partner notification was provided to 66% of the women and 86% of men, and 75% and 89%, respectively, were counselled on the use of condoms. In half of the health facilities the lack of a fixed light source was the main constraint in carrying out a vaginal speculum examination. The availability of antibiotics and condoms was excellent. In 40% of the health facilities, all STD algorithms were displayed in the consultation room. CONCLUSION: One-third of women and one-fifth of men did not receive appropriate treatment for their STD, in spite of excellent provision of drugs. Although Botswana health workers perform relatively well on partner notification and counselling, there is considerable scope for improving the quality of medical history and clinical examination, especially in women. Emphasis should be given on training health workers in clinical examinations, in particular in pelvic examinations, and to supervision and in-service training.     

Financially independent primary health care drug supply system in Cameroun

The drug supply system in the North-west Province of Cameroun differs from 'simple' health financing projects in three important respects. Firstly, the system does not promote drug sales for cofinancing purposes but aims at supporting the prescribers to provide better medical care, and patients' access to the most essential drugs at fair prices. Secondly, the project guarantees equal prices and services throughout the Province regardless of distance from the central warehouse and sales at a given location. Thirdly, along with the revolving fund-financed drug supply system, a community-based legal framework has been established. Built-in management alert mechanisms helped the project resist common causes of collapse such as uneconomic behaviour and political interference. The drug supply system has gained full independence from subsidies and external authorities. Its strong community participation promotes good governance.     

Role of technology in controlling health care costs

The objectives of medical technology are to define basic knowledge about the function of the body and to aid in making patients better. Because the escalation of costs for advanced technology has been dramatic, it has been labelled one of the culprits for the great increases in health care costs in the past decade. Yet technology can improve the quality of care while providing mechanisms for lowering costs. Such an approach requires improved productivity. Several approaches to improve productivity, with emphasis on the electronic and computer revolution that has been brought to medicine, are discussed. In addition, it is suggested that the use of technology gives medical staff more time to meet the personal needs of patients.     

An action research in the delivery of primary health care through community based distribution

In adhering to the spirit of primary health care (PHC), the Varanasi District in India began its community based distribution (CBD) project of oral rehydration solution (ORS) packets in Chiraigaon block in 1979. The CBD later included Cholapur, Kashi Vidyapith, Sewapuri, Araijiline, Haurah, Pindra, and Niyamatabad during 1980-1981. In 1989, an honorary project director headed the project and its cadre of regular paid staff. At the main office, staff included a project coordinator, technical consultant medical officer, field supervisors, and field assistants. 754 depot holders or kendra kalyan sanjojak (KKS) worked at the community level. They came from all segments of the society, e.g., farmers, teachers, individuals in business, etc. The KKS implemented the CBD and its policies. Individuals at the headquarters prepared ORS packets using the standard WHO formula. They included health information brochures about ORS written in the local language in each packet. Field assistants delivered these packets to the KKS each month at a no profit no loss cost. The depot holders then sold the packets at a marginal profit. From 1980-1983, the number of packets increased from 1725-9660. From 1980-1985, CBD workers distributed a total of 29.862 packets to all 8 blocks. Rigid social marketing criteria adopted in 1984 brought about a downturn in distribution, however. The number of families trained in ORS preparation varied from 80 in 1980 to 1688 in 1985. The number of families totaled 6919. Health education activities, such as group discussion and individual contracts, flourished at the community level which stimulated demand for ORS packets.     

Community health centers as primary providers of health care

In their essay, Shelly Raymer Duncan and Cinthia L. Deye examine the experience of community health centers as primary providers of health care. These centers provide quality health care for their clientele and operate in an efficient manner. The authors argue that community health centers are a viable mechanism for the provision of comprehensive quality primary care for underserved persons. For some consumers, community health centers represent their only real choice for health care services, when their other options include no health care at all or severe financial duress. She directs the association’s efforts for implementation of technical services and related activities involving key association staff, association members, and agencies of local, state, and federal government. Prior to her current position, she served as director of plan development and compliance for Community Health Choice in Chicago, an HMO contracted with the State of Illinois. She is working on both an M.D. degree at the U of I College of Medicine and a Ph.D. in the Department of Community Health with a focus in health policy. Her research is on the impact of the State Children’s Health Insurance Program on health disparities among low-income children in Illinois. She recently co-authored the article, “The State Children’s Health Insurance Program: an Administrative Experiment in Federalism,” published in theU. of Illinois Law Review.     

Phylogeography of human lymphatic filarial parasite, Wuchereria bancrofti in India

Wuchereria bancrofti, a nematode parasite causing human lymphatic filariasis is widely distributed in India. The phylogeography of this parasite was studied by constructing RAPD profiles of parasite populations collected from 71 microfilaria carriers residing in different geoclimatic regions of India. The analysis showed that the phylogeography of W. bancrofti populations is complex, with a high genetic divergence and gene flow among populations. The total genetic diversity (H(T)) and genetic differentiation (G(ST)) estimated for all the parasite populations were 0.0926 and 0.5859, respectively. The gene flow (Nm) between different regions indicated that two strains of W. bancrofti were prevalent in the country, one in the eastern side and the other on the western side of the Western Ghats. A highly significant genetic differentiation (F(ST) [theta] = 0.7978) was estimated between these two strains (chi 2 = 308.2789; P < 0.001). The gene flow between these strains was very low (0.2338). These two strains appear to have drifted genetically because of their geographic isolation by this thickly forested mountain range. The strain in the eastern side was found to be monophyletic in origin and is undergoing genetic divergence as the major parasite population in the country, spanning from eastern peninsular region to the northern plains. The variable geoclimatic factors and the antifilarial chemotherapeutical pressure on the parasite, which is in place for the past half a century, might have contributed for the high genetic heterogeneity its strains/populations in the country. The route of entry of the parasite into Indian sub-continent possibly appeared to be from an ancient origin from the countries of the Southeast Asian archipelago, through the eastern coastal line of the southern peninsula.     

Community participation in primary health care

The advantages of a community participation approach in primary health care (PHC) are as follows: a community participation approach is a cost effective way to extend a health care system to the geographical and social periphery of a country; communities that begin to understand their health status objectively rather than fatalistically may be moved to take a series of preventive measures; communities that invest labor, time, money, and materials in health promoting activities are more committed to the use and maintenance of the things they produce, such as water supplies; health education is most effective in the context of village activities; and community health workers, if they are well chosen, have the confidence of the people. An error made in early efforts at community participation was to assume that villages were uniformly free from internal exploitation. Some are cohesive moral communities, but in other there is grievous exploitation of landless laborers by landowners and shopkeepers. Villages may be divided by caste or ethnic origin. Political organization of villages may be democratic or they may be governed in an authoritarian manner. In politically unstable countries where the central government has a rather tenuous control over the rural periphery, genuine community initiatives may be viewed as threatening and may not receive official encouragement. Social groups within communities may be tremendous assets. In planning the community participation aspects of primary health care, the collaboration of an anthropologist or rural sociologist with field experience is recommended. Promoting community participation is a skill which must be taught to community health workers, and backed up with support services. The genuine commitment of medical staff to community self help is crucial to the motivation process. Motivation within the community quickly breaks down if materials, expertise, and salaries fail to arrive when promised. Community activities are most successfully promoted with reference to the people's own ideas of purity/pollution, cleanliness/dirtiness, and health/illness. Guidelines for successful community participation include: projects undertaken should be ones that the community has identified as a priority; demonstrations and activities to promote health might be linked with agricultural initiatives, adult literacy campaigns, or programs from other sectors; and it is necessary to make sure the community fully understands all the costs in labor, time, money, and materials. If projects or longterm community health programs fail, a quick, simple analysis should be made of constraints that may be operating. Some points to be covered are suggested.