Preliminary enquiry into the availability, price and quality of malaria rapid diagnostic tests in the private health sector of six malaria-endemic countries

Objectives This enquiry aimed to provide a snap‐shot of availability, price and quality of malaria rapid diagnostic tests (RDTs) in private health facilities at selected sites in six malaria‐endemic countries in Africa, South East Asia and South America. Methods In each study site, data collectors surveyed private healthcare facilities which were selected based on accessibility from their home institution. Using a questionnaire, information was recorded about the facility itself and the malaria RDT(s) available. Where possible, a small number of RDTs were procured and quality control tested using a standardized procedure. Results Of the 324 private healthcare facilities visited, 35 outlets (mainly private clinics and hospitals) were found to supply 10 different types of RDTs products. RDT prices across the six countries ranged from US$1.00 to $16.81. Five of the 14 malaria RDTs collected failed quality control testing. Conclusions In the private outlets sampled, the availability of RDTs was limited. Some of the RDTs whose quality we tested demonstrated inadequate sensitivity. This presents a number of risks. Given the more widespread distribution of antimalarials currently planned for private sector facilities, parasite‐based diagnosis in this sector will be essential to adhere to the WHO guidelines for effective case management of malaria. Considerable regulation and quality control are also necessary to assure the availability of accurate and reliable RDTs, as well as adequate case management and provider adherence to RDT results. Public sector engagement is likely to be essential in this process.     

Peripheral arterial disease in diabetic and nondiabetic patients: a comparison of severity and outcome

OBJECTIVE: The aim of this study was to quantify the distribution of peripheral arterial disease in the diabetic and nondiabetic population attending for angiography and to compare severity and outcome between both groups of patients. RESEARCH DESIGN AND METHODS: Randomly selected lower-extremity angiograms were examined according to the Bollinger system. Patient demographics and medical history were recorded and case notes were examined to determine which patients later underwent a revascularization procedure or amputation and which patients had died. RESULTS: A total of 136 arteriograms obtained between 1992 and 1996 were analyzed. The age (mean +/- SD) of the patients was 64.7 +/- 10.8 years. Diabetic patients (43%) and nondiabetic patients were of similar age (63.9 +/- 10.4 vs. 65.3 +/- 11.1 years, P = 0.43), with a similar history of smoking (81.0 vs. 76.9%, P = 0.26), ischemic heart disease (41.4 vs. 37.2%, P = 0.54), and hypercholesterolemia (24.4 vs. 30.8%, P = 0.48). However, there were a greater proportion of hypertensive patients in the diabetic group (63.8 vs. 39.7%, P = 0.006). Diabetic patients had greater severity of arterial disease in the profunda femoris and all arterial segments below the knee (P = 0.02). A greater number of amputations occurred in the diabetic group: diabetic patients were five times more likely to have an amputation (41.4 vs. 11.5%, odds ratio [OR] 5.4, P < 0.0001). Mortality was higher in the diabetic group (51.7 vs. 25.6%, OR 3.1, P = 0.002), and diabetic patients who died were younger at presentation than nondiabetic patients (64.7 +/- 11.4 vs. 71.1 +/- 8.7 years, P = 0.04). CONCLUSIONS: In patients with peripheral arterial disease, diabetic patients have worse arterial disease and a poorer outcome than nondiabetic patients.     

Adverse reactions following annual ivermectin treatment of onchocerciasis in Nigeria.

OBJECTIVES: This study aims to document and underscore the need to monitor adverse reactions following repeated ivermectin treatment under the current dispensation of the implementation of the Community-directed Treatment with Ivermectin (CDTI) Program. As communities are empowered to distribute ivermectin, monitoring of adverse reactions by health care professionals is important in achieving the onchocerciasis control objectives through mass ivermectin therapy. METHODS: Eight hundred and ninety subjects from 204 randomly selected households (based on cluster of households) were interviewed using structured questionnaires and in-depth interviews. Responses concerning the adverse effects of ivermectin at the first and sixth rounds were obtained using self-report and treatment records. RESULTS: Of the 890 individuals, 40.67% presented with adverse reactions at the first round of treatment (TX(1)). This was reduced to 15.06% at the sixth (TX(6)) round of treatment. Pains in joints were more frequently reported at TX(1) and TX(6), 22.7% and 8.5%, respectively. CONCLUSION: The relatively mild adverse reaction rates observed at TX(1) did not affect future participation in community treatment with ivermectin, due to adequate community mobilization with health education messages. The current CDTI program has a good chance of achieving the onchocerciasis control program's objectives in Shao, Kwara State, Nigeria.