R4D Malaria and TB

Should people on TB treatment be given nutritional supplements?

Fri, 06 Nov 2009 14:59:00 GMT

Miscellaneous 2009 Evidence Update, Tuberculosis Series. Effective Health Care Research Programme Consortium, Liverpool School of Tropical Medicine, Liverpool, UK, 2 pp. Each Evidence Update is a 2-page summary of a Cochrane Review of healthcare interventions relevant to people in low-income and middle-income countries.

This Evidence Update is adapted from Abba K, Sudarsanam TD, Grobler L, Volmink J. Nutritional supplements for people being treated for active tuberculosis. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD006086. DOI: 10.1002/14651858.CD006086.pub2.

Data on the effects of food or micronutrients on illness recovery are limited in patients with TB.

Do corticosteroids prevent death and improve respiratory function in people with tuberculous pleurisy?

Fri, 06 Nov 2009 14:54:00 GMT

Miscellaneous 2009 Evidence Update, Tuberculosis Series. Effective Health Care Research Programme Consortium, Liverpool School of Tropical Medicine, Liverpool, UK, 2 pp. Each Evidence Update is a 2-page summary of a Cochrane Review of healthcare interventions relevant to people in low-income and middle-income countries.

This Evidence Update is adapted from Engel ME, Matchaba PT, Volmink J. Corticosteroids for tuberculous pleurisy. Cochrane Database of Systematic Reviews 2007, Issue 4.

There is insufficient evidence to determine whether corticosteroids benefit people with tuberculous pleurisy.

Drugs for preventing malaria in travellers

Fri, 06 Nov 2009 14:10:00 GMT

Miscellaneous F. A. Jacquerioz, and A. M. Croft 2009 Jacquerioz FA, Croft AM. Drugs for preventing malaria in travellers. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD006491. DOI: 10.1002/14651858.CD006491.pub2 Malaria is a mosquito-transmitted disease which commonly infects international travellers, sometimes fatally. Deaths from malaria are usually caused by Plasmodium falciparum.

Malaria can be prevented through a range of anti-mosquito precautions (barrier measures), and by taking antimalaria drugs (chemoprophylaxis). Chloroquine is effective chemoprophylaxis in those parts of the world where P. falciparum has not developed resistance to chloroquine. For most malaria-endemic regions, however, travellers must take a newer and stronger drug regimen. These newer antimalaria regimens have unpredictable adverse effects, including severe illness or death.

This review was designed to assess the efficacy, safety, and tolerability of atovaquone-proguanil, doxycycline, and mefloquine (the three currently available chemoprophylaxis choices for regions with P. falciparum resistance) compared to each other, and also when compared to chloroquine-proguanil (an older drug combination) and to primaquine (a candidate for chemoprophylaxis).

We found eight trials (4240 participants). Overall the evidence base was small, and we found no evidence to support the use of primaquine. There was only limited evidence on which of the three currently available drugs is most effective in preventing malaria. While none of the eight trials reported any serious adverse events (which are usually rare) all trials reported common adverse events from antimalaria drugs.

Atovaquone-proguanil and doxycycline are well tolerated by most travellers, and they are less likely than mefloquine to cause neuropsychiatric adverse events. Chloroquine-proguanil causes more gastrointestinal adverse events than other chemoprophylaxis. In other respects, the common unwanted effects of currently available drugs are similar.

As well as the eight trials, we also found 22 published case reports of deaths, including five suicides, associated with mefloquine use at normal dosages. No other currently used drugs were reported as causing death, at normal dosages.

In conclusion, there were differences in the common unwanted effects of the drugs which are currently available to prevent malaria, in adult and child travellers. However, the quality of evidence was overall low. Atovaquone-proguanil and doxycycline are the best tolerated regimens. Mefloquine has more adverse effects than other drugs, and these adverse effects are sometimes serious. However mefloquine may still be an appropriate choice for those travellers who have taken it previously, without any adverse events. Other factors should be considered by prescribers, in addition to tolerability: cost, ease of administration, possible drug-drug interactions, travel itinerary, and the additional protection that may be afforded by doxycycline against other infections, besides malaria.

Artemisinin-based combination therapy for treating uncomplicated malaria

Fri, 06 Nov 2009 14:00:00 GMT

Miscellaneous D. Sinclair, B. Zani, S. Donegan, P. Olliaro, P. Garner 2009 Sinclair D, Zani B, Donegan S, Olliaro P, Garner P. Artemisinin-based combination therapy for treating uncomplicated malaria. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD007483. DOI: 10.1002/14651858.CD007483.pub2. Malaria is a major cause of illness and death in many of the world's poorest countries. It is spread from person to person by the bite of mosquitoes infected with a microorganism called Plasmodium. The Plasmodium species P. falciparum is the most common cause of malaria worldwide and causes the majority of deaths. Uncomplicated malaria is the mild form of the disease which, if left untreated, can progress rapidly to become life threatening. The drugs traditionally used to treat uncomplicated malaria have become ineffective in many parts of the world due to the development of drug resistance. This review summarizes the relative benefits and harms of the four ACTs in common use, one relatively new ACT (dihydroartemisinin plus piperaquine), and one combination which does not contain an artemisinin derivative but remains in use in some African countries (amodiaquine plus sulfadoxine-pyrimethamine).

Oral iron supplementation for preventing or treating anaemia among children in malaria-endemic areas

Fri, 06 Nov 2009 13:52:00 GMT

Miscellaneous J. U. Ojukwu, J. U. Okebe, D. Yahav, M. Paul 2009 Ojukwu JU, Okebe JU, Yahav D, Paul M. Oral iron supplementation for preventing or treating anaemia among children in malaria-endemic areas. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD006589. DOI: 10.1002/14651858.CD006589.pub2 Children commonly develop anaemia (low haemoglobin) after birth. Anaemia is associated with several ill-effects, including hindering motor development and learning skills, and it may have an adverse effect on immunity. Babies and children are therefore commonly given iron supplements to prevent or treat anaemia. In countries where malaria is prevalent, it has been suggested that iron supplementation increases the risk of malaria and deaths. The high dose of iron which is given as medicine may result in free iron circulating in the blood and available to the malaria parasite, which promotes its growth. We therefore aimed to assess the effects of iron administered to children living in countries where malaria is prevalent. We included only randomized controlled trials that compared iron given orally as a medicinal product (and not as food or drink fortification) with placebo or no treatment.

Iron did not increase the risk of malaria disease, indicated by fever and presence of parasites in the blood. The presence of parasites in the blood was slightly higher with iron overall, but not in trials with adequate randomization methods. There was no increased risk of death among iron-treated children. Although more than 70 trials were identified for this review, malaria-related outcomes and deaths were reported in only 16 and 11 trials, respectively. Iron supplementation increased haemoglobin by about 1 g/dL in areas where malaria is highly prevalent. At the end of follow up, which varied between two weeks and six months after the end of iron supplementation, the gain was smaller but still present at 0.4 g/dL. Iron did not increase the risk of respiratory infections, but episodes of diarrhoea were more frequent with iron when it was administered with zinc. Children given iron visited medical clinics less than children given placebo, but the rate of hospitalization was similar. Weight and height at the end of treatment were similar. Iron did not adversely affect rates of cure when given together with antimalarial treatment in three trials that examined this issue.

Our conclusions are that iron supplementation does not adversely affect children living in malaria-endemic areas. The evidence shown in our review is limited by the lack of trials examining the relevant outcomes and the limited information allowing us to analyse factors that can affect our results, such as the children's baseline level of haemoglobin. Based on our review, routine iron supplementation should not be withheld from children living in countries where malaria is prevalent.

The research of the Medicines for Malaria Venture (MMV) will feature at the forthcoming 5th MIM Pan-African Malaria Conference

Fri, 30 Oct 2009 01:00:00 GMT

MMV will be co-hosting symposia and making oral and poster presentations at the 5th Multilateral Initiative on Malaria (MIM) Pan-African Malaria Conference in Nairobi, Kenya, 2-6 November 2009

HERD folder for SAARC Conference

Wed, 28 Oct 2009 10:01:00 GMT

Miscellaneous 2009 7 pp. This is a folder distributed to participants of a SAARC (South Asian Association for Regional Cooperation) TB conference, describing the work of HERD (Health Research and Social Development Forum), the COMDIS partner for Nepal.

Fighting The Battle Against Disease - Leeds Researchers Take On The World

Wed, 28 Oct 2009 09:52:00 GMT

Miscellaneous 2006 Medical News Today, 02 Mar 2006 This news reports the start of the COMDIS programme fighting malaria, TB and HIV.

Fighting The Battle Against Disease - Leeds Researchers Take On The World

Wed, 28 Oct 2009 09:52:00 GMT

Miscellaneous 2006 Medical News Today, 02 Mar 2006 This news reports the start of the COMDIS programme fighting malaria, TB and HIV.

COMDIS Bulletin 1

Wed, 28 Oct 2009 09:46:00 GMT

Miscellaneous L. Brehmer 2009 COMDIS Bulletin 1, Autumn 2009. 6 pp. The aim of this bulletin is to allow COMDIS partners to share updates with each other. It contains information on events, activities and new projects in the COMDIS programme.

COMDIS Bulletin 1

Wed, 28 Oct 2009 09:46:00 GMT

Changes to malaria national treatment policy in Africa

Wed, 28 Oct 2009 09:35:00 GMT

Miscellaneous L. Brehmer 2009 Health reporter, 12 June 2009 This feature in Health Reporter highlights new developments in the treatment and diagnosis of malaria in Africa. Links for further information, and summaries of a number of journal articles and other information sources, are provided.

COMDIS Brochure

Wed, 28 Oct 2009 09:14:00 GMT

Miscellaneous 2009 2 pp. This updated brochure introduces the COMDIS programme on HIV, malaria and tuberculosis.

COMDIS Brochure

Wed, 28 Oct 2009 09:14:00 GMT

Miscellaneous 2009 2 pp. This updated brochure introduces the COMDIS programme on HIV, malaria and tuberculosis.

TARGETS Newsletter Issue No. 10

Tue, 27 Oct 2009 15:54:00 GMT

Miscellaneous 2009 October 2009, 2 pp. This issue has an article on 'Acceptable Interventions for Malaria in Pregnancy: innovative ways of working with health care users and providers,' by Lucy Smith (LSHTM). Details are also given of Forthcoming Events and TARGETS Partner Research News.

Malaria risk and access to prevention and treatment in the paddies of the Kilombero Valley, Tanzania

Wed, 21 Oct 2009 15:01:00 GMT

Miscellaneous M. W. Hetzel, S. Alba, M. Fankhauser, I. Mayumana, C. Lengeler, B. Obrist, R. Nathan, A. M. Makemba, C. Mshana, A. Schulze, and H. Mshinda 2008 Malaria Journal (2008) 7: 7 [doi:10.1186/1475-2875-7-7] BACKGROUND: The Kilombero Valley is a highly malaria-endemic agricultural area in south-eastern Tanzania. Seasonal flooding of the valley is favourable to malaria transmission. During the farming season, many households move to distant field sites (shamba in Swahili) in the fertile river floodplain for the cultivation of rice. In the shamba, people live for several months in temporary shelters, far from the nearest health services. This study assessed the impact of seasonal movements to remote fields on malaria risk and treatment-seeking behaviour.

METHODS: A longitudinal study followed approximately 100 randomly selected farming households over six months. Every household was visited monthly and whereabouts of household members, activities in the fields, fever cases and treatment seeking for recent fever episodes were recorded.

RESULTS: Fever incidence rates were lower in the shamba compared to the villages and moving to the shamba did not increase the risk of having a fever episode. Children aged 1-4 years, who usually spend a considerable amount of time in the shamba with their caretakers, were more likely to have a fever than adults (odds ratio = 4.47, 95% confidence interval 2.35-8.51). Protection with mosquito nets in the fields was extremely good (98% usage) but home-stocking of antimalarials was uncommon. Despite the long distances to health services, 55.8% (37.9-72.8) of the fever episodes were treated at a health facility, while home-management was less common (37%, 17.4-50.5).

CONCLUSION: Living in the shamba does not appear to result in a higher fever-risk. Mosquito nets usage and treatment of fever in health facilities reflect awareness of malaria. Inability to obtain drugs in the fields may contribute to less irrational use of drugs but may pose an additional burden on poor farming households. A comprehensive approach is needed to improve access to treatment while at the same time assuring rational use of medicines and protecting fragile livelihoods.

Estimates of the burden of malaria morbidity in Africa in children under the age of 5 years

Wed, 21 Oct 2009 14:36:00 GMT

Miscellaneous A. Roca-Feltrer, I. Carneiro, J. R. M. Armstrong Schellenberg 2008 Tropical Medicine & International Health (2008) 13 (6) 771-783 [DOI: 10.1111/j.1365-3156.2008.02076.x] OBJECTIVE: To estimate the direct burden of malaria among children younger than 5 years in sub-Saharan Africa (SSA) for the year 2000, as part of a wider initiative on burden estimates.

METHODS: A systematic literature review was undertaken in June 2003. Severe malaria outcomes (cerebral malaria, severe malarial anaemia and respiratory distress) and non-severe malaria data were abstracted separately, together with information on the characteristics of each study and its population. Population characteristics were also collated at a national level. A meta-regression model was used to predict the incidence of malaria fevers at a national level. For severe outcomes, results were presented as median rates as data were too sparse for modelling.

RESULTS: For the year 2000, an estimated 545,000 (uncertainty interval: 105,000-1,750,000) children under the age of 5 in SSA experienced an episode of severe malaria for which they were admitted to hospital. A total of 24,000 (interquartile range: 12,000-37,000) suffered from persistent neurological deficits as a result of cerebral malaria. The number of malaria fevers associated with high parasite density in under-5s in SSA in 2000 was estimated as 115,750,000 (uncertainty interval: 91,243,000-257,957,000).

CONCLUSION: Our study predicts a lower burden than previous estimates of under-5 malaria morbidity in SSA. As there is a lack of suitable data to enable comprehensive estimates of annual malaria incidence, we describe the information needed to improve the validity of future estimates.

Composition and Biting Activity of Anopheles (Diptera: Culicidae) in the Amazon Region of Colombia

Wed, 21 Oct 2009 11:21:00 GMT

Miscellaneous M. Rodríguez, L. Pérez, J. C. Caicedo, G. Prieto, J. A. Arroyo, H. Kaur, M. Suárez-Mutis, F. De La Hoz, J. Lines and N. Alexander 2009 Journal of Medical Entomology (2009) 46 (2) 307-315 To provide information for public health policy on mosquito nets in the Amazon region of Colombia, we conducted landing catches to estimate Anopheles species composition and biting activity. Two hundred twenty person-nights of catches were done in seven locations over a period of 14 mo. A total of 1,780 Anopheles mosquitoes were caught (8.1 per person-night). Among the nine species found, An. oswaldoi Peryassú was the most common (776 mosquitoes, 44%), followed by An. darlingi Root s.l. (498, 28%). An. oswaldoi was the most common species collected outdoors, where its biting rate dropped steadily from a peak of >15 bites/person-night at the start of the night (1800-1900 hours) to ≈2 bites/person-night before dawn. An. darlingi was the most common species collected indoors, with a biting rate of ≈3-4 bites/person-night until about midnight, when the rate dropped below 1 bite/person-night, before showing a secondary peak before dawn. Sixty-four mosquito nets were analyzed by the technique of high-performance liquid chromatography (HPLC) for levels of deltamethrin (DM). All but two (62) of these were reported by their owners to have been impregnated with insecticide, and 53 were found by HPLC to have deltamethrin. However, one half (32) of the nets had concentrations <4 mg/m2 and therefore were likely to have been inadequately protective. An inverse association was found between the reported time between washes and deltamethrin concentration. These findings show a need for additional protection from mosquitoes when not inside nets, as well as for more effective impregnation, possibly through wash-resistant insecticide formulation.

This is Open Access Week

Mon, 19 Oct 2009 01:00:00 GMT

This week, 19-23 October 2009, is the first International Open Access Week, which aims to broaden awareness and understanding of Open Access.

This is Open Access Week

Mon, 19 Oct 2009 01:00:00 GMT

This week, 19-23 October 2009, is the first International Open Access Week, which aims to broaden awareness and understanding of Open Access.

Pulmonary disease in HIV-infected African children.

Fri, 16 Oct 2009 16:54:00 GMT

Miscellaneous Graham, S.M.; Coulter, J.B.S.; Gilks, C.F. 2001 International Journal of Tuberculosis and Lung Disease (2001) Volume 5, Number 1, pp. 12-23. Childhood human immunodeficiency virus (HIV) infection is common in most regions of sub-Saharan Africa. Acute and chronic respiratory diseases are major causes of morbidity and mortality in HIV-infected children. They represent a significant added burden in a region where diagnostic capabilities are limited and management decisions are often made on the basis of clinical guidelines alone. Pneumocystis carinii pneumonia is now recognised as an important cause of acute severe pneumonia and death in HIV-infected infants. However, there are few data on incidence and aetiology for more treatable conditions such as bacterial pneumonia. The association of pulmonary tuberculosis and HIV infection is uncertain, and the diagnosis is further confused by the presence of lymphoid interstitial pneumonitis and other chronic HIV-related pulmonary disease. This article reviews the literature and highlights the urgent need for further research in order to improve clinical management and appropriate interventions. [Summaries available in French and Spanish].

Operational assessment of isoniazid prophylaxis in a community AIDS service organisation in Uganda.

Fri, 16 Oct 2009 16:32:00 GMT

Miscellaneous Lugada, E.S.; Watera, C.; Nakiyingi, J.; Elliott, A.; Brink, A.; Nanyunja, M.; French, N.; Antivelink, L.; Gilks, C.; Whitworth, J. 2002 International Journal of Tuberculosis and Lung Disease (2002) 6 (4) pp. 326331. SETTING: Isoniazid therapy was shown to be 70% effective at preventing tuberculosis in HIV-infected, PPD-positive Ugandan adults, but the feasibility of implementation outside an efficacy trial has not been established. OBJECTIVE: To study uptake, adherence and feasibility of a 6-month course of isoniazid preventive therapy in community-based HIV clinics in Uganda. DESIGN: Observational cohort study describing selection of patients and adherence to isoniazid 300 mg daily. Adherence was measured by clinic attendance, pill counts and urine isoniazid metabolite testing. Implementation was costed on a service delivery basis. RESULTS: Of 1597 cohort members, 22% were PPD-positive. Over 18 months, 193 PPD-positive individuals were assessed for prophylaxis and 98 (51%) were enrolled. Of those enrolled, 74 (76%) completed their course of isoniazid therapy, and 80% were fully adherent. Symptoms or previous treatment for tuberculosis and suspicion of tuberculous lymphadenopathy were the main reasons for exclusion. The additional cost of providing this service was US $14549. CONCLUSION: Clinics specialising in the care of persons with HIV/AIDS can successfully implement isoniazid prophylaxis. Difficulties in excluding active tuberculosis and the costs of running the programme may limit its widespread implementation. [Summaries available in French and Spanish].

Vulnerability to malaria, tuberculosis, and HIV/AIDS infection and disease. Part II: determinants operating at environmental and institutional level.

Fri, 09 Oct 2009 16:17:00 GMT

Miscellaneous Bates, I.; Fenton, C.; Gruber, J.; Lalloo, D.; Lara, A.M.; Squire, S.B.; Theobald, S.; Thomson, R.; Tolhurst, R. 2004 The Lancet Infectious Diseases (2004) Volume 4, Issue 6, pp. 368-375 [doi:10.1016/S1473-3099(04)01047-3] This review summarises a wide range of evidence about environmental and institutional factors that influence vulnerability to malaria, tuberculosis, and HIV infection. By combining this information with that obtained on factors operating at individual, household, and community level (see part 1), we have identified potential common strategies for improving resilience to all three diseases simultaneously. These strategies depend on collaborations with non-health sectors and include progress in rapid access to funds, provision of education about disease transmission and management, reduction of the burden on carers (predominantly women), and improvement in the quality of health services.

New TB Regimens: What Countries Want

Tue, 15 Sep 2009 01:00:00 GMT

A new report from the TB Alliance based on interviews with over 200 key stakeholders explores

How will climate change affect insect-borne diseases?

Mon, 14 Sep 2009 01:00:00 GMT

The latest SciDev.Net spotlight looks at how climate change might impact the spread of insect-borne diseases such as malaria, and how countries can prepare for these changes.

New funding opportunities for four health-related Research Programme Consortia (RPCs)

Mon, 24 Aug 2009 01:00:00 GMT

DFID is calling for expressions of interest for service providers to lead Research Programme Consortia (RPCs) to work on four health themes. Closing date 9th October 2009.

New funding opportunities for four health-related Research Programme Consortia (RPCs)

Mon, 24 Aug 2009 01:00:00 GMT

DFID is calling for expressions of interest for service providers to lead Research Programme Consortia (RPCs) to work on four health themes. Closing date 9th October 2009.

DFID releases a new project database

Fri, 21 Aug 2009 01:00:00 GMT

Information about projects funded by DFID, ranging from emergency aid for countries affected by conflict or humanitarian crises, to ongoing support to improve health, education and sanitation in the poorest countries, is now available online.

DFID releases a new project database

Fri, 21 Aug 2009 01:00:00 GMT

Medicines For Malaria Venture (MMV)

Wed, 05 Aug 2009 09:18:00 GMT

Current

Purpose of engagement:

The Medicines for Malaria Venture (MMV) is a not-for-profit foundation, its goal is to reduce deaths and illness from malaria and its purpose is to discover, develop and help deliver new, appropriate, effective and affordable antimalarial drugs through public-private partnerships and facilitate access to these medicines in the malaria-endemic countries.

Since its establishment in 1999, MMV has established an impressive portfolio of antimalarial drug candidates. One drug has been submitted for regulatory approval and two are in late-stage clinical trials. Further compounds in the current portfolio may successfully emerge as approved and licensed anti-malarial drugs. The availability of such medicines is of huge potential significance given estimates that every 30 seconds a child dies of malaria

DFID engagement Strategy/DFID line:

Tackling malaria fits within the DFID Health and Research Strategies, the Global plan to eradicate malaria and helps fulfil the Millennium Development Goals. Funding Product Development Public Private Partnerships (PDPs) for drug development fits within the Research Strategy.

To discover, develop and help deliver new, appropriate, effective and affordable antimalarial drugs; and facilitate access to these medicines in the malaria-endemic countries.

The future for artemisinin in the treatment of malaria

Tue, 04 Aug 2009 01:00:00 GMT

Chris Whitty, DFID's Head of Research, discusses artemisinin resistance and Colin Hill from a Defra-funded consortium looks at the potential for artemisinin production in the UK, in BBC Radio 4's Material World.

DFID seeks applications for three posts in the Research Uptake Team

Tue, 21 Jul 2009 01:00:00 GMT

DFID is seeking to fill three posts in the Research Uptake team within the Policy and Research Directorate - Team Leader and two Research Evidence Brokers

DFID seeks applications for three posts in the Research Uptake Team

Tue, 21 Jul 2009 01:00:00 GMT

DFID is seeking to fill three posts in the Research Uptake team within the Policy and Research Directorate - Team Leader and two Research Evidence Brokers

New guide to reporting on tuberculosis.

Fri, 08 May 2009 01:00:00 GMT

A new media toolkit from Panos London 'Sorting fact from fiction' aims to improve media reporting on TB.

Update on DFID call for applications for new product development partnerships for drugs and vaccines

Thu, 30 Apr 2009 01:00:00 GMT

The second phase of the DFID call for applications for new product development partnerships for drugs and vaccines is now underway. Seven organisations have been invited to submit bids for funding.

Update on DFID call for applications for new product development partnerships for drugs and vaccines

Thu, 30 Apr 2009 01:00:00 GMT

The second phase of the DFID call for applications for new product development partnerships for drugs and vaccines is now underway. Seven organisations have been invited to submit bids for funding.

DFID Supports World Malaria Day 2009

Fri, 24 Apr 2009 01:00:00 GMT

DFID is supporting a range of research projects alongside programmes to scale up interventions already known to be effective in the control of malaria

Kenyan shopkeepers join fight against malaria

Fri, 17 Apr 2009 01:00:00 GMT

DFID-funded research on the effectiveness of training retailers to advise on the home use of shop-bought antimalarial drugs for fevers in coastal areas of Kenya has shown that shopkeeper training can lead to much quicker treatment of malaria

Video stories help health workers learn about the stigma of HIV/AIDS

Thu, 09 Apr 2009 01:00:00 GMT

DVD-led discussions using material from the DFID-funded soap opera Makutano Junction have helped Kenyan health workers gain more awareness of the stigma associated with HIV and AIDS. Those attending an upcoming Healthlink London dicussion will have the chance to find out more from people working on the project

Why don't those caring for young children use the free health care provided by the Ugandan government?

Tue, 07 Apr 2009 01:00:00 GMT

A recent study in Uganda has shown that private health providers are often used in preference to the free health care provided by the government by carers looking after young children with symptoms of fever.

Chinese herbal medicines set to inspire new tuberculosis drugs

Fri, 03 Apr 2009 01:00:00 GMT

Pilot screening of traditional herbal medicines by researchers from the Chinese Academy of Sciences has identified natural product extracts with potential to attack the tuberculosis microbes. The scientists plan to work with the DFID-funded TB Alliance to identify more potential anti-TB agents from natural sources, including microbes and traditional Chinese medicines

£18 million boost for discovery of new oral treatment for TB

Tue, 24 Mar 2009 01:00:00 GMT

TB Alliance to receive £18 million additional funding from DFID for research into new oral treatments for tuberculosis.

Preparing for malaria in the changing climate of East Africa's highlands

Thu, 22 May 2008 01:00:00 GMT

Kenyan researchers are combining climate observation with medical research to improve an existing model of malarial prediction so that local officials can better prepare

Towards integrated control of malaria and livestock diseases in Africa

Tue, 20 Nov 2007 00:00:00 GMT

Completed Ethiopia suffers epidemic levels of malaria during the rainy season. This region is part of a zone across sub-Sahara Africa where the mosquito vector feeds on both humans and cattle opportunistically, so that mosquito control methods based on killing mosquitoes as they enter human dwellings have not been particularly effective. Recent trials in the area carried out by FARM African have shown that treating livestock with insecticides to kill tsetse flies is highly effective at reducing trypanosomosis, and there is anecdotal evidence that these trials also reduce the incidence of malaria. Studies in Pakistan where mosquito species also feed on both humans and animals have shown that treatment of animals with insecticide reduced mosquito populations. The project aims to assess the feasibility of developing integrated control of malaria and trypanosomosis in Africa by treating livestock with insecticides. This will be done by review of the literature and discussion with experts on control of malaria and trypanosomosis in order to determine;
1. bionomics of mosquito vectors in southern Ethiopia.
2. response of these vectors to insecticide in southern Ethiopia.
3. scope and cost-effectiveness of current methods for control of malaria in the region.
4. requirements and constraints to integrating malaria control with control of tsetse and trypanosomosis by treatment of cattle with insecticides. The output will be a report assessing the feasibility of integrating control of malaria with control of trypanosomosis in Africa by treating livestock with insecticides, and the parameters affecting this.

The cost-effectiveness of permethrin-treated bednets in an area of intense malaria transmission in Western Kenya

Tue, 20 Nov 2007 00:00:00 GMT

Completed This study compared the costs and effects of permethrin treated bednet (ITN) use in children <5 years of age in an area of intense, perennial malaria transmission in western Kenya. The data were derived from a group-randomized controlled trial of ITNs in an area of intense perennial malaria transmission in western Kenya conducted between 1996 and 1999. The annual net cost per Life Year Gained (LYG) was US $34 and the net annual cost per case of all-cause sick child clinic visit averted was US $49. After taking into account a community effect - protection from malaria afforded to non-ITN users who lived within 300 meters from users - these estimates fell to US $25 and US $38, respectively. This study provides further evidence that ITNs are a highly cost-effective use of scarce health care resources.

Private and public providers of malaria services in Anambra State, Nigeria

Tue, 20 Nov 2007 00:00:00 GMT

Ongoing 'Levels and determinants of the costs equity and overall contributions of private and public health care providers to appropriate effective and equitable treatment of malaria are not well known in Nigeria and other sub-Saharan African countries but are needed for the improvement of malaria treatment services. This research aims to generate new knowledge about the provision and utilisation of malaria treatment in Nigeria in order to inform policy makers on areas for intervention with high poten but are needed for the improvement of malaria treatment services. This research aims to generate new knowledge about the provision and utilisation of malaria treatment in Nigeria in order to inform policy makers on areas for intervention with high potential impact to improve utilisation of adequate quality malaria treatment services. This will be achieved by:
a) assessing the factors influencing the supply of malaria treatment;
b) assessing the factors influencing the demand for malaria treatment;
c) examining the degree of socio-economic and spatial segmentation of the market for malaria treatment; and
d) providing guidance to policy makers and other stakeholders about potential areas for intervention.

The study will last for 2 years and will be conducted in three urban and three rural towns from the three senatorial zones of Anambra State in Southeast Nigeria. The study tools for investigating treatment provision are in-depth interviews with key informants, structured interviews, and exit polls. Focus group discussions and a household survey will be used to examine treatment utilisation. Participatory methods will be used to catalyse the research findings into practice.

The use of environmental information systems in developing and improving malaria control strategies in Africa

Tue, 20 Nov 2007 00:00:00 GMT

Completed Malaria is one of the most serious public health problems in Africa. The burden of the disease falls mostly on the rural poor, especially pregnant women and the young, with estimates of between 1 and 2 million children dying annually. The global economic costs have been put at around US$1,700 million, per annum, at 1995 prices. The disease is on the increase, due in part to increasing drug and insecticide resistance, but also decreasing health infrastructure. Furthermore, environmental and demographic changes have resulted in dramatic inceases in transmisison in areas previously free of the disease. Reassessment of the global Malaria situation underaken at the Amsterdam Conference in 1992 led to the development of a pragmatic control strategy based on a Primary Health Care approach. Its aims are to: (a) reduce mortality and the negative social and economic consequences of the disease (b) prevent epidemics (c) protect malaria-free areas. Such a control strategy requires recognition of the underlying variability in the epidemiology of the disease, the potential for modification, availability of resources and the need to adapt Malaria control planning to local conditions in areas where there is a reasonable chance of success. New tools are urgently needed to assist health planners in adapting all available control techniques to suit their particular situation. To develop new methods for stratifying malaria, based on seasonal variability in environmental parameters obtained from satellite imagery. The imagery will be obtained locally as a component of national environmental monitoring and information systems.

To develop a "Risk Mapping" approach to advise Malaria control staff of areas where epidemic potential is developing. Satellite data on environmental variables (such as cloud cover, rainfall estimates and vegetation density) can be used to predict rates of malaria transmission with a lead time of one to three months. WHO-AFRO and national policy-makers in a number of African countries have either recommended or already adopted the use of GIS/EIS for malaria surveillance and epidemic preparedness. The management and logistical capacity of health systems to respond quickly and appropriately to early warning of malaria epidemics has not been studied, but might require strengthening in some countries in order to ensure that the potential health and economic benefits of epidemic prediction are realised. An interactive GIS incorporating data sets relevant to Malaria risk assessment in case study countries; Stratification map and interactive ,risk map, of Namibia based on environmental variable and epidemiological information; Stratification map and interactive ,risk map, of Kenyan/Ugandan Highlands based on environmental variables and epidemiological infomation.

Decision support criteria for using environmental data for Malaria ,risk Mapping, in case study areas; Software module for decision support that is based on climatic and other risk data to indicate epidemic potential in ,case study, collaborating countries; Staff in Malaria control services in case study countries. Work by the project has provided sound statistical evidence of the association between age-related prevalence rates found in the community and seasonal vegetation state as measured by environmental monitoring satellites. Results from the spatial model developed were used to demonstrate the relevance of satellite data to studies of seasonal malaria transmission and indicate how remote sensing, GIS, epidemiological data and spatial analysis can be used to indicate village-based variation in the effectiveness of an intervention. Risk maps for malaria in Namibia were also produced using vegetation condition and routine data from the MoH Health Information System.

Weather satellite data has been shown to allow ready access to proxies of environmental variables, such as rainfall, temperature and humidity, which are directly related to malaria transmission. Standard techniques for rainfall estimation are widely used by the food security and drought monitoring systems to monitor seasonal variability. Using the same rainfall estimates the research team developed a model giving three months lead warning of the timing and amplitude of malaria transmission in Namibia. Satellite derived estimates of ambient air temperatures have been developed from Meteosat Thermal Infra Red. Meteosat derived rainfall estimates over complex terrain and high altitudes have been improved.

The project demonstrated how more reliable forecasting of malaria epidemics may be achieved through progressive stratification of regions of high climatic variability and enhanced epidemic risk, routine monitoring of environmental variables, and use of regional forecasting models. Indicators of increased risk of epidemics were shown to be available with considerable lead times from regional climate forecasts. In the case of the 1998 epidemics in East Africa, first indicators were available in May 1997. These were enhanced in October 1997 by the satelllite rainfall estimates, fully three months prior to the epidemics in February 1998.

Artemisinin based combination therapy for the treatment of malaria: an economic and policy analysis

Tue, 20 Nov 2007 00:00:00 GMT

Ongoing Antimalarial drug resistance is now recognised to be a major cause of the increasing burden due to falciparum malaria. Artemisinin based combination therapies (ACTs) for the treatment of acute malaria are being deployed in the anticipation that they will improve treatment efficacy and delay in the development of drug resistance. However uncertainties remain about their effectiveness and cost-effectiveness and in particular how these outcomes are affected by differences in malaria epidemiology, health care settings, human behaviour, and implementation strategies. A comprehensive bio-economic model of malaria transmission and the spread of drug resistance was developed in order to address these uncertainties. The model incorporates vector factors, human immunity, human behaviour and outputs clinical outcomes, percentage resistance and costs. A wide range of data were obtained to populate the model, including from a community drug usage survey in Cambodia. Coverage with the ACT (artesunate and mefloquine) was found to be extremely low, largely due to the predominance of the informal sector in the provision of treatment. However, adherence to the blister packaged combination was generally good. The modelling process revealed unexpected complexities and gaps in epidemiological data, the significance of which were made more apparent when the model was run with inputs from different scenarios in order to explore its user-friendliness and the credibility of the results. Despite these limitations, the model suggests that switching from monotherapy to an artemisinin based combination therapy is an effective and cost-effective policy choice under a range of circumstances within the 8 year timescale considered in the analysis.

Cost and cost-effectiveness of malaria vector control by residual insecticide house-spraying in Southern Mozambique: a rural and urban analysis

Tue, 20 Nov 2007 00:00:00 GMT

Completed Although there is evidence that residual household spraying (RHS) has proven to be a great success in some areas in South Africa in terms of reduced morbidity and mortality, there is a need for better knowledge about the cost-effectiveness of RHS. This paper analyses two separately funded, but operationally similar, residual household spraying initiatives in Southern Mozambique. The first is a regional programme involving the participation and co-ordination of individuals across three countries in Southern Africa (South Africa, Swaziland and Mozambique), within a rural project called The Lubombo Spatial Development Initiative (LSDI). The second project, the Mozal project focuses on spraying an urban community within a district boundary. Both these initiatives show that introducing a RHS programme can deliver a cost-effective reduction in malaria related suffering with financial support, political will and community involvement.

Cost-effectiveness study of iron supplements and malaria chemo-prophylaxis in the prevention of anaemia and malaria among infants in Northern Ghana

Tue, 20 Nov 2007 00:00:00 GMT

Ongoing Anaemia is a leading cause of morbidity and mortality among children in developing countries. The DFID funded Navrongo Anaemia Study NAS) aims to identify an effective and safe intervention to reduce suffering from anaemia in infants. The randomised placebo-controlled clinical trial is based at Navrongo Research Centre in Kassena-Nankana District, Ghana. The study aims to determine the effect on the incidence of anaemia, as well as mild and severe malaria, when iron supplements and SP are administered intermittently in conjunction with existing EPI delivery. The Economic Objectives of the Study are
To provide a full economic costing of the operational components of NAS from the provider prospective
To estimate the cost per case of anaemia averted.
To estimate the cost per case of mild malaria averted
To estimate the cost per case of severe malaria averted.
To produce reliable costing data that could be used to inform policy and allocation decisions.

Study to investigate the cost of malaria epidemics to the private sector in Ethiopia

Tue, 20 Nov 2007 00:00:00 GMT

Completed Very little is known about the economic burden of malaria epidemics, particularly their impact on production and the private sector. This study aims to investigate the burden of malaria epidemics from the perspective of employers and employees in two study sites in Ethiopia: a sugar plantation and orange plantation.

Controlling malaria and trypanosomiasis with insecticide-treated cattle

Tue, 20 Nov 2007 00:00:00 GMT

Completed To develop cost-effective and appropriate technologies (through the use of insecticide-treated cattle) to reduce mortality and the disabling effects of malaria that affect the livelihoods of the poor. The project achieved all its intended outputs by establishing that the malaria-transmitting An. arabiensis mosquitoes are highly susceptible to insecticides used to control tsetse, the formulation does not repel them to the extent that they are not killed by contact with the cattle, and treatment is effective if older cattle only are treated. Ultimately, these results could have a great (positive) impact on the cost and effectiveness of malaria prevention methods used in rural areas. The purpose of the project has not yet been achieved. However, the DFID Animal Health Programme initiated a project in October 2002 to obtain social, economic and epidemiological data to establish whether treating cattle with insecticide can contribute to the alleviation of malaria. This new project leads directly on from the KaR-funded project and will be conducted in collaboration with FARM Africa in the Konso District of southern Ethiopia. 1. Field studies of the mortality of mosquitoes exposed to insecticide-treated cattle.

Test animals were treated with a pour-on formulation of deltamethrin (Spot-on) widely used for tick and tsetse control in Africa and the mortality of mosquitoes exposed to treated cattle was assessed.

2. Field studies of the attraction and feeding responses of mosquitoes to insecticide-treated cattle.

Single cattle, either treated with deltamethrin or not, were tethered within 2 m of two human collectors who collected mosquitoes landing on each other. If treatment diverted mosquitoes from the cattle to the humans, then the collectors would be expected to collect more mosquitoes on nights when they are adjacent to a treated animal. The experiment was repeated with four matched pairs of cattle continued for 30 days for each pair of animals. In addition, visual observations were made of mosquitoes feeding on treated and untreated cattle and feeding time and success from treated and untreated cattle were compared.

3. Field studies to determine whether mosquitoes feed selectively on particular (e.g. age, size) cattle within a herd.

A PCR-based technique for identifying the individual-specific sources of cattle bloodmeals was used to determine whether mosquitoes feed preferentially on certain cattle. The experiments focused on determining whether there were significant difference in responses to young (< 3 years) and mature cattle; African farmers controlling ticks and tsetse tend not to treat young cattle with insecticide.

4. Make recommendations on the suitability of using insecticide-treated cattle to control malaria and hold dissemination workshops.

To disseminate the findings within Ethiopia, more than 50 representatives from government, scientific and NGO organisations concerned with human and animal health were invited to a 3-day workshop convened in Arba Minch in December 2002. The meeting was conducted in Ammharic and Dr Habtewold presented the scientific findings and recommendations of this project.

To disseminate the project outputs more widely, a one-day workshop on interactions between agriculture and vector-borne diseases was organised at the Royal Entomological Society in London in April 2003. Some 100 UK- and Africa-based scientists/administrators concerned with the control of vector-borne diseases, including malaria, attended the meeting. Dr Habtewold gave a 30 min presentation on the outputs of this project.

One scientific paper on aspects of this project was published in the scientific press (Prior & Torr, 2002) and a second is in preparation.

The Zambian Pro Test Project : A Package to reduce the impact of Tuberculosis and other HIV-related diseases

Tue, 20 Nov 2007 00:00:00 GMT

Completed Development of a sustainable, replicable model package to reduce impact of TB and HIV in poor urban settings.

Tanzania: A field trial in Usangu Plains Area, Mbeya to validate the performance of the tuberculin test and evaluate different ELISA assays to determine their potential as complementary tests for the diagnosis of bovine tuberculosis

Tue, 20 Nov 2007 00:00:00 GMT

Completed

Quantifying costs and risk factors of Bovine Tuberculosis in Tanzania

Tue, 20 Nov 2007 00:00:00 GMT

Completed Reducing poverty in rural areas of Tanzania by improving livestock productivity through control of bovine tuberculosis. Improving human health and welfare by minimising the public health burden of bovine tuberculosis, particularly for women and children who appear most at risk from infection. In the World Animal Health Report of 1996 the Government of Tanzania Veterinary Services identified the need for funding of bovine tuberculosis research to address the animal and human health problems posed by the disease. Research on the epidemiology of livestock diseases has been identified as a priority by the Ngorongoro Conservation Areas General Management Plan, to alleviate the acute poverty and malnutrition faced by pastoralists as a result of a deteriorating livestock production base. The project will identify risk factors for infection so that control measures for bovine tuberculosis can be implemented and targetted to where they will be most effective. Successful control of this disease will lead to improved productivity in cattle through increased milk yield, greater return on meat sales and reduced losses from carcass condemnation. Control of bovine tuberculosis in cattle herds will also reduce the zoonotic threat to livestock owners and consumers of dairy products. Assessment of the economic and social impact of bovine tuberculosis on quality, value and use of meat and milk products in the semi-arid system.

Development of sustainable, environmentally beneficial and cost-effective strategies for control of bovine tuberculosis. Providing information on the public health and economic burden of bovine tuberculosis in Tanzania. The study has been able to quantify for the first time the contribution of M.bovis to the human tuberculosis epidemic in Tanzania and compare the public health burden of M.bovis with M.tuberculosis and with other zoonotic diseases in Tanzania. This will provide important information for identifying priorities for disease control for government officials in Tanzania, the World Heath Organization, and public health workers in other countries. Although the prevalence of M.bovis in cattle was relatively low (0.9%), the infection is widespread and occurs in 12% of cattle herds. Furthermore, M.bovis is the cause of 10% of culture-positive cases of human extrapulmonary tuberculosis (EPTB), which is equivalent to approximately 800-1000 human cases per year. In collaboration with DFID project R7229, the study has highlighted the importance of atypical Mycobacteria in both human and livestock tuberculosis in Tanzania, with many tuberculous lesions in livestock and culture-positive cases of human EPTB caused by atypical Mycobacteria spp. The economic burden of M.bovis has been difficult to quantify due to the relatively low numbers of reactors detected in this study. No differences were detected in body condition score between infected and non-infected animals. However, in some herds, milk yields were significantly lower in infected than non-infected cattle. Milk yield is often the first indicator of a production problem and suggests that M.bovis infection may have an impact on cattle production in Tanzania. However, a more detailed long-term study is required to tease out the impact of M.bovis from the other multiple factors contributing to production losses in traditional systems. Providing data to assist in the development of strategies for control of bovine tuberculosis in cattle. The results of the cross-sectional cattle study provide an important contribution to the understanding of the epidemiology of M.bovis, with wildlife identified for the first time as a significant risk factor for bovine TB in Tanzania. Large herds were also shown to be at higher risk than small herds. The potential importance of wildlife is supported by the additional work of this project, which determined a relatively high prevalence of infection (up to 10% animals) in wildebeest and lion populations. These results will contribute directly to the project goal by allowing recommendations to be formulated for disease control. For example, management strategies could be developed to minimise contact with wildlife or for keeping large herds as smaller, separate units. Data on the prevalence of diseases and infection in different wildlife species is providing valuable information for wildlife authorities and highlights important areas for further investigation. Results from a parallel analysis of non-specific skin-test reactivity in cattle (which could result from infection with atypical Mycobactera) have provided additional information on risk factors for bovine tuberculosis. Wildlife and herd size both emerged as significant risk factors, therefore management strategies that reduce contact with wildlife and allow cattle to be kept in relatively small units are likely to protect against atypical Mycobacteria interaction as well as against M.bovis. Mathematical models are currently in development to explore the relative merits of different control strategies using data on individual- and herd-prevalence of bovine TB, and incorporating wildlife as a significant source of external infection for cattle. These results will indicate whether control measures are best targetted at reducing transmission from wildlife to cattle (eg: through management of grazing strategies) or by reducing transmission within the herd (eg: through cattle vaccination). Providing data to assist in the control of extrapulmonary tuberculosis in humans. The original study of To identify and evaluate risk factors for M.bovis infection in cattle and humans.

Evaluation of animal and human health burden of bovine tuberculosis.

Evaluation of cost and benefits of potential control measures related to herd management and cattle vaccination.

Improved intersectoral collaboration. Identification and evaluation of risk factors for M.Bovis infection in cattle and humans in Tanzania.
Risk factors for M.bovis infection have been identified and evaluated for both cattle and human populations in Tanzania through analysis of cross-sectional and case-control data. Additional outputs have been generated in terms of evaluating risk factors for human infection with both M.tuberculosis and atypical Mycobacteria spp. and important links with livestock have been identified.

Evaluation of the economic burden of bovine tuberculosis in Tanzania.
Data on the economic burden of bovine tuberculosis has been generated, however, due to the relatively low prevalence of reactors in Arusha region and the culling of many reactors once identified as positive, only limited longitudinal data is available.

Evaluation of the public health burden of bovine tuberculosis in Tanzania.
The public health burden of bovine tuberculosis and its contribution to the human tuberculosis epidemic in Tanzania has been quantified through calculation of disability-adjusted life years (DALYs) lost due to M.bovis and M.tuberculosis.

Evaluation of the costs and benefits of potential control measures related to herd management and cattle vaccination.
Mathematical modellng has been initiated to investigate the relative merits of different measures for controlling bovine tuberculosis in Tanzanian cattle herds. This work has been delayed because of the heavy involvement of collaborators during the 2001 foot-and-mouth epidemic in the UK, but preliminary results are available and final results expected by the end of March 2002.

Improved inter-sectoral collaboration between veterinary and medical fields.
Collaboration between the public health and veterinary sectors has been greatly enhanced as a result of this project and the sister study R7229, with strong links established between Sokoine University of Agriculture and the National Institute for Medical Research. In addition, the project has led to improved collaboration between Tanzanian wildlife agencies and the veterinary/medical sectors, with growing recognition of important links between wildlife disease and public health.

Information on knowledge, attitudes and practices relating to risk factors and control of tuberculosis.
Perception and risk factors relating to tuberculosis in the community have been identified through collection of additional data on knowledge, attitudes and practices incorporated into the cross-sectional study design.

Additional information on the prevalence of infection in wildlife species.
As a complementary output to results from wildlife samples obtained through hunting camps, collaborations were established with vets and scientists from Tanzania National Parks and Tanzania Wildlife Research Institute. Data has been obtained on the prevalence of M.bovis and seroprevalence of tuberculosis in several wildlife species within the Serengeti National Park.

Additional information on relative importance of zoonotic pathogens and wildlife as risk factors for emerging human disease and OIE livestock diseases.
Additional activities during the study period included an analysis of a human and livestock pathogen database developed at the Centre for Tropical Veterinary Medicine, University of Edinburgh in terms of risk factors for emerging diseases.

Knowledge Programme on Tuberculosis (London)

Tue, 20 Nov 2007 00:00:00 GMT

Current The Tuberculosis Programme is a five-year medical research project based at the London School of Hygiene & Tropical Medicine in collaboration with the Nuffield Institute in Leeds. It is a multidisciplinary Programme encompassing economics, anthropology, epidemiology, laboratory disciplines, health policy and clinical research. Improved TB control and care especially among poor people. 1. Better understanding of the social, economic and cultural influences on access to services for TB and adherence to treatment. 2. Developing and testing affordable approaches to improving the speed and accuracy of diagnosis. 3. Testing new strategies to improve coverage and treatment outcomes in TB control programmes. 4. Evaluating innovative ways to promote synergy between services for TB and HIV in countries most affected by the dual epidemic. 5. Exploring approaches to reducing the threat of multi-drug resistant TB. 6. Understanding the impact on disease control programmes, of different approaches to Health Sector Reform. 7.Policy transfer. 8. Communication.

Bovine tuberculosis in the tropics

Tue, 20 Nov 2007 00:00:00 GMT

Completed With the recent upsurge in human tuberculosis cases, particularly in developing countries, the importance and possible involvement of bovine tuberculosis has been questioned. Earlier this century, in some developed countries, zoonotic infection with M.bovis was found to be a significant problem, particularly in children. This lead to the introduction of bovine tuberculosis control and eradication programmes, including the widespread introduction of milk pasteurisation. In developing countries, especially in Africa where M. bovis infection is present in a range of animal species, there is a substantial lack of knowledge of the distribution, epidemiology and zoonotic importance of this important disease. Local customs such as the drinking of raw and soured milk may be playing a key role in the transmission of M.bovis. There are current programmes in many developing countries to encourage milk production through small holder and other dairy schemes. The fact that a significant amount of the milk produced is being marketed through informal channels, where non-pasteurisation and unhygienic practices abound, is cause for considerable concern. The classic conditions for the widespread transmission of bovine tuberculosis to the human population, as seen in Europe in the Thirties, are being created with a virtual absence of adequate monitoring or control measures. Tuberculosis has a close link with HIV infection and AIDS , and by far the largest number of people who carry both these infections live in developing countries. In addition, HIV seroprevalence rates of over 40 percent have been found in tuberculous patients in various African countries. M.bovis has also been isolated from HIV/AIDS patients, particularly in developing countries. The possible impact of HIV/AIDS on the epidemiology of M.bovis infection under African conditions required urgent investigation particularly as concern has recently been expressed at the emergence of multiple drug resistant strains of mycobacteria with which, some strains of M.bovis appear to be associated. Establish a culture facility for mycobacteria at the Veterinary Faculty, Sokoine University of Agriculture, Morogoro for the diagnosis of tuberculosis from both animal and human clinical samples.
Determine the distribution and prevalence of M. bovis in Tanzania and investigate whether human cases are occurring.
Validate the performance of the tuberculin test in Tanzania.
Undertake an epidemiological field investigation to identify management practices conducive to the transmission of bovine tuberculosis between cattle and man (cattle to cattle, cattle to man and man to cattle) and between cattle and other possible domestic or wildlife reservoirs. Identify factors that may be causally associated with the prevalence of bovine tuberculosis in Tanzania.
Develop and evaluate in Tanzania new techniques for bovine tuberculosis detection and diagnosis, in particular:-
i) The gamma interferon test for improved sensitivity and specificity in detecting tuberculous animals.
ii) An ELISA for detecting actively infected animals.
iii) Molecular, DNA based techniques for rapid identification of members of the M,tuberculosis complex (PCR) and discrimination between strains (RFLP).
Digitise maps of the study areas in Tanzania and overlay bovine tuberculosis data as appropriate for furthering epidemiological understanding by use of Geographical Information System.
Produce information on bovine tuberculosis in Tanzania to assist the compilation of extension material, including video, for staff training and the information of livestock owners and consumers alike.
Foster good and effective veterinary-medical liaison where optimal information exchange and maximal programme collaboration is promoted. Tuberculin testing of almost 6000 indigenous short horn Zebu cattle in the Usangu Plains revealed that 13% were positive for bovine tuberculosis. This high prevalence was supported by examination of subsets of this group by ELISA and post-mortem inspection at slaughter slabs, which estimated the prevalence of BTB to be 12% and 26% respectively (Kazwala et al,1995). Validation of these results awaits the outcome of culture of the samples collected at slaughter.

A cross-sectional study of bovine and human tuberculosis in the Monze District of Zambia

Tue, 20 Nov 2007 00:00:00 GMT

Completed Human tuberculosis is a major cause of death and suffering in sub-Saharan Africa. The joint burden of HIV and TB infection falls upon the economically vital part of the population - adults aged 15 - 50 years - and thus has an impact on development both through loss of labour and social disruption. TB control requires prevention of transmission of infection. This is primarily by early detection and effective treatment of human cases. However, prior to effective control of bovine TB in developed countries, up to 6 percent of pulmonary TB and up to 20 percent of extra-pulmonary disease was attributed to infections of bovine origin. The zoonotic role of bovine TB in developing countries has received little attention. If the rural opulation in particular is exposed to tubercule bacilli from their cattle, which are often an integral part of traditional agriculture, this may represent an avoidable source of human infection. Bovine TB also has a direct impact upon cattle, causing reduced productivity. In traditional areas, this may reduce the availability of milk cultivated and hence, the amount of food available for eating or sale. During the past year, Zambia has suffered from a drought. Livestock infected with TB are likely to be more susceptible to lack of water and grazing. In addition, the greater concentration of animals around available watering points increases the contract rate and thus the chance of transmission of tubercule bacilli between animals. This pilot study is measuring the prevalence of bovine TB in traditionally owned cattle. As well as intradermal tuberculin tests, are being collected for screening by ELISA. Nasal swabs from tuberculin positive animals are being cultured and all isolates of mycobacteria obtained will be genetically fingerprinted by RFLP analysis. The RFLP results can be compared with those of human isolates. Interviews are being conducted to collect information on TB in rural households, and on cattle disease husbandry. The data will be used to investigate whether households in contact with TT positive animals differ from those without such animals. Data on dipping source of water and grazing management will be used to investigate possible means of transmission between herds. At the end of the study, it will be possible to judge whether or not bovine TB is a threat to human health in this district. If a threat is posed, then the information gathered would assist in designing appropriate interventions. The experience gained in the use of the ELISA test and RFLP analysis will be of relevance to other investigators in this field.

Insecticide-treated nets prevent foetal loss in pregnancy

Wed, 25 Apr 2007 01:00:00 GMT

A DFID-funded systematic review shows that pregnant African women can reduce the risk of foetal loss and low birthweight if they use insecticide-treated nets

Are TB patients in China taking their drugs?

Fri, 23 Mar 2007 01:00:00 GMT

Effective tuberculosis control is a priority for the Government of China. In Chongqing Province the numbers of registered TB patients has increased due to better detection and service provision

Understanding TB-HIV Related Stigma in Zambia

Fri, 05 Jan 2007 01:00:00 GMT

Research co-funded by DFID and USAID reveals that Tuberculosis-HIV stigma has severe implications for the treatment of TB Patients

Strengthening the application of social sciences in malaria control policy, programme development and implementation

Wed, 22 Nov 2006 01:00:00 GMT

Malaria control relies on understanding the interplay of factors that influence the behaviours of both those who suffer from malaria and those who provide health care

Africa: the role of research

Thu, 28 Sep 2006 01:00:00 GMT

Research is tackling the problems faced by people in Africa in many areas including health, agriculture and climate change

Africa: the role of research

Thu, 28 Sep 2006 01:00:00 GMT

Research is tackling the problems faced by people in Africa in many areas including health, agriculture and climate change

New systems for prediction and detection of malaria epidemics in the East African highlands (HIMAL)

Wed, 27 Sep 2006 01:00:00 GMT

Improving malaria control through the early detection and prediction of epidemics saves lives, which is the focus of the Highland Malaria project (HIMAL)

Improving TB Control Programmes to Save Lives - Lessons from Pakistan

Mon, 10 Apr 2006 01:00:00 GMT

Research into the barriers to access and adherence to TB treatment

TB and HIV: Fighting a Dual Epidemic in Africa

Tue, 28 Mar 2006 01:00:00 GMT

The ProTest project, reducing the impact of TB and other HIV-related illnesses on the community...

A Rapid Test for Drug Resistant Tuberculosis

Fri, 10 Mar 2006 01:00:00 GMT

A novel, low cost technology to detect rifampicin resistance...