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1.  Longitudinal analysis of antigen specific response in individuals with Schistosoma mansoni infection in an endemic area of Minas Gerais, Brazil 
Background
Immunoepidemiologic studies have shown a relationship between IgE and IgG4 antibodies with age and with resistance and susceptibility to infection. It is believed that the IgE and IgG4 responses to soluble egg antigen (SEA) can be used for serological analysis of infection and post-treatment status. This study aimed to evaluate the association between Schistosoma mansoni infection and anti-SEA IgG4 and IgE reactivities, and determine whether these reactivities could be used as biomarkers of infection.
Methods
Between 2001 and 2009, a longitudinal study was performed in which parasitologic and blood specimens and socioeconomic and water-contact information were collected from 127 individuals. All patients positive for S. mansoni infection were treated.
Results
Schistosomiasis prevalence and the geometric mean of the egg count in 2001 were 59% and 61.05, respectively, decreasing to 26.8% and 8.78 in 2009. IgG4 anti-SEA reactivity in infected individuals was significantly higher than that in uninfected individuals at all time points. Analysis of receiver-operating characteristic (ROC) area showed that the IgG4 anti-SEA antibodies were able to predict infection by S. mansoni at each time point.
Conclusion
IgG4 anti-SEA reactivity can be used as a biomarker for immune monitoring of the presence of infection with S. mansoni in endemic areas.
doi:10.1093/trstmh/trt091
PMCID: PMC3888303  PMID: 24189480
Schistosomiasis; Longitudinal study; IgG4; IgE; Immunoepidemiology; Biomarkers
2.  Longitudinal analysis of antigen specific response in individuals with Schistosoma mansoni infection in an endemic area of Minas Gerais, Brazil 
Background
Immunoepidemiologic studies have shown a relationship between IgE and IgG4 antibodies with age and with resistance and susceptibility to infection. It is believed that the IgE and IgG4 responses to soluble egg antigen (SEA) can be used for serological analysis of infection and post-treatment status. This study aimed to evaluate the association between Schistosoma mansoni infection and anti-SEA IgG4 and IgE reactivities, and determine whether these reactivities could be used as biomarkers of infection.
Methods
Between 2001 and 2009, a longitudinal study was performed in which parasitologic and blood specimens and socioeconomic and water-contact information were collected from 127 individuals. All patients positive for S. mansoni infection were treated.
Results
Schistosomiasis prevalence and the geometric mean of the egg count in 2001 were 59% and 61.05, respectively, decreasing to 26.8% and 8.78 in 2009. IgG4 anti-SEA reactivity in infected individuals was significantly higher than that in uninfected individuals at all time points. Analysis of receiver-operating characteristic (ROC) area showed that the IgG4 anti-SEA antibodies were able to predict infection by S. mansoni at each time point.
Conclusion
IgG4 anti-SEA reactivity can be used as a biomarker for immune monitoring of the presence of infection with S. mansoni in endemic areas.
doi:10.1093/trstmh/trt091
PMCID: PMC3888303  PMID: 24189480
Schistosomiasis; Longitudinal study; IgG4; IgE; Immunoepidemiology; Biomarkers
3.  Knowledge and perceptions about the health impact of climate change among health sciences students in Ethiopia: a cross-sectional study 
BMC Public Health  2014;14:587.
Background
Climate change affects human health in various ways. Health planners and policy makers are increasingly addressing potential health impacts of climate change. Ethiopia is vulnerable to these impacts. Assessing students’ knowledge, understanding and perception about the health impact of climate change may promote educational endeavors to increase awareness of health impacts linked to climate change and to facilitate interventions.
Methods
A cross-sectional study using a questionnaire was carried out among the health science students at Haramaya University. Quantitative methods were used to analyze the results.
Result
Over three quarters of the students were aware of health consequences of climate change, with slightly higher rates in females than males and a range from 60.7% (pharmacy students) to 100% (environmental health and post-graduate public health students). Electronic mass media was reportedly the major source of information but almost all (87.7%) students stated that their knowledge was insufficient to fully understand the public health impacts of climate change. Students who knew about climate change were more likely to perceive it as a serious health threat than those who were unaware of these impacts [OR: 17.8, 95% CI: 8.8-32.1] and also considered their departments to be concerned about climate change (OR: 7.3, 95% CI: 2.8-18.8), a perception that was also significantly more common among students who obtained their information from the electronic mass media and schools (p < 0.05). Using electronic mass media was also significantly associated with knowledge about the health impacts of climate change.
Conclusion
Health sciences students at Haramaya University may benefit from a more comprehensive curriculum on climate change and its impacts on health.
doi:10.1186/1471-2458-14-587
PMCID: PMC4074871  PMID: 24916631
Climate change; Ethiopia; Climate related human health impacts; Knowledge and perception
4.  Solar disinfection: an approach for low-cost household water treatment technology in Southwestern Ethiopia 
Disinfection of contaminated water using solar radiation (SODIS) is known to inactivate bacteria. Its inactivation efficiency depends on local conditions where the disinfection is made. This study was aiming to test the efficiency of solar disinfection using different water parameters as low-cost household water treatment technology. Inactivation of microbes was tested using fecal coliform as test organism. The SODIS experiment was carried out at turbidity 2NTU, pH 7, and various water temperature (38.1°C, 41.8°C, 45.6°Cand 51.1°C) and solar intensities, using clear and black plastic bottles filled to different depths. The results show that the rate of microbial inactivation in relation to depth of water, turbidity, container type, intensity of light and color of container was statistically significant (p < 0.05). However, bottle placement, exposure and water pH were unrelated to microbial inactivation. Bacterial re-growth was not observed after solar disinfection. By adjusting the parameters, complete and irreversible fecal coliform inactivation was achieved within an exposure time of less than four hours in the areas where the solar irradiance is about 3.99 kW/m2 and above. Our results indicate that application of SODIS could play a significant role in the provision of safe water in rural communities of developing countries where there is ample sunshine, specifically in sub-Saharan African countries.
doi:10.1186/2052-336X-12-25
PMCID: PMC3895732  PMID: 24410979
Safe water supply; Water disinfection; Household water treatment; Solar radiation
5.  A Research Agenda for Helminth Diseases of Humans: Social Ecology, Environmental Determinants, and Health Systems 
In this paper, the Disease Reference Group on Helminth Infections (DRG4), established in 2009 by the Special Programme for Research and Training in Tropical Diseases (TDR), with the mandate to review helminthiases research and identify research priorities and gaps, focuses on the environmental, social, behavioural, and political determinants of human helminth infections and outlines a research and development agenda for the socioeconomic and health systems research required for the development of sustainable control programmes. Using Stockols' social-ecological approach, we describe the role of various social (poverty, policy, stigma, culture, and migration) and environmental determinants (the home environment, water resources development, and climate change) in the perpetuation of helminthic diseases, as well as their impact as contextual factors on health promotion interventions through both the regular and community-based health systems. We examine these interactions in regard to community participation, intersectoral collaboration, gender, and possibilities for upscaling helminthic disease control and elimination programmes within the context of integrated and interdisciplinary approaches. The research agenda summarises major gaps that need to be addressed.
doi:10.1371/journal.pntd.0001603
PMCID: PMC3335881  PMID: 22545168
6.  High load of multi-drug resistant nosocomial neonatal pathogens carried by cockroaches in a neonatal intensive care unit at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia 
Background
Cockroaches have been described as potential vectors for various pathogens for decades; although studies from neonatal intensive care units are scarce. This study assessed the vector potential of cockroaches (identified as Blatella germanica) in a neonatal intensive care unit setup in Tikur Anbessa Hospital, Addis Ababa, Ethiopia.
Methods
A total of 400 Blatella germanica roaches were aseptically collected for five consecutive months. Standard laboratory procedures were used to process the samples.
Results
From the external and gut homogenates, Klebsiella oxytoca, Klebsiella pneumoniae, Citrobacter spp. Enterobacter cloacae, Citrobacter diversus, Pseudomonas aeruginosa, Providencia rettgeri, Klebsiella ozaenae, Enterobacter aeruginosa, Salmonella C1, Non Group A streptococcus, Staphylococcus aureus, Escherichia coli, Acinetobacter spp. and Shigella flexneri were isolated. Multi-drug resistance was seen in all organisms. Resistance to up to all the 12 antimicrobials tested was observed in different pathogens.
Conclusion
Cockroaches could play a vector role for nosocomial infections in a neonatal intensive care unit and environmental control measures of these vectors is required to reduce the risk of infection. A high level of drug resistance pattern of the isolated pathogens was demonstrated.
doi:10.1186/2047-2994-1-12
PMCID: PMC3436638  PMID: 22958880
Blatella germanica; Multi-drug resistant pathogens; Neonatal intensive care unit; Ethiopia
7.  Outcomes of antiretroviral treatment program in Ethiopia: Retention of patients in care is a major challenge and varies across health facilities 
Background
Many resource-limited countries are scaling up antiretroviral treatment (ART) towards universal access. However, there are few studies which evaluated outcomes of ART programs in these countries. In addition, these studies generally include a limited number of facilities and patients creating a clear need for studies with a wide range of facilities and large numbers of patients. In this study, we intended to evaluate the outcomes of the ART services in 55 health facilities in Ethiopia.
Methods
A retrospective longitudinal study was conducted to determine levels of patient retention in care, CD4 count and shift to second-line ART regimen in 30 hospitals and 25 health centers selected as sentinel sites for monitoring the outcomes of ART program in the country. The outcomes were determined at baseline, after 6, 12 and 24 months on ART. Data was collected from routine patient registers and charts, and entered and analyzed using EPI-Info statistical software.
Results
Health facilities were able to retain 29,893 (80%), 20,079 (74%) and 5,069 (68%) of their patients after 6, 12 and 24 months on ART, respectively. Retention rates vary across health facilities, ranging from 51% to 85% after 24 months on ART. Mortality was 5%, 6% and 8% after 6, 12 and 24 months on ART. More than 79% of patients with available CD4-cell counts had a baseline CD4-cell counts less than 200 cells per micro-liter of blood. The median CD4-cell counts (based on patients who were retained after 24 months on ART) increased from 125 (inter-quartile (IQ), 68-189) at baseline to 242 (IQ, 161-343), 269 (IQ, 185-380) and 316 (IQ, 226-445) cells per micro-liter after 6, 12, and 24 months on ART, respectively. The transition to second-line ART remained very low, 0.33%, 0.58% and 2.13% after 6, 12 and 24 months on ART.
Conclusion
The outcomes of the ART services in the 55 health facilities in Ethiopia are similar to those in other countries. Retention of patients in care is a major challenge and varies across health facilities with high, medium and low retention rates. We therefore recommend further studies to understand the organization of care in health facilities with high, medium and low retention rates. It is also imperative that early initiation of patients on ART is taken seriously as more than 79% of the patients had baseline CD4-cell counts less than 200 cells per micro-liter of blood. Finally, we recommend that the shift to second-line ART might be too low and warrants close monitoring.
doi:10.1186/1472-6963-11-81
PMCID: PMC3094207  PMID: 21501509
8.  Schistosoma mansoni infection in a rural area of the Jequitinhonha Valley, Minas Gerais, Brazil: analysis of exposure risk 
Acta tropica  2009;113(1):34-41.
This study examines the relative contribution of age-specific total IgE levels, eosinophils and water contact behavior to the prevalence and intensity (geometric mean egg counts) of Schistosoma mansoni infection in the poor rural population of Virgem das Graças in northern Minas Gerais State. In bivariate analysis, age was strongly correlated with both prevalence and intensity of infection, while eosinophil levels with prevalence only (p<0.0001); IgE levels and 5 demographic and socioeconomic variables were moderately correlated with prevalence (p<0.05), as were number of persons per room and TBM (total body minutes) with egg counts. In multivariate analysis, after controlling for demographic and socioeconomic factors, only total IgE levels were significantly correlated with both prevalence (p=0.248, 95% CI= 1.01–1.11) and intensity (p=0.0217, 95% CI=0.01–0.14) of infection and eosinophil levels with prevalence (p=0.0005, 95% CI=1.07–1.24). Although any causal relationship cannot be confirmed by a cross-sectional study, we demonstrated an associated decrease in prevalence and intensity of S. mansoni infection with increased IgE levels.
doi:10.1016/j.actatropica.2009.09.001
PMCID: PMC2784266  PMID: 19765542
Schistosoma mansoni; IgE; eosinophils; water contact; age distribution; Brazil
9.  Socioeconomic Studies of Schistosomiasis in Brazil: a Review 
Acta tropica  2008;108(2-3):194-201.
This review finds considerable evidence that socioeconomic status has significantly influenced the transmission, spread and treatment of schistosomiasis in Brazil. High infection rates persist among both the rural and urban poor. Rural living, poor housing and water supplies and low educational level were major factors in schistosomiasis occurrence among agricultural populations. In urban areas, prevailing living conditions in shantytowns and labor migrations from and periodic return movements to rural areas were predictive of schistosomiasis. The risk of the establishment of new transmission foci exists in both rural and urban areas, conferred by and affecting poorer people. Associations between schistosomiasis and socioeconomic parameters, persisting inequities in health services accessibility, prevailing health impacts of schistosomiasis, and the ongoing decentralization of health services point to opportunities and strategies for focused interventions aimed at promoting health-enhancing behavior and living conditions and improving access to health care. The authors call for multidisciplinary studies to better examine the complexities of the socioeconomic environment in relation to schistosomiasis and for economic programs to reduce prevailing socioeconomic inequalities.
doi:10.1016/j.actatropica.2008.07.002
PMCID: PMC2650274  PMID: 18694715
schistosomiasis; socioeconomic conditions and impacts; health services; Brazil
10.  Popular Beliefs about the Infectivity of Water among School Children in Two Hyperendemic Schistosomiasis Areas of Brazil 
Acta tropica  2008;108(2-3):202-208.
This article examines changing common knowledge of elementary school children to scientific knowledge related to the relationship between water characteristics and the transmission of schistosomiasis through health education. A review of the literature and two case studies from rural elementary schools in Brazil show how the prevailing concept of dirty and polluted water, which has operated as an epistemological obstacle for acquiring scientific knowledge, may be related to symbolic thought and cultural parameters. Through an educational intervention not commonly applied to health programs involving elementary school students in two schistosomiasis-endemic rural communities in Brazil this paper describes the difficulties researchers encountered in changing the prevailing perception that very dirty and polluted water provides optimal conditions for schistosome transmission, to the scientifically accepted view that transmission occurs most often in visually clean, although fecally contaminated water. This conceptual difficulty may be largely explained in terms of the symbolism involved in clean and dirty water and the life-giving quality of water. Based on our results, we recommend that knowledge about water-related beliefs and concepts among school children should be considered in school-based health education programs in areas of endemic schistosomiasis and possibly other intestinal infections.
doi:10.1016/j.actatropica.2008.05.009
PMCID: PMC2629796  PMID: 18599008
Health education; common knowledge; symbolism; scientific knowledge; schistosomiasis; Brazil
11.  Malaria and water resource development: the case of Gilgel-Gibe hydroelectric dam in Ethiopia 
Malaria Journal  2009;8:21.
Background
Ethiopia plans to increase its electricity power supply by five-fold over the next five years to fulfill the needs of its people and support the economic growth based on large hydropower dams. Building large dams for hydropower generation may increase the transmission of malaria since they transform ecosystems and create new vector breeding habitats. The aim of this study was to assess the effects of Gilgel-Gibe hydroelectric dam in Ethiopia on malaria transmission and changing levels of prevalence in children.
Methods
A cross-sectional, community-based study was carried out between October and December 2005 in Jimma Zone, south-western Ethiopia, among children under 10 years of age living in three 'at-risk' villages (within 3 km from dam) and three 'control' villages (5 to 8 km from dam). The man-made Gilgel-Gibe dam is operating since 2004. Households with children less than 10 years of age were selected and children from the selected households were sampled from all the six villages. This included 1,081 children from 'at-risk' villages and 774 children from 'control' villages. Blood samples collected from children using finger prick were examined microscopically to determine malaria prevalence, density of parasitaemia and identify malarial parasite species.
Results
Overall 1,855 children (905 girls and 950 boys) were surveyed. A total of 194 (10.5%) children were positive for malaria, of which, 117 (60.3%) for Plasmodium vivax, 76 (39.2%) for Plasmodium falciparum and one (0.5%) for both P. vivax and P. falciparum. A multivariate design-based analysis indicated that, while controlling for age, sex and time of data collection, children who resided in 'at-risk' villages close to the dam were more likely to have P. vivax infection than children who resided farther away (odds ratio (OR) = 1.63, 95% CI = 1.15, 2.32) and showed a higher OR to have P. falciparum infection than children who resided in 'control' villages, but this was not significant (OR = 2.40, 95% CI = 0.84, 6.88). A classification tree revealed insights in the importance of the dam as a risk factor for malaria. Assuming that the relationship between the dam and malaria is causal, 43% of the malaria occurring in children was due to living in close proximity to the dam.
Conclusion
This study indicates that children living in close proximity to a man-made reservoir in Ethiopia are at higher risk of malaria compared to those living farther away. It is recommended that sound prevention and control programme be designed and implemented around the reservoir to reduce the prevalence of malaria. In this respect, in localities near large dams, health impact assessment through periodic survey of potential vectors and periodic medical screening is warranted. Moreover, strategies to mitigate predicted negative health outcomes should be integral parts in the preparation, construction and operational phases of future water resource development and management projects.
doi:10.1186/1475-2875-8-21
PMCID: PMC2649153  PMID: 19178727
12.  Socioeconomic Determinants of Schistosomiasis in a Poor Rural Area in Brazil. Running short title: Socioeconomic Determinants of Schistosomiasis in Brazil 
Acta tropica  2006;99(2-3):260-271.
The objective of this paper is to identify and quantify socioeconomic determinants of S. mansoni infection in the rural area of Virgem das Graças in Minas Gerais State of Brazil. A cross-sectional study was carried out to examine the prevalence and intensity of schistosomiasis in relation to socioeconomic characteristics of the households. Log-binomial regression analysis was used to examine the data on both the household and individual levels, analyzing the prevalence ratios for the association of schistosomiasis and socioeconomic variables related to the head of the household. Multiple comparisons through mixed effect modeling were used to examine the relationship between intensity of infection (geometric mean egg counts) and different levels of socioeconomic variables, respectively. In the univariate analysis, place of residence, number of persons per room, and lack of motorized transport were associated with schistosomiasis at the household level and age and unsafe water contact at the individual level. Age, unsafe water contact, number of persons per room, household possessions and lack of education of head of household remained significant predictors of schistosomiasis in the multivariable analysis. Only age was significantly associated with intensity of infection of individuals. It is concluded that widespread poverty, the rural environment, and weak socioeconomic differentiation that result in intense contact with infective water appear to minimize the protective effect of piped water supply and other socioeconomic parameters on schistosomiasis found in other studies. The potential role of socioeconomic development in conjunction with schistosomiasis control is described and areas for further studies are identified.
doi:10.1016/j.actatropica.2006.09.001
PMCID: PMC1828742  PMID: 17045559
Schistosoma mansoni; socioeconomic factors; rural environment; Brazil
13.  Utilization of antiretroviral treatment in Ethiopia between February and December 2006: spatial, temporal, and demographic patterns 
Background
In 2003, the Ethiopian Ministry of Health (MOH) started to implement a national antiretroviral treatment (ART) program. Using data in the monthly HIV/AIDS Updates issued by the MOH, this paper examines the spatial and temporal distribution of ART on a population basis for Ethiopian towns and administrative zones and regions for the period February to December 2006.
Results
The 101 public ART hospitals treated 44,446 patients and the 91 ART health centers treated 1,599 patients in December 2006. The number of patients currently receiving ART doubled between February and December 2006 and the number of female patients aged 15 years and older surpassed male patients, apparently due to increased awareness and provision of free ART. Of 58,405 patients who ever started ART in December 2006, 46,045 (78.8%) were adhering to treatment during that month. Population coverage of ART was highest in the three urban administrative regions of Addis Ababa, Harari and Dire Dawa, in regional centers with referral hospitals, and in several small road side towns that had former mission or other NGO-operated hospitals. Hospitals in Addis Ababa had the largest patient loads (on average 850 patients) and those in SNNPR (Southern Nations and Nationalities Peoples Republic) (212 patients) and Somali (130 patients) regions the fewest patients. In bivariate tests, number of patients receiving treatment was significantly correlated with population size of towns, urban population per zone, number of hospitals per zone, and duration of ART services in 2006 (all p < 0.001). The stronger relationship with urban than total zonal populations (p < 0.001 versus p = 0.014) and the positive correlation between distance from 44 health centers to the nearest ART hospital and patients receiving treatment at these health centers may be due to a combination of differential accessibility of ART sites, patient knowledge and health-seeking behavior.
Conclusion
The sharp increase in ART uptake in 2006 is largely due to the rapid increase in the provision of free treatment at more sites. The marked variation in ART utilization patterns between urban and rural communities and among zones and regions requires further studies. Recommendations are made for further expansion and sustainability of the ART scale-up.
doi:10.1186/1476-072X-6-45
PMCID: PMC2045665  PMID: 17894877

Results 1-13 (13)