Evaluation Of Control Programs Research Articles

Assessment of the capacity of Whatman filter papers as support to store stools for the molecular diagnostic testing of soil-transmitted helminthiasis

Storage of stools for the detection of soil-transmitted helminths (STH) remains challenging for the molecular diagnostic testing of STH infections. This study aimed to overcome this challenge by assessing the capacity of Whatman filter papers to store stools for the molecular detection of STHs. Stool samples were collected from school-aged children of soil-transmitted helminthiasis endemic areas of Cameroon and then, analysed using Kato Katz technique. For this study, 128 and 40 stool samples respectively with and without STH eggs were analysed. From each sample, 10, 20, 40 and 80 mg of stool were weighted and spread on 6 grades of Whatman filter papers that were stored at room temperature from one to ten weeks. DNA was extracted from spread stool using CTAB based-method. The amount of stool to spread on filter papers and the grade of filter paper offering good storage were determined by amplifying specific DNA fragments of Ascaris lumbricoides. The capacity of filter papers to store stool samples for several weeks before the molecular detection of STH species was assessed by amplifying specific DNA fragments of different STHs. The amplification rates of A. lumbricoides were significantly higher (P < 0.0001) for 10 and 20 mg of stored stools. Stools spread on Whatman paper grade 2 yielded the highest amplification rate of 100% for A. lumbricoides, T. trichiura and hookworm. PCR revealed STH infections in all the 128 spread stools carrying STH eggs. It also revealed Necator americanus and Ancylostoma duodenale respectively in 10 and 13 of 15 spread stools contained hookworm eggs. PCR confirmed the co-infections of these hookworm species as well as that of A. lumbricoides and Trichuris trichiura in 7 spread stools. Out of 40 stools without STH eggs, PCR revealed that 5 (12.5%) and 9 (22.5%) had respectively A. lumbricoides and T. trichiura infections. The amplification rate of each STH species was 100% from one to 8 weeks and decreased to 86.7% after 10 weeks of storage. This study highlighted the capacity of filter papers to store stools for the molecular detection of STHs. Storing stools on these papers will enable to monitor and evaluate control programs and ensure post-elimination surveillance.

Four years trends of malaria admissions in rural and urban Kandi health facilities in northeast of Benin Republic

Malaria clinical data from health facility records are used for evaluating control programmes’ impact and providing insights of epidemiological situation. In the present study we assessed trend of malaria admissions between 2009 and 2012 in rural and urban health facilities of the district of Kandi, a very arid area with particularly severe drought lasting up to 6 months.Curative care records in the Gansosso urban health facility and Sonsoro rural health facility were consulted and all uncomplicated and severe cases of malaria in local population between 2009 and 2012 were reported. For each malaria case, information on age, gender, origin of the patient were collected on electronic forms using tablets installed with Open Data Kit (ODK) Collect. Characteristics of patients positive to malaria, change in age groups and monthly variation were compared between the urban and rural health facilities.Of the 21,008 febrile patients consulted, a total of 7,990 cases (38%; 95% CI 37-39) were detected positive to malaria by the means of RDTs or microscopy. The number of confirmed malaria cases in rural and urban Kandi were respectively 2,911 (36%, 95% CI 35-37) and 5,079 (39%, 95% CI 38-40) (p

Secondary Indicators for an Evaluation and Guidance System for Quality of Care in Inflammatory Bowel Disease Centers: A Critical Review of the Inflammatory Bowel Disease Quality of Care Center.

The number of patients with inflammatory bowel disease (IBD) has increased remarkably in recent years. However, the level of health care for IBD patients varies greatly among regions of China. Standardization of health care for IBD patients is essential to improve quality of care (QoC). The mission of the IBD Quality Care Evaluation Center (IBDQCC) is to establish indicators for QoC. Since 2017, the IBDQCC has developed structure, process, and outcome indicators with the steering committee of IBD specialists and methodologists; 28 core and 13 secondary IBD QoC indicators were selected using a Delphi method. Applications for certification of IBD quality care units were made voluntarily and preliminarily screened through the IBDQCC committee. Regional units had to meet all core indicators, and units of excellence were required to meet all core indicators together with an additional 50% of secondary indicators. As of 2019 and 2020, 69 IBD units (all from tertiary referral hospitals) have been certified as regional IBD units in China. The certification of excellence of the IBD units is currently undergoing auditing. The awareness of and appreciation for QoC in IBD is increasing in China, especially through the quality control evaluation program initiated by the IBDQCC, with a higher number of IBD units applying for the next round of certification. Although secondary indicators seem to play relatively minor roles in QoC, they suggest additional requirements for high-level centers.

Studies of host preferences of wild-caught Phlebotomus orientalis and Ph. papatasi vectors of leishmaniasis in Sudan.

IntroductionUnderstanding the feeding behavior and host choice of sand flies provides valuable information on vector-host relationships and elucidates the epidemiological patterns of leishmaniasis transmission. Blood meal analysis studies are essential for estimating the efficiency of pathogen transmission, assessing the relative human disease risk, and assist in identifying the other potential hosts of leishmaniasis. In Sudan and most of East Africa, there are large remaining gaps in knowledge regarding the feeding habits of phlebotomine vectors. The study aimed to identify the blood meal sources and, therefore, the host preferences of the principal vectors Phlebotomus orientalis and Ph. papatasi in leishmaniasis endemic areas of eastern and central Sudan.Materials and methodsSand flies were collected from two endemic villages in eastern and central Sudan using CDC light traps and sticky traps. The phlebotomine sand flies were morphologically and then molecularly identified. The source of blood meal of the engorged females was determined using a multiplex PCR methodology and specific primers of cytochrome b gene of mitochondrial DNA for human, goat, cow, and dog. The detection of the Leishmania parasite was done using PCR.ResultsThe total number of collected female phlebotomine sand flies was 180. Morphological identification revealed the abundance of Ph. orientalis 103 (57.2%), Ph. papatasi 42 (23.3%), Ph. bergeroti 31 (17.2%), Ph. rodhaini 2 (1.1%) and Ph. duboscqi 2 (1.1%) in the study sites. Out of the 180 collected, 31 (17%) were blood-fed flies. Three species were blood-fed and molecularly identified: Ph. papatasi (N = 7, 22.6%), Ph. bergeroti (N = 9, 26%), and Ph. orientalis (N = 15, 48.4%). Blood meal analysis revealed human DNA in two Ph. orientalis (6.4%), hence, the anthropophilic index was 13.3%.ConclusionsMultiplex PCR protocol described here allowed the identification of blood meal sources of many vertebrate species simultaneously. The results indicate that wild-caught Ph. orientalis are anthropophilic in the study areas. Further studies on larger blood-fed sample size are required to validate the potential applications of this technique in designing, monitoring and evaluating control programs, particularly in investigating the potential non-human hosts of leishmaniasis.

Evaluation and planning of Chagas control activities using geospatial tools.

Chagas continues to be a relevant public health problem in Latin America. In this work, we present a spatiotemporal analysis applied for the evaluation and planning of Chagas vector control strategies. We analysed the spatial distribution of the vector Triatoma infestans infestation related to ongoing control interventions cycles in rural communities near Añatuya, Santiago del Estero, Argentina. A geographical information system was developed for the spatial analysis obtaining, for each house, variables that describe the history of spraying and infestation at each time of interventions. Bi-dimensional histograms were used to describe the spatiotemporal pattern of these activities and peri-domestic infestation at the last intervention was modelled by a neural network model. We qualitatively evaluate control programmes considering the history of infestation and spraying from a spatiotemporal point of view, incorporating new ways of visualising this information. Predictions are based on novel, non-linear models and spatiotemporal indices, which should be useful for strategically allocating Chagas control resources in the future and thus help to better plan spraying strategies.

Characterization of Foreign-Born vs. Native-Born Worker Fatalities in Kentucky, 2001-2014.

Information on foreign-born worker (FBW) and native-born worker (NBW) fatal injuries is scarce. The Kentucky Fatality Assessment and Control Evaluation program analyzed 2001-2014 worker fatality data. The Kentucky FBW fatality rate was double the US FBW and NBW rates, and 50% higher than the Kentucky NBW fatality rate. FBW average age at death was 38years; NBW age was 47years. FBW deaths occurred in construction (26%) and services (22%) industries, and transportation [28% (54% due to semi truck crashes)] and construction [26%(48% due to roofing, scaffolding, and ladder-related falls)] occupations; in contrast, NBW deaths occurred in services (22%), and transportation (18%) industries, and transportation (25%) and management (20%) occupations, and were due to exposures to inanimate mechanical forces (38%), and transport accidents (30%). Enhanced FBW cultural competent interventions and policies are needed to prevent FBW occupational injuries, and improve FBW workplace safety and health.

Age structure of owned dogs under compulsory culling in a visceral leishmaniasis endemic area.

The age structure of the dog population is essential for planning and evaluating control programs for zoonotic diseases. We analyzed data of an owned-dog census in order to characterize, for the first time, the structure of a dog population under compulsory culling in a visceral leishmaniasis endemic area (Panorama, São Paulo State, Brazil) that recorded a dog-culling rate of 28% in the year of the study. Data on 1,329 households and 1,671 owned dogs revealed an owned dog:human ratio of 1:7. The mean age of dogs was estimated at 1.73 years; the age pyramid indicated high birth and mortality rates at the first year of age with an estimated cumulative mortality of 78% at the third year of age and expected life span of 2.75 years. In spite of the high mortality, a growth projection simulation suggested that the population has potential to grow in a logarithmic scale over the years. The estimated parameters can be further applied in models to maximize the impact and minimize financial inputs of visceral leishmaniasis control measures.

Schistosomiasis in Cameroon: an assessment of community knowledge pattern.

Schistosomiasis is one of the most widespread of all human parasitic diseases and is a serious health problem in Cameroon despite tremendous efforts by health authorities. The purpose of this study was to determine community knowledge of the infection in order to evaluate control programmes put in place. A random sampling method was used to administer questionnaires to 3200 individuals in 80 communities throughout the ten regions of the country. Globally the percentage of persons with good knowledge of schistosomiasis was low (28.8%). Of the 2586 who responded 1311 (50.7%) were females and 1275 (49.3%) were males. There was a statistically significant difference in the community knowledge pattern by gender (chi2 = 157.28, P < 0.05), and persons with good knowledge were more frequent among males than females (61.8% vs. 38.2% P < 0.05). The percentage of people who had good knowledge about the disease was highest in the Far North region (35.4), followed by the North (33.8) and the Southwest (31.1) regions. There was a statistically significant difference in community knowledge pattern of Schistosomiasis by region and gender (chi2 = 1265.648 P < 0.001). Also, there was a statistically significant difference in community knowledge pattern of by setting (chi2 = 38.538 P = 0.001) and the percentage of people who had a good knowledge of the disease was higher in rural areas than in urban areas (72.5% vs. 3.1% P < 0.05). was a low community knowledge pattern of schistosomiasis, mostly among the female population and among people living in urban areas. We advocated that health education should be adopted as one of the control strategies by the

Prevalence of Psychiatric Disorders in a Sample of Elderly Residents in Rural and Urban Population of Zulfi Region - Saudi Arabia

The population of the world is aging rapidly, because of increasing life expectancy and falling birth rates This age is also more prone to have chronic diseases and hence there is a need to ensure that the health and social support to these individuals is available. Mental illness represents an important public health problem. Local-level data concerning mental illness in different populations provides the evidence-base for public health authorities to plan, implement and evaluate control programs. Aims: to estimate the prevalence of psychiatric disorders among the elderly in this region and to analyze for differences between urban and rural areas and also identify and suggest some risk factors for these disorders. Methodology: The study was done in Zulfi region of Saudi Arabia. The sample size of rural & urban study was 550&392 persons from 65 years and more, respectively. Instruments and procedures: All the participants of the study were given a general health questionnaire, a symptom check list, a questionnaire to assess the social and economic level and a Structured clinical interview for DSM –IV (SCID) Results: The psychiatric symptoms among elderly in this study according to SCL 90 were not seen in 15.56% in urban people and 40.4% in rural area. The most prevalent psychiatric disorder in urban area is dysthymia 19.37% while the most prevalent psychiatric disorder in rural area is adjustment disorder with depressed mood at 14%.

Mental illness in metropolitan, urban and rural Georgia populations

BackgroundMental illness represents an important public health problem. Local-level data concerning mental illness in different populations (e.g., socio-demographics and residence – metropolitan/urban/rural) provides the evidence-base for public health authorities to plan, implement and evaluate control programs. This paper describes prevalence and covariates of psychiatric conditions in Georgia populations in three defined geographic areas.MethodsData came from the Georgia population-based random-digit-dialing study investigating unwellness and chronic fatigue syndrome (CFS) in Georgia populations of three defined geographic areas (metropolitan, urban, and rural). Respondents were screened for symptoms of fatigue, sleep, cognition, and pain at household screening interviews, and a randomly selected sample completed detailed individual phone interviews. Based on the detailed phone interviews, we conducted one-day clinical evaluations of 292 detailed interview participants classified as unwell with a probable CFS (i.e. CFS-like; a functional somatic syndrome), 268 classified as other unwell, and 223 well (matched to CFS-like). Clinical evaluation included psychiatric classification by means of the Structured Clinical Interview for DSM (SCID). To derive prevalence estimates we used sample weighting to account for the complexity of the multistage sampling design. We used 2- and 3-way table analyses to examine socio-demographic and urbanicity specific associations and multiple logistic regression to calculate adjusted odds ratios.ResultsAnxiety and mood disorders were the most common psychiatric conditions. Nineteen percent of participants suffered a current anxiety disorder, 18% a mood disorder and 10% had two or more conditions. There was a significant linear trend in occurrence of anxiety or mood disorders from well to CFS-like. The most common anxiety disorders were post-traumatic stress disorder (PTSD) (6.6%) and generalized anxiety disorder (GAD) (5.8%). Logistic regression showed that lower education and female sex contributed significantly to risk for both PTSD and GAD. In addition, rural/urban residence and Hispanic ethnicity were associated with PTSD. We defined moderate to severe depression as Major Depressive Disorder or a Zung score >60 and logistic regression found lower education to be significantly associated but sex, age and urbanicity were not.ConclusionsOverall occurrence of anxiety and mood disorders in Georgia mirrored national findings. However, PTSD and GAD occurred at twice the published national rates (3.6 and 2.7%, respectively). State and local prevalence and associations with education, sex and urbanicity comprise important considerations for developing control programs. The increased prevalence of anxiety and mood disorders in people with a functional somatic syndrome (or CFS-like illness) is important for primary care providers, who should consider additional psychiatric screening or referral of individuals presenting with somatoform symptoms.

Elevated occupational transportation fatalities among older workers in Oregon: An empirical investigation

Older workers have an elevated risk of being killed on the job, and transportation incidents involving vehicles or mobile machinery are especially deadly for this group. The present study was designed to address the research gap in understanding contributing factors to these incidents and recommend evidence-based guidelines for interventions. We gathered and analyzed data from several sources, including the Oregon Fatality Assessment and Control Evaluation program, the Oregon Workers’ Compensation system, the Census of Fatal Occupational Injuries, the Bureau of Labor Statistics, and peer reviewed research literatures. Rates and rate ratios (RR) were used to evaluate excess risk among groups. The results of this study show that older workers in Oregon have an elevated risk of fatality both in all events (RR=3.0, 95% CI 2.2–4.0) and transportation events (RR=3.6, 95% CI 2.4–5.4). Additional analyses and extant literature supports our hypotheses that multiple risk factors contribute to the phenomenon, including (a) hazard exposure, (b) organization of work, (c) physical fragility, and (d) normative cognitive, sensory, and psychomotor changes that occur with age. The evidence-based framework proposed may provide valuable guidance for developing safety interventions that protect older workers.

Manure pit injuries: Rare, deadly, and preventable

A male worker entered an underground manure pit and lost consciousness. His coworker tried to rescue him and also lost consciousness in the pit. Emergency service arrived in minutes and removed both of them from the pit. Both men suffered anoxic brain injury and died in the hospital. Cases from Iowa Fatality Assessment and Control Evaluation Program Data Base program were reviewed. Occupational mortality rate was found to be 7.4 per 10,000 per year for occupational deaths related to agriculture compared to 3.1 per 10,000 per year for deaths not related to agriculture. In most of the cases associated with sewage or livestock waste handling, victims died of asphyxiation. While manure pit injury is rare, it has an extremely high fatality rate. The most effective strategy to decrease mortality is active prevention.

Modelling age-heterogeneous Schistosoma haematobium and S. mansoni survey data via alignment factors

BackgroundReliable maps of the geographical distribution, number of infected individuals and burden estimates of schistosomiasis are essential tools to plan, monitor and evaluate control programmes. Large-scale disease mapping and prediction efforts rely on compiled historical survey data obtained from the peer-reviewed literature and unpublished reports. Schistosomiasis surveys usually focus on school-aged children, whereas some surveys include entire communities. However, data are often reported for non-standard age groups or entire study populations. Existing geostatistical models ignore either the age-dependence of the disease risk or omit surveys considered too heterogeneous.MethodsWe developed Bayesian geostatistical models and analysed existing schistosomiasis prevalence data by estimating alignment factors to relate surveys on individuals aged ≤ 20 years with surveys on individuals aged > 20 years and entire communities. Schistosomiasis prevalence data for 11 countries in the eastern African region were extracted from an open-access global database pertaining to neglected tropical diseases. We assumed that alignment factors were constant for the whole region or a specific country.ResultsRegional alignment factors indicated that the risk of a Schistosoma haematobium infection in individuals aged > 20 years and in entire communities is smaller than in individuals ≤ 20 years, 0.83 and 0.91, respectively. Country-specific alignment factors varied from 0.79 (Ethiopia) to 1.06 (Zambia) for community-based surveys. For S. mansoni, the regional alignment factor for entire communities was 0.96 with country-specific factors ranging from 0.84 (Burundi) to 1.13 (Uganda).ConclusionsThe proposed approach could be used to align inherent age-heterogeneity between school-based and community-based schistosomiasis surveys to render compiled data for risk mapping and prediction more accurate.

Public preferences for controlling upland invasive plants in state parks: Application of a choice model

Invasive plants can have ecological impacts and cause economic harm particularly when recreational opportunities are lost. While the value of nature-related tourism has been assessed, little is known about the effect of invasive plants on recreational choices. This study uses non-market valuation techniques for the first time to quantify the net benefit of managing invasive plants in upland areas. We surveyed 1436 Florida residents to determine their preferences for state parks using discrete choice experiment questions with various levels of invasive plants and other attributes that impact visitation. Results imply that residents would be willing to pay $5.41 per-visit to reduce the coverage of invasive plants, $3.72 to improve facilities, $3.73 to increase the diversity of native plant species, and $6.71 to increase the diversity of native animal species. Using score variables to capture interaction effects, demographic variables were found to influence the marginal willingness-to-pay for invasive species control by −$1.13 to +$0.97 per visit. Those who have taken action against or are more knowledgeable about invasive species were also found to influence a respondent's willingness to pay (+$2.47 and +$0.83, respectively). Respondents who consider invasive species to be beneficial (e.g., since many species were imported for their esthetics) would be willing to pay an additional $0.80 per visit to a park with increased coverage. Using annual attendance data from 115 Florida state parks, we calculated statewide willingness-to-pay to manage invasive plants in upland parks. Park users would be willing to spend $89.4 million annually to reduce the level of invasive plants in the parks, which provides a baseline for evaluating control programs. Since current levels of funding ($32 million annually) are insufficient to control invasive plants, additional management may be warranted.

Descriptive epidemiology of chronic hepatitis B by using data from a hepatitis registry in Central Greece

Background In Greece, there are few data on the epidemiological characteristics of HBV. Our aim was to study the epidemiological patterns of HBV in Central Greece and identify the possible differences in HBV prevalence (clusters) among areas inside this region using data from the hepatitis registry. Methods The study was performed in Thessaly, one out of the thirteen regions of Greece and covers most of the part of Central Greece. A total of 921 HBV patients were registered in the hepatitis registry during the period 1999–2004 while 303 were randomly selected to be studied further using a detailed questionnaire on several epidemiological factors. Results 187/303 patients (61.7%) classified as chronic inactive HBV carriers, 78/303 (25.7%) had chronic hepatitis B, 29/303 (9.6%) had HBV-related cirrhosis and 9/303 (3%) HBV-related hepatocellular carcinoma (HCC). The route of HBV transmission was vertical in 103 (34%), sexual in 46 (15.1%) and intrafamilial in 98 (32.4%). Folk remedies were identified as the predisposing risk factor for contracting HBV infection in 38 (12.5%), previous transfusion in 9 (3%) and unknown mode of transmission in 9 patients (3%). Alcohol abuse was the only independent factor (OR: 2.5; p = 0.01) associated with the progression to cirrhosis–HCC. There were specific areas (clusters) inside Thessaly region with increased ratio of HBV infection; Vertical and sexual modes of transmission were more prominent in some of these areas. Conclusions Vertical, intrafamilial and sexual modes of HBV transmission identified as the major routes of HBV infection in our study. We also identified cluster areas of HBV infection in Central Greece. Alcohol abuse is frequent among HBV patients and is acting as an effect modificator risk factor for the development of HBV-related cirrhosis and HCC. Extended population studies in Greece are needed to assess in detail the epidemiological patterns of HBV and evaluate control programmes.

Ovine echinococcosis: I. Immunological diagnosis by enzyme immunoassay

Immunodiagnosis in sheep presents problems of sensitivity and specificity, limiting its applicability in surveillance systems. The objective of this study was to develop a sensitive, specific and accessible technique for diagnosing cystic echinococcosis in naturally infected sheep and to evaluate the validity of necropsy as a reference test. A total of 247 sheep were studied at slaughterhouses, confirming the parasitological diagnosis with histology. Serum was processed with enzyme immunoassay (EIA) using three antigen preparations: total hydatid liquid (LHT), purified fraction of LHT (S2B) and purified lipoprotein (B). Western Blot (WB) was used as a control. EIA proved effective for differentiating Echinococcus granulosus from larval stage of Taenia hydatigena and intestinal cestodes in all three antigen preparations. Serums from macroscopically negative sheep were reactive to EIA and positive with WB. In the whole flock, sensitivity was 89.2% for LHT, 80.0% for S2B and 86.4% for B. Sensitivity in lambs was 78.6% for LHT, 75.0% for S2B and 64.3% for B. Macroscopic diagnosis at the time of slaughter was found to have limitations as a reference test for immunodiagnosis of cystic equinococcosis in sheep , so it was necessary to include histology and WB as reference tests. LHT was the antigen preparation of greatest value and EIA proved to be a sensitive and specific technique, adequate for surveillance systems and for evaluating control programmes.

Fatalities Associated With Large Round Hay Bales—Minnesota, 1994-1996

Agriculture has one of the highest occupational fatality rates of all U.S. industries. Since the mid-1970s, traditional small-bale balers have gradually been replaced by large-bale balers in the agriculture industry. Expanded use of these balers has resulted in worker exposure to new hazards not present during handling of traditional small bales; the larger size of the bales increases the potential for serious injury or death while workers handle them. During 1994-1996, seven persons in Minnesota died in separate incidents that involved large round hay bales (i.e., cylindrical bales approximately 5 feet in length with flat ends, diameters of approximately 6 feet, and weights ranging from 750 to 1500 lbs). The Minnesota Fatality Assessment and Control Evaluation program (MN FACE), a program sponsored by CDC's National Institute for Occupational Safety and Health (NIOSH), was notified of these incidents by the Minnesota Extension Service, a newspaper clipping service, and/or by death-certificate review. This report describes three incidents that were reported to MN FACE during 1994-1996, summarizes national surveillance for bale-associated deaths during 1980-1995, and provides recommendations to prevent fatalities associated with large bales.

An On-Line Method to Evolve Behavior and to Control a Miniature Robot in Real Time with Genetic Programming

We present a novel evolutionary approach to robotic control of a real robot based on genetic programming (GP). Our approach uses GP techniques that manipulate machine code to evolve control programs for robots. This variant of GP has several advantages over a conventional GP system, such as higher speed, lower memory requirements, and better real-time properties. Previous attempts to apply GP in robotics use simulations to evaluate control programs and have difficulties with learning tasks involving a real robot. We present an on-line control method that is evaluated in two different physical environments and applied to two tasks—obstacle avoidance and object following—using the Khepera robot platform. The results show fast learning and good generalization.

Filarial-specific IgG4 response correlates with active Wuchereria bancrofti infection.

The filarial-specific humoral immune response of adult residents of two areas of Papua New Guinea, differing in transmission of Wuchereria bancrofti infection was compared. The majority of residents of the village of Bonahoi, in an area where transmission of filariasis had been interrupted by a 20-year insecticide spray program to control malaria, showed no parasitologic signs of active W. bancrofti infection and were negative for both circulating phosphorylcholine Ag and peripheral blood microfilariae. In contrast, adult residents of the village of Nanaha were in an area exposed to infection, and were phosphorylcholine-Ag- and microfilariae-positive. The antibody response of these two groups to both adult worm excretory/secretory (ES) Ag and somatic antigen extract was examined to determine which components of the filarial-specific immune response were dependent on active infection. Identification of these immune responses may point to immunologic methods to evaluate control programs for lymphatic filariasis. Adults from Bonahoi were found to have significant immune responses to [35S] methionine-labeled ES Ag by immunoprecipitation and to adult somatic antigen extracts by ELISA and by immunoblotting. This result is consistent with the fact that these individuals were previously exposed to and/or infected with W. bancrofti. Similarly, residents of the endemic village had detectable immune responses to these Ag irrespective of if they were microfilaremic. The most striking immunologic difference observed between the two groups was that residents of Bonahoi had a dramatically reduced filarial-specific IgG4 antibody response to both adult somatic Ag and adult ES Ag. These data suggest that longitudinal measurement of filarial-specific IgG4 levels may be a useful seroepidemiologic indicator of changes in W. bancrofti infection status.

Child Survival. Strategies for Research

Part I. Introduction and Conceptual Framework: 1. Child survival: research and policy W. Henry Mosley 2. An analytical framework for the study of child survival in developing countries W. Henry Mosley and Lincoln C. Chen Part II. Intervening Variables: Nutrition: 3. Malnutrition, morbidity, and mortality Reynaldo Martorell and Teresa J. Ho 4. Measurement of dietary intake Kenneth H. Brown 5. Breastfeeding performance and child survival Sandra L. Huffman and Barbara B. Lamphere Part III. Intervening Variables: Infectious and Parasitic Diseases: 6. Immunizable and respiratory diseases and child mortality Stanley O. Foster 7. Diarrheal diseases and child morbidity and mortality Robert E. Black 8. Parasitic diseases: measurement and mortality impact David J. Bradley and Anne Keymer Part IV. Socioeconomic Variables: 9. Effects of maternal education, women's roles, and child care on child mortality Helen Ware 10. Studying the impact of household economic and community variables on child mortality T. Paul Schultz 11. Technology and child survival: the example of sanitary engineering John Briscoe Part V. Case Studies: 12. Determinants of child mortality: a study of squatter settlements in Jordan Belgin Tekce and Frederic C. Shorter 13. Intervention projects and the study of socioeconomic determinants of mortality Anne R. Pebley 14. A household survey of child mortality determinants in Malaysia Julie DaVanzo Part VI. Analytical Methods: 15. Estimating levels, trends, and determinants of child mortality in countries with poor statistics James Trussell and Jane Menken 16. Mathematical models of infectious diseases: seeking new tools for planning and evaluating control programs Burton Singer 17. Modeling resource allocation for child survival Howard N. Barnum and Robin Barlow.