Casos de malária no Brasil atingiu seu nível mais baixo em 35 anos e o Plasmodium vivax é responsável por 85% dos casos em todo o país. A vigilância epidemilógica da transmissão residual da malária persistente na Amazônia é o próximo grande desafio para os esforços vigentes de eliminação. Esta situação nos levou a avaliar uma estratégia para detecção de portadores do parasito (sintomáticos ou não) em áreas que se aproximam a eliminação da malária. Nossa hipótese é que o monitoramento sistemático de moradores de domicílios com um ou mais casos de malária vivax clínica confirmados pela vigilância passiva de rotina (referido como casos índices) e seus vizinhos tem um melhor custo-benecífio na identificação de novas infecções em relação aos inquéritos em massa da população em geral. Para testar essa hipótese, foram recrutados 41 casos índices (24 indivíduos classificados como autóctones, 11 como possíveis recaídas e, seis como casos importados), 163 moradores dos domicílios índices (indivíduos morando na mesma residência do caso índice), 878 moradores vizinhos (moradores de domicílios a um raio de < 3 km) e 841 controles (moradores da mesma localidade, porém a > 5 km de distância do domicílio índice) entre os meses de fevereiro a julho de 2013. Participantes residiam em comunidades rurais pertencentes a Acrelândia, onde o P. vivax é a única espécie implicada na transmissão da malária humana. Todos os participantes foram convidados a fornecerem amostra de sangue capilar para realização do diagnóstico para malária no momento de identificação do caso índice (dia 0), 30, 60 e 180 dias após a primeira visita. Em geral, 6028 análises por microscopia revelaram um aumento na prevalência de malária nos domicílios índices (6,1%; odds ratio [OR] = 36,3, P < 0,001) e vizinhos (2,6%; OR = 13,6, P < 0,001) comparados aos controles (0,1%). Não houve casos positivos para P. falciparum. Moradores dos domicílios índices e vizinhos foram associados com uma maior probabilidade de infecção pelo P. vivax em comparação com os indivíduos controles, após análise ajustada por potenciais confundidores (modelos de regressão logística para efeitos mistos), além desses participantes albergarem > 90% da biomassa parasitária circulante. Nos quatro seguimentos da RCD a microscopia identificou somente 49,5% das infecções diagnosticadas por qPCR, porém 76,8% do total da carga parasitária circulante nas proximidades do domicílio índice. Embora, moradores dos domicílios controles foram responsáveis por 27,6% das amostras positivas por qPCR, 92,6% desses indivíduos eram portadores assintomáticos da infecção, que provavelmente não seriam alvos da RCD. Tipagem molecular dos parasitos utilizando três marcadores polimórficos - msp1F3, MS16 e pv3.27 revelaram alta diversidade de P. vivax, consistente com a complexidade das vias de transmissão e múltiplas fontes de infecção dentro dos aglomerados, potenciais complicações para os programas de eliminação de malária. / Malaria burden in Brazil has reached its lowest levels in 35 years and Plasmodium vivax now accounts for 85% of cases countrywide. The epidemiological surveillance residual malaria transmission entrenched in the Amazon is the next major challenge for ongoing elimination efforts. This situation prompted us to evaluate a strategy for targeted detection of parasite carriers (either symptomatic or asymptomatic) in areas approaching malaria elimination. We hypothesize that repeated screening of households (HHs) with one or more slide-confirmed clinical vivax malaria cases diagnosed by routine passive surveillance (referred to as index cases) and their neighbors is more cost-effective for finding new malaria infections than population-wide mass blood surveys. To test this hypothesis, we recruited 41 index cases (24 subjects classified with indigenous, 11 possible relapsing and 6 cases imported) 163 index household members (subjects sharing the household with index cases), 878 neighbors (subjects living within a radius of up to 3 km from index cases) and 841 controls (subjects living in the same locality, but > 5 km from the index case) between January and July 2013. Study participants lived in rural communities surrounding Acrelândia town, where P. vivax is the only malaria parasite diagnosed in humans. They were invited to contribute finger-prick blood samples, for laboratory diagnosis of malaria, at the time of index case diagnosis (day 0) and 30, 60, and 180 days later. Overall, 6,028 microscopical analysis revealed an increased prevalence of infection in index households (6.1%; odds ratio [OR] = 36.3, P < 0.001) and neighbors (2.6%; OR = 13.6, P < 0.001) compared to controls (0.1%). There were no positive cases for P. falciparum. Subjects in index and neighbor households were significantly more likely to be parasitemic than control households members, after adjusting for potential confounders (mixed-effects logistic regression models), and together harbored > 90% of the P. vivax biomass in study subjects. Four rounds of microscopy-based RCD would identify only 49.5% of the infections diagnosed by qPCR, but 76.8% of the total parasite biomass circulating in the proximity of index HHs. However, control HHs accounted for 27.6% of qPCR-positive samples, 92.6% of them from asymptomatic carriers who were beyond the reach of RCD. Molecular genotyping analysis of parasites with three polymorphic molecular markers (msp1F3, MS16, and Pv3.27) revealed high P. vivax diversity, consistent with complex transmission networks and multiple sources of infection within clusters, potentially complicating malaria elimination efforts.

Casos de malária no Brasil atingiu seu nível mais baixo em 35 anos e o Plasmodium vivax é responsável por 85% dos casos em todo o país. A vigilância epidemilógica da transmissão residual da malária persistente na Amazônia é o próximo grande desafio para os esforços vigentes de eliminação. Esta situação nos levou a avaliar uma estratégia para detecção de portadores do parasito (sintomáticos ou não) em áreas que se aproximam a eliminação da malária. Nossa hipótese é que o monitoramento sistemático de moradores de domicílios com um ou mais casos de malária vivax clínica confirmados pela vigilância passiva de rotina (referido como casos índices) e seus vizinhos tem um melhor custo-benecífio na identificação de novas infecções em relação aos inquéritos em massa da população em geral. Para testar essa hipótese, foram recrutados 41 casos índices (24 indivíduos classificados como autóctones, 11 como possíveis recaídas e, seis como casos importados), 163 moradores dos domicílios índices (indivíduos morando na mesma residência do caso índice), 878 moradores vizinhos (moradores de domicílios a um raio de < 3 km) e 841 controles (moradores da mesma localidade, porém a > 5 km de distância do domicílio índice) entre os meses de fevereiro a julho de 2013. Participantes residiam em comunidades rurais pertencentes a Acrelândia, onde o P. vivax é a única espécie implicada na transmissão da malária humana. Todos os participantes foram convidados a fornecerem amostra de sangue capilar para realização do diagnóstico para malária no momento de identificação do caso índice (dia 0), 30, 60 e 180 dias após a primeira visita. Em geral, 6028 análises por microscopia revelaram um aumento na prevalência de malária nos domicílios índices (6,1%; odds ratio [OR] = 36,3, P < 0,001) e vizinhos (2,6%; OR = 13,6, P < 0,001) comparados aos controles (0,1%). Não houve casos positivos para P. falciparum. Moradores dos domicílios índices e vizinhos foram associados com uma maior probabilidade de infecção pelo P. vivax em comparação com os indivíduos controles, após análise ajustada por potenciais confundidores (modelos de regressão logística para efeitos mistos), além desses participantes albergarem > 90% da biomassa parasitária circulante. Nos quatro seguimentos da RCD a microscopia identificou somente 49,5% das infecções diagnosticadas por qPCR, porém 76,8% do total da carga parasitária circulante nas proximidades do domicílio índice. Embora, moradores dos domicílios controles foram responsáveis por 27,6% das amostras positivas por qPCR, 92,6% desses indivíduos eram portadores assintomáticos da infecção, que provavelmente não seriam alvos da RCD. Tipagem molecular dos parasitos utilizando três marcadores polimórficos - msp1F3, MS16 e pv3.27 revelaram alta diversidade de P. vivax, consistente com a complexidade das vias de transmissão e múltiplas fontes de infecção dentro dos aglomerados, potenciais complicações para os programas de eliminação de malária. / Malaria burden in Brazil has reached its lowest levels in 35 years and Plasmodium vivax now accounts for 85% of cases countrywide. The epidemiological surveillance residual malaria transmission entrenched in the Amazon is the next major challenge for ongoing elimination efforts. This situation prompted us to evaluate a strategy for targeted detection of parasite carriers (either symptomatic or asymptomatic) in areas approaching malaria elimination. We hypothesize that repeated screening of households (HHs) with one or more slide-confirmed clinical vivax malaria cases diagnosed by routine passive surveillance (referred to as index cases) and their neighbors is more cost-effective for finding new malaria infections than population-wide mass blood surveys. To test this hypothesis, we recruited 41 index cases (24 subjects classified with indigenous, 11 possible relapsing and 6 cases imported) 163 index household members (subjects sharing the household with index cases), 878 neighbors (subjects living within a radius of up to 3 km from index cases) and 841 controls (subjects living in the same locality, but > 5 km from the index case) between January and July 2013. Study participants lived in rural communities surrounding Acrelândia town, where P. vivax is the only malaria parasite diagnosed in humans. They were invited to contribute finger-prick blood samples, for laboratory diagnosis of malaria, at the time of index case diagnosis (day 0) and 30, 60, and 180 days later. Overall, 6,028 microscopical analysis revealed an increased prevalence of infection in index households (6.1%; odds ratio [OR] = 36.3, P < 0.001) and neighbors (2.6%; OR = 13.6, P < 0.001) compared to controls (0.1%). There were no positive cases for P. falciparum. Subjects in index and neighbor households were significantly more likely to be parasitemic than control households members, after adjusting for potential confounders (mixed-effects logistic regression models), and together harbored > 90% of the P. vivax biomass in study subjects. Four rounds of microscopy-based RCD would identify only 49.5% of the infections diagnosed by qPCR, but 76.8% of the total parasite biomass circulating in the proximity of index HHs. However, control HHs accounted for 27.6% of qPCR-positive samples, 92.6% of them from asymptomatic carriers who were beyond the reach of RCD. Molecular genotyping analysis of parasites with three polymorphic molecular markers (msp1F3, MS16, and Pv3.27) revealed high P. vivax diversity, consistent with complex transmission networks and multiple sources of infection within clusters, potentially complicating malaria elimination efforts.

<p>The focus of this research is the experiences of patients with regard to social and health services factors that contribute to delays in seeking treatment for tuberculosis. The goal of this&nbsp / research study was to do an explorative study in order to establish the experiences of patients with regard to social and health services factors that contribute to delays in seeking treatment for Tuberculosis. The objectives to meet the goal were an exploration and description of patients&rsquo / experiences with regards to social and health service factors contributing to delays in seeking&nbsp / treatment for Tuberculosis. Another goal was to make recommendations on social and health service factors that contribute to patients&rsquo / delays in seeking treatment based on the findings. The research study had been of a qualitative nature exploring patients&rsquo / experiences of social and health services factors that contribute to delays in seeking treatment for Tuberculosis. Qualitative&nbsp / research was used in this study using semi-structured interviews with an interview guide. Data analysis was done according to the eight steps as recorded in Tesch in Creswell (1994: 155). The&nbsp / findings of this research were or include social factors contributing to patients&rsquo / delays in seeking treatment for TB. There were four categories related to social factors namely socio-economic,&nbsp / substance abuse, psycho-social and interpersonal relations factors. The findings also indicated that there were health service factors contributing to patients&rsquo / delay in seeking treatment for TB.&nbsp / These include quality of health care services, attitudes of medical staff and other medical conditions treatment. It was concluded that social and health services, as mentioned indeed contribute to patients&rsquo / delays in seeking treatment for Tuberculosis. Recommendations for practice included better case detection, treatment and health education. In order to address the various social&nbsp / factors as described above it is necessary to treat TB holistically and include a social worker as part of the multidisciplinary team.</p>

<p>The goal of this research study was to do an explorative study in order to establish the experiences of patients with regard to social and health services factors that contribute to delays in seeking treatment for Tuberculosis.</p>

<p>The goal of this research study was to do an explorative study in order to establish the experiences of patients with regard to social and health services factors that contribute to delays in seeking treatment for Tuberculosis.</p>

<p>The focus of this research is the experiences of patients with regard to social and health services factors that contribute to delays in seeking treatment for tuberculosis. The goal of this&nbsp / research study was to do an explorative study in order to establish the experiences of patients with regard to social and health services factors that contribute to delays in seeking treatment for Tuberculosis. The objectives to meet the goal were an exploration and description of patients&rsquo / experiences with regards to social and health service factors contributing to delays in seeking&nbsp / treatment for Tuberculosis. Another goal was to make recommendations on social and health service factors that contribute to patients&rsquo / delays in seeking treatment based on the findings. The research study had been of a qualitative nature exploring patients&rsquo / experiences of social and health services factors that contribute to delays in seeking treatment for Tuberculosis. Qualitative&nbsp / research was used in this study using semi-structured interviews with an interview guide. Data analysis was done according to the eight steps as recorded in Tesch in Creswell (1994: 155). The&nbsp / findings of this research were or include social factors contributing to patients&rsquo / delays in seeking treatment for TB. There were four categories related to social factors namely socio-economic,&nbsp / substance abuse, psycho-social and interpersonal relations factors. The findings also indicated that there were health service factors contributing to patients&rsquo / delay in seeking treatment for TB.&nbsp / These include quality of health care services, attitudes of medical staff and other medical conditions treatment. It was concluded that social and health services, as mentioned indeed contribute to patients&rsquo / delays in seeking treatment for Tuberculosis. Recommendations for practice included better case detection, treatment and health education. In order to address the various social&nbsp / factors as described above it is necessary to treat TB holistically and include a social worker as part of the multidisciplinary team.</p>

Magister Artium - MA / The goal of this research study was to do an explorative study in order to establish the experiences of patients with regard to social and health services factors that contribute to delays in seeking treatment for Tuberculosis. / South Africa

Doctor Legum - LLD / Although it may seem ironic that a policy affecting so few children should engage so much political and social attention, the symbolic significance of intercountry adoption far outweighs its practical import. This fact is partly demonstrated by the polarised views on intercountry adoption, and opinions continue to be divided over the necessity and propriety of the practice. At present, there can be few who would quibble with the fact that African children are attracting an increasing attention from prospective adoptive parents living in other parts of the world. Celebrity adoptions (the adoptions of Angelina Jolie and Madonna) have contributed to this increased interest in African children. While intercountry adoption from African countries is still quite modest compared to adoptions from the top four countries of origin, there are concrete reasons to believe that interest in adoption from African countries will continue to increase. Thus, while Africa is “the new frontier” for intercountry adoption - it is highly questionable if the continent is equipped to provide its children with the necessary safeguards in respect of the practice. A central thesis of this study was to explore how the best interests of the African child can be upheld in intercountry adoption. In connection with this thesis, a number of related research questions were raised, such as: does the African context present any peculiar situations that are relevant to intercountry adoption? Does the African Children’s Charter (ACRWC) add any value to the provisions of the CRC in addressing African realities relevant for intercountry adoption? What are some of the challenges, lessons, and opportunities for the regulation of intercountry adoption on the African continent? Five themes are considered in dedicated Chapters of this study. They are the African context; the international legal framework; adoptability; the principle of subsidiarity; and illicit activities in respect of intercountry adoption. It is argued that context matters, and there are historical, cultural, social, religious, and legal contexts that are relevant for intercountry adoption in Africa. Since human rights issues are at the core of the current debate over intercountry adoption, international children’s rights law is also very crucial for the discussion. Four countries (Ethiopia, Kenya, Malawi and South Africa) are used in this study in supplementary fashion to demonstrate African countries’ experiences. The study identifies the role of various stakeholders for the promotion and protection of children’s rights in Africa in respect of intercountry adoption. It is concluded that as a predominantly sending continent, Africa’s views on intercountry adoption issues should be seriously considered and taken into account, if a socially and legally sound, and child-centred, intercountry adoption regime is to be formed on the continent. / South Africa

Collaborative TB/HIV management is essential to prevent and treat TB among HIV-positive TB patients, and to ensure that HIV-positive TB patients are detected and treated appropriately. This quantitative, descriptive, contextual study identified problems encountered during the implementation of TB case detection among HIV-positive individuals in one Ethiopian hospital. During December 2012, 300 checklists were completed about HIV-positive patients’ TB/HIV collaborative management, as reflected in their files. Only 60.2% of HIV-positive patients, who should have received Isoniazid preventive treatment (IPT), were placed on this treatment. X-rays and laboratory examinations of sputum samples were not done according to the Ethiopian guidelines. Most TB patients’ initial screening was done by nurses, not doctors, and included only symptom screening without CD4 count considerations. Managers and healthcare personnel should improve IPT, especially for those with early HIV infection and timely effective treatment for those suffering from TB, before complications arise / Health Studies / Health Studies / M.A. (Public Health)

O diagnóstico precoce e o tratamento são imprescindíveis para o controle da hanseníase, pois visam eliminar o mais precocemente possível as fontes de transmissão. O principal critério de cura da doença é o tempo de tratamento, relacionado às doses fixas da poliquimioterapia. O tempo de tratamento dos pacientes multibacilares foi reduzido de 24 para 12 doses em até 18 meses em 1998. Os objetivos desta tese foram: avaliar a detecção de casos de hanseníase entre os contatos dos pacientes e avaliar fatores de risco associados à piora das incapacidades físicas nos pacientes após a alta do tratamento poliquimioterápico com as 12 doses mensais. Dois artigos foram elaborados. O primeiro artigo avaliou características dos pacientes com hanseníase e de seus contatos associadas ao risco de adoecimento entre os contatos. O segundo artigo avaliou fatores de risco relacionados à piora das incapacidades físicas dos pacientes com hanseníase multibacilar, submetidos ao tratamento com 12 doses fixas da poliquimioterapia. Os resultados mostraram que o risco para hanseníase, relacionado aos contatos foi o tipo de convivência com o caso índice. Entre os fatores dos casos índices, a carga bacilar foi o único associado ao adoecimento dos contatos. Além desses fatores, os contatos que apresentam relação de consangüinidade com o caso índice e os contatos dos pacientes com menor nível de escolaridade mostraram maior chance de se apresentarem doentes no momento do diagnóstico do caso índice. A cicatriz BGC e a vacina recebida após o diagnóstico do caso índice contribuíram independentemente como fatores de proteção. A neuropatia piorou em 40% dos pacientes durante o período de 10 anos após a alta do tratamento. Esta piora foi associada à presença de incapacidades físicas e ao número de lesões cutâneas no momento do diagnóstico assim como à presença de neurite durante o acompanhamento. / Early diagnosis and treatment are essential for the control of leprosy disease, since they aim to eliminate as soon as possible sources of transmission. The main criterion for cure of the disease is the treatment time, related to fixed doses of multidrug therapy. The duration of treatment of multibacillary patients was reduced from 24 to 12 doses up to 18 months in 1998. The aim of this thesis is to evaluate the detection of leprosy among contacts of patients and to evaluate risk factors associated with worsening of physical disability in patients after discharge from the treatment with 12 monthly doses. Two articles have been prepared. The first article evaluated characteristics of leprosy patients and their contacts related to risk of disease among the contacts. The second article evaluated risk factors related to the worsening of the physical disabilities of patients with multibacillary leprosy, undergoing treatment with fixed doses of 12 multidrug therapy. The results showed that the risk for leprosy among contacts was related to the type of relationship with the index case. Among the factors of the index cases, the bacterial load was the only factor associated with the disease among contacts. Besides these factors, the contacts that are related to consanguinity with the index case and contacts of patients with lower education level showed a greater chance of presenting patients at diagnosis of the index case. The scar and the BGC vaccine received after the diagnosis of the index case contributed independently as protective factors. Neuropathy worsened in 40% of patients during the 10 years after the discharge of treatment. This worsening was associated with the presence of physical disabilities and number of lesions at time of diagnosis as well as the presence of neuritis during monitoring.