Search PubMed⌕ Search

Biomedical subjects

G D Shanks

Publications and source records attributed to G D Shanks.

64 records · Page 4Linked to original sources
PubMedDate not supplied

Changing patterns of clinical malaria since 1965 among a tea estate population located in the Kenyan highlands.

The changing epidemiology of clinical malaria since 1965 among hospitalized patients was studied at a group of tea estates in the western highlands of Kenya. These data indicate recent dramatic increases in the numbers of malaria admissions (6.5 to 32.5% of all admissions), case fatality (1.3 to 6%) and patients originating from low-risk, highland areas (34 to 59%). Climate change, environmental management, population migration, and breakdown in health service provision seem unlikely explanations for this changing disease pattern. The coincident arrival of chloroquine resistance during the late 1980s in the subregion suggests that drug resistance is a key factor in the current pattern and burden of malaria among this highland population.

Altitude↗
PubMedDate not supplied

Epidemic dysentery in western Kenya.

This paper describes the epidemiology of a probable Shigella dysenteriae type 1 dysentery epidemic in western Kenya. A retrospective record review over 2 years of all cases of dysentery, amoebiasis and diarrhoea was carried out in 13 healthcare facilities in the Rarieda Division of Nyanza province. Of the 3301 cases recorded, 2191 were dysentery, giving a cumulative 2 years incidence rate for dysentery of 4%. The epidemic began in December 1994 and peaked in February 1995, coinciding with the very dry season. One location in the area had an overall attack rate of 9.3%, double that of other locations. Highest rates were in children aged < 5 years and in persons > 15 years old. S. dysenteriae type 1, with its increasing multiantibiotic resistance, is a continuing threat to the health of people in this region; this area may be suitable for intensive, prospective surveillance as a prelude to a Shigella vaccine trial.

Adolescent↗
PubMedDate not supplied

Reemergence of epidemic malaria in the highlands of western Kenya.

Hospital records (1990-1997) of a tea company in the Kericho district, western Kenya, showed malaria epidemics almost annually from May to July, with an annual attack rate of 50%, 857 hospitalizations per 100,000 per year, and 42 deaths per 100,000 per year; 32% of deaths in hospitalized patients were caused by malaria. A questionnaire survey (June 1997) of 244 patients hospitalized for malaria showed that only 8% had traveled to an area with known malaria transmission 30 days before diagnosis. The increasing malaria incidence may be due to drug resistance.

Humans↗
PubMedDate not supplied

Treatment of falciparum malaria in the age of drug resistance.

The growing problem of drug resistance has greatly complicated the treatment for falciparum malaria. Whereas chloroquine and sulfadoxine/pyrimethamine could once cure most infections, this is no longer true and requires examination of alternative regimens. Not all treatment failures are drug resistant and other issues such as expired antimalarials and patient compliance need to be considered. Continuation of a failing treatment policy after drug resistance is established suppresses infections rather than curing them, leading to increased transmission of malaria, promotion of epidemics and loss of public confidence in malaria control programs. Antifolate drug resistance (i.e. pyrimethamine) means that new combinations are urgently needed particularly because addition of a single drug to an already failing regimen is rarely effective for very long. Atovaquone/proguanil and mefloquine have been used against multiple drug resistant falciparum malaria with resistance to each having been documented soon after drug introduction. Drug combinations delay further transmission of resistant parasites by increasing cure rates and inhibiting formation of gametocytes. Most currently recommended drug combinations for falciparum malaria are variants of artemisinin combination therapy where a rapidly acting artemisinin compound is combined with a longer half-life drug of a different class. Artemisinins used include dihydroartemisinin, artesunate, artemether and companion drugs include mefloquine, amodiaquine,sulfadoxine/pyrimethamine, lumefantrine, piperaquine, pyronaridine, chlorproguanil/dapsone. The standard of care must be to cure malaria by killing the last parasite. Combination antimalarial treatment is vital not only to the successful treatment of individual patients but also for public health control of malaria.

Antimalarials↗