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Biomedical subjects

P Byass

Publications and source records attributed to P Byass.

At least 55 records · Page 3Linked to original sources

Serologic responses to an Haemophilus influenzae type b polysaccharide-Neisseria meningitidis outer membrane protein conjugate vaccine in very young Gambian infants.

Recent studies in the United States and Europe have shown that Haemophilus influenzae type b polysaccharide-protein conjugate vaccines can induce protective antibody levels in young infants, but it was not clear that this would be the case in African infants, to whom H influenzae vaccines must be given at a very early age to prevent disease caused by H influenzae. Therefore, antibody responses to an H influenzae type b polysaccharide-Neisseria meningitidis outer membrane protein conjugate vaccine were measured in very young Gambian infants. In the first group (n = 85), to whom the vaccine was given at the ages of 1 and 3 months, the geometric mean antibody level rose from a prevaccination level of 0.23 microgram/mL to a postvaccination level of 1.27 micrograms/mL, and in the second group (n = 56), vaccinated at the ages of 2 and 4 months, the prevaccination level of 0.16 microgram/mL rose to a postvaccination level of 1.59 micrograms/mL. These two final postvaccination levels did not differ significantly, and interpolation suggests that similar antibody levels were present in both groups of infants at the age of 3 months. This is the age by which protection would need to be achieved to protect against H influenzae meningitis in The Gambia and in other countries where the infection has similar epidemiologic characteristics. No significant side effects of vaccination were noted.

Antibodies, Bacterial↗

Risk factors for malaria among British missionaries living in tropical countries.

Thirty-two episodes of malaria (10 confirmed by laboratory tests) were reported by 162 people living in 18 developing countries under the auspices of one British missionary society. Malaria was endemic in all countries involved, and a total of 367 person-years were observed. The overall incidence rate for malaria was 87.3 per 1000 person-years at risk. Important factors identified were residence in West Africa compared with elsewhere (relative risk (RR) = 13.0, P less than 0.001), being in the 20-39 year age group (RR = 3.2, P less than 0.002), history of gastroenteritis (RR = 3.1, P less than 0.002) and living in a rural area (RR = 1.7, n.s.). Chemoprophylaxis was taken by 119 people (73.5%).

Adolescent↗

Evaluation of a primary health care programme in The Gambia. I. The impact of trained traditional birth attendants on the outcome of pregnancy.

In 1983 a primary health care (PHC) programme was introduced into the Farafenni area of The Gambia; an important component of this programme was the identification and training of a traditional birth attendant (TBA) in each village with a population of 400 or greater. The outcome of pregnancy has been documented among women resident in 15 villages which joined the PHC programme and in 26 which were too small to do so, for 1 year before and for 3 years after the start of the programme. In PHC villages 65% of women were assisted at delivery by a trained TBA during the post-implementation period and the proportion of women who delivered in a hospital or health centre increased. Both maternal and neonatal death rates fell in PHC villages during the post-intervention period, declining to about half the levels recorded during pre-intervention surveys during the last year of the study. In non-PHC villages there was also a fall in the maternal death rate but little change in the neonatal death rate. Trained traditional birth attendants probably played some part in improving the outcome of pregnancy in the Farafenni area but other factors, such as improvements in transport, may also have contributed.

Adolescent↗

Evaluation of a primary health care programme in The Gambia. II. Its impact on mortality and morbidity in young children.

Mortality and morbidity in children under 5 years of age were measured in 41 villages and hamlets in a rural area of The Gambia for a 1-year period before and for a 3-year period after the introduction of a primary health care (PHC) programme into 15 of the larger villages in the area. Both infant mortality and child mortality rates fell during the post-intervention period but declines were similar in PHC and in non-PHC villages suggesting that factors such as an up-grading of the Farafenni dispensary, improvements in transport and the survey itself may have played an important part in bringing about these changes. Measurements of morbidity showed a lower prevalence of diarrhoea, vomiting or severe cough in PHC villages after the introduction of the PHC programme. Introduction of the PHC programme had no significant effect on nutritional status or on vaccine coverage. Significant improvements in the health of children in the Farafenni study area have taken place during the past 5 years but the PHC programme is probably only one of the factors that have brought about these changes.

Child Health Services↗

Assessment of clinical criteria for identification of severe acute lower respiratory tract infections in children.

222 acute lower respiratory tract infections (LRI), as defined by the World Health Organisation, were identified during one year's surveillance of a cohort of 500 Gambian children aged 0 to 4 years. Symptoms and signs at presentation were related to radiological evidence of lobar consolidation, indicating severe LRI. In infants, a fever of greater than 38.5 degrees C, refusal to breast-feed, or the presence of vomiting were the best predictors of severe LRI. In children aged 1 to 4 years, a fever of greater than 38.5 degrees C or a respiratory rate greater than 60/min were the most accurate clinical signs for severe LRI. Chest indrawing did not discriminate severe LRI. These community-based findings differ from results of hospital-based studies.

Acute Disease↗

Follow-up of Gambian children for a 1-year period after rotavirus infection.

To investigate the hypothesis that rotavirus infection in young children can trigger chronic diarrhoeal disease, a group of cases from a documented epidemic of rotavirus and a group of matched controls were followed for a 1-year period after infection. No evidence of excess chronic diarrhoea or vomiting in the group known to have been infected with rotavirus was found.

Diarrhea, Infantile↗

Choosing and using a microcomputer for tropical epidemiology. II. Study implementation.

Continuing from the previous paper (Byass 1989), practical considerations in setting up a computer system to assist in the collection of data from an epidemiological project are discussed. Organizing field work so as to facilitate computer processing is considered, together with establishing data entry and checking procedures. The use of the hypothetical example in the first paper is continued here.

Data Collection↗

Choosing and using a microcomputer for tropical epidemiology. I. Preliminary considerations.

Practical considerations involved in ascertaining data processing requirements, starting with the protocol of an epidemiological study, are discussed. These include assessments of both hardware and software requirements. Throughout the paper special emphasis is placed on the problems of conducting an epidemiological study in a tropical environment, with minimal infrastructural, logistic and expert support. The requirements of a hypothetical study protocol are used as an example. This paper covers aspects of data processing required in preparing a project proposal; its sequel considers getting the project under way.

Computers↗

Tropical epidemiology: a system for continuous demographic monitoring of a study population.

Epidemiologists in many developing countries, where official demographic services are unavailable, have to include some demographic functions in their work. The usual method of documenting a study population for epidemiological research in a developing country consists of three stages: mapping, enumeration and vital registration. This paper considers the last element of this process, detailing the development of a suitable data system and explaining how its implementation using microcomputers and a database management system can help in the creation of an on-line continuous vital registration system for a study population as an epidemiological tool. The issues covered are data collection, entry and analysis, and the advantages of such a system for use in epidemiological research in developing countries are also discussed.

Africa, Western↗

Trial of co-trimoxazole versus procaine penicillin with ampicillin in treatment of community-acquired pneumonia in young Gambian children.

134 Gambian children under 5 years of age with severe pneumonia (as defined by the World Health Organisation classification of acute respiratory infections) were given either oral co-trimoxazole for 5 days, or a single intramuscular dose of fortified procaine penicillin and 5 days of oral ampicillin. At 2 weeks, there was no significant difference in outcome between the two groups. Co-trimoxazole is much less expensive than ampicillin or procaine penicillin, requires only twice-daily administration, and can be given by health-care staff with little training. The results support the use of co-trimoxazole as the antibiotic of first choice in outpatient management of young children with pneumonia in developing countries.

Ambulatory Care↗

Comparison of two strategies for control of malaria within a primary health care programme in the Gambia.

Two drug strategies for the control of malaria in children aged 3-59 months have been compared in a rural area of The Gambia--treatment of presumptive episodes of clinical malaria with chloroquine by village health workers, and treatment combined with fortnightly chemoprophylaxis with 'Maloprim' (pyrimethamine/dapsone) which was also given by village health workers. Treatment alone did not have any significant effect on mortality or morbidity from malaria. In contrast, treatment and chemoprophylaxis reduced overall mortality in children aged 1-4 years, mortality from probable malaria, and episodes of fever associated with malaria parasitaemia. A high level of compliance with chemoprophylaxis was obtained and no harmful consequences of chemoprophylaxis were observed.

Antimalarials↗

Microcomputer management of a vaccine trial.

A microcomputer system used for the management of a trial of rotavirus vaccine in The Gambia is described. This system facilitated call and recall of infants due for vaccination. The resulting compliance is reported and compared retrospectively with vaccination records in the same community.

Anthropometry↗

Immunity to malaria in young Gambian children after a two-year period of chemoprophylaxis.

A cohort of 48 Gambian children was protected against malaria by fortnightly administration of Maloprim (pyrimethamine and dapsone) for 2 years between their 3 and 5 birthdays. A matched cohort of 47 children received placebo. During the year following the termination of prophylaxis there was no increase in the frequency of clinical attacks of malaria in the protected children compared with the control children. Antibody levels to circumsporozoite protein were measured by a radioimmunoassay and that to blood-stage antigens by a variety of techniques including an ELISA to whole blood-stage Plasmodium falciparum antigen, immunofluorescent assays (IFAT) to acetone fixed, glutaraldehyde fixed and unfixed parasites, a merozoite inhibition test and an opsonizing assay. Antibody levels were, in general, lower in protected than in control children and several differences between the two groups were statistically significant. When antibody levels were measured by ELISA and IFAT at the end of the following rainy season, when malaria transmission was intense, those in protected children had increased to comparable levels to those found in control children. Our findings suggest that chemoprophylaxis given for 2 years lowers malaria antibody levels but that it does not interfere with the development of protective immunity.

Animals↗

Anti-sporozoite antibodies and immunity to malaria in a rural Gambian population.

A conserved repeated epitope, (NANP)3, of the circumsporozoite protein of Plasmodium falciparum has been identified previously as a putative target for artificially induced immunity to malaria. We examined the role of humoral responses to this epitope in acquired immunity to malaria in a rural African population. Seropositivity to (NANP)3 was slow to develop (9% positive in subjects aged 1-11 years; 88% in those of 30 years and above), and responses in younger subjects were transient. The poor response in younger subjects did not appear to be due to immunosuppression by concomitant blood stage parasitization. The relationship between levels of anti-(NANP)3 antibodies and parasitaemia changed from positive to negative with age. 126 subjects age 1-11 years were followed through an entire transmission season; those who were seropositive at the beginning ended the season with lower parasite rates (20% vs 59%) and experienced fewer episodes of clinical malaria (0.43 vs 0.67). However, the trend towards increasing susceptibility to clinical malaria in subjects entering the transmission season with lower levels of anti-(NANP)3 antibodies was modest, and combined cross-sectional and longitudinal data indicated that the humoral response to (NANP)3 did not play a major role in the development of immunity to clinical malaria in the population we studied.

Age Factors↗

Factors influencing vaccination compliance in peri-urban Gambian children.

The vaccination status of 251 children aged 12-18 months in two peri-urban Gambian communities was determined from their health cards. Two subgroups were identified: children who were fully vaccinated, and those who had received less than half their vaccinations. The social and environmental circumstances of these children were investigated to detect factors which were associated with poor vaccination compliance. Mothers of well vaccinated children were more inclined to bring them for non-curative services. Mothers of poorly vaccinated children had a poorer knowledge of the diseases against which their children should be vaccinated and they also had a more superstitious view of disease causation. Those children who showed poor compliance came from larger families. In the poorly vaccinated group both parents were less well educated and there was a trend towards poorer literacy.

Adult↗