Biomedical subjects

Paul K Drain

Publications and source records attributed to Paul K Drain.

6 recordsLinked to original sources

PubMed2006

Male circumcision, religion, and infectious diseases: an ecologic analysis of 118 developing countries.

BACKGROUND: Both religious practices and male circumcision (MC) have been associated with HIV and other sexually-transmitted infectious diseases. Most studies have been limited in size and have not adequately controlled for religion, so these relationships remain unclear. METHODS: We evaluated relationships between MC prevalence, Muslim and Christian religion, and 7 infectious diseases using country-specific data among 118 developing countries. We used multivariate linear regression to describe associations between MC and cervical cancer incidence, and between MC and HIV prevalence among countries with primarily sexual HIV transmission. RESULTS: Fifty-three, 14, and 51 developing countries had a high (>80%), intermediate (20-80%), and low (<20%) MC prevalence, respectively. In univariate analyses, MC was associated with lower HIV prevalence and lower cervical cancer incidence, but not with HSV-2, syphilis, nor, as expected, with Hepatitis C, tuberculosis, or malaria. In multivariate analysis after stratifying the countries by religious groups, each categorical increase of MC prevalence was associated with a 3.65/100,000 women (95% CI 0.54-6.76, p = 0.02) decrease in annual cervical cancer incidence, and a 1.84-fold (95% CI 1.36-2.48, p < 0.001) decrease in the adult HIV prevalence among sub-Saharan African countries. In separate multivariate analyses among non-sub-Saharan African countries controlling for religion, higher MC prevalence was associated with a 8.94-fold (95% CI 4.30-18.60) decrease in the adult HIV prevalence among countries with primarily heterosexual HIV transmission, but not, as expected, among countries with primarily homosexual or injection drug use HIV transmission (p = 0.35). CONCLUSION: Male circumcision was significantly associated with lower cervical cancer incidence and lower HIV prevalence in sub-Saharan Africa, independent of Muslim and Christian religion. As predicted, male circumcision was also strongly associated with lower HIV prevalence among countries with primarily heterosexual HIV transmission, but not among countries with primarily homosexual or injection drug use HIV transmission. These findings strengthen the reported biological link between MC and some sexually transmitted infectious diseases, including HIV and cervical cancer.

Africa South of the Sahara↗

PubMed2006

Low serum albumin and the acute phase response predict low serum selenium in HIV-1 infected women.

BACKGROUND: Low serum selenium has been associated with lower CD4 counts and greater mortality among HIV-1-seropositive individuals, but most studies have not controlled for serum albumin and the presence of an acute phase response. METHODS: A cross-sectional study was conducted to evaluate relationships between serum selenium concentrations and CD4 count, plasma viral load, serum albumin, and acute phase response markers among 400 HIV-1-seropositive women. RESULTS: In univariate analyses, lower CD4 count, higher plasma viral load, lower albumin, and the presence of an acute phase response were each significantly associated with lower serum selenium concentrations. In multivariate analyses including all four of these covariates, only albumin remained significantly associated with serum selenium. For each 0.1 g/dl increase in serum albumin, serum selenium increased by 0.8 microg/l (p < 0.001). Women with an acute phase response also had lower serum selenium (by 5.6 microg/l, p = 0.06). CONCLUSION: Serum selenium was independently associated with serum albumin, but not with CD4 count or plasma viral load, in HIV-1-seropositive women. Our findings suggest that associations between lower serum selenium, lower CD4 count, and higher plasma viral load may be related to the frequent occurrence of low serum albumin and the acute phase response among individuals with more advanced HIV-1 infection.

Acute-Phase Reaction↗

PubMed2004

Correlates of national HIV seroprevalence: an ecologic analysis of 122 developing countries.

BACKGROUND: Ecologic analyses of social and developmental correlates of country-level HIV seroprevalence may suggest strategies for combating the HIV/AIDS epidemic. METHODS: Regression analyses were performed for 81 variables obtained primarily from United Nation agencies for 122 developing countries. Variable measures were compared between highest and lowest tertiles of HIV seroprevalence. RESULTS: Geography, religion, and income inequality were independently associated with HIV seroprevalence. Countries with earlier ages at first sex, higher teenage birth rates, and higher fertility rates had higher HIV seroprevalence. Countries with high HIV seroprevalence had fewer women using contraceptives, more persons with casual sex partners, and higher herpes simplex virus 2 seroprevalence. Male circumcision and Muslim religion were colinearly associated with lower HIV seroprevalence. Countries with high HIV seroprevalence had fewer doctors, more midwives, and less access to essential medications, but health spending differences were minor. CONCLUSIONS: Ecologic analyses support population-level behavioral approaches, such as delaying sexual debut and discouraging casual sex partners, and reinforce biologic measures, such as controlling sexually transmitted infections and promoting male circumcision, for HIV prevention. Fewer births attended by skilled personnel, but more midwives, in countries with the highest HIV seroprevalence suggest potential strategies for reducing mother-to-child transmission. Correlations with selected health indicators suggest additional obstacles for implementing HIV treatment programs.

Adolescent↗

PubMed2003

Single-dose versus multi-dose vaccine vials for immunization programmes in developing countries.

Excessive vaccine wastage and safety concerns have prompted the international health community to develop and supply vaccines in formats other than the standard multi-dose vial. This article presents a programmatic and economic comparison of the major differences between the multi-dose vials and single-dose formats used for immunization services in developing countries. Multi-dose vials, in general, sell at a lower per-dose price and occupy less cold-chain capacity than single-dose formats. However, higher wastage rates may offset these benefits, especially for more expensive vaccines. Single-dose formats offer several important programmatic benefits, such as increased vaccination opportunities and improved vaccine safety. One single-dose format, the prefilled auto-disable (AD) device, provides additional injection safety and convenience features because it physically combines the vaccine and AD syringe. Selecting the appropriate vaccine presentation will depend on many factors. However, multi-dose vials are likely to be most appropriate for cheaper vaccines and in settings where cold-chain storage capacity is restricted. Single-dose formats will be most appropriate for more expensive vaccines and where there are problems with unsafe injection practices. Prefilled AD injection devices will be particularly useful in expanding outreach services while eliminating the possibility of needle reuse.

Developing Countries↗

PubMed2003

Introducing auto-disable syringes to the national immunization programme in Madagascar.

OBJECTIVE: To evaluate the safety and coverage benefits of auto-disable (AD) syringes, weighed against the financial and logis- tical costs, and to create appropriate health policies in Madagascar. METHODS: Fifteen clinics in Madagascar, trained to use AD syringes, were randomized to implement an AD syringe only, mixed (AD syringes used only on non-routine immunization days), or sterilizable syringe only (control) programme. During a five-week period, data on administered vaccinations were collected, interviews were conducted, and observations were recorded. FINDINGS: The use of AD syringes improved coverage rates by significantly increasing the percentage of vaccines administered on non-routine immunization days (AD-only 4.3%, mixed 5.7%, control 1.1% (P<0.05)). AD-only clinics eliminated sterilization sessions for vaccinations, whereas mixed clinics reduced the number of sterilization sessions by 64%. AD syringes were five times more expensive than sterilizable syringes, which increased AD-only and mixed clinics' projected annual injection costs by 365% and 22%, respectively. However, introducing AD syringes for all vaccinations would only increase the national immunization budget by 2%. CONCLUSION: The use of AD syringes improved vaccination coverage rates by providing ready-to-use sterile syringes on non-routine immunization days and decreasing the number of sterilization sessions, thereby improving injection safety. The mixed programme was the most beneficial approach to phasing in AD syringes and diminishing logistical complications, and it had minimal costs. AD syringes, although more expensive, can feasibly be introduced into a developing country's immunization programme to improve vaccination safety and coverage.

Child, Preschool↗

PubMed2002

Determinants of cervical cancer rates in developing countries.

Although cervical cancer (CC) is a leading cause of cancer-related deaths in developing countries, incidence rates vary considerably, ranging from 3 to 61 per 10(5) females. Identifying determinants of high vs. low rates may suggest population-level prevention strategies. CC rates for 175 countries were obtained from the IARC. Country-specific behavioral, health, economic and demographic measures were obtained from United Nations agencies and other international organizations. Regression analyses performed for 127 low or medium developed countries identified both geography and religion as independently associated with high CC rates. Among behavioral measures, high fertility rates, early age at birth of first child and high teenage birth rates were significantly associated with high CC rates. Countries with high CC rates had fewer doctors per capita, less immunization coverage, more HIV infections and shorter life expectancies. CC rates also tended to be higher in countries with more spending on health and younger, less educated populations. Patterns of CC rates suggest that programmatic approaches, such as promoting delayed childbearing and sexual monogamy, may be appropriate interventions. For countries with high CC rates and some flexibility in their health-care budgets, a once-in-a-lifetime screen of women 30-50 years of age, using Pap smears, direct visual inspection and/or HPV DNA testing, may be cost-effective. Finally, relatively low immunization rates and a shortage of health-care workers in countries with high CC rates suggest potential challenges for introducing prophylactic HPV vaccines.

Adolescent↗