Infectious Diseases - Research Publications

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    Knowledge about hepatitis and previous exposure to hepatitis viruses in immigrants and refugees from the Mekong Region
    Caruana, SR ; Kelly, HA ; De Silva, SL ; Chea, L ; Nuon, S ; Saykao, P ; Bak, N ; Biggs, BA (WILEY, 2005-02)
    OBJECTIVE: Infection with hepatitis B (HBV) and hepatitis C (HCV) viruses is relatively common throughout South-East Asia and chronic infection can lead to severe consequences. This study assesses knowledge about HBV and HCV and estimates the seroprevalence of markers for these viruses in immigrants from Laos and Cambodia. METHODS: Ninety-five Laotian (aged 18-82 years) and 234 Cambodian (15-92 years) immigrants participated in separate community-based surveys conducted during 1998 and 2002, respectively. Participants completed a questionnaire on health status and level of knowledge about viral hepatitis. Blood samples were collected and tested for the presence of HBV and HCV markers. RESULTS: Nine per cent of Laotian and 8% of Cambodian participants were infected with HBV. While 49% of Laotian and 64% of Cambodian participants showed evidence of previous exposure to HBV, 30% and 9%, respectively, were vulnerable to infection. The seroprevalence of antibodies to HCV was 3% in the Laotian and 8% in the Cambodian participants. Between one-fifth and one-third of the Laotians and Cambodians who had heard of HBV and HCV knew of possible transmission routes for the viruses. Most of those with HBV or HCV infection were unaware they were infected. CONCLUSIONS: These findings indicate a significant prevalence of undetected HBV and HCV infections and an urgent need for the provision of culturally relevant information about viral hepatitis in immigrants of South-East Asian origin.
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    KAP surveys and malaria control in Vietnam: findings and cautions about community research
    Anh, NQ ; Hung, LX ; Thuy, HN ; Tuy, TQ ; Caruana, SR ; Biggs, B-A ; Morrow, M (SEAMEO Tropmed, 2005-05)
    The malaria disease burden is increasing in many countries despite the existence of effective preventative strategies and antimalarial drugs. An understanding of community perspectives and practices is one of the essential components of a successful malaria control program. This paper reports on a KAP (Knowledge, Attitudes and Practices) survey among the Raglai ethnic minority population in Ninh Thuan Province, Vietnam, which in 2003 had one of the country's highest confirmed rates of malaria. We found high levels of correct knowledge about malaria's transmission and symptoms, and self-reports of adequate bed net usage and appropriate health-seeking behavior. While the survey generated useful findings, an initial, qualitative investigation (eg, observation and focus group discussions) to explore the large numbers of potential influences on behavior and exposure risk would have provided a more robust underpinning for the design of survey questions. This would have strengthened its validity and generated additional information. The adoption of rigorous, multi-disciplinary research methods offers the best chance of contributing to the development of successful malaria control programs and effective policies.
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    Prevalence of polymorphisms in DHFR, DHPS, PFMDR1 and PFCRT genes of Plasmodium falciparum isolates in Quang Tri Province, Vietnam
    Phuc, BQ ; Caruana, SR ; Cowman, AF ; Biggs, B-A ; Thanh, NV ; Tien, NT ; Thuan, LK (SEAMEO TROPMED Network, 2008-11)
    In 2002 an antimalarial drug resistance survey was carried out in a seasonally endemic area of Vietnam. Sulfadoxine/pyrimethamine (S/P) was the standard treatment recommended for uncomplicated Plasmodium falciparum malaria in that area at the time. Early or late treatment failure as defined by WHO was observed in 14.9% (7/47) of patients. Molecular analysis of treatment failure isolates identified that 5/6 carried two or more dhfr and dhps polymorphisms associated with S/P resistance. Chloroquine resistance-associated polymorphisms occurred in 38.5% (15/39) of the isolates. These results support the move to artemisinin-based combination therapy for malaria in Vietnam.
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    Anemia, iron deficiency, meat consumption, and hookworm infection in women of reproductive age in northwest Vietnam
    Pasricha, S-R ; Caruana, SR ; Phuc, TQ ; Casey, GJ ; Jolley, D ; Kingsland, S ; Tien, NT ; MacGregor, L ; Montresor, A ; Biggs, B-A (AMER SOC TROP MED & HYGIENE, 2008-03)
    Iron deficiency anemia poses an important public health problem for women of reproductive age living in developing countries. We assessed the prevalence of iron deficiency and anemia and associated risk factors in a community-based sample of women living in a rural province of northwest Vietnam. A cross-sectional survey, comprised of written questionnaires and laboratory analysis of hemoglobin (Hb), ferritin, transferrin receptor, and stool hookworm egg count, was undertaken, and the soluble transferrin receptor/log ferritin index was calculated. Of 349 non-pregnant women, 37.53% were anemic (Hb < 12 g/dL), and 23.10% were iron deficient (ferritin < 15 ng/L). Hookworm infection was present in 78.15% of women, although heavy infection was uncommon (6.29%). Iron deficiency was more prevalent in anemic than non-anemic women (38.21% versus 14.08%, P < 0.001). Consumption of meat at least three times a week was more common in non-anemic women (51.15% versus 66.67%, P = 0.042). Mean ferritin was lower in anemic women (18.99 versus 35.66 ng/mL, P < 0.001). There was no evidence of a difference in prevalence (15.20% versus 17.23%, P = 0.629) or intensity (171.07 versus 129.93 eggs/g, P = 0.412) of hookworm infection between anemic and non-anemic women. Although intensity of hookworm infection and meat consumption were associated with indices of iron deficiency in a multiple regression model, their relationship with hemoglobin was not significant. Anemia, iron deficiency, and hookworm infection were prevalent in this population. Intake of meat was more clearly associated with hemoglobin and iron indices than hookworm. An approach to addressing iron deficiency in this population should emphasize both iron supplementation and deworming.
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    Management of Chronic Strongyloidiasis in Immigrants and Refugees: Is Serologic Testing Useful?
    Biggs, B-A ; Caruana, S ; Mihrshahi, S ; Jolley, D ; Leydon, J ; Chea, L ; Nuon, S (AMER SOC TROP MED & HYGIENE, 2009-05)
    We assessed the usefulness of serologic testing in monitoring strongyloidiasis in immigrants after treatment with two doses of ivermectin. An observational study was conducted in a group of Cambodian immigrants residing in Melbourne who were treated for strongyloidiasis and followed-up in a general practice setting. Two doses of ivermectin (200 microg/kg) were administered orally. Periodic serologic enzyme-linked immunosorbent assay testing was undertaken for up to 30 months after treatment. Antibody titers for Strongyloides sp. decreased in 95% (38 of 40) of the patients, 47.5% (19 of 40) had a decrease in optical density to less than 0.5, and 65% (26 of 40) reached levels consistent with a cure during the follow-up period. Serologic testing for Strongyloides sp. is a useful tool for monitoring a decrease in antibody levels after effective treatment. This testing should be carried out 6-12 months after treatment to ensure a sustained downward trend suggestive of cure.