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Objective Epidemiological studies have observed that genital schistosomiasis increases the risk of HIV infection in Africa. We analysed the correlation between Schistosoma haematobium prevalence and HIV prevalence across sub-Saharan African countries. Design Regression analysis of prevalence of HIV and S. haematobium across sub-Saharan African countries. Methods Using compiled country-level S. haematobium prevalence, HIV prevalence and other demographic and economic data from published sources, we applied univariate and multivariate regression models to assess the correlations between S. haematobium prevalence and HIV prevalence while controlling for risk factors associated with each infection. Results In 43 sub-Saharan African countries, the mean prevalence of S. haematobium was 22.4% [standard deviation (SD): 9.8%] and for HIV was 6.21% (SD: 5.71%). In multivariate analysis, adjusted for prevalence of male circumcision, years since a country's first HIV/AIDS diagnosis, geographical region and immunization coverage, each S. haematobium infection per 100 individuals was associated with a 2.9% (95% CI: 0.2–5.8%) relative increase in HIV prevalence. S. haematobium was not associated with Schistosoma mansoni, HSV-2, hepatitis C, malaria or syphilis. Conclusions Schistosoma haematobium prevalence was associated with HIV prevalence in sub-Saharan Africa. Controlling S. haematobium may be an effective means of reducing HIV transmission in sub-Saharan Africa. Objectif Des etudes epidemiologiques ont observe que la schistosomiase genitale augmente le risque d'infection par le VIH en Afrique. Nous avons analyse la correlation entre la prevalence de S. haematobium et celle du VIH dans des pays d'Afrique subsaharienne. Methodes En utilisant la prevalence compilee de S. haematobium a l’echelle du pays, celle du VIH et d'autres donnees demographiques et economiques provenant de sources publiees, nous avons applique des modeles de regression univariee et multivariee afin d’evaluer les correlations entre la prevalence de S. haematobium et celle du VIH tout en ajustant les facteurs de risque associes a chaque infection. Resultats Dans 43 pays d'Afrique subsaharienne, la prevalence moyenne de S. haematobium etait de 22,4% [deviation standard (DS): 9,8%] et pour le VIH, 6,21% (DS: 5,71%). Dans l'analyse multivariee, ajustee pour la prevalence de la circoncision masculine, l'annee depuis le premier diagnostic du VIH/SIDA dans le pays, la region geographique et la couverture vaccinale, chaque infection par S. haematobium pour 100 individus a ete associee a 2.9% (IC95%: 0,2-5,8%) d'augmentation relative de la prevalence du VIH. S. haematobium n’etait pas associee a S. mansoni, au HSV-2, a l'hepatite C, au paludisme ni a la syphilis. Conclusions La prevalence de S. haematobium etait associee a celle du VIH en Afrique subsaharienne. La lutte contre S. haematobium pourrait etre un moyen efficace de reduire la transmission du VIH en Afrique subsaharienne. Summary Objetivo En estudios epidemiologicos se ha observado que la esquistosomiaisis genital aumenta el riesgo de infeccion por VIH en Africa. Hemos analizado la correlacion entre la prevalencia de S. haematobium y de VIH en paises de Africa subsahariana. Metodos Utilizando prevalencias de S. haematobium, prevalencia de VIH, y otros datos demograficos y economicos de fuentes publicas recopiladas a nivel del pais, hemos aplicado modelos de regresion univariada y multivariada para evaluar las correlaciones entre la prevalencia de S. haematobium y la prevalencia de VIH controlando para factores de riesgo asociados con cada infeccion. Resultados En 43 paises del Africa subsahariana, la prevalencia media de S. haematobium era del 22.4% [desviacion estandar (DS): 9.8%] y para VIH del 6.21% (DS: 5.71%). En un analisis multivariado, ajustado para la prevalencia de circuncision masculina, los anos desde el primer diagnostico de VIH/SIDA en el pais, la region geografica y la cobertura vacunal, cada infeccion por S. haematobium por cada 100 individuos estaba asociada con un aumento relativo del 2.9% (95% CI: 0.2–5.8%) en la prevalencia de VIH. S. haematobium no estaba asociado con S. mansoni, HSV-2, Hepatitis C, malaria o sifilis. Conclusiones La prevalencia de S. haematobium estaba asociada con la prevalencia de VIH en Africa subsahariana. Controlar a S. haematobium podria ser una forma efectiva de reducir la transmision del VIH en Africa subsahariana.

OBJECTIVES Indonesia has a high incidence of tuberculosis (TB), despite the successful introduction of the directly observed treatment short-course strategy (DOTS strategy). DOTS depends on passive case finding. It is therefore important to identify determinants of patient delay and reasons for visiting a DOTS healthcare provider when seeking care. The aim of this study was to assess these determinants in TB suspects (coughing for at least 2 weeks). METHODS Cross-sectional data were gathered with a structured questionnaire in which psychosocial determinants were based on an extended version of the theory of planned behaviour (TPB). The study was conducted in five governmental lung clinics of Yogyakarta province. In total, 194 TB suspects that registered at the lung clinics were interviewed. RESULTS The median patient delay was 14 days (range 0-145). Ordinal regression analyses showed that visiting a private healthcare provider when first seeking health care, reporting travel distance/travel time as reason for choosing a certain healthcare provider when first seeking health care, discussing the symptoms with family and a reported short travel time, but no factors of TPB, were significantly associated with a shorter patient delay. An important factor negatively associated with visiting a DOTS clinic was the reported travel time. CONCLUSION Accessibility of the healthcare provider was the main determinant of patient delay, but the role of psychosocial factors cannot be fully excluded. Urban and suburban areas have relatively good access to (private) health care, hence the short delay. Thus, future studies should be focussed on extending the DOTS strategy to the private sector.

Objective: To investigate the multifactorial relationship between illness insight, cognitive and emotional processes, and illness characteristics in bipolar disorder patients. Methods: Data from 85 euthymic or mildly to moderately depressed bipolar disorder patients were evaluated. Insight was measured using the Mood Disorder Insight Scale (total score and subscale scores: awareness of illness, symptom attribution, and need for treatment). Cognitive and emotional functioning was measured in four domains (processing speed, memory, executive functioning, and emotional learning) in addition to premorbid IQ. Illness characteristics were assessed using the Mini-International Neuropsychiatric Interview, the Questionnaire for Bipolar Disorder, and the Inventory of Depressive Symptomatology-self rating scale. Regression analyses were performed for the whole sample. Post-hoc, interactions with lifetime psychotic features (LPF) were statistically tested and if significant, analyses were repeated for patients with (n = 36) and without (n = 49) LPF separately. Results: In the whole group, better insight was associated with lower processing speed, better memory performance, increased emotional learning, higher level of depressive symptoms, and longer duration of illness. Patients with LPF had worse awareness of illness, but better symptom attribution than patients without LPF. No group differences for need for treatment and overall insight were found. Finally, processing speed significantly predicted subscores for symptom attribution in patients with LPF only. Conclusions: Cognitive functioning as well as impairments in emotional learning and psychotic features independently contributes to impaired insight in bipolar disorder. Processing speed seems to be a key variable in the prediction of insight in patients with LPF and not in patients without LPF.

The World Health Assembly has defined targets for measuring performance of tuberculosis (TB) control programmes, which have been included in the framework of the Millennium Development Goals. To be able to measure progress towards these targets TB control programmes need epidemiological information. At the moment, surveillance data of countries with a high burden of TB are insufficient to assess performance of the TB control programme as a result of incompleteness or low quality. Several high-burden countries have performed TB prevalence surveys to obtain epidemiological information. As a standardized method for TB prevalence surveys has not been defined, we discuss the different options for measuring prevalence and their advantages and disadvantages. Most surveys use comparable strategies. Alternatives strategies at lower cost need to be evaluated.

National tuberculosis (TB) programmes need accurate estimates of the burden of TB in order to assess case detection and progress towards the millennium development goals (MDGs). We reviewed nationwide epidemiological data on TB burden in Bangladesh to decide whether additional information is needed in order to assess the current burden of TB. We collected all nationwide epidemiological information: notification data for the period 1995-2004; reports of TB prevalence surveys in 1964-1966 and 1987-1988 and a tuberculin survey in 1964-1966. Data were evaluated for usefulness to provide information about the current burden of TB. The TB prevalence surveys from 1964 to 1966 and 1987 to 1988 provide very different results respectively 127/100 000 and 471/100 000 smear positives. In 1964-1966 the annual risk of infection was 0.6% in the 5- to 9-year age group and 1.2% in those aged between 10 and 14 years. The notification data show an increase from 18/100 000 in 1995 to 46/100 000 smear positives in 2004. Interpretation and extrapolation of the existing epidemiological data of Bangladesh to estimate the current burden of TB is difficult. Many of the 22 high-burden countries have as few or even less survey data than Bangladesh. To enable the evaluation of progress towards the MDGs and to be able to assess the global burden of TB epidemiological surveys are needed. (authors)

The definitive version is available at www3.interscience.wiley.com, BACKGROUND A project to improve integrated control of schistosomiasis in the primary health care system of Northern Senegal was implemented from February 1995 until September 1999, shortly after a Schistosoma mansoni outbreak. The activities included additional training of doctors and nurses in symptom-based treatment and making praziquantel (PZQ) available for an affordable price. OBJECTIVE To investigate staff performance and the availability and costs of diagnostic materials and PZQ at the end of this intervention project. METHODS We performed structured interviews with staff from 55 health care facilities in five districts. RESULTS Respondents from 23 health care facilities reported both S. haematobium and S. mansoni in the coverage area, 32 reported only S. haematobium and three only S. mansoni. The average cost to patients for consultation, diagnosis, treatment and transportation to a referral health care facility was approximately 1.60 Euro. Fifty-seven per cent of the health care facilities with reported S. haematobium in the coverage area treated patients presenting with haematuria on symptoms; 56% of the health care facilities with reported S. mansoni in the coverage area treated patients presenting with blood in stool on symptoms. Thirteen per cent performed a diagnostic test for patients presenting with haematuria and 12% for patients presenting with blood in stool. The remainder, approximately one-third of the health care facilities, referred their patients to another facility for a diagnostic test. Implementation of symptom-based treatment in all health care facilities will reduce the total costs by 0.43 Euro (29%) for patients infected with S. haematobium and 0.78 Euro (46%) for patients infected with S. mansoni. Of the 53 health care facilities with schistosomiasis in their area, 37 had PZQ in stock of which 33 (88%) sold PZQ for the recommended retail price of 0.15 Euro per tablet (or 0.60 Euro per course of four tablets) or lower. CONCLUSION Four years after the start of the intervention project, patients presenting with schistosomiasis related symptoms can generally expect proper diagnosis and treatment at all levels of the health care system in Northern Senegal, either at the initial visited health care facility or after referral. However, a further reduction of the total costs of treatment is still possible by a better implementation of symptom-based treatment and further reduction of the costs of PZQ.