Background: In the Democratic Republic of Congo (DRC), few studies have focused on treatment-seeking paths selected by caretakers for the management of severe childhood malaria in an urban environment. The present study aims at describing the treatment-seeking paths according to the characteristics of households, as well as the subsequent impact on pre-hospitalisation delay and malarial fatality and on the main syndromes associated with severe childhood malaria. Methods: This descriptive study included data collected at nine hospitals in Kinshasa between January and November 2011. A total of 1,350 children, under 15 years of age and hospitalised for severe malaria, were included in the study. Results: Regarding the management of malaria, 31.5% of households went directly to the health centre or hospital while 68.5% opted for self-medication, church and/or traditional healing therapy. The most frequent first-line option was self-medication, adopted by more than 61.5% of households. Nevertheless, rational self-medication using antimalarial drugs recommended by the WHO (artemisinin-based combinations) was reported for only 5.5% of children. Only 12.5% of households combined 2 or 3 traditional options. The following criteria influenced the choice of a modern vs. traditional path: household socioeconomic level, residential environment, maternal education level and religious beliefs. When caretakers opted for traditional healing therapy, the pre-hospitalisation delay was longer and the occurrence of respiratory distress, severe anaemia and mortality was higher. Conclusion: The implementation of a malaria action plan in the Democratic Republic of Congo should take into account the diversity and pluralistic character of treatment-seeking behaviours in order to promote the most appropriate options (hospital and rational self-medication) and to avoid detrimental outcomes.

In early 2014, dengue cases werereported from the northern Mozambique, 30 years since the last outbreak. Weidentified potential dengue vector species in three northern towns, Pemba, Nampulaand Nacala, and one southern town, Maputo, during the outbreak in April 2014. Amajor dengue vector species, Aedes (Stegomyia) aegypti, wasfound in all these towns. The dominant vector subspecies in the northern townswas Aedes aegypti aegypti, while Ae. aegyptiformosus was dominant in Maputo. Considering the high proportions of Ae. aegypti aegypti and its high vectorcompetence, the findings from this study suggest that Ae. aegypti aegypti was responsible for the outbreakin the northern Mozambique.

Informed consent process remains a constant challenge in clinical research.  The aim of the present study was to evaluate the understanding of researchers and members of Institutional Review Boards (IRBs) regarding the essential elements of an Informed Consent Form (ICF) as required by internationally recognized regulations.  Using 8 case studies to illustrate basic ethical elements, the study consisted of 107 participants, mainly from the Asia Pacific and African regions.  The results showed that most of the participants had general knowledge regarding the essential elements required in an ICF. However, the issues of confidentiality of data and payment for study participation proved to be problematic for some participants, accounting for 35% and 28% of all incorrect answers respectively.  This suggests that participants’ understanding of the underlying concepts of the required ICF elements is limited.  Ethical training of researchers and IRB members, particularly in the Asia Pacific and African regions, concerning valid informed consent is still needed.

A patient, an adultJapanese traveler who had just returned from Thailand, had developed denguehemorrhagic fever (DHF). A primary infection of dengue virus (DENV) wasconfirmed, in particular, DENV serotype 2 (DENV-2) via the detection of the virusgenome, a significant increase in its specific neutralizing antibody and the isolationof DENV-2. DHF is often observed following a secondary infection from another serotypeof dengue virus, particularly in children, but this case was a primaryinfection of DENV. Japan is a non-endemic country of dengue disease. Instead,only Japanese encephalitis (JE) is known to be an endemic flavivirus family. Inthis study, IgG antibody against Japanese encephalitis virus (JEV) was detected.JEV belongs to the family of dengue virus and prevails in Japan, particularly inKyushu. Among many risk factors for the occurrence of DHF, a plausiblecandidate could be a cross-reactive antibody-dependent enhancement (ADE)mechanism by JEV antibody. This indicates that most Japanese travelers, wholive in non-endemic areas of dengue, particularly in Kyushu, should payattention to the occurrence of DHF.

InLao PDR, the National Malaria Control Program (NMCP) evaluates bednet coverage,often at the village level, using a coverage target of one net per 2.5 (or fewer)persons in a given population. However, in villages that meet the target, notall households necessarily meet the target or utilize all available bednets. Thisstudy explored households that fell short of the target and household utilizationof bednets in villages that met the target of bednet coverage set by the NMCP. Thepersons per net ratio (PPNR), which is defined as the population divided by thenumber of available bednets in a household/village, was used to determine whethera household/village met the NMCP target. Using a household survey, we collectedand analyzed the data of 635 households in 17 villages in Xepon district in2012. Households that fell short of the target (households with a PPNR of >2.5 or no bednet) existed in every village. The proportion of these households differedgreatly among the villages, ranging from 3.4–50%, with some households fallingfar short. Of the 635 households, 275 (43.5%) had at least one bednet that wasnot being used on the night preceding the survey and 131 (20.6%) had at leasttwo. In conclusion, in villages that met the NMCP target, a considerable numberof households fell short of the target. Available bednets were not fullyutilized in many of the surveyed households.

Background: Given the shortage of medical professionals in the Philippines, Barangay HealthWorkers (BHWs) may play a role in providing postpartum healthcare services.However, as there are no reports regarding BHW activities in postpartumhealthcare, we conducted this study to understandpostpartum healthcare services and exploring the challenges and motivations ofmaternal health service providers. Methods: Focus group interview (FGI) of 13participants was conducted as Qualitative Research Methodology at Muntinlupa City. The results were analyzed according tothe interview guide. The proceedingsof the FGI were transcribed verbatim, and researchers read and coded thetranscripts. The codes were then used to construct a categories. Results: Four important activities were highlighted among 11 analysiscodes. These activities were “Assessment of postpartum women’s conditions,”“Recommendation to visit a health facility,” “Measurement of blood-pressure andvitamin intake,” and “Providing postpartum health information.” Among fiveanalysis codes, we identified three challenges that BHWs face, which were “Nocurrent information regarding postpartum care,” “Some postpartum women do notwant to receive healthcare services from BHW,” and “Too many assigned postpartumwomen.” Among five analysis codes, we identified two reasons for continuing BHWactivities, which were “Hospitality to help postpartum women and their familyin the community” and “Performance of mission in providing BHW services.” Conclusion: This study is the first to evaluate BHW activities in postpartumhealthcare services. Our results indicate that BHWs may play an important rolein evaluating postpartum women’s physical and mental conditions throughhome-visiting services. However, several difficulties adversely affected theiractivities, and these must be addressed to maximize the contributions of BHWsto the postpartum healthcare system.

Dengue virus (DENV) infection is a significant burden in Indonesia and other tropical countries. DENV infection have wide spectrum of clinical manifestations i.e. asymptomatic, dengue fever, dengue hemorrhagic fever and dengue shock syndrome. The difference of clinical manifestation may due to the deversity of genetic constitution of the host. The C-type lectin DC-SIGN (CD209) has been identified to be the major dengue receptor on human dendritic cells. There are at least five polymorphisms in exon  5 and 6 of DC-SIGN encoded gene which have been identified and recorded in dbSNP. The aim of this work is to measure the frequency of these polymorphisms among asymptomatic and hospitalized DENV infected patients. We enrolled 23 hospitalized and 73 asymptomatic DENV infected patients. Among those subject we performed PCR amplification and DNA direct seqencing for 23 hospitalized DENV infected patients and 24 asymptomatic DENV infected patients. The result showed that there were no polymorphic nucleotides in CD209 encoded gene found among the patients.

We encountered a probable case ofloiasis in a returned traveler from Central Africa. A 52-year-old Japanese womanpresented to our hospital complaining of discomfort in her eyes and skin. She reportedhaving frequently visited Central Africa over many years and having been extensivelyexposed to the rainforest climate and ecosystem. Although no microfilariae werefound in her blood, there was an elevated level of IgG antibodies against thecrude antigens of Brugia pahangi,which have cross-reactivity with Loa loa.She was treated with albendazole for 21 days, after which the antigen-specificIgG level decreased and no relapse occurred.

Organizationsworking for the elimination of Chlamydia triggered blindness (trachoma) followthe WHO SAFE (surgery of trichiasis, antibiotics, face washing andenvironmental changes) strategy with the aim to achieve a minimum of 80% ofchildren with clean faces in the endemic communities, mass treatment coveringthe whole district with trachoma rates of 10% or more and surveillance plans.Trachoma recurrence is common after implementing 3, 5 or even 7 times the SAFEstrategy, revealing that the cognitive processes that require assimilation andintegration of knowledge did not register with parents, care takers andchildren. Moreover, repeated awareness campaigns to improve hygiene did notsystematically produce irreversible changes of behavior in neglectedpopulations. Facing evidence, the rational supporting mass drug administrationas the mainstay of preventable blindness elimination requires a wider scopethan those of mathematical models. The inhibition to perceive disappointingoutcomes requiring repeated interventions may suggest from a sociologic pointof view that the strategies are product of those evaluating the activities ofthose that fund them and vice versa. In this field, similar articulationappears for reciprocal interactions of researchers with those judging thepertinence and quality of their work. So far, the lack of autocritic forcertain elimination strategy approaches may reveal inbred circles that did notclearly assess that antibiotics, trichiasis surgery and education limited toimprovement of hygiene are inefficient if not associated with long term basiceducational actions in schools.

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging disease that is endemic in East Asia. The SFTS virus (SFTSV) is transmitted to other organisms by infected ticks and is endemic to Nagasaki in western Japan. However, epidemiological information regarding SFTSV in Nagasaki ticks has not been elucidated. In this study, we first examined the sensitivities of SFTSV gene detection by real-time RT-PCR and virus isolation in cultured cells and mice. These methods could detect SFTSV in the samples containing more than 4 × 10⁰ ffu. Next, we attempted to isolate SFTSV and to detect viral gene in 2,222 nymph and adult ticks collected from May to August 2013 among seven regions of Nagasaki. However, neither virus isolation nor viral gene detection were confirmed in those tick pools. SFTSV positivity rates are considered very low in ticks and viral loads in ticks are also very limited. Further investigation by increasing the number of ticks and including larval samples in the investigation, as well as improved detection methods, may be required to find SFTSV-positive ticks in this region.