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There are approximately 8 million people with trachomatous trichiasis globally; in the year 2009, less than 160,000 people had surgery. These numbers are too low in order to achieve the goal of elimination of blinding trachoma by the year 2020. Task shifting approaches have led to the training of general nurses in trichiasis surgery in eastern Africa. The overall aim of this study was to determine the attrition and productivity (and the factors associated with productivity) of trichiasis surgeons in Kenya, Tanzania, and Malawi.A 3-year cohort study of trichiasis surgeons.The overall response rate was 86%. Defining high productivity as 50+ operations per year per surgeon, only 16.1% of the trichiasis surgeons were highly productive. Among the surgeons, 27.9% were no longer at their site and ceased providing surgery (attrition) over the 3 years of study. High productivity was associated with having been trained by an experienced trainer, supervised by a clinical officer, having more than three surgical sets, and having an outreach program.Attrition of general nurses trained in trichiasis surgery was high. Surgical productivity of trichiasis surgeons remained too low. It is likely that other approaches are needed to address the burden of trichiasis in the three countries. In terms of recommendations, training of trichiasis surgeons should be done in a "package," including a plan for provision of surgical equipment, continuous support and supervision, and outreach.

Henneguya azevedoi n. sp. is described from the piava (Leporinus obtusidens). Between 2005 and 2007, 60 fish were collected from the Mogi-Guaçu River near Cachoeira de Emas Falls located in the municipality of Pirassununga, state of São Paulo, Brazil. A total of 70% had plasmodia of the parasite. The plasmodia were white, spherical, and measured 40-200 μm in diameter. Histopathological analysis revealed that the development of the parasite was intralamellar and caused stretching of the epithelium, with accentuated deformation, as well as compression of the capillary and adjacent tissues. Ultrastructural analysis revealed that the wall of the plasmodium was a single membrane in direct contact with the host cells and contained pinocytic canals that extended into the plasmodium. The development of the parasite was asynchronous, with the earliest stages at the periphery and mature spores in the central region. Mature spores were elongated in the frontal view [mean ± standard deviation (range)]: 45.2 ± 0.6 (45.0-47.0) μm in total length, 10.0 ± 0.07 (9.9-10.2) μm in body length, 35.6 ± 0.9 (34.9-36.5) μm in caudal process length, and 4.4 ± 0.4 (4.0-5.0) μm in body width. The polar capsules were elongated and equal in size: 3.8 ± 0.3 (3.5-4.0) μm in length and 1.0 μm in width. The polar filaments were coiled in six to seven turns and perpendicular to the axis of the capsule. Scanning electron microscopy revealed smooth valves and a conspicuous rim around the spore body. This is the first time that a myxosporean has been reported in L. obtusidens.

Background Knowledge and skills of primary health care workers (PHCWs) in primary eye care have been demonstrated to be inadequate in several districts of Kenya, Malawi, and Tanzania. We tested whether enhanced supervision, focused on improving practical skills over two years, would raise the scores of these workers on a test of basic knowledge and skills. Methods This was a randomised controlled trial. All primary health care (PHC) facilities within two districts of each country were enrolled and randomly assigned by district (Kenya, Malawi) or by health care facility (Tanzania) to receive quarterly skills-based supervision by a district eye coordinator or to continue existing routine supervision. At baseline, a test of basic knowledge and skills in five key areas was administered to PHCWs, and visual acuity (VA) charts and working torches were provided. After two years the test was administered again. Changes in test scores were compared between the intervention (enhanced supervision) and the non-intervention (routine supervision) facilities. Results All 137 facilities in the six districts were enrolled including 343 PHCWs. At baseline, no facility had a visual acuity chart and 18 (13%) had a working torch; the average total skills scores were 6.04 and 6.38 (maximum of 12) in the non-intervention and the intervention facilities, respectively. After two years, 16 intervention facilities (23.2%) had a visual acuity chart correctly placed and 19 (27.5%) had a working torch, compared to 4 (5.9%) and 6 (8.8%), respectively, in the routine supervision facilities. At the facility level, the change in overall test scores was +1.84 points in the intervention sites compared to +0.42 points in the non-intervention sites (p

The class Myxosporea of the phylum Myxozoa contains 52 genera (Kent M.L., Andree K.B., Bartholomew J.L., ElMatbouli M., Desser S.S., Devlin R.H., Feist S.W., Hedrick R.P., Hoffmann R.W., Khattra J., Hallett S.L., Lester R.J.G., Longshaw M., Palenzeula O., Siddall M.E., Xiao C.X. 2001: J. Eukaryot. Microbiol. 48: 395–413), most of which parasitize fishes. Henneguya Thelohan, 1892 is the second most common of these genera and contains more than 150 species, some of which are important pathological agents (Dykova I., Lom J. 1978: J. Fish Biol. 12: 197–202; Kalavati C., Narasimhamurti C.C. 1985: Arch. Protistenkd. 129: 199–202; Lom J., Dykova I. 1995: In P.T.K. Woo (Ed.), Fish Diseases and Disorders. Protozoan and Metazoan Infections. Vol. 1. CAB International, Wallingford pp. 97–147; Martins M.L., Souza V.N., Moraes J.R.E., Moraes F.R. 1999: Rev. Bras. Biol. 59: 527– 534). In South America, Henneguya is the most abundant genus, with 31 species. To date, two species of Henneguya have been reported in Serrasalmus spp.: Henneguya iheringi Pinto, 1928 parasitizing Serrasalmus spilopleura caught in the state of Sao Paulo, and H. striolata Casal, Matos et Azevedo, 1997 parasitizing S. striolatus collected in the Amazon River estuary near Belem, state of Para, Brazil. Fish of the genus Serrasalmus are voracious carnivorous fish popularly known as piranhas and are widely distributed throughout South American rivers. In this study, we describe a new species of Henneguya parasitizing S. spilopleura. Eighteen adult and juvenile specimens of S. spilopleura were collected locally from a lake on a farm in the municipality of Campinas, state of Sao Paulo, Brazil, and examined for the presence of myxosporeans. The fish were captured between January and June 2001, and transported alive to the laboratory where they were killed by transection of the spinal cord then measured and necropsied. The measurements of 30 fresh mature spores (Lom J., Arthur J.R. 1989: J. Fish Dis. 12: 151–156) were obtained using a micrometer incorporated into a microscope eyepiece. The dimensions were expressed as the mean ± standard deviation (SD). India ink staining was used to detect the mucus envelope. The spores were checked for the presence of an iodinophilous vacuole after adding a drop of Lugol solution. Smears containing free spores were stained with Giemsa’s solution and mounted in low viscosity medium as permanent mounts (Adriano E.A., Arana S., Ceccarelli P.S., Cordeiro N.S. 2002: Folia Parasitol. 49: 259–262). For histological analysis, portions of the gills containing plasmodia were fixed in 10% buffered formalin for 24 h, embedded in paraffin, cut into sections 4 μm thick and stained with sirius red (Adriano et al. 2002, op. cit.), haematoxylin and eosin and PAS.

A new species of Myxosporea, Henneguya chydadea, is described parasitizing the gills of Astyanax altiparanae collected from a lake on Rio das Pedras farm near Campinas, state of Sao Paulo, Brazil. Of the fish examined, 88.3% had gills parasitized by myxosporeans. The prevalence of the parasite ranged from 80% in the spring and fall, 93% in the summer and 100% in the winter. The parasite induced the formation of white, oval-shaped cysts measuring 40-64 microm x 64-80 microm which deformed the gill lamellae, compressed the capillaries, and caused retraction of the neighboring lamellae. The mature spores were elongated and had two identical, parallel elongate polar capsules. Each capsule contained a polar filament with 9-10 turns. There was no mucous envelope or iodinophilous vacuole. Morphometric differences between this parasite and other species of the genus Henneguya indicated, that the parasite observed in A. altiparanae is a new species. This is the first report of a myxosporeanparasitizing A. altiparanae.