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Objective To assess whether traditional measures of access to health care (distance and travel time to a facility) and non-traditional measures (social and financial support indicators) are associated with mortality among children under 5 years of age in the Gambia. Methods We conducted a case-control study in a population under demographic surveillance. Cases (n = 140) were children under 5 years of age who died between 31 December 2003 and 30 April 2006. Each case was matched in age and sex to five controls (n = 700). Information was gathered by interviewing primary caregivers. The data were analysed using conditional logistic regression. Findings Of traditional measures of access, only rural versus urban/periurban residence was important: children from rural areas were more likely to die (OR: 4.9; 95% confidence interval, Ch 1.2-20.2). For non-traditional measures, children were more likely to die if their primary caregivers lacked help with meal preparation (OR: 2.3; 95% Ch 1.2-4.1), had no one to relax with (OR: 1.8; 95% Ch 1.1-2.9), had no one who could offer good advice (OR: 23.1; 95% Ch 4.3-123.4), had little say over how earned money was spent (OR: 12.7; 95% Ch 1.3-127.6), were unable to cut spending for health care (OR: 2.5; 95% Ch 1.5-4.2) or had to carry out odd jobs to pay for the care (OR: 3.4; 95% Ch 2.1-5.5). A protective effect was observed when the caregiver had other children to care for (OR: 0.2; 95% Cl: 0.1-0.5). Conclusion Improving access to health-care for children in the Gambia and similar settings is not simply a matter of reducing travel time and distance to a health facility, but requires improvements in caregivers&apos; support networks and their access to the financial resources they need. Objectif Evaluer les eventuelles associations entre les mesures classiques de l&apos;acces aux soins (distance et duree du trajet jusqu&apos;a l&apos;etablissement) ou les mesures non conventionnelles (indicateurs de soutien social et financier) et la mortalito des enfants de moins de 5 ans en Gambie. Methodes Nous avons mene une etude cas-tomoins dans une population sous surveillance demographique. Les cas (n = 140) etaient des enfants de moins de 5 ans, decedes entre le 31 decembre 2003 et le 30 avril 2006. Chaque cas etait apparie selon l&apos;age et le sexe a 5 tomoins (n = 700). Des informations ont eto recueillies en interrogeant les aidants principaux. Les donnees ont ete analysees par regression logistique classique. Resultats Parmi les mesures classiques de l&apos;acces aux soins, seule la distinction entre residence en milieu rural et residence en milieu urbain ou periurbain etait importante :les enfants provenant de zones rurales avaient une plus grande probabilito de mourir (OR: 4,9; IC a 95 % 1,2-20,2). S&apos;agissant des mesures non conventionnelles, la probabilito de deces des enfants etait plus forte si leur aidant principal manquait d&apos;aide pour la preparation des repas (OR : 2,3 ;IC a 95 % : 1,2-4,1), n&apos;avait personne avec qui se detendre (OR : 1,8 ; IC a 95 % : 1,1-2,9), n&apos;avait personne pour lui prodiguer de bons conseils (OR: 23,1 ; IC a 95 % : 4,3-123,4), n&apos;avait pas son mot a dire sur la facon dont l&apos;argent gagne etait depense (OR: 12,7 ; IC a 95 % : 1,3-127,6), etait dans l&apos;incapacito de reduire les depenses de santo (OR :2,5 ;IC a 95% : 1,5-4,2) ou devait effectuer des << petits boulots >> pour payer ces depenses (OR : 3,4 ;IC a 95 % : 2,1-5,5). Un effet protecteur a ete observe lorsque l&apos;aidant principal devait egalement s&apos;occuper d&apos;autres enfants (OR : 0,2 ; IC a 95 % : 0,1-0,5). Conclusion Ameliorer l&apos;acces aux soins des enfants en Gambie ou dans d&apos;autres contextes similaires ne signifie pas seulement reduire le temps de trajet et la distance jusqu&apos;a l&apos;etablissement de soins, mais suppose un renforcement des reseaux de soutien aux aidants et un meilleur acces pour eux aux ressources financieres dont ils ont besoin. Objetivo Determinar si las medidas tradicionales (distancia y tiempo de viaje hasta un establecimiento) y no tradicionales (indicadores de apoyo social y financiero) de acceso a la atencion de salud guardan relacion con la mortalidad entre les menores de 5 anos en Gambia. Metodos Llevamos a cabo un estudio de casos y controles en una poblacion sometida a vigilancia demografica. Les casos (n = 140) fueron ninos menores de 5 anos fallecidos entre el 31 de diciembre de 2003 y e130 de abril de 2006. Cada case se emparejo por edad y sexo con cinco controles (n = 700). Se entrevisto a les cuidadores principales para reunir la informacion pertinente, analizandose luego les datos mediante regresion Iogistica condicional. Resultados De las medidas tradicionales de acceso, solo la residencia rural frente a la urbana/periurbana tenia un efecto importante: los ninos de las zonas rurales tenian mas probabilidades de morir (OR: 4,9; intervalo de confianza (IC) del 95%: 1,2-20,2). En cuanto a las medidas no tradicionales, los ninos tenian mas probabilidades de morir cuando sus cuidadores principales carecian de ayuda para preparar las comidas (OR: 2,3; IC95%: 1,2-4,1), no disponian de nadie con quien distenderse (OR: 1,8; IC95%: 1,1-2,9), no tenian a nadie que pudiera ofrecerles buenos consejos (OR: 23,1; IC95%: 4,3-123,4), no podian influir apenas en las decisiones de gasto det dinero ganado (OR: 12,7; IC95%: 1,3-127,6), no podian reducir el gasto en atencion de salud (OR: 2,5; IC95%: 1,5-4,2) o tenian que desempenar trabajos poco corrientes para pagar la atencion (OR: 3,4; IC95%: 2,1-5,5). Un efecto protector rue que el cuidador tuviera que ocuparse tambien de otros ninos (OR: 0,2; IC95%: 0,1-0,5). Conclusion La mejora del acceso a la atencion sanitaria para les ninos de Gambia y entornos similares no estriba simplemente en reducir el tiempo de viaje y la distancia a les centros de salud. Es preciso mejorar las redes de apoyo a les cuidadores y su acceso a les recursos financieros que necesitan., Une traduction en francais de ce resume figure a, la fin de l'article. Al final de/articulo se facilita una traduccion al espanol Introduction Every year approximately 10 million children under [...]

ABSTRACT Background Very little longitudinal information is available regarding the performance of T cell-based tests for Mycobacterium tuberculosis infection. To address this deficiency, we conducted a longitudinal assessment of the [...]

OBJECTIVE. To compare the enzyme-linked immunospot (ELISPOT) assay with the tuberculin skin test (TST) in children for the diagnosis of Mycobacterium tuberculosis infection in the Gambia. METHODS. We divided child contacts of sputum smear-positive tuberculosis cases into 3 age categories ( RESULTS. In child contacts of 287 cases, 225 (32.5%) of 693 were positive by TST and 232 (32.3%) of 718 by ELISPOT. The overall agreement between tests was 83% and the discordance was not significant. Both tests responded to the M tuberculosis exposure gradient in each age category. The percentage of those who were TST positive/ELISPOT negative increased with increasing exposure. At the lowest exposure level, the percentage of ELISPOT-positive children who were TST negative was increased compared with the highest exposure level. Neither test had evidence of false positive results because of BCG. CONCLUSIONS. In Gambian children, the ELISPOT is slightly less sensitive than the TST in the diagnosis of M tuberculosis infection from recent exposure, and neither test is confounded by prior BCG vaccination. Evidence of reduced TST sensitivity in subjects with the lowest known recent M tuberculosis exposure suggests that, when maximal sensitivity is important, the 2 tests may be best used together. Key Words tuberculin skin test, ELISPOT, tuberculosis, Mycobacterium tuberculosis, Abbreviations TST--tuberculin skin test BCG--Bacille Calmette Guerin ESAT-6--early secretory antigenic target 6 CFP-10--culture filterate protein 10 ELISPOT--enzyme-linked immunospot MRC--Medical Research Council SFU--spot forming units OR--odds ratio CI--confidence interval TUBERCULOSIS IN [...]

Abstract Background Molecular genotyping of bacteria has revolutionized the study of tuberculosis epidemiology, yet these established laboratory techniques typically require subjective and laborious interpretation by trained professionals. In the context of a Tuberculosis Case Contact study in The Gambia we used a reverse hybridization laboratory assay called spoligotype analysis. To facilitate processing of spoligotype images we have developed tools and algorithms to automate the classification and transcription of these data directly to a database while allowing for manual editing. Results Features extracted from each of the 1849 spots on a spoligo film were classified using two supervised learning algorithms. A graphical user interface allows manual editing of the classification, before export to a database. The application was tested on ten films of differing quality and the results of the best classifier were compared to expert manual classification, giving a median correct classification rate of 98.1% (inter quartile range: 97.1% to 99.2%), with an automated processing time of less than 1 minute per film. Conclusion The software implementation offers considerable time savings over manual processing whilst allowing expert editing of the automated classification. The automatic upload of the classification to a database reduces the chances of transcription errors.

Staphylococcus aureus is one of the most common causes of hospital-acquired infections. At the same time, 25% of healthy persons are symptom-free S. aureus carriers, and they have an increased risk of developing nosocomial S. aureus septicemia. Paradoxically, their prognosis is much better than that of noncarriers. We compared the antibody profiles for carriers and noncarriers toward S. aureus superantigens. In carriers, we found high titers of neutralizing antibodies specific for those superantigens that are expressed by their colonizing strain. The results show that carriage status confers strain-specific humoral immunity, which may contribute to protection during S. aureus septicemia. [ABSTRACT FROM AUTHOR]

The purified protein derivative (PPD) skin test for Mycobacterium tuberculosis infection lacks specificity. We assessed 2 more specific M. tuberculosis antigens (ESAT-6 and CFP-10) by enzyme-linked immunospot assay (ELISPOT) compared with PPD by ELISPOT and skin test in The Gambia. Of 735 household contacts of 130 sputum smear–positive tuberculosis cases, 476 (65%) tested positive by PPD ELISPOT, 300 (41%) tested positive by PPD skin test, and 218 (30%) tested positive by ESAT-6/CFP-10 ELISPOT. Only 15 (2%) had positive ESAT- 6/CFP-10 results and negative PPD results by ELISPOT. With increasing M. tuberculosis exposure, the percentage of subjects who were PPD skin test positive/ESAT-6/CFP-10 ELISPOT negative increased (P < .001) whereas the percentage of subjects who were PPD skin test negative/PPD ELISPOT positive decreased (Pp ). Eighteen (31%) SAT-6/CFP-10 ELISPOT–positive subjects in the lowest exposure category had negative .011 PPD skin test results. ESAT-6/CFP-10 ELISPOT probably offers increased specificity in the diagnosis of M. tuberculosis infection in this tropical setting of endemicity, at the cost of some sensitivity. [ABSTRACT FROM AUTHOR]

Background: Mycobacterium tuberculosis (MTb) infects approximately 2 billion people world-wide resulting in almost 2 million deaths per year. Determining biomarkers that distinguish different stages of tuberculosis (TB) infection and disease will provide tools for more effective diagnosis and ultimately aid in the development of new vaccine candidates. The current diagnostic kits utilising production of IFN-gamma in response to TB antigens can detect MTb infection but are unable to distinguish between infection and disease. The aim of this study was to assess if the use of a longer term assay and the analysis of multiple cytokines would enhance diagnosis of active TB in a TB-endemic population., Methods: We compared production of multiple cytokines (TNF-alpha, IFN-gamma, IL-10, IL-12(p40), IL-13, IL-17 and IL-18) following long-term (7 days) stimulation of whole-blood with TB antigens (ESAT-6/CFP-10 (EC), PPD or TB10.4) from TB cases (n = 36) and their Mycobacterium-infected (TST+; n = 20) or uninfected (TST-; n = 19) household contacts (HHC)., Results and Conclusions: We found that TNF-alpha production following EC stimulation and TNF-alpha and IL-12(p40) following TB10.4 stimulation were significantly higher from TB cases compared to TST+ HHC, while production of IFN-gamma and IL-13 were significantly higher from TST+ compared to TST- HHC following PPD or EC stimulation. Combined analysis of TNF-alpha, IL-12(p40) and IL-17 following TB10.4 stimulation resulted in 85% correct classification into TB cases or TST+ HHC. 74% correct classification into TST+ or TST- HHC was achieved with IFN-gamma alone following TB10.4 stimulation (69% following EC) and little enhancement was seen with additional cytokines. We also saw a tendency for TB cases infected with M. africanum to have increased TNF-alpha and IL-10 production compared to those infected with M. tuberculosis. Our results provide further insight into the pathogenesis of tuberculosis and may enhance the specificity of the currently available diagnostic tests, particularly for diagnosis of active TB.