Selective Primary Health Care

Walsh, Julia; Warren, Kenneth S.

doi:10.1056/nejm197911013011804

Cited by 819 publications

(79 citation statements)

References 29 publications

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“…In 1979, the infection affected 500-700 million people in Africa, Asia and Latin America (Walsh and Warren, 1979). In 1999, the infection rate increased to 1049 million cases, including 114 and 233 million preschool and schoolchildren, respectively, and caused 220 million deaths (Crompton, 1999;Stephenson et al, 2000).…”

Section: Introductionmentioning

confidence: 99%

Trichuriasis and low-iron status in schoolchildren from Northwest Mexico

et al. 2010

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Background/Objectives: The aim of this study was to investigate the association between trichuriasis and iron status in rural schoolchildren from Northwest Mexico. Subjects/Methods: A total of 73 schoolchildren (37 boys, 36 girls) between the ages of 6 and 10 years were voluntarily recruited from the public primary school of the rural community of El Higueral in Culiacan, Sinaloa (Northwest Mexico) for a cross-sectional study with a longitudinal follow-up of 5 weeks. Data were collected on socioeconomic status, anthropometry, haematological and biochemical indices of iron status, daily iron intake, and prevalence and intensity of trichuriasis. Multiple regression models, independent t-test and paired t-test were used to analyse the association between trichuriasis and iron status in cross-sectional and longitudinal samples, respectively. Adjusted models were tested for linear regression assumptions using residual plots. Results: The mean age of the Trichuris-free and Trichuris-infected groups was 7.7±1.3 and 7.7±1.5 years respectively (P ¼ 0.92). The height for age was significantly higher in the Trichuris-free group than the Trichuris-infected group (P ¼ 0.02). No differences were found in the socioeconomic variables between the two groups. At baseline, significantly higher concentrations of haemoglobin, haematocrit, blood cell count (RBC) and serum iron were measured in the Trichuris-free group compared with the Trichuris-infected children (Po0.05). An association was found between trichuriasis and haemoglobin adjusted for socioeconomic variables, age and sex. Haemoglobin, RBC and serum ferritin concentrations were significantly increased in the infected children 5 weeks after treatment (Po0.05). Conclusions: Trichuriasis could be a risk factor for low-iron status in the schoolchildren of Northwest Mexico.

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Section: Introductionmentioning

confidence: 99%

Trichuriasis and low-iron status in schoolchildren from Northwest Mexico

et al. 2010

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“…Parasitic protozoa of the genus Leishmania are the etiological agents of leishmaniasis, a disease that affects an estimated 12 million people worldwide (1) and ranges from the disfiguring cutaneous form to fatal visceral leishmaniasis (2). Because current empirically identified drugs suffer from many deficiencies, including toxicity and resistance, it is important to identify unique biochemical targets that could be exploited for rational development of improved therapies.…”

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confidence: 99%

“…Analysis of one of these cosmids has led to the identification of two ORFs encoding 491 amino acids, designated LdNT1. 1 …”

mentioning

confidence: 99%

Cloning of Leishmania nucleoside transporter genes by rescue of a transport-deficient mutant

Vasudevan

Carter

Drew

et al. 1998

Proc. Natl. Acad. Sci. U.S.A.

121

118

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All parasitic protozoa studied to date are incapable of purine biosynthesis and must therefore salvage purine nucleobases or nucleosides from their hosts. This salvage process is initiated by purine transporters on the parasite cell surface. We have used a mutant line (TUBA5) of Leishmania donovani that is deficient in adenosine͞pyrimi-dine nucleoside transport activity (LdNT1) to clone genes encoding these nucleoside transporters by functional rescue. Parasitic protozoa of the genus Leishmania are the etiological agents of leishmaniasis, a disease that affects an estimated 12 million people worldwide (1) and ranges from the disfiguring cutaneous form to fatal visceral leishmaniasis (2). Because current empirically identified drugs suffer from many deficiencies, including toxicity and resistance, it is important to identify unique biochemical targets that could be exploited for rational development of improved therapies. Perhaps the most striking metabolic discrepancy between parasites and their hosts is the purine pathway. Whereas most mammalian cells synthesize purines de novo, all parasitic protozoa studied to date are unable to synthesize purines (3) and consequently must rely on purine acquisition from their hosts for survival and growth. The first step in this salvage pathway involves the transport of these substrates across the parasite plasma membrane. Moreover, these purine transporters initiate the uptake of certain pyrazolopyrimidine analogs of hypoxanthine and inosine that are toxic to both Leishmania and Trypanosoma (4). These pyrazolopyrimidines, such as allopurinol, allopurinol riboside, and formycin B, are subsequently metabolized to the nucleotide level by the parasite metabolic machinery and incorporated into RNA, metabolic transformations that do not occur in mammalian cells (4). Both the essential nutritional function of these transporters and their roles in mediating the toxicities of well-characterized antiparasitic agents provide compelling rationale to study these membrane permeases at the molecular level.Biochemical and genetic studies have established that Leishmania donovani parasites express two distinct nucleoside transporters with nonoverlapping substrate specificities (5). One transporter mediates the uptake of adenosine and pyrimidine nucleosides and also transports tubercidin, a cytotoxic analog of adenosine, whereas the other transporter allows membrane permeation of guanosine, inosine, and formycin B (5). Parasites deficient in either or both transport activities have been isolated by mutagenesis with N-methyl-NЈ-nitro-N-nitrosoguanidine followed by selection in tubercidin or formycin B (6). The availability of these null mutants provided a functional strategy for cloning genes encoding each of these nucleoside permeases.In the present study, we have transfected the adenosine͞pyrimidine nucleoside transport-deficient TUBA5 cell line with a cosmid library containing inserts of L. donovani genomic DNA (7) and screened individual transfectants for restoration of tubercidin...

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“…The goal of comprehensive primary health care for all (WHO, 1978) is accepted as "above reproach" (Walsh and Warren, 1979); and should include "promotive, preventive, curative and rehabilitative services" (WHO, 1978). In the long term, strengthening health systems to provide such care to the whole population would also best meet MDG 4 and MDG 5.…”

Section: Campaigns Versus Routine Servicesmentioning

confidence: 99%

Mothers and Children: Designing research toward integrated care for both

Stalcup

Verguet

2012

hcs

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The Millennium Development Goals (MDG) set time-bound targets that are powerful shapers of how and for whom health is pursued. In this paper we examine some ramifications of both the temporal limitation, and maternal-child health targeting of MDG 4 and 5. The 2015 end date may encourage increasing the number of mass campaigns to meet the specific MDG objectives, potentially to the detriment of a more comprehensive approach to health. We discuss some ethical, political, and pragmatic ramifications of this tendency, and show that these are not unique to the MDGs but rather have a long history in health policy debates. We also examine attempts to counter a narrow focus on vertical interventions in campaigns through integrated health system delivery platforms. We argue that the way forward is not to assume that evidence is value free, but rather to make explicit the political and ethical decisions in the design of metrics and evaluation research. We propose an index of five factors that should be included in research designed to inform decision making about providing interventions as part of routine services or periodic campaigns, toward serving more members of the population, and long-term strengthening of the health system via integrated health interventions.

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Selective Primary Health Care

Cited by 819 publications

References 29 publications

Trichuriasis and low-iron status in schoolchildren from Northwest Mexico

Trichuriasis and low-iron status in schoolchildren from Northwest Mexico

Cloning of Leishmania nucleoside transporter genes by rescue of a transport-deficient mutant

Mothers and Children: Designing research toward integrated care for both

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