Browsing by Author "Markus, M. B."

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Association of deworming with reduced eosinophilia : implications for HIV/AIDS and co-endemic diseases
    (Academy of Science of South Africa, 2003-04) Fincham, J. E.; Markus, M. B.; Adams, V. J.; Lombard, C. J.; Bentwich, Z.; Mansvelt, E. P. G.; Dhansay, M. A.; Schoeman, S. E.
    Eosinophil counts in venous blood were monitored during a randomized controlled deworming trial (n = 155 children) that lasted for a year, and in a whole-school deworming programme (range 174-256 children) of 2 years' duration. Mean eosinophil counts (x109/I) decreased from 0.70 in the randomized trial, and 0.61 in the whole-school study, to well within the normal paediatric range of 0.05-0.45 (P < 0.05). The prevalence of eosinophilia declined from 57% to 37% in the randomized trial (mean for 400, 800 and 1200 mg albendazole doses); and from 47% to 24% in the whole-school study (500 mg stat mebendazole). Benzimidazole anthelminthics were highly effective against Ascaris but less so against Trichuris. Activated eosinophils are effector and immunoregulatory leucocytes of the T-helper cell type 2 (Th2) immune response to parasitic helminths and atopic disorders. Under conditions of poverty where soil-transmitted helminths are hyperendemic, Th2 polarization of the immune profile is characteristic. Regular anthelminthic treatment should reduce contact with worm antigens, and this may contribute to re-balancing of the immune profile. Suppression of eosinophil recruitment and activation, together with related cellular and molecular immunological changes, might have positive implications for prevention and treatment of co-endemic diseases, including HIV/AIDS, cholera, tuberculosis and atopic disorders.
  • Thumbnail Image
    Item
    Synchronized and regular deworming of children and women in South Africa : Policy and practice
    (Academy of Science of South Africa, 2005) Fincham, J. E.; Markus, M. B.; Ngobeni, J. T.; Mayosi, B. N.; Adams, V. J.; Kwitshana, Z. L.; Obihara, C. C.; Dhansay, M. A.; Jackson, T. F. H. G.
    SOUTH AFRICA IS A SIGNATORY TO WORLD Health Assembly (WHA) resolution 54.19 (May 2001), which calls for regular, synchronized treatment of helminthiasis in developing countries, particularly where the prevalence of worm infestation exceeds 50%. Helminthic infection is usually a hallmark of poverty and reasons why it should be controlled in disadvantaged communities are compelling. However, existing South African legislation regulating the procurement and use of anthelmintic medicines effectively renders group-based deworming as agreed to by WHA member states, and endorsed by the South African minister of health, non-implementable in practice. In order to make deworming sustainable, low-cost, unregistered anthelmintics must be imported from international procurement agencies. At present, this is not permitted. Another problem is that both medical and non-medical personnel are confused by out-of-date information in package-inserts regarding safety for young children and pregnant women. Albendazole and praziquantel should be de-scheduled and ivermectin, levamisole and possibly nitazoxanide should be registered in a way that permits treatment by non-medical personnel. Rational alternation of medication is important because reliance on mebendazole will lead to resistance. All batches of anthelmintics ought to comply with pharmacological quality specifications and testing should be routine. Facilities for doing this are available in South Africa.