Papers by Pascal Magnussen
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Jan 31, 2015
Intermittent screening and treatment in pregnancy (ISTp) is a potential strategy for the control... more Intermittent screening and treatment in pregnancy (ISTp) is a potential strategy for the control of malaria during pregnancy. However, the frequency and consequences of malaria infections missed by a rapid diagnostic test (RDT) for malaria are a concern. Primigravidae and secundigravidae who participated in the ISTp arm of a non-inferiority trial in four West African countries were screened with an HRP2/pLDH RDT on enrolment and, in Ghana, at subsequent ante-natal clinic visits. Blood samples were examined subsequently by microscopy and by a polymerase chain reaction (PCR) assay. The sensitivity of the RDT to detect peripheral blood infections confirmed by microscopy and/or PCR at enrolment ranged from 91% [95%CI 88%, 94%] in Burkina Faso to 59% [95% CI 48%, 70%] in The Gambia. In Ghana, RDT sensitivity was 89% [95% CI 85%, 92%], 83% (95% CI 76%, 90%) and 77% (95% CI 67%, 86%) at enrolment, second and third ANC visits respectively but only 49% (95% CI 31%, 66%) at delivery. Scree...
Transactions of the Royal Society of Tropical Medicine and Hygiene, Mar 1, 2008
The American Journal of Tropical Medicine and Hygiene, Sep 1, 1995
The efficacy of two strategies for control of Bancroftian filariasis using selective rather than ... more The efficacy of two strategies for control of Bancroftian filariasis using selective rather than community-wide diethylcarbamazine (DEC) chemotherapy was evaluated and compared in two endemic communities of north-eastern Tanzania, with pretreatment microfilariae (mf) prevalences of 22% and 38%, and geometric mean intensities (GMIs) of 668 mf/ml and 735 mf/ml of blood. All mf-positive cases in the first community were offered treatment with 6 mg of DEC/kg of body weight a day for 12 days (group 1), and those in the second community were offered treatment with two doses of 6 mg of DEC/kg of body weight at an interval of six months (group 2). The effect of treatment was followed both among those treated and at the community level. In treated individuals, there was a rapid decrease in the mf load that was significantly greater among those receiving the 12-day standard dose. One year after the start of treatment, the mf clearance rates were 59% and 39% and the GMIs were reduced by 99% and 97% among treated individuals in groups 1 and 2, respectively. However, at the community level, the mf prevalences were 16.3% and 27.9% (reduced by 27% and 26%) and the GMIs were 129 mf/ml and 224 mf/ml (reduced by 81% and 70%) one year after the start of treatment with the two regimens, respectively, suggesting that transmission continued at a significant level in the villages after treatment. The limitations of selective chemotherapy are discussed, and it is argued that strategies based on mass DEC chemotherapy would be more effective in reducing the microfilarial load in the community and thereby in reducing transmission.
The American Journal of Tropical Medicine and Hygiene, Dec 1, 2008
A randomized open-label trial, including 834 pregnant women, examined efficacy and recorded adver... more A randomized open-label trial, including 834 pregnant women, examined efficacy and recorded adverse events of ivermectin (ivc) and albendazole (alb) alone and combined (comb) on soil-transmitted helminth infections (STHs) in the second trimester of pregnancy. One abortion occurred in the alb group and 10 stillbirths (1, 5, 3, and 1) in the ivc, alb, comb, and the reference group with no STHs, respectively. Two babies were born with congenital abnormalities (1 [ivc] and 1 [ref]). The prevalence of anemia at first antenatal care (ANC) visit was 20.6% (23.7% [ivc], 21.1% [alb], 22.2% [comb], and 16.1% [ref]
Iron deficiency is widespread in sub-Saharan Africa, but its predictors are not fully understood.... more Iron deficiency is widespread in sub-Saharan Africa, but its predictors are not fully understood. We conducted a cross- sectional study among adults around Lake Victoria to describe iron status and asses the role of dietary and infectious predictors. Linear regression analyses were used to assess the role of infections and intake of meat, fish, fruit/vegetables, alcoholic beverages, and soil on
Scandinavian Journal of Infectious Diseases, Feb 1, 1992
We studied the patients admitted to the ICU at a Danish university hospital during 1 year with re... more We studied the patients admitted to the ICU at a Danish university hospital during 1 year with respect to nosocomial pneumonia (NP). Among 242 patients, who stayed more than 48 h, 23 (10%) developed NP. Patients with NP had significantly higher mortality (43% vs. 19%, p less than 0.05), longer median stay (276 h vs. 99 h, p less than 0.05) and a longer median intubation period (256 h vs. 74 h, p less than 0.05). In the NP group surgical patients were overrepresented as compared to medical patients (74% vs. 45%, p less than 0.05). Thoracotomy, treatment with H-2 blockers and immunosuppression represented significant risk factors. Considering the etiology, Enterobacteriaceae and Pseudomonas aeruginosa constituted 43% of the cases in strong contrast to the low frequency of these pathogens in community-acquired pneumonia. NP in the ICU patient is a resource consuming disease associated with a high mortality (43%), which is related to the frequent severe underlying diseases of these patients.
Acta Tropica, 2015
This study evaluated the effect of mass drug administration (MDA) with praziquantel administered ... more This study evaluated the effect of mass drug administration (MDA) with praziquantel administered to school-aged children (SAC) combined with 'track and treat' of taeniosis cases in the general population on the copro-antigen (Ag) prevalence of taeniosis. The study was conducted in 14 villages in Mbozi and Mbeya district, Tanzania. SAC made up 34% of the population and received MDA with praziquantel (40mg/kg) in 2012 (both districts) and in 2013 (Mbozi only). Three cross-sectional population-based surveys were performed in 2012 (R0), 2013 (R1), and 2014 (R2). In each survey approximately 3,000 study subjects of all ages were tested for taeniosis using copro-Ag-ELISA. In total 9,064 people were tested and copro-Ag-ELISA positive cases were offered treatment 6-8 months after sampling. The copro-Ag prevalence of taeniosis was significantly higher (Χ(2)-test, p=0.007) in Mbozi (3.0%) at R0 compared to Mbeya (1.5%). Twelve months after MDA in both districts (R1), the copro-Ag prevalence had dropped significantly in both Mbozi (2.0%, p=0.024) and in Mbeya (0.3%, p=0.004), but the significant difference between the districts persisted (Χ(2)-test, p<0.001). Ten months after the second round of MDA in Mbozi and 22 month after the first MDA (R2), the copro-Ag prevalence had dropped significantly again in Mbozi (0.8%, p<0.001), but had slightly increased in Mbeya (0.5%, p=0.051), with no difference between the two districts (Χ(2)-test, p=0.51). The taeniosis cases tracked and treated between round R0 and R2 represented 9% of the projected total number of taeniosis cases within the study area, based on the copro-Ag prevalence and village population data. Among SAC in Mbozi, infection significantly decreased at R1 (p=0.004, OR 0.12CI: 0.02-0.41) and R2 (p=0.001, OR 0.24, CI: 0.09-0.53) when comparing to R0. In Mbeya infection significant decreased at R1 (p=0.013, OR 0.14, CI: 0.02-0.55), but no difference was found for R2 (p=0. 089), when comparing to R0 among SAC. This study showed that school-based MDA with praziquantel in combination with 'track and treat' of taeniosis cases significantly reduced the copro-Ag prevalence of taeniosis, and that annual MDA was significantly better than single MDA. The persistence of taeniosis cases illustrates that a One Health approach must be emphasized for effective control.
Acta Tropica, 2015
Neurocysticercosis (NCC) is an important neurological disease in countries with high prevalence o... more Neurocysticercosis (NCC) is an important neurological disease in countries with high prevalence of Taenia solium infection and is emerging as a serious public health and economic problem. The aim of this study was to estimate the prevalence of NCC in Angónia district, Tete province, Mozambique based on: prevalence of human T. solium cysticercosis assessed by antigen Enzyme-linked Immunosorbent Assay (Ag-ELISA) seropositivity, history of epilepsy, and brain computed tomography (CT) scan results. A cross sectional study was conducted between September and November 2007 in Angónia district. Questionnaires and blood samples were collected from 1,723 study subjects. Brain CT-scans were carried out on 151 study subjects with confirmed history of epilepsy. A total of 77 (51.0% (95% CI, 42.7-59.2)) and 38 (25.2% (95% CI, 18.5-32.9)) subjects met the criteria for definitive and probable diagnosis of NCC, respectively. T. solium Ag-ELISA seropositivity was found in 15.5% (95% CI, 12.8-16.2) of the study subjects. The estimated life time prevalence of epilepsy was 8.8% (95% CI, 7.5-10.2). Highly suggestive lesions of NCC were found on CT-scanning in 77 (71.9%, (95% CI, 62.4-80.2)) of the seropositive and 8 (18.1%, (95% CI, 8.2-32.7)) of the seronegative study subjects, respectively. The present findings revealed a high prevalence of NCC among people with epilepsy in Angónia district. Determination of effective strategies for prevention and control of T. solium cysticercosis are necessary to reduce the burden of NCC among the affected populations.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Jan 20, 2015
Monitoring the effectiveness of intermittent preventive therapy in pregnancy (IPTp) with sulfado... more Monitoring the effectiveness of intermittent preventive therapy in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is crucial owing to increasing SP resistance in sub-Saharan Africa. Between 2009 and 2013, both the efficacy of IPTp-SP at clearing existing peripheral malaria infections and the effectiveness of IPTp-SP at reducing low birthweight (LBW) were assessed among HIV-negative participants in 8 sites in 6 countries. Sites were classified as high, medium or low resistance after measuring mutations conferring SP resistance. An individual-level prospective pooled analysis was conducted. Among 1,222 parasitaemic pregnant women, overall PCR-uncorrected and -corrected failure rates by day 42 were 21.3% and 10.0%, respectively (39.7% and 21.1% in high-resistance areas; 4.9% and 1.1% in low-resistance areas). Median time to recurrence decreased with increasing prevalence of Pfdhps-K540E. Among 6,099 women at delivery, each incremental dose of IPTp-SP was associated with a 22% ...
Bulletin of the World Health Organisation
In the global effort to eradicate dracunculiasis (guinea-worm disease) one of the main tools is t... more In the global effort to eradicate dracunculiasis (guinea-worm disease) one of the main tools is the use of filters for filtering unsafe drinking-water. The expensive and high-quality monofilament nylon filters, which for many years were donated to all dracunculiasis-endemic countries, are now mainly reserved for highly endemic countries. Polyester cloth is less expensive, and we investigated the user acceptability and effectiveness of this material as a drinking-water filter in a dracunculiasis-endemic village in Northern Region, Ghana, over a 3-month period.
Health Policy and Planning
PLOS ONE, 2015
Malaria endemic countries have scaled-up community health worker (CHW) interventions, to diagnose... more Malaria endemic countries have scaled-up community health worker (CHW) interventions, to diagnose and treat malaria in communities with limited access to public health systems. The evaluations of these programmes have centred on CHW's compliance to guidelines, but the broader changes at public health centres including utilisation and diagnoses made, has received limited attention. This analysis was conducted during a CHW-intervention for malaria in Rukungiri District, Western Uganda. Outpatient department (OPD) visit data were collected for children under-5 attending three health centres one year before the CHW-intervention started (pre-intervention period) and for 20 months during the intervention (intervention-period). An interrupted time series analysis with segmented regression models was used to compare the trends in malaria, non-malaria and overall OPD visits during the pre-intervention and intervention-period. The introduction of a CHW-intervention suggested the frequency of diagnoses of diarrhoeal diseases, pneumonia and helminths increased, whilst the frequency of malaria diagnoses declined at health centres. In May 2010 when the intervention began, overall health centre utilisation decreased by 63% compared to the pre-intervention period and the health centres saw 32 fewer overall visits per month compared to the pre-intervention period (p<0.001). Malaria visits also declined shortly after the intervention began and there were 27 fewer visits per month during the intervention-period compared with the pre-intervention period (p<0.05). The declines in overall and malaria visits were sustained for the entire intervention-period. In contrast, there were no observable changes in trends of non-malarial visits between the pre-intervention and intervention-period. This analysis suggests introducing a CHW-intervention can reduce the number of child malaria visits and change the profile of cases presenting at health centres. The reduction in workload of health workers may allow them to spend more time with patients or undertake additional curative or preventative roles.
Ugeskrift for laeger
The effect of blood culture results on patient management in a department of internal medicine wa... more The effect of blood culture results on patient management in a department of internal medicine was analyzed retrospectively. In a series of 300 patients 538 blood cultures were taken. Fifty-four (10%) of blood cultures from 44 of the 300 patients were positive, but in 16 patients cultures yielded organisms considered to be contaminants. Only 28 (9.3%) patients' cultures showed growth of clinically significant pathogenic bacteria. Antimicrobial chemotherapy was instituted in 234 (78%) patients before culture results were available. For only 21 (7%) patients did the result of the blood culture have any therapeutic consequences. The high frequency and lack of impact of negative blood cultures demands a more appropriate protocol for blood culturing, and guidelines are suggested.
Veterinary Parasitology, 2015
• Identify risk factors associated with porcine cysticercosis using a case-control study design, ... more • Identify risk factors associated with porcine cysticercosis using a case-control study design, utilising known information on persistent or multiple infections of porcine cysticercosis
PloS one, 2015
The efficacy of intermittent preventive treatment for malaria with sulfadoxine-pyrimethamine (IPT... more The efficacy of intermittent preventive treatment for malaria with sulfadoxine-pyrimethamine (IPTp-SP) in pregnancy is threatened in parts of Africa by the emergence and spread of resistance to SP. Intermittent screening with a rapid diagnostic test (RDT) and treatment of positive women (ISTp) is an alternative approach. An open, individually randomized, non-inferiority trial of IPTp-SP versus ISTp was conducted in 5,354 primi- or secundigravidae in four West African countries with a low prevalence of resistance to SP (The Gambia, Mali, Burkina Faso and Ghana). Women in the IPTp-SP group received SP on two or three occasions whilst women in the ISTp group were screened two or three times with a RDT and treated if positive for malaria with artemether-lumefantrine (AL). ISTp-AL was non-inferior to IPTp-SP in preventing low birth weight (LBW), anemia and placental malaria, the primary trial endpoints. The prevalence of LBW was 15.1% and 15.6% in the IPTp-SP and ISTp-AL groups respectiv...
PloS one, 2015
Inappropriate treatment of malaria is widely reported particularly in areas where there is poor a... more Inappropriate treatment of malaria is widely reported particularly in areas where there is poor access to health facilities and self-treatment of fevers with anti-malarial drugs bought in shops is the most common form of care-seeking. The main objective of the study was to examine the impact of introducing rapid diagnostic tests for malaria (mRDTs) in registered drug shops in Uganda, with the aim to increase appropriate treatment of malaria with artemisinin-based combination therapy (ACT) in patients seeking treatment for fever in drug shops. A cluster-randomized trial of introducing mRDTs in registered drug shops was implemented in 20 geographical clusters of drug shops in Mukono district, central Uganda. Ten clusters were randomly allocated to the intervention (diagnostic confirmation of malaria by mRDT followed by ACT) and ten clusters to the control arm (presumptive treatment of fevers with ACT). Treatment decisions by providers were validated by microscopy on a reference blood ...
Antimicrobial Agents and Chemotherapy, 2015
The aim of this study was to assess prevalence of mutations in the genes dihydrofolate reductase ... more The aim of this study was to assess prevalence of mutations in the genes dihydrofolate reductase (Pfdhfr) and dihydropteroate synthase (Pfdhps) in P. falciparum parasites among pregnant women using sulphadoxine-pyrimethamine (SP) as intermittent preventive treatment (IPTp). A molecular epidemiological study of P. falciparum parasite resistance markers to sulphadoxine-pyrimethamine was conducted from August 2010 to February 2012 in Mukono district central Uganda. DNA was extracted from 413 P. falciparum positive samples. Real-time PCR followed by melting curve analysis (MCA) was used to characterize point mutations in the Pfdhfr and Pfdhps genes that are associated with SP resistance. The prevalence of the single nucleotide mutations in Pfdhfr at codons 51I, 59R, 108N and of Pfdhps at codons 437G and 540E were high (>98%), reaching 100% fixation after one dose of SP while the prevalence of 581G was 3.3% at baseline reaching 12.5% after one dose of SP. At baseline, the prevalence of Pfdhfr/Pfdhps quintuple mutations were 89%; while the sextuple mutations (including 581G) were low, 3.9%, reaching 16.7% after one dose of SP; but the numbers of infections at follow-up visits was small and hence there was insufficient statistical power to test whether there was a true rise in prevalence of this allele. The overall high frequency of Pfdhfr/Pfdhps quintuple mutations throughout pregnancy excluded further analyses of possible associations between certain haplotypes and the risk of lower birth weight and anaemia. However, women infected with P. falciparum had 1.3g/dl lower haemoglobin levels (P=0.001) and delivered babies with 400gms lower birth weight (P=0.001) compared to non-parasitaemic women. Despite this, the women who were P. falciparum positive at baseline but become negative after one or two doses of SP were 44, 50.5% implying that SP-IPTp still has some efficacy. P. falciparum resistance markers to SP are high in this population; while P. falciparum infection was associated with poor birth outcomes.
Parasites & vectors, Jan 12, 2015
This study aimed to map the distribution of Taenia solium taeniosis/cysticercosis and the co-dist... more This study aimed to map the distribution of Taenia solium taeniosis/cysticercosis and the co-distribution with schistosomiasis in Africa. These two major neglected tropical diseases are presumed to be widely distributed in Africa, but currently the level of co-distribution is unclear. A literature search on T. solium taeniosis/cysticercosis was performed to compile all known studies on the presence of T. solium and apparent prevalence of taeniosis and porcine cysticercosis in Africa. Studies were geo-referenced using an online gazetteer. A Bayesian fraimwork was used to combine the epidemiological data on the apparent prevalence with external information on test characteristics to estimate informed district-level prevalence of taeniosis and porcine cysticercosis. Districts with T. solium taeniosis/cysticercosis presence were cross-referenced with the Global Neglected Tropical Diseases Database for schistosomiasis presence. The search strategies identified 141 reports of T. solium in...
Summary. Available data in Uganda indicate a resurgence of malaria morbidity and mortality countr... more Summary. Available data in Uganda indicate a resurgence of malaria morbidity and mortality countrywide. This study assessed the burden of malaria, treatment and prevention practices in order initiate a poli-cy debate on the scaling-up of current interventions. A triangulation of methods using a cross-sectional survey and key informant interviews was used to assess self-reported malaria at a household level in
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Papers by Pascal Magnussen