Deficiencies were found in the management of sick children by CHWs, although care was not consistently poor. Key reasons for the deficiencies appear to be guideline complexity and inadequate clinical supervision; other possible causes are discussed.

BackgroundLymphatic filariasis (LF) is targeted for global elimination through treatment of entire at-risk populations with repeated annual mass drug administration (MDA). Essential for program success is defining and confirming the appropriate endpoint for MDA when transmission is presumed to have reached a level low enough that it cannot be sustained even in the absence of drug intervention. Guidelines advanced by WHO call for a transmission assessment survey (TAS) to determine if MDA can be stopped within an LF evaluation unit (EU) after at least five effective rounds of annual treatment. To test the value and practicality of these guidelines, a multicenter operational research trial was undertaken in 11 countries covering various geographic and epidemiological settings.MethodologyThe TAS was conducted twice in each EU with TAS-1 and TAS-2 approximately 24 months apart. Lot quality assurance sampling (LQAS) formed the basis of the TAS survey design but specific EU characteristics defined the survey site (school or community), eligible population (6–7 year olds or 1st–2nd graders), survey type (systematic or cluster-sampling), target sample size, and critical cutoff (a statistically powered threshold below which transmission is expected to be no longer sustainable). The primary diagnostic tools were the immunochromatographic (ICT) test for W. bancrofti EUs and the BmR1 test (Brugia Rapid or PanLF) for Brugia spp. EUs.Principal Findings/ConclusionsIn 10 of 11 EUs, the number of TAS-1 positive cases was below the critical cutoff, indicating that MDA could be stopped. The same results were found in the follow-up TAS-2, therefore, confirming the previous decision outcome. Sample sizes were highly sex and age-representative and closely matched the target value after factoring in estimates of non-participation. The TAS was determined to be a practical and effective evaluation tool for stopping MDA although its validity for longer-term post-MDA surveillance requires further investigation.

Campylobacter jejuni is the most common enteric pathogen isolated from university and college students in the United States. During the fall and winter quarters of the 1983-1984 academic year, the authors conducted a case-control study at the University of Georgia, Athens, Georgia, to identify risk factors for C. jejuni enteritis. Students with diarrhea whose cultures yielded C. jejuni were compared with controls matched by age, sex, and residence. A total of 45 case-control pairs were interviewed about exposures during the week before the case's onset of illness. The infections occurred sporadically and were caused by a wide variety of C. jejuni serotypes. Three risk factors were identified: eating fully cooked chicken, eating chicken reported to be raw or undercooked, and contact with a cat or kitten. No case reported drinking raw milk. No significant association was found between illness and the places where chicken meals were prepared or the specific manner in which chicken was cooked. Chicken may be the principal vehicle of transmission for sporadic Campylobacter enteritis among college students.

Action is urgently needed. Our results suggest that to improve health care delivery, interventions should target both the health system and the community level.