A. De Muynck

Multi-centre evaluation of repeatability and reproducibility of the direct agglutination test for visceral leishmaniasis

Summary objective  To evaluate the repeatability and reproducibility of the serological direct agglutination test (DAT) for visceral leishmaniasis (VL) with aqueous antigen in a multi‐centre study in VL‐endemic areas in Sudan, Kenya and Nepal.

Uptake of preventive health care among Mediterranean migrants in Belgium.

STUDY OBJECTIVE--The aim was to investigate the influence of ethnicity on the demand for preventive care by Mediterranean migrants in Belgium. DESIGN--This was a survey of patient contacts with general practitioners. SETTING AND PATIENTS--33 general practitioners working in Belgian localities with the highest migrant density collaborated in the study. During two months they recorded information on consultations with an estimated 72,600 clients. Participation was obtained from all subjects attending for preventive care or for a new episode of illness (n = 6256). MAIN RESULTS--An average of 30% of the patients sought preventive care, but multivariate analysis showed ethnicity to be a strong independent predictor of this type of demand. The higher primary preventive uptake by female Moroccans and Turks and the higher secondary preventive uptake by males from the same ethnic groups, as compared with the Belgian reference population, contrasted with a lower demand for tertiary prevention in migrants of either gender. The relative demand for preventive care by the more acculturated migrants was, however, quite similar to the demand of the Belgian population. CONCLUSIONS--The differential uptake of primary preventive care could be partly explained by the higher fertility rates of immigrant women, and the differential secondary uptake by a lower incidence of tuberculosis in the indigenous population. The meagre demand for tertiary prevention by Moroccan and Turkish migrants could be due to weaker compliance with treatments for chronic disorders, which is related to the perceptions of illness in these ethnic groups. The establishment of cross cultural mechanisms of dialogue should enhance compliance and improve the access of immigrants to the benefits of tertiary preventive care.

THE INCUBATION TIME OF RELAPSES AFTER TREATMENT OF MULTIBACILLARY LEPROSY WITH RIFAMPICIN CONTAINING REGIMENS

In order to determine the duration of follow-up needed to evaluate the efficacy of short-course bactericidal regimens for multibacillary leprosy, information is needed on the incubation time of relapses after stopping treatment. Several groups of patients, who had been on rifampicin-containing regimens, were followed up for periods ranging from 4 to 10 years, Two groups of relapses were observed: early relapses occurring within 3.5 years after stopping treatment, with a median incubation time of 1 year and 10 months (upper limit of 95% confidence interval: 2 years); and late relapses occurring more than 3.5 years after stopping treatment, with a median incubation of 5 years. Early relapses are probably due to insufficient treatment, and late relapses to persisting bacilli or to reinfection. It is concluded that the efficacy of short-course RMP-containing therapeutic regimens can be evaluated by observing the occurrence of early relapses, 50% of which occur before 2 years after the end of therapy.