Ioan Eerikäinen Bulzan
TROPICAL DISEASES AND THEIR
SIMULTANEOUS TREATMENT
WORLDWIDE
Bachelor’s Thesis
Degree Program in Nursing
January, 2010
DESCRIPTION
Date of the bachelor's thesis:
15.01.2010
Author:
Degree program and option:
Ioan Eerikäinen Bulzan
Degree Program in Nursing
Option: Bachelor of Nursing
Name of the bachelor's thesis:
Tropical Diseases and Their Simultaneous Treatment Worldwide
Abstract:
Th ur
f th tudy w t v lu t n r l m d t n th t u d f r numb r
f n gl t d tr
ld
t th
m t m t f nd ut wh h tr tm nt
nb
u
ful f r th ty
f
r h. F r th ur
f th tudy, l t r tur
r h
w
rr d ut nd M dl n d t b
w
r h d (1966 thr ugh Jun 2007) f r
R T tudy ng r l drug tr tm nt f r n gl t d tr
ld
.
rd ng t th
d t , r und n b ll n
l r ff t d by n r m r n gl t d tr
ld
( TD). Th y r
n d r d "n gl t d" b u th y r t x lu v ly n th
r t nd m t m rg n l z d. R rt furth r r v l d th t d
t th m gn tud f
th numb r f
l uff r ng fr m n gl t d tr
ld
, l th n 1% f th
n rly 1400 drug r g t r d b tw n 1975 nd 1999 w r u d t tr t tr
l
d
. Th f gur
nd d t u d n th tudy r v l d th t th v r u f t r th t
r h m r ng ff rt t r u fr m bl v n th TD, w ll
r gr
n th
r v nt n, l m n t n nd r d t n f m f th
d
. R ult f this
tudy r v l d th t nt gr t n f tr tm nt f r tr
ld
n b f l t t d by
tr t ng 2 r m r d
mult n u ly.
Subject headings, (keywords):
Tropical, disease, simultaneous, treatment, serum, electrolyte, randomized, controlled,
neglected, drug, therapy, precaution, fever, water, health, sanitation, prevalence;
Pages:
Language:
82 pages + appendices 8 pages
English
URN:
Remarks, notes on appendices:
Tutor:
Leila Pihlaja
Employer of the bachelor's thesis:
Table of Content
1.INTRODUCTION ....................................................................................................... 1
1.1.A Short History of Tropical Diseases .................................................................. 1
2.TROPICAL DISEASES IN DEVELOPED COUNTRIES ........................................ 5
2.1.Malaria………………………………………………………………………….. 5
2.2. th r M qu t -B rn D
2.3. l h nt
nd R v r Bl ndn
2.4.Fl tw rm , n l , nd
2.5. Try n
.............................................................................8
m D
h t
........................................................................9
m
............................................................. 10
........................................................................................11
2.6. More Tropical Diseases...................................................................................... 13
3.THEORETICAL FRAMEWORK ............................................................................ 17
4.HYPOTESIS ............................................................................................................. 18
5.THE PROBLEM TO BE SOLVED .......................................................................... 19
6.LITERATURE REVIEW .......................................................................................... 20
7.REVIEW OF FLUID, ELECTROLYTE AND MINERAL PERTUTBATIONS
IN TROPICAL DESEASES...................................................................................... 27
7.1.R n l H m dyn m
7.2.Bl
7.3.R
7.4.
........................................................................................ 30
d V lum .................................................................................................... 33
n
T Flu d L d ng ............................................................................... 34
th l l Tr n
7.5. h ng
n
rt f
d um nd W t r n Tr
rum l tr lyt
lD
...................... 36
Hy n tr m .................................................. 38
7.6.Hy rn tr m .................................................................................................... 40
7.7.Hy k l m ...................................................................................................... 40
7.8.Hy rk l m ..................................................................................................... 41
7.9. h ng
n
rum M n r l ............................................................................... 42
l m ................................................................................................... 42
7.10.Hy
7.11.Hy r l m .................................................................................................. 43
7.12.Hy
h
h t m ........................................................................................... 44
7.13.Hy r h
h t m .......................................................................................... 45
7.14.Hy m gn
7.15.Tr
m ............................................................................................. 45
El m nt ................................................................................................. 46
8.DISEASE SEVERITY .............................................................................................. 47
9.TROPICAL MEDICINE ........................................................................................... 48
10.METHODOLOGY .................................................................................................. 51
10.1.
m l
l t n ............................................................................................. 53
10.2. ut m M
ur
f N gl t d Tr
lD
M n g m nt ................... 55
11.RELIABILITY AND QUALITY OF RESEARCH……………………………...56
12.RESULTS................................................................................................................ 59
12.1.Drug Th r y nt rv nt n T rg t ng 4 N gl t d Tr
lD
........... 60
12.2.Drug Th r y nt rv nt n T rg t ng 3 N gl t d Tr
lD
........... 62
12.3.Drug Th r y nt rv nt n Targeting 2 N gl t d Tr
lD
........... 64
13.CONCLUSIONS ..................................................................................................... 64
14.FUTURE RESEARCH DIRECTIONS… … … … … … … … … … … … … … … … ... 66
15.LIMITATIONS........................................................................................................69
16.BIBLIOGRAPHY ................................................................................................... 70
APPENDICES - 8 pages
1
1.INTRODUCTION
The purpose of this study was to evaluate an oral medication that is used for number
of neglected tropical diseases at the same time to find out which treatments can be
successful for this type of approach. Results of this study revealed that integration of
treatment for tropical diseases can be facilitated by treating 2 or more diseases
simultaneously.
1.1.A Short History of Tropical Diseases
Th n
l g
ur
l
t g ry f tr
nn t n
l rg -
gr w ut f th
nd th Un t d t t
th n hundr d y r , tr
m n ng,
ld
lm d n b
nt f r
l hum n d
t th
l
tub r ul
th
t
ntry w ll
l ng-t rm n
th r n ly
bt
try n
m
r m ry l u
nd
l ). Th
f th gl b l burd n f d
l
f tr n m
mm nt nly n th m t m rt nt
t t n n m
nt m n t d nv r nm nt—
, nd l
n n tr
fd
n lud f ur d
u h
d by
l r
v t,
b l ty ( h rt- r
z n
tr n m tt d by th
n
d ( n h
); tw
untr
r . (Chirac, 2006 p. 26)
l t d by Murr y nd L
hm n
t n f
u
v r ty r n r
u
); f ur tr n m tt d by th r rthr
d
l
g nt but t gl b lly d tr but d
r v l n
d,
f th r l ng
f und t d y n tr
v rty, hung r, nd l k f m d
, h g
ngly d v d f
nd th r m rg n
f m qu t (m l r , d ngu h m rrh g f v r, J
lym h t f l r
ntury. n l
n ) r du d th d nt f
rt n f d
r v t r-b rn
Th l t f nf t n w th
th
t rm n r
lm t
, H V, nd m k ng, wh
njun t n f
m
m nt ( m ng th r r
g n . n dd t n, th l rg t r
r
nd f th n n t nth
n f
r h, d t r r t ng ubl h lth nfr tru tur , nd r
n w v t r-b rn nf t n n t m r t
r n t du t
l n l x n
n
r
qu r d by
h l t , nd
,
nt t w th
l ( nt t n l n m t d nf t n ) r w t r w th
2
nf t d n l ( h t
r t n
nt t
r by fl
th
m
t dm d
h t ry, r v nt v m
f tr n m
d
rt lly r n t t ll r v r
n
d
h lt
fr m h k r r
fd y
f lln
rm yb
r l k ly t
th m t
th t th tru lln
v nf rd t
M l r
m r m
h rt
burd n
,l
h rt,
b l ty ( th r th n th n
d
hm n
nfr t
t t n du t
v r ty f th n t l
d
nd
z r m l r (by f r
, nd nt t n l n m t d ,
ll w d by th
ntry. t mu t b
und r t m t d b
u
qu l
, th m j r r du r
rd ng t Murr y nd L
m nth r l ng r, w th r l
th
. n
m h
f th l k f l
th y r
z d, th ugh,
lr
ur
,
ll t n (H t z 2004, . 24).
r
r nt b t
r nt f untr t d.
n ur m t r d f
r
ur th nf t n w ll
b l ty r du d by th d
. m ng ll th
rly d th
ntr t, th
(f l
rum,
f v r, h ll , w t , nd h d h f r
t rr gul r nt rv l f r y r th r ft r,
r v d d. F l
h k, r n l nd l v r f lur , n
n
n b f und
l f -thr t n ng yndr m
n th
, v l , nd v v x) nd r du
w kt
10–40
d
u d by ny f f ur r t z n l m d um
m l r
unl
r t ry
mm n), f l r
n d r d n th
t n f th n tur l
ym t m t . nly m l r , d ngu , nd
r du
nd
r n l
n t x
, th n t l nf t n u u lly r du
) m tly d
nd
u
th l ng-t rm d
nf t n, nd th r ult ng l ng-t rm d
m l r lr l
n.
nt m n t d
, r l ng d
, tr tm nt ( f v l bl ) t
und ff r nt t d f br l lln
n
nt t w th
ur , nd drug th r y f r th
l wh r . n ll f th
J
qu r d thr ugh
(tr h m ); nd l r y, f r wh h l
u
lm t ll f th
); n
h l
f
rum m l r m y r gr
thy, nd
m , w th
r br l m l r m y r
t j und
-f t l ty r t
v r w th gn f
,
f
nt
t (M lyn ux 2005, . 99).
v r m nf t t n
t d nf t n th t r
f lym h t f l r
t v f r y r . Wu h r r
r u u lly th r ult f
b n r ft , Brug
m l y , nd
3
Brug
t m r l rv , tr n m tt d by m qu t
, l dg n th lym h t
lung
nd m y r du
thm , hr n lung d
d
, rthr t , d n t , lym h ng t , hylur , nd l h nt
r xy m l n turn l
l mb . Drug tr tm nt l r m t m r f l r
dult w rm ,
t mu t u u lly b r
th tr tm nt f th
t nt
w ll n w th lym h, wh h
nd ur
f knl
r
h
r t
w th urg ry.
r
r v nt
th
y , v u l d turb n
)
l
u
f nf t d
r
r
d
untr
m l r d n t n by th r h rm
wh t
b
u
ut
l
numb r f
f th
r t z n g nu L
nd th n h l
lln
w th
h
f th
ff
ml t n
y nd
fd
f ty f th drug
d d tr but n n tw rk n
t bl h d ubl h lth y t m ), t mul t d
m l h df r
ut n u
n 1987 w
mmun ty-b
t nt lly b
nd r du
yt m
d d t d n t t w th ut h rg . Th g ft
uld
ndfl
. Th
t l f br u n dul , nd, f th y r
r
t bl h ng
( v n f th y h d n
hr n
r
(Utz ng r 2006, . 44).
th m nuf tur r (M r k) d
ff t d r
n b tr t d
w th lym h w ll ng
mul um (bl k) fl
k n nd r du
r bl ndn
r v d d th n nt v f r
)
r du d by f l r l w rm ( n h
Th ntr du t n f v rm t n f r n h
nd b
r t l
ntly ubl h d.(Dreyer et al 2002, p. 52)
nd tr hy, ub ut n u
d v l
lg l n
, l v t n f ff t d l mb , nd w r ng f
m gr t thr ugh th
tr tm nt n l
rn
m l h d thr ugh g d hyg n , r v nt n
v lvulu ) but tr n m tt d by th b t
kn d m
r
nd ry b t r l nf t n n r
v ry u ful gu d f r m n g m nt f r
(r v r bl ndn
m r fl r
,r n l
d but m y n t d tr y ll
l ( ll t n f flu d n d th
b nr
nd th
f th g n t l
t d t y rly nt rv l . Th
nb
n, x r
. Hydr
(lym h d m ) h
n h
t
fr m th bl
u
nd mu
m n
, nd
D th r y. L
hm n ,
ll
n
hm n
n x m l
,
u d by
tr n m tt d by th b t
n th t m y l t w k
nt n u ly, nly t r ur v n y r l t r w th d
f
f
r m nth
m n t n nd
4
n
h ryng l t
u d tru t n. V
f v r, d rrh , bd m n l
m
t n,
Th
rn
n, h
r ll
t
hm n
(k l - z r), h r t r z d by
l n m g ly,
n yt
n , nd r gr
v
u u lly f t l w th n 3–20 m nth f untr t d (F n h m 2003, . 16).
l nt t n l n m t d nf t n
n yl t m du d n l , n yl t m
r undw rm d
(
r h kw rm d
yl n um, nd N
r lumbr
(un n r
t r m r
d ), nd tr hur
, by
nu ),
(Tr hur tr h ur )
(H t z 2006, . 20).
H kw rm gg
d w th f
h t h n th gr und. L rv
(u u lly th b r f t) nd m gr t thr ugh lym h t
tr h , nd th n d wn th
w ll, f d ff th
r
h gu t th
t nt' bl d, nd r du
m y r ult n ulm n ry nf ltr t ,
fd
b l ty n h vy nf t n
n m , hy
r
r nd f
r
nf t n m y r du
th u nd
rn
“tr
l
lz dm d
r h blt t nf r
n y, w th hy
h t
ulm n ry
l
hr m m r yt
r
f th nt t n , nd h vy
f ll w : n ur l g
r
m
r f r h g
hm n
r
nd r
, nd n h
qu l
l nd hy
h l t du t d ngu
, nd l r y; k n
, l r y, l
2006, . 15).
r r qu r d by th l ng-t rm
n b gr u d
v ru , lym h t f l r
tr tm nt f r n h
u
l d v l m nt f h ldr n.
tt h t th mu
r br l m l r , n
lym h t f l r
h d y. Th
b w l b tru t n, bl dy t l , d rrh , nutr t n l
l” nf t n
t
f gg
ugh, nd tr h t , but th m j r
n y, nd gr wth r t rd t n n h ldr n ( h r
Th
h
m ll nt t n , wh r th y tt h t th
qu r d by th ng t n f gg thr ugh
nt m n t d v g t bl . Th l rv
d f
nd bl d t th lung , u th
r t n m , nd r t rd d m nt l nd hy
nd Tr hur
n tr t hum n k n
rJ
;
m g
rd my
l n; nd
thy, ur n ry
h lt
hth lm l g
rd l g
h t
n
urg ry f r
, tr h m , nd l r y; g tr nt r l g
nd h g
l
n
n tru t v
r
f th
l x rt
l, ur l g
m
n
l, nd
, nd f l r l
5
nt r t t l lung d
,r
t v ly. Unf rtun t ly, th
ul t n w th th r h ghly nd m
t
du t n nd m d
v r d
rv
, u h
l tt nt n nd r
l
r r qu r d by
H V, th t h v l ttl
burd n d by
v rty nd
m lnutr t n.(Hotez 2006, p. 60)
2.TROPICAL DISEASES IN DEVELOPED COUNTRIES
t ll, tr
ll t
ld
r m r
mm nly f t r th r
nf t n w th th m.
un n t ry
r v l nt n d v l
r d. W r r fug
n m
nd
nd t n du t r
nv r nm nt n wh h n
t
l r
ng
untr
, wh r
nd t n
m gr t ng t
th r r
rry
tr
h lth y t m . nd
d urb n z t n nd r
nd th r n m l
d
ul t n gr wth f t r n
n tr n m t d
- r du ng
rg n m .
2.1.M l r
m tm
ll d th K ng f D
l , 90% f th m n fr
M l r
u d by f ur
nf t d f m l
n h l
h ll , nd flu-l k
d l y d,
d
m qu t
r
r h. m r
n wh h v
n K ny ," h
k ng f v r, h k ng
r l v r r bl m m y d v l . f tr tm nt
n h ldr n b
u
m , nd d th.
th y l k mmun ty,
y tr
l
mdr. l n M g ll, M.D., f W lt r R d rmy n t tut
n n fr
mmun ty t m l r
t , tr n m tt d t hum n by
. ym t m n lud
ym t m . n m
l t Lt.
fr
f l m d um
m ny fr
u t 500 m ll n
, w th u t 2.7 m ll n d th , m tly y ung h ldr n.
v r nf t n m y l d t k dn y f lur ,
M l r k ll
R
, m l r y rly tr k
lk
urv v d
--tr v l r
h ld', h
t g fv
r tr
-- l
r
y . Th y h v m r
nd d v l
y , " f y u dr w bl d fr m 100
tr kb
u
f
th r
v r m l r th n
d mmun ty. " t ur tudy t
m ngly n rm l fr
n
t th
6
l
l m rk t, y u'
d f nd m l r
nf t d, nd th tr n m
r
t
n m t f th r bl d tr m . Th y'
r
n y l g
n, but th y d n'
th v
bv u ll ff t ."
(Albonico 2003, p. 343-352)
Th n t n l
r
rt
nt r f r D
y r fm l r
qu r d n r
ntr l nd r v nt n ( D ) g t
n th Un t d t t .
n
f th w rld wh r m l r
1957, n rly ll th
kn wn t
D m t m l r , n f t, w
d l r d r d
t d n th
fr m 1957 thr ugh 1994, th
D g t 76 r
rt
tr n m tt d l
ty n 1993.
m t
1995 r
, vd n
d
,"
r
lly, n lud ng
y
nt thr ugh ut th
m qu t
f l
t d th t l
D m l r
w r
ur.
untry n th 1940 . But
fm l r
th t m y h v b n
m fr m uburb n N w J r y n 1991 nd N w Y rk
rt fr m M h g n w
nd
b ut 1,000
th f r t th t f r n rth n
lly nf t d m qu t
x rt L wr n
1972. " n
d d tr n m t th
B r t, M.D. " n
h l
m qu t
r
nt gu u Un t d t t . But w '
v n v r f und n nf t d
n th Un t d t t . M r r
rum m l r , th m r
ntly, w '
v h d utbr k
f l m d um
v r f rm. W w nt t m n t r th v ry l
ly."
(Albonico 2003, p. 343-352)
F r
v r ld
d
ft r th
tr tm nt nd r v nt n w
t l r t d, f t- t ng, nd
h.D.,
hl r qu n n f l
t nly 9
(N
n
r r u dh r
r
ur
h ld,"
t D
r
r d n
f rm l r
). "Th drug w
uth m r
nd v ntu lly nt
fr
w ll
y R b rt Gw dz,
, N t n l n t tut
D). H w v r, n th 1950 , h
nt n nt
nm tm l r u
Th FD h
nt t
rum m l r
r d thr ugh ut b th
h r
hl r qu n ( r l n nd g n r
t nt h f, L b r t ry f
nd nf t u D
u l
nd W rld W r, th drug f h
y ,r
nd
f ll rgy
t n
uth
. " hl r qu n
t
t
nd
n w
." (Albonico 2004, p. 1205-1210)
r v d num r u
nly f r nd
t n
nt -m l r drug . M ny r n t m rk t d
th r th n m l r .
7
hl r qu n r m n th tr tm nt f h
t ll u
t bl t th drug. R
f r
t n
mm n, h w v r, nd lt rn t v drug
n th Un t d t t , B r t
rum m l r
b n d nt f d. F r
untr
b
m ng m r
ry.
l
wh r r
t n
t d m l r wh
t
hl r qu n h
r t
ll t t k
r l
u d n th Un t d t t . M fl qu n (L r m) nd
u d t tr t hl r qu n -r
t nt f l
n t urr ntly m rk t d h r . ntr v n u qu n n
rum m l r .
u d n th r
. (Albonico 1995, p. 538-541)
Th n d n
fr
t n
fm l r
t
ff t v n
nt nu
hl r qu n
nd
t
nd
n r
, Gw dz
v r l f t
y ,"n
rt du t th
ub t tut , but l
t b l ty f m qu t -k ll ng n
t
r d
t r du d
d ." (Balk 2002. p 273-
282)
n 1995, th W rld H lth rg n z t n
r
t n
tr t b
n
u
uth
t
t
n h ng f rm t
t B l gy nd B
l
nd f gur
n t
N
r h. G ldm n
D
tr n m
h m try
ut h w t
y t m t m n t r drug
f . Th
r
th hum n mmun
t dr t rf rr
v lu t n nd R
t bl h d
nd th W t rn
G ldm n, h.D.,
r
r
th b t r g m n f r tr tm nt f m ld t
m l
m d n , ntr v n u qu n d n
H l f ntr n
hl r qu n
r n
qu r d n r
t nt w th
h l f ntr n (H lf n) r
t
u d by
y , r l qu n n g v n t g th r w th th r t tr y l n
ulf d x n - yr m th m n (F n d r)
m d r t f l
t nt w th m l r
y
r h t FD '
nt t
ndu t r
t th
t
n b d ff ult t
y t m,
nt r f r B l g
nt r' L b r t ry f
r h "t l rn h w th
nt rru t t. f w m k
y N l
br k n th
r
r l , m yb w
nf t n."
nt t
l
n fm l r
r
ndu t ng th f r t hum n tr l f v
r
t
fr m nf t d
l .
t k
n t bl k
8
2.2. th r M qu t -B rn D
d
m qu t
ty
, m nly .
f d ngu v ru
untr
,
h y r. .
gy t , n urb n-dw ll ng n
u ng b ut 20 m ll n
gy t m qu t
u u lly r
l dt
v r w th ut
m l
n m r th n 100
t nd t b t n th d yt m ,
n, nd
v m t ng nd r h.
n
f tr tm nt. ym t m
n 15 y r h t L t n m r
m r th n 600,000
d gn
v r
t nt
r u , d ngu h m rrh g f v r
tr t d w th b d r t, ntr v n u flu d , nd drug t r du
d m
lly ju t
udd nly w th h gh f v r,
m tm
t n .M r
h k, bl d ng, nd d th. Th r
d ngu
n tr n m t f ur
fd
ft r d wn nd ju t b f r d rk. D ngu f v r b g n
fr nt l h d h , j nt nd mu l
t,
nd th
f h m rrh g f v r
n
nb
f v r. n 1995, th w r t
r bb n. W rldw d , th
u d 24,000 d th . D
n 1995
d d ngu f v r n 86 U. . tr v l r , u fr m 46 dur ng 1993-1994 nd 17 n
1992.
.
gy t m qu t
y ll w f v r
l
d m
r d th y ll w f v r v ru .
n th
m r
d m th t y r. M ld y ll w f v r
nv lv bl d ng nd l v r r bl m ,
m , nd d th. Tr tm nt
WH
nd g v n t
rg n z t n (
d m .
585-589)
H
r v dv
n
1950. W t fr
u
flu-l k
m tm
H ) h l d n th v
th r g n l WH
nt r . Th
n t n
ff
x r n d n
v r
l d ng t d l r um,
n
. Y ll w f v r v
n t n
l
ym t m .
ym t m t . r v nt n
r n l r t t n g n t m qu t
ru n 1995 h d th b gg t
m
f r th
t
nvul
n,
fv
n t n nd
n mu t b
r v d by
n m r
gn th t
m r
m y
n H lth
ntr ll d th
ru
. (Albonico 1994 p.
9
2.3. l h nt
nd R v r Bl ndn
W rm r l t d t th h rtw rm th t
fl r
, d
ff t ng b ut 120 m ll n
d , n h l , nd v r u
Th
n hurt d g
dult w rm
th r m qu t
n g v hum n lym h t
l w rldw d . nf t d f m l
d
t th w rm l rv
n d m g th lym h y t m, r ult ng n l h nt
w ll ng n th l g , rm , nd th r r
. Th FD h
(H tr z n) f r tr tm nt. urg ry m y b n d d f
r
--d f gur ng
r v d d thyl rb m z n
rt n r
, u h
th
u d by r -l rv l nd dult t g
f
r tum,
ff t d.
R v r bl ndn
n h
r
wh l b t ng.
r
( n h
r
v lvulu , f l r l
dly fl w ng r v r
l wh h v
rt n r
)
t tr n m tt d by f m l bl k fl
nd tr m , bl k fl
n h
f
r
r
f r nf t n, wh h
b t by d y. M t f th 17.6 m ll n
r n fr
ntr l m r
, th ugh th d
u u lly f und n m r
u h
ym t m n lud
n xtr m ly t hy r h, lum
nfl mm t n th t
n l d t bl ndn
D hm
r vd
r
th drug fr
v l bl h r fr m th
B h r, n
drug
f tw
t th
t
, f ld
t g wh n t
untr
t wh
but r
ld
tl wr k
nly wh n th y t y n th
nt t , nd
und r th
r
r
v lunt r .
k n, nd y
.
u
ym t m . M r k, h r &
wh r r v r bl ndn
v r
ubl h lth
nd th r drug f r tr
rt b
D und r n gr m nt w th th FD .
h rm
nd b l g
th Un t d t t
t
n r
n
l ng t m n r l
v rm t n k ll th
mm n n
w ll. h rt-t rm tr v l r
m
. L v ng n r
rv
th drug
rv
, "w
.M t r f rr r d
v l bl thr ugh th
rv
mm n. t
rd ng t J hn
r vd
rt n
." v rm t n
r n t
r v d n
r v d d und r nv t g t n l drug x m t n gr nt d by
th FD . (Albonico 1999, p. 591-596)
10
N
D' L b r t ry f
l h nt
r
t D
nd r v r bl ndn
r r
mmun l gy
t n. "Th
r
rt n m rt nt
th m, m nuf tur
t t tub
t nt,
y Th m
r
n ugh
r h t w rd v
. Wh l n rly v ry n
f w nd v du l
f t
ndu t r
w
db
t
nt b d
f r
m
Nutm n, M.D., wh h d
t nt nd v du l h v
r
x
n
nf t d,
n
n th r bl
r t n . W d nt fy th
d th t
r t n, l n
n tudy th m, nd th n t t th m." T t ng
n t d f n n m l , wh h d n'
t t k th nf t n
n
hum n d .
(Barry 2007, p. 2561-2564).
2.4.Fl tw rm , n l , nd
Fl tw rm
u
v lv nt
h t.
h t
r r
k n, m l
. F r t- t g l rv
nd f m l
r bl dd r nd m t . gg
u ly, r t rt ng th
d
m
m
l rv , wh h x t th
n tr t ng th
nt t n
h t
l d t
n l
nd w m l ng t f nd hum n
r r
m v n th bl
x r t d n hum n w t
y l . b ut 200 m ll n
b ut 200,000 d th
r du n t t th w rm , but t
nf t n m y b
ym t ml
r
nd u
l w rldw d
d tr m t th
n th w t r
r nf t d.
v r
h y r.
M t ym t m
j nt nd mu l
nf t fr hw t r n l , th n
u
gg tr
u h ym t m
n, d rrh , nd n u
. hr n
d nt
f v r, t hy r h, h d h ,
nf t n
k dn y , nd bl dd r, r nt t n . Th FD h
u . h rt-t rm
n d m g th l v r,
r v d r z qu nt l (B ltr
d )
tr tm nt.
l
wh r
Lu
h t
m
( n l nd n th
uth rn h n , th
r k r
m t r v l nt n lud Br z l, u rt R
t W t nd
hl
n , nd
); gy t nd m t f ub-
h r n fr
uth
D . t gr t t
t
,
rd ng t
l wh w d , w m, r b th n fr h w t r n rur l r
r nd n l h t
r
r
nt.
, nd t.
wh r
; nd
nt t n
11
Tr v l r t
u h r
hl r n t d
d gr
ff
r
h uld n t w m n fr h w t r;
l,
lt w t r, l k th
n nd
n d r d l w r k. B th ng w t r h uld b h t d t 122
F r tr t d w th
dn
r hl r n ,
f lt r m y r m v th
r
f r dr nk ng. F lt r ng w t r w th
t . f th
m th d
mm nd th t tr v l r l t b th ng w t r t nd thr
r m
d y;
r
bl , D
r r
r r ly l v
l ng r th n 48 h ur . (Bartoloni 1993, p. 114-116)
2.5.Try n
m D
Th
r
Try n
l
ng
fl
t
kn
m bru
g mb n
. b ut 20,000
nd T. bru
w rldw d
, wh h b t dur ng th d y, tr n m t th
t fr
' l
ng
kn
th " l
ng"
, du t T. bru
rt f th lln
r r
rh d
fr
n
n
.
nf t n,
' hr n g mb n
nfu
u
r u d
unt l m nth t y r
n lud f v r, h d h , l th rgy, nd
n
rt d y rly. nf t d t t
xtr m ly
ym t m w th n d y t w k . W t fr
u
rh d
u
v r ty m y n t
ft r x
ur . ym t m
n, wh h m y r gr
t
nvul
n,
m , nd d th.
ur m n, v l bl fr m th
rh d
n
fr m th
l
ng
D ,
kn
f r th
.M l r
D t tr t f n l t g
rly t g
r l, n r n d r v t v ,
f b th v r t
. f th
g mb n , h w v r, th drug fl rn th n ( rn dyl),
ff t v
nd
r bl m n
g mb n
Try n
m
l
m
ntr l nd
d f
f b
u
r l
n
t nt . fl rn th n
ng
ruz
kn
u
uth m r
t , th y d
m l r
t th
; t
f b th g mb n
u
n t ff t v f r rh d
, wh h ff t
. Th
r
r
t , wh h
v l bl
kn wn t h v
r v d by th FD ,
r u , v n f t l, n rv u
u ful f r b th
h g 'd
t nt
l
nd
rly nd l t
n
tl
kn
t g
m r
yt m
f
.
t 16 m ll n
t nf t r duv d bug . Wh n th bug
n nt r hum n thr ugh br k n th
l n
12
k n r thr ugh mu u m mbr n , u h
y . Th b t r v nt n
th t h bu ld ng ,
v d
lly th
r y ng nf t d r
n t
t
th t wh h l n
th n
, m uth, r
t nt l r duv d h b t t --mud, d b , nd
w th r k
nd u ng b d n t
h rt-t rm t g , h g 'd
r r v
nh l
m y
u
. f th
n'
tf
bl ,
r v nt nf t n.
n
ym t m
rm y
u
f v r,
w ll n lym h n d , nd nfl mm t n f th h rt r, r r ly, th br n. D th
ur, m nly n h ldr n, but m t
d
r ng ft r f ur t
d v l
r u,
n nl rg d
urv v , th r ym t m u u lly
x w k . M ny y r l t r, b ut f urth f
m tm
h gu
t nt
r
f t l, h rt nf t n r d m g d d g t v
l n f r th l ng t rm. N furt m x
f r th tr tm nt f h rt-t rm h g 'd
tr tm nt f r hr n
lln
b ut 70% f
h g 'd
w r r
by th
m
f th
nd f th
r
,
d t n t n w r t ur t r
h m r hyl x , thr
untr
b g n
ntury.
n
th n, h u
H r
r gr m t
nf t t n h
rt . (Beach 1999, p. 479-486)
t nt w r f m l ,
rt n r B njul. N n tr v ll r d d n t t k
u d hl r qu n
dur t n f th r t y n G mb w
t y d f ur w k . Thr
r , but ll thr
f th
b tw n 27 nd 66 y r . Th r tr v l
r
b tw n n
h d
ny
r hyl x . T n f th 12
v d nf rm t n b ut th m l r r k nd r
nt n v
r gu y, nd
x
t l., 2008 p. 15). F v
v n w r m l . g d tr but n w
t nt wh
t
rt d b tw n 3 nd 27 N v mb r 2008, ll F nn h tr v ll r
r turn ng fr m G mb (V lv
r
v l bl fr m D
t d nt - r
ur n rg nt n , B l v , Br z l, h l ,
d l n d 75% t 98% n
Tw lv
n
rg n , u h
.
Urugu y. n 1991, th h lth m n t r
lmn t
. Th r
t nt
m l
v r d. F r n n
mm nd d h m
nd tw w k
x
t nt h d
r hyl x . Th
tf r n
t n th t r qu r d tr tm nt n
t nt , th d gn
w
m d
13
w th n thr
d y
b n d gn
f n t f ym t m . Th thr
d w th d l y f u t
t nt w th
m l
t n h d
ght d y .
2.6.More Tropical Diseases
Th tr pics r usu lly d fin d s th t p rt f th
qu t ri l w rld b und d by th
tr pics f C nc r nd C pric rn. D fining tr pic l inf cti us dis s is n t s
str ightf rw rd. lm st ll inf cti us dis s s c n b f und in th tr pics; th r
gr t numb r th t ccur pr d min ntly in th tr pics; nd th r
sl ping sickn ss, th t r
r
r
f w, such s
nly f und in th tr pics. B f r discussing s m
m r pr v l nt tr pic l inf cti ns f t d y, it is w rth t king bri f l
f th
k t th hist ry
f f w f th s inf cti ns.
Tr pic l spru , n
pr gr ssiv
f inf cti us dis s s c using g n r liz d m l bs rpti n, is
nd chr nic m l bs rptiv dis s
ccurring in p pl living in c rt in
tr pic l c untri s. This dis s ch r ct riz d by bn rm liti s in int stin l structur
nd functi n, sympt ms r l t d t m l bs rpti n, nd g t r sp n t tr tm nt with
f lic cid, t tr cyclin , r b th. Tr pic l spru is diff r nt with subclinic l
m l bs rpti n, n nd mic c nditi n in tr pic l c untri s th t m y pr duc simil r
structur l ch ng s, but th t d s n t pr duc sympt ms. Tr pic l spru
ccurs b th in
th n tiv p pul ti n nd in f r ign rs wh liv in tr pic l pl c s f r l ng p ri ds.
(Bill 2009, p.5)
Th incid nc
f tr pic l spru is d clining r n t, is n t cl r. It is unkn wn th t with
impr v nutriti n, g d s nit ti n, r pr mpt tr tm nt with ntibi tics f cut
di rrh
is us ful f r this dis s . Th m st imp rt nt hyp th sis b ut th c us
f
tr pic l spru is th t it d scrib s f rm f sm ll b w l b ct ri l v rgr wth. M st
individu ls with tr pic l spru h v
v rgr wth nd t l st s m
vid nc
f
r bic gr m-n g tiv b ct ri l
f th s str ins pp r t s cr t
nt r t xins. It is
14
uncl r wh t distinguish s individu ls with tr pic l spru fr m th r p ti nts with
b ct ri l v rgr wth ( th r th n th
bvi us pid mi l gy).
Typic l clinic l m nif st ti n f tr pic l spru b gins s n cut di rrh l dis rd r
th t th n m r
dv nc d int
m nths, vid nc
chr nic p rsist nt di rrh . v r th c urs
f m r subst nti l m l bs rpti n d v l ps th t ss ci t d with
pr gr ssiv w ight l ss. Tr pic l spru
th r is v ri bl
fs v r l
ls c n c us m g l bl stic n mi
nd ls
vid nc f r th r d fici ncy st t s. It c n b f t l if tr pic l spru is
n t tr t d. (H t z 2006, p.467–482)
Dysfuncti n f th muc s c nsid r d s th b sis f r m l bs rpti n. Hist l gic lly,
th villi r sh rt n d nd thick n d (p rti l vill us tr phy); th fl t muc s
spru is unusu lly bs rv d. Th r
f c li c
r disrupti n f micr villi nd r duc d brush
b rd r nzym l v ls f nt r cyt s. In tr pic l spru c n pr s nt chr nic
infl mm t ry infiltr t in th submuc s
nd g l bl stic ch ng s m y b pr s nt d
in th crypt pith lium.
Tr pic l spru is di gn s d d p nd n r c gniti n f m l bs rpti n in p ti nt
c mpl ining f di rrh
wh w s r sid nt f n
di gn sis sh uld sugg st wh r th r
f th
nd mic c untri s. Th
r finding f B12 r f l t d fici ncy nd
typic l bi psy ch ng s. th r inf cti us pr bl ms must b
xclud d, such s
gi rdi sis r crypt sp ridi sis.
Tr tm nt f tr pic l spru includ s ph rm c l gic d s s f f lic cid (5 mg d ily),
inj cti n f B12 (if d fici nt), nd ntibi tic. Th tr tm nt f ch ic is T tr cyclin
(250 mg f ur tim s d y) r sulf n mid . ntibi tic th r py sh uld b c ntinu d f r
1–6 m nths. ptim l th r py includ s b th f l t
nd n ntibi tic; th r py with f lic
cid l n d s n t ll w r s luti n f ll f th structur l ch ng s in th int stin
th r py with ntibi tic l n d l ys c rr cti n f th vit min d fici nci s until
nd
15
structur l int grity is r st r d. With ptim l th r py, impr v m nt sh uld b s n
v r th c urs
f f w w ks. (Zu 1992, p.95–99)
r und th Ri Dulc
r , th
ccurr nc
f tr pic l dis s s is quit r r but
is l t d c s s f int stin l pr bl ms, m l ri
nd d ngu f v r will cc si n lly cr p
up. S m y rs g th r w s min r utbr k f ch l r in th Fr nt r s r . Th
s luti n is simply this: 1) Und r n circumst nc s sh uld y u drink th riv r w t r. 2)
D n'
t b th in th riv r n r r d wnstr m f h vily p pul t d r s, i . Fr nt r s.
S m h v
xpr ss d g n r l int r st in tr pic l dis s s nd h v c mpl in d f
th l ck f inf rm ti n b ut such dis s s. T s tisfy this n d th f ll wing g n r l
v rvi w f tr pic l dis s s w rldwid is includ d h r . S m
f th dis s s
c v r d b l w d n t ccur in C ntr l m ric but r includ d t s tisfy th curi us.
R d rs with t st f r th m c br m y b
b ut th
sp ci lly int r st d in th n ws-clip
b l virus.
Tr pic l dis s s r illn ss s th t ith r ccur uniqu ly in tr pic l nd subtr pic l
r gi ns (which is r r ) r, m r c mm nly, r
ith r m r wid spr d in th tr pics
r m r difficult t pr v nt r c ntr l. Th tr pics r m r pr bl m tic f r c rt in
dis s s f r tw r s ns:
1) Tr pic l clim t s r m r c nduciv t c rt in dis s s.
2) r s f p v rty nd primitiv s nit ti n c nditi ns r m r c mm n in th
tr pics. (V rh g n 2001, p.54)
Th m st imp rt nt dis s s in th tr pic l r gi ns f S uth st si , fric , nd
S uth m ric
r m l ri , schist s mi sis, l pr sy, fil ri sis, tryp n s mi sis, nd
l ishm ni sis. lth ugh ff ctiv ch m th r py nd ins cticid s h v r duc d r
limin t d m l ri in m st f th w st rn h misph r , th s m sur s h v b n l ss
succ ssful in si . B th th inf cting p r sit
nd its m squit c rri r h v b c m
r sist nt t curr nt drugs nd 200 milli n p rs ns r
stim t d t h v m l ri in
16
tr pic l r s. In sub-S h r n fric s m 1 milli n childr n und r fiv di
dis s
f th
ch y r.
Schist s mi sis h s n v r b n c mm n in t mp r t clim t s, but it ff cts 125
milli n p rs ns w rldwid , f wh m ppr xim t ly 20 p rc nt r
t l st p rtly
dis bl d by th dis s . Pr ziqu nt l, highly ff ctiv n w drug, is n w v il bl f r
tr tm nt f schist s mi sis. L pr sy h s ls
lw ys b n m r c mm n in tr pic l
th n in m d r t clim t s, nd b ut 11 milli n p rs ns in th w rld h v this illn ss.
In nd mic r s m ny s v r c s s f l pr sy r n w r sist nt t th drug first us d
g inst it, nd n w r, m r
xp nsiv th r py must b
mpl y d. Fil ri sis is
c mm n tr pic l d bilit ting illn ss c us d by inf cti n with r undw rm l rv .
Tryp n s mi sis, which r sults fr m inf cti n with pr t z n p r sit , h s c us d
10 milli n c s s f hum n sickn ss in fric
l n .
r l t d pr t z n in S uth
m ric c us s l ss d dly f rm f tryp n s mi sis c ll d Ch g s'dis s .
L ishm ni sis is ls
r sult f w rm inf cti n, nd in its si n nd fric n f rms
th dis s c n d m g th int rn l rg ns.
lth ugh tub rcul sis is l rg ly und r c ntr l in d v l p d c untri s, it is still
c nsid r bl public h lth pr bl m in much f th w rld nd is r sp nsibl f r b ut
h lf milli n d ths nnu lly, 75 p rc nt f th m in si . th r dis s s f r which
tr tm nt is v il bl but which r still c mm n in d v l ping c untri s includ
ch l r , y ll w f v r, y ws, nd m bic dys nt ry.
Tw f rms f c nc r, Burkitt'
s lymph m
fric
nd liv r c nc r, r v ry c mm n in
nd si , r sp ctiv ly, lth ugh r r in t mp r t z n s. Burkitt'
s lymph m is
th ught t b du t
c mbin ti n f m ssiv inf cti n with virus
rly in lif
nd
m l ri in dulth d. Liv r c nc r m y b c us d by inf cti n with th h p titis B
virus. (Jüni 2002, p.2407–2408)
17
s m ny s 25 milli n p rs ns h v b c m blind fr m pr v nt bl dis s s in
tr pic l c untri s. Th s dis s s includ x r phth lmi , du t l ck f vit min
in
th di t; nch c rci sis, r riv r blindn ss, n inf cti n f th skin by fil ri l l rv
th t m y ls
ff ct th c njunctiv
f th
y ; nd tr ch m , chr nic c njunctiv l
inf cti n c us d by th p r sitic b ct rium Chl mydi tr ch m tis, which is
tr nsmitt d by fli s r thr ugh cl s p rs n l c nt ct. (Bundy 1992 , p.168–179)
Fin lly, numb r f s v r virus-c us d f v rs th t w r id ntifi d during th 1970s
r f und pr d min ntly in tr pic l r gi ns. Th s dis s s includ L ss , b l ,
M rburg, Buny , nd Chikunguny f v rs, s m
f which c us d th by h m rrh g
(h m rrh gic f v r). n m mb r f this f mily, d ngu virus, w s kn wn f r m ny
y rs but h s r c ntly spr d t th C ribb n nd M xic . ll th s dis s s r r r .
3.THEORETICAL FRAMEWORK
Th numb r f
th d
l
f m l r d gn
d . M r th n 40
n F nl nd l t y r w
l w r tr t d f r th d
n wr
. n dd t n, v r 30
ught tr tm nt f r D ngu f v r nf t n . Unt l l t y r th
numb r f
f D ngu f v r h
rd f r
nnu l
b n r und 20. The number is increasing which
is a worldwide tendency also.
rd ng t N t n l n t tut f r H lth nd W lf r , m ny F nn h v
f rg tt n th t v r u tr v l d t n t n r qu r d ff r nt h lth r
tr v l n t ur t h l d y t th tr
n fr
qu t
nd d n'
tn
d ff r nt th ng th n tr
t
ur
rh
ut n .
l
r ly r m mb r th t h l d y
r v nt
,"
y
kk n n. (Belizario 2003, p. 35-42)
lth ugh m ny
k g t ur rg n z r
h lth r k , n t ll d , nd
h l d y ng n th tr
kk n n urg
. Th n gl t d tr
r v d nf rm t n n th r w b t
tr v ll r t
ld
b ut
k w th d t r b f r
r
gr u
f 13 nf t n
18
th t ff t m r th n 1 b ll n
lth ugh n x n v
n t
bl t th
r l drug th r
ff t d
U $2 d y nd w th ut
d
l w rldw d , wh l v n xtr m
r ult n
x t t tr t th
ul t n ,
t h lth
rt fr m un f w t r,
nd t n . nf t n w th n gl t d tr
d f gur m nt, nd
w m n, r lu t nt t
m rb d ty th t
k
uld b
l
hm n
Tr h m
th
th n
l
n tr gg r l f -l ng d
t gm n turn m k
l ,
blt
rt ul rly
nd t n r ult n
v r
r v nt d.
ld
r
w rm, h kw rm, r v r bl ndn
wh w rm), 3 r
nl
n t t n, nd ub t nd rd h u ng
r . L ft untr t d, th
v n f th 13 n gl t d tr
gu n
r
r
ft n
r tu t n f n gl t d tr
ld
l t gm , nd th
nd t n , th y r
l wh l v n r m t
r . Th
v rty.
r t z l ( fr
u d by w rm ( l h nt
, r undw rm,
n l
ng
kn
h t
, h g
,
m
, nd
d
, nd
) nd th r t r b t r l (Burul ul r, l r y, nd tr h m ).
th l d ng
nd-l d ng
u
d f gur m nt f l g
n qu ntly n
u
f
f r v nt bl bl ndn
rm n nt d
b l ty n th w rld (by
nd g n t l ), nd h kw rm
f th m t m
n th w rld, l h nt
u
v r
u ng
n m
nd
rt nt m t rn l- h ld r bl m .
(Behnke 1994, p. 187-195)
4.HYPOTESIS
N gl t d tr
ld
ntr but t 500 000 d th
dd t n lly, th
nd t n r ult n 57 m ll n d
nnu lly, numb r lm t
v ru (H V)/
D , tub r ul
m y n r
u
H V/
h gh
b l ty- dju t d l f -y r l t
t d w th hum n mmun d f
, r m l r . nf t n w th n gl t d tr
t b l ty t H V/
D , tub r ul
th t
r y r worlwide.
D
nd w r n ut m
, r m l r . N gl t d tr
ld
n th
n y
ld
w th
r m r ly ff t
,
19
y ung r nd v du l
h ldr n nd d r
nd
n r ult n l w d gr wth nd
r
d w rk r du t v ty n dult , th r by
h l
rf rm n
r tu t ng
n
v rty.
5.THE PROBLEM TO BE SOLVED
D
t th hug m
th m
t f n gl t d tr
f nd r
n
d tr but n f tud
t th
. Furth rm r , l
mmun ty, nd th r
r bl m. n
rt, th
t th 10 l d ng
th n 1% f n w drug d v l
ub t nt l g gr h
d
urr ng n
v rl
ngl r g n.
h v
f n
dv
l rg
r
k w d
l
m nt v r th l t 30 y r
.
ld
rt n f
ld
ubl
f th gl b l burd n f
ld
, w th u t 6
l
r nf t d w th
ft n ugm nt th d l t r u
t d th m l m nt t n f n nt gr t d
n gl t d tr
ld
nfr tru tur ( g,
uld b m r
uld u
ff t v th n f
I have y t m t
d, nnu l m
hd
w
vd n
h.
l
th t mult n u ly t rg t 2 r m r
m h lth
t r
drug d tr but n), n nt rv nt n
t rg t d
r t ly.
fr m r nd m z d
t n th t tr t mult l n gl t d tr
mult n u ly t d t rm n wh h tr tm nt
r
h t n gl t d tr
ntr l f th
v rty d l n . (Bill 2009, p. 25)
lly r v w d th
v lu t ng r l m d
drug th r
r
. By d l v r ng tr tm nt u ng th
ul t n-b
uld l d t
nt gr t d
l ttl
n th r. Th r f r , th W rld H lth rg n z t n (WH ) nd th r
m n g m nt th t
d
u
f n gl t d tr
m r th n 1. dd t n lly, n gl t d tr
ff t
th r ult f
b l ty t tr t
l l t r tur n wh h l n
b n m d t dv n ng drug tr tm nt f r tr
Th r
d
l
ubl h d n th g n r l m d
tr l g n r lly h v l ttl r l v n
h
w rldw d , th
l rg ly unkn wn n th g n r l m d
w r n
d
ld
uld b
ntr ll d tr l (R T )
ld
ff t v f r u h n
20
6.LITERATURE REVIEW
This ch pt r will discuss th r vi w f th lit r tur r g rding th tr pic l dis s s.
Tr
l nf t u d
nd yt k n
r m d l
h v m rt nt
f nfl mm t n n wh h v r u m d t r
th g n r l . h ng
n h m dyn m
m rtm nt l z t n, nd r n fun t n nd m mbr n tr n
x rt y t m
f tur
h
ff t
n rg n fun t n. N tr g n w t ng
f nf t u lln
h t
h ng
nd tr
n
hy
h
m n d by d f
l m nt . rt f
th t r
yr x
,
m l r t th
u
r
f
ln
l
r t ry lk l
th hy
trum f
l g
.M l r ,l t
g d tr
ld
d
lt nd w t r r
ld
th t r
rv .
th
ld
,
h ng
lly
r u u lly tr n
m
v r ty f d
v n r fl t th
r
r
ld
ld
mm n nd
nd hy
.
, th y r
nd
ut , nd th
f
u
n th
tw
r
f tr
h t m
l
r
ft n
n lly
ym t m , th y
th hy
n b th r
v r
nd t n
lyur
ut
l g
l
lly r l v nt.
r th r f r th m t
. Th r v w f flu d, l tr lyt
f u
n
f
t nt w th
r f tur
h
nt nd d n t
nt r t.
rturb t n n tr
n n
v r
n ; n v rth l
fr qu ntly tud d tr
w d r ng
lt r t n
l m
v rl k d by l n
nd l t
v r nf t n
, d ngu h m rrh g f v r nd f br l
t nd t b
M l r
t b l
rg n f lur .
m r bl t th
. Hy n tr m , hy k l m , hy
b rv d.
um,
nd
n m
m d l . Flu d nd l tr lyt
t d w th tr
n
gn z d
r du
, l d ng t hy k l m
v r tr
r
ur nd
um, m gn
lly ndu d hy rth rm
nd l t
l h ng
w ll-r
t
t d w th h k, r n l dy fun t n nd mult l
Th
n
b rv d dur ng nf t n. Hy rv nt l t n du t
h t m . D rrh
b
t
rt
, flu d
nd m n r l
nd t n .
t first sight, n instituti n b tt r illustr t s th d p rtur in imp ri l p licy th n th
Tr pic l Dis s s R s rch Fund. C l ni l S cr t ry J s ph Ch mb rl in (1895-
21
1902), l ding ch mpi n f c nstructiv imp ri lism, initi t d th Fund in rd r t
nc ur g th und rst nding nd pr v nti n f dis s in th
mpir . ( lb nic 2002,
p. 685–690)
Subsidis d by th
Indi , th
nnu l c ntributi ns f cr wn c l ni s nd th G v rnm nt f
dvis ry c mmitt
f th Fund w uld pl y n instrum nt l r l in
instituti n lising th study f tr pic l dis s s in Brit in. Fr m 1903 until th
utbr k f W rld W r I, th
dvis ry c mmitt
dis s s, chi fly by subsidising r s rch sci nc
pr m t d th study f tr pic l
t C mbridg Univ rsity, th
Liv rp l nd L nd n Sch ls f Tr pic l M dicin , nd L nd n Univ rsity. Th s
b n fici ri s f th Fund w r n t nly th l c ti n f s m
f th
rli st
stud ntships, p siti ns nd l b r t ri s in h lminth l gy, p r sit l gy, pr t z l gy
nd nt m l gy but ls c ll ctiv ly r pr s nt d th c ntr
f tr pic l dis s
r s rch f r th British mpir in th tw nti th c ntury. Und ubt dly, th
d m stic ti n f tr pic l dis s r s rch r f rr d t th
xig nci s f th l t
nin t nth c ntury British mpir . In str ssing ch ng in imp ri l p licy, h w v r,
hist ri ns h v t
ft n v rl
k d h w th s ci l p w r f th imp ri l st t
m tr p lit n mpl y r f d ct rs nd s urc
s
f funding f r th sci ntific c mmunity
sh p d th r sp ns t th pr bl m f dis s in th
mpir .'(W rld H lth
rg niz ti n. Tr ch m 2009, p. 52-85)
Tw f rms f c nc r, Burkitt'
s lymph m
fric
nd liv r c nc r, r v ry c mm n in
nd si , r sp ctiv ly, lth ugh r r in t mp r t z n s. Burkitt'
s lymph m is
th ught t b du t
c mbin ti n f m ssiv inf cti n with virus
rly in lif
nd
m l ri in dulth d. Liv r c nc r m y b c us d by inf cti n with th h p titis B
virus.
s m ny s 25 milli n p rs ns h v b c m blind fr m pr v nt bl dis s s in
tr pic l c untri s. Th s dis s s includ x r phth lmi , du t l ck f vit min
in
22
th di t; nch c rci sis, r riv r blindn ss, n inf cti n f th skin by fil ri l l rv
th t m y ls
ff ct th c njunctiv
f th
y ; nd tr ch m , chr nic c njunctiv l
inf cti n c us d by th p r sitic b ct rium Chl mydi tr ch m tis, which is
tr nsmitt d by fli s r thr ugh cl s p rs n l c nt ct.
Pr s rving th h lth f imp ri l s rv nts nd, wh n r s urc s p rmitt d, indig n us
inh bit nts, d fin d th minimum nd m ximum f th c l ni l m dic l s rvic s. But
th
v rsupply f pr ctiti n rs in Brit in m d th d liv ry f prim ry c r in th
mpir
pr ctic l p ssibility. Th C l ni l ffic r utin ly fill d v c nci s in th f r-
flung d p nd nt mpir with ut h ving t
ff r sp ci l inc ntiv s b y nd m d st
b s s l ry. C l ni l g v rnm nts, in turn, m ximis d th l b ur f imp ri l d ct rs
by linking th ir r mun r ti n t th discr ti n f th c l ni l dministr ti n r
g v rn r nd p rf rm nc -b s d inc ntiv s.
Wh r v r th Uni n J ck fl w in th British mpir , th r w s sur t b c l ni l
m dic l p rs nn l n rby. N m tt r th c us
f th
f xp nsi n, th und rlying vi bility
mpir ultim t ly d p nd d n th surviv l f its c l ni l p rs nn l. This
imp r tiv , t g th r with Vict ri n fisc l c n my, d t rmin d th missi n f th
c l ni l m dic l s rvic s: th c st- ffici nt d liv ry f h lth c r t
ur p n
s rv nts nd, wh n r s urc s p rmitt d, c l ni l subj cts. Wh t v r th succ ss th
s rvic s r lis d w r l rg ly du t th r l
f th imp ri l st t
s n mpl y r f
m tr p lit n m dic l pr f ssi n ls.
Th C l ni l ffic w s n
pr f ssi n ls. By th
f th l rg st mpl y r f full-tim civili n m dic l
nd f th c ntury, it fill d w ll v r 300 p siti ns. In m dic l
m rk t th t suff r d fr m chr nic surplus f qu lifi d m dic l pr f ssi n ls, th
l v r g th t c m with b ing l rg civili n mpl y r n bl d th C l ni l ffic t
s tisfy th p rs nn l n ds f f r-flung mpir
r quir m nts f th
n its wn t rms. Unlik th
ntry
rmy nd th Indi n nd N v l M dic l S rvic s, th C l ni l
23
ffic n ith r s t c mp titiv
x min ti n n r r quir d th c mpl ti n f p st-
gr du t tr ining. t m st, it xp ct d pplic nts t b fr m 23 t 30 y rs f g ,
pr f r bly singl
nd p ss ss tw qu lific ti ns (m dic l nd surgic l). B y nd th s
f rm l r quir m nts, th
pplic nt h d t p ss h lth ss ssm nt nd submit t
n
int rvi w with priv t s cr t ry nd/ r st ff m mb r f th C l ni l ffic . Th s
minim l r quir m nts did m r th n simply nsur th l rg st p
l f p t nti l
pplic nts. Th y ls pr vid d m ximum fl xibility in m ting th p rs nn l n ds f
th
mpir . F r c sting v c nci s w s virtu lly p ssibl f r n mpir wh s st ffing
h t r g n ity w s m tch d nly by its g gr phic l div rsity. N r w r imp ri l
ffici ls, wh w r
v r c nsci us f c n my, pr p r d t b burd n d with l rg
supply f und r mpl y d imp ri l d ct rs s w s th c s with th st t s rvic s
(Sim n 1995, p. 1875–1883). Inst d, th C l ni l ffic st gg r d th
pr c ss t
cc mm d t th p rs nn l n ds nd fisc l imp r tiv s f th
pp intm nt
mpir .
Pr sp ctiv c ndid t s submitt d th ir pplic ti ns in pril. Th s wh w r
ppr v d w r th n pl c d n th S cr t ry f St t '
s pp intm nt list. Fr m this list,
c ndid t s w r m tch d s v c nci s p n d during th y r. Pl c m nt n this list
did n t gu r nt
n pp intm nt. No pr mis is giv n th t ny pp intm nt will b
v ntu lly m d ,'pr sp ctiv
pplic nts w r w rn d, 'nd it is n t p ssibl t
f r c st ith r th numb r r th n tur
f th v c nci s which will ris in th c urs
f ny giv n y r. M r v r, th duti s f imp ri l m dic l p rs nn l did n t r quir
sp ci lis d pr f ssi n l tr ining. f c urs , th n ds v ri d fr m c l ny t c l ny,
but in g n r l imp ri l d ct rs w r
xp ct d t s rv th n ds f ur p n
p rs nn l nd th ir f mili s t n ch rg
ll w d. M st pp intm nts w r
c uld b quit
s w ll s c l ni l subj cts s r s urc s
t th district l v l. Within th s districts, which
xt nsiv , ffic rs w r ch rg d with v ri d r sp nsibiliti s. l° Th s
includ d tt nding th l c l h spit l, p
r-h us
r sylum, v rs ing th s nit ti n
24
f th district, nd p rf rming public v ccin ti ns. nc
pp intm nt, h quickly b c m th fin nci l c ptiv
b f r b ing disp tch d t
pr ctiti n r cc pt d n
f th c l ni l s rvic . v n
c l ny, imp ri l d ct rs w r
xp ct d t purch s
c stly utfits, including cl thing, c mp cutl ry nd m dic l kits. lth ugh th b s
s l ry v ri d fr m c l ny t c l ny, it w s c nsist ntly l w in c mp ris n with
v r g s l ri s t h m . Th y r ng d fr m l w f £100 t 300 f r pr b ti n rs,
s m district m dic l ffic rs nd c l ni l surg ns t £400 t 700 f r m st district
ffic rs nd up t £800 f r th chi f m dic l ffic r f th G ld C st c l ny. T b
sur , h using nd tr v l suppl m nts diminish d th high c st f living in th
mpir .
Imp ri l d ct rs still l st gr und sinc s l ry incr s s w r n t ut m tic. Usu lly,
th y w r
w rd d t th discr ti n f th c l ni l dministr t r r g v rn r ft r th
c mpl ti n f pr b ti n ry p ri d-l sting fr m tw t thr
y rs- r ft r fix d
numb r y rs f s rvic , nd c pp d t m ximum s l ry l v l.
(H t z 2006, p. 467–482 )
C l ni l g v rnm nts us d th discr ti n ry n tur
tt ch d t priv t pr ctic t
f s l ry incr s s nd c nditi ns
nsur th t imp ri l d ct rs m d th
x cuti n f th ir
duti s pri rity. Th y ls t k st ps t m k duty n with s lf-int r st thr ugh
p rf rm nc b s d fin nci l inc ntiv s. In th L w rd Isl nds nd British H ndur s,
f r x mpl , m dic l p rs nn l r c iv d f s f r succ ssful v ccin ti ns, p stm rt m x min ti ns, c urtr m pp r nc s, nd x cuting lun cy nd buri l
c rtific t s. In Fiji, th y r c iv d c pit ti n f s f r tr ting ind ntur d l b ur rs.
Stip nds w r
w rd d t m dic l p rs nn l f r ssuming dditi n l duti s, such s
t king ch rg
f public instituti ns such s th civil pris n r th lun tic sylum in
Gibr lt r; r s rving s th
ffic r f h lth in L g s; r s x ffici insp ct r r
r sid nt surg n f th L ck H spit l, sup rint nd nt f th civil m dic l h spit l r
h lth insp ct r f migr nts in H ng K ng. Th s
nd th r dministr tiv t
ls
25
c rt inly n bl d c l ni l g v rnm nts t d liv r h lth c r in c st- ffici nt
m nn r. Y t, th
mph sis n ddr ssing n rr w r ng
pr bl ms ultim t ly circumscrib d th r l
m dicin
f prim ry h lth c r
f imp ri l d ct rs s g nts f pr v ntiv
r, f r th t m tt r, inv stig t rs. This did n t n c ss rily m n th t c l ni l
g v rnm nts w r indiff r nt t th h lth f th c l nis d. n th c ntr ry, c l ni l
g v rnm nts uth ris d wid sp ctrum f rdin nc s th t d lt with g n r l h lth.
(Zu 1992, p. 95–99)
Th s r ng d fr m fin ncing public w rks pr j cts, fr m st blishing nd m int ining
w t r syst ms, impr ving th c ll cti n nd r m v l f s w g , h spit l nd
c m t ry c nstructi n, t pr v nting th spr d f r bi s by r gul ting d g wn rship
t imp sing qu r ntin m sur s g inst ch l r
m sur s did n t d p nd n th
nd pl gu . Th s
nd th r
uth rity f imp ri l d ct rs s xp rts p r s , but
r th r n h st f v ri bl s. Th s r ng d fr m th
dvic
f s nit ry ngin rs,
pr vi us nc unt rs with inf cti us r c nt gi us dis s s, th c mmitm nt f th
c l ni l g v rn r r dministr t r, th
c
v il bility f l c l fin nci l r s urc s, nd th
p r ti n f pr p rty- wn rs nd th r int r st gr ups. Th p litic lly c nstruct d
n tur
f public h lth th r f r sh p d th l c l r sp ns t th pr bl m f dis s .
Pr dict bly, n ith r imp ri l d ct rs n r c l ni l ffici ls pr s nt fl tt ring pictur
wh n f c d with nd mic r pid mic dis s . Sp sms f c nc ntr t d- nd, n t
infr qu ntly, c unt r-pr ductiv - ctivity punctu t l ng p ri ds f s ming
indiff r nc . (J ngsuksuntigul 1993, p. 724–729)
Until th l st d c d
n tic
f th nin t nth c ntury, imp ri l ffici ls in L nd n t k littl
f inf cti us dis s cris s in th p riph ry. v n in th
dist nc , t g th r with c n my, c nspir d g inst m li r tiv
th c ntr . This p stur ch ng d s th str t gic v lu
in fric , r s in th f c
g 69 th t l gr ph,
cti n dir ct d fr m
f Brit in'
s mpir , sp ci lly
f c l ni l nd imp ri l ch ll ng s. Zulul nd, wh r ts ts
26
fly dis s surf c d in 1894, r pr s nt d critic l r gi n in th c ns lid ti n f
British h g m ny in s uth rn fric
g inst th
n ti n.(Goodfellow 1966, p. 3) Ug nd , th
xp nsi nistic B r
pic ntt
f th 1901 sl ping sickn ss
pid mic, w s n l ss imp rt nt. This r gi n n t nly f rm d th h rt f th British
st fric n pr t ct r t , but ls insul t d th high r r ch s f Brit in'
s. m st
imp rt nt imp ri l tr ding c nduit t th
st-th Nil Riv r C n l-fr m Fr nch nd
G rm n ncr chm nt.(Galbright 1972, p. 5) With st k s s high nd l c l r s urc s
c nst ntly str tch d nd quickly v rwh lm d, it is n t surprising th t imp ri l
ffici ls l
k d ls wh r f r ssist nc . In 1894 nd 1901, th C l ni l ffic
nd
F r ign ffic r sp ctiv ly c nsult d th R y l S ci ty c nc rning th ts ts fly nd
sl ping sickn ss pid mics. In 1899, th C l ni l ffic
g in s licit d th
dvic
f
th R y l S ci ty r g rding th r l ti nship f bl ckw t r f v r t m l ri . Th s
c nsult ti ns l d t th f rm ti n f n dvis ry c mmitt
f r ts ts fly
inv stig ti ns in Zulul nd in 1896, tw sl ping sickn ss r s rch xp diti ns t
st
fric , nd m l ri c mmissi n in 1899. (V rh g n 2001, p. 54)
N s tisf ct ry xpl n ti n h s y t b n giv n s t why th imp ri l st t c nsult d
with R y l S ci ty. T b sur , th S ci ty w s th l ding sci ntific instituti n in
Brit in nd th
mpir . Th tug f imp ri l duty d s n t xpl in why th S ci ty
suppl m nt d th c sts f th s m tr p lit n initi tiv s. R th r, s r cipi nt f
g v rnm nt subsidy sinc 1850, th R y l S ci ty w s n ith r in p siti n t s y n
t th s licit ti ns f th st t , n r c uld it r sist c ntributing t th c sts f r s rch
in th
mpir . s th n xt s cti n will sh w, this r l ti nship m di t d th c nduct f
imp ri l sci nc
nd h lp d f st r th f rm ti n f th Tr pic l Dis s s R s rch
Fund.
Th s funding d cisi ns did n t p r t in v cuum. n th c ntr ry, th y r plic t d
th un v n p w r r l ti nship b tw n th imp ri l m tr p l
nd th c l ni l
27
p riph ry. N diff r nt fr m th r f rms f c n mic xtr cti n, th s
ll c ti ns
r pr s nt d n t div rsi n f sc rc r s urc s fr m th p riph ry t th m tr p l .
This div rsi n h d r l c ns qu nc s f r th s ci l pr ducti n f kn wl dg
dis s in th
b ut
mpir . Th v ry gr wth f sci ntific sp ci liti s nd sp ci list
kn wl dg in Brit in r m in d nm sh d in th c ntinu d ccup ti n l sub rdin ti n
f m dic l p rs nn l in th
mpir
s prim ry c r -giv rs. (Y ngc 1981, p. 285–290)
Schist s mi sis h s n v r b n c mm n in t mp r t clim t s, but it ff cts 125
milli n p rs ns w rldwid , f wh m ppr xim t ly 20 p rc nt r
t l st p rtly
dis bl d by th dis s . Pr ziqu nt l, highly ff ctiv n w drug, is n w v il bl f r
tr tm nt f schist s mi sis. L pr sy h s ls
lw ys b n m r c mm n in tr pic l
th n in m d r t clim t s, nd b ut 11 milli n p rs ns in th w rld h v this illn ss.
In nd mic r s m ny s v r c s s f l pr sy r n w r sist nt t th drug first us d
g inst it, nd n w r, m r
xp nsiv th r py must b
mpl y d. Fil ri sis is
c mm n tr pic l d bilit ting illn ss c us d by inf cti n with r undw rm l rv .
Tryp n s mi sis, which r sults fr m inf cti n with pr t z n p r sit , h s c us d
10 milli n c s s f hum n sickn ss in fric
l n .
r l t d pr t z n in S uth
m ric c us s l ss d dly f rm f tryp n s mi sis c ll d Ch g s'dis s .
L ishm ni sis is ls
r sult f w rm inf cti n, nd in its si n nd fric n f rms
th dis s c n d m g th int rn l rg ns. (Jüni 2002, p. 2407–2408)
7.REVIEW OF FLUID, ELECTROLYTE AND MINERAL PERTUTBATIONS
IN TROPICAL DESEASES
Tr
l nf t u d
nd yt k n
r m d l
h v m rt nt
f nfl mm t n n wh h v r u m d t r
th g n r l . h ng
n h m dyn m
m rtm nt l z t n, nd r n fun t n nd m mbr n tr n
x rt y t m
ff t
n rg n fun t n. N tr g n w t ng
rt
w ll-r
n
, flu d
ur nd
gn z d
n
28
f tur
h
f nf t u lln
h t
h ng
nd tr
n
hy
h
m n d by d f
l m nt . rt f
th t r
yr x
,
m l r t th
u
r
f
t
lly ndu d hy rth rm
r t ry lk l
ln
l
th hy
trum f
l g
nd l t
.M l r ,l t
g d tr
lt nd w t r r
ld
th t r
r
ld
d
v r tr
l h ng
rv .
,
h ng
lly
r u u lly tr n
nt r t.
m
v r ty f d
r
fr qu ntly tud d tr
rturb t n n tr
r
ld
ld
mm n nd
.
, th y r
nd
ut , nd th
f
h t m
n th
tw
l
r
ft n
n lly
ym t m , th y
th hy
n b th r
r
f tr
lyur
u
v r
nd t n
ut
l g
l
lly r l v nt.
r th r f r th m t
. Th r v w f flu d, l tr lyt
f u
n
f
t nt w th
r f tur
h
nt nd d n t
n ; n v rth l
v n r fl t th
nd hy
v r
v rl k d by l n
nd l t
n n
lt r t n
l m
t nd t b
M l r
w d r ng
, d ngu h m rrh g f v r nd f br l
ld
th
v r nf t n
rg n f lur .
m r bl t th
. Hy n tr m , hy k l m , hy
b rv d.
t b l
nd
n m
m d l . Flu d nd l tr lyt
t d w th tr
um,
r du
, l d ng t hy k l m
t d w th h k, r n l dy fun t n nd mult l
Th
um, m gn
b rv d dur ng nf t n. Hy rv nt l t n du t
h t m . D rrh
b
t
nd m n r l
nd t n .
This r s rch r p rt is v ry imp rt nt f r m in rd r t und rst nd th b sic purp s s
f trpic l dis s
nd th ir simultaneous tr tm nt worldwide. B ginning th tr pic l
dis s s cti n with d t il d c nsid r ti n f tropical micr v scul r dyn mics
ll ws sm th tr nsiti n fr m c rdi v scul r-r l t d t pics t kidn y-r l t d t pics.
In dditi n, r ducti ns in Tr pic l dis s
nd gl m rul r filtr ti n r t (GFR) r
ft n ss ci t d with m ny p th physi l gic l c nditi ns including hyp rt nsi n,
malaria, h rt f ilur , nd di b t s, nd it is ss nti l f r th stud nt t
bt in s lid
29
f und ti n r g rding th princip l m ch nisms r gul ting tropical th m dyn mics.
(Kn wl r, 2008, p. 25-32).
Th f ll wing bj ctiv s pr vid
cl r guid for f ct rs r gul ting tropic l dis s
dyn mics:
1) To b
bl t d fin
2) To know th
3) To be
nd c lcul t th influ nc
f tr pic l dis s .
v r g v lu s f r tr pic l dis s in dult hum ns.
bl t d fin
nd c lcul t th filtr ti n fr cti n.
4) To known th m j r sit s f tr pic l dis s r sist nc
pr ssur pr fil
nd d scrib th hydr st tic
l ng th tropical v scul tur .
5) To d scrib th r l s f hydr st tic nd c ll id sm tic pr ssur s in r gul ting
gl m rul r nd p ritubul r c pill ry dyn mics.
6) To know to expl in in qu ntit tiv m nn r th d t rmin nts f GFR nd h w
th s
r r gul t d.
7) To id ntify th
xtrinsic, n ur l, nd h rm n l syst ms th t r gul t tr pic l
h m dyn mics.
8) To d scrib th r l s f th m j r p r crin syst ms th t p rticip t in th intrinsic
c ntr l f Hepatitis B.
9) To desscribe th ph n m n n f tropical ut r gul ti n nd d scrib th my g nic
m ch nism nd th tubul gl m rul r f db ck m ch nism in m di ting
ut r gul t ry b h vi ur.
10) T und rst nd th m j r v rvi w f tr pic l dis s tr tm nt worldwide . It is
n t p ssibl t discuss ll th s l rning bj ctiv s in th pr s nt rticl . (L wd r,
2001, p. 6).
C ns qu ntly, tt nti n h s b n f cus d n th s
sp cts th t r c nc ptu lly m r
difficult r th t c us c nfusi n. In p rticul r, th r c nt r c gniti n f multipl
30
hum r l nd p r crin f ct rs r gul ting tropic l dis s dyn mics r quir s v ry
discrimin ting s l cti n f sp cific t pics. (Knowler, 2008 p. 25-32)
7.1.R n l H m dyn m
M t tud
m l r
f th h m dyn m
rl t
r
v r ty f d
r
t n
n r
ld
r
tt rn f h m dyn m
nd t
d r
t d
d, wh r
m l
rd
ul r r
rt ul rly n tr
t n
x d . Und rf ll ng f th
nt d ur t h rm n ( DH; v
th
m d t r n r
n l
n r
t mul t th r l
d
rd
t n . nm t
nf t n r
r gr
mbl
n
flu d fr m th ntr v
dl t n
rt r l v
b r r
dv
n, th h m dyn m
th t f
l w th
t d w th n r
ul r
rd
ut ut th r f r d r
yt k n
nd nf t u my
nd nt n th
yt m v
ul r r
t n
u d by
dv
ul r b d du t
rd t
l
d
rt r l
t r , l d ng t th r l
f
nd ld t r n . R l
f
ul r r
t n
f
d um. F v r
r rrh
ntr but t th
d
l
f th l v r. D
rm b l ty, f
t g . My
nd n r
t nt w th tr
m rtm nt nd r ult ng n hy
t th d
r
, th r f r , b rv d.
t tu
ul r
ul r
v r lm d t r ,
f tubul r r b r t n f w t r nd
u d by d r
t nt w th
r r du d. D r
n), ng t n n
f DH. Hy rv l m
ut ut
bl d v lum . F r th r
tv t
r
th r t
d
ut ut nd r n l v
r ult f v
d l t n (r l t v hy v l m )
ndu t d n
h ng
d. R n l bl d fl w nd gl m rul r f ltr t n r t
yt m v
v
. Th
f tr
l t t ng l k g
v l m (F gur 1).
rd l d r
h n m n n.
nt
f
31
Source: Hitoshi K. et al., 2008 p. 13
n
t nt w th m ld
ut f br l d
f ltr t n th r d n t h ng
ln
l l v l, t
r l t nh
m d
rd r
r
rd n
t
. n
unt n
b tw n th
f r n l bl d fl w nd gl m rul r
l ghtly.(Pecul 1999, p. 85-95)
d ff ult t d f n th d gr
t h m dyn m
d f n d by th
,r t
f
r h r l bl d, w th th
v lum
v t th t th r
nb
nb
r l bl
d.
m ld (<1% f rythr yt
d fl w nd gl m rul r f ltr t n r t
th r n rm l r l ghtly n r
nd t
v r ty f nf t n
r h r l bl d nd th t n v
(Olds 1999, p. 996-1003) Wh n m l r l nf t n
nf t d), r n l bl
v r ty f nf t u d
t nt w th m l r th
unt n
t th
r n rm l, nd bl
d. Wh n m l r l nf t n
d
m d r t ly
32
v r (1-5% f rythr yt
d r
,12 nd bl
nd l m l v l
d v lum n r
fn r
f t mul t n f b r r
m d t d by n tr
rythr yt
m r m
nf t d), r n l bl d fl w nd gl m rul r f ltr t n r t
n hr n
t r by
xd . n
(F gur 2); h w v r, l m r n n
nd rg n n v
nt nu u
t nt w th
r
n r
m ty ng f th
t v ty
l v t d
rt r l v
r ult
ul r b d
v r m l r l nf t n (>5% f
nf t d), bl d v lum dr
nd r n l h m dyn m
r gr tly
d, w th furth r d m nut n f r n l bl d fl w nd gl m rul r f ltr t n
r t (F gur 2); th
h ng
r
m und d by h m rrh l g
lt r t n nd
yt dh r n , l d ng t r n l f lur . (Muchiri 2001, p. 87)
Source: Hitoshi K. et al., 2008 p. 16
Th
l t
tt rn f r n l h m dyn m
r
nd th r tr
nfl mm t ry m d t r
h ng
th t
l nf t n , b
n nm l r
u
ll th
l
d
h r t r t
nv lv th
nd yt k n .(Molyneaux 2005, p 336) H m dyn m
n th r n nm l r l nf t u d
t nd t b l
m rk d,
rh
f
m
33
b
u
rythr yt
qu tr t n. n
l t ng b
u
r n t nf t d nd th r f r d n t und rg
t nt w th
f th
wh h d wnr gul t
41) Th
th
hy
h m dyn m
th
, r n l h m dyn m
h ng
nd l ng
nd th l l n tr
n th k dn y.(Montori 2001, p.
xd
r
ynth
nv lv
xd ,
d r t n hr t x ty n dd t n t
f th tubul nt r t t um r ndu d by
f th nf t v b t r . F r th r
l
v r
f r ul t ng n tr
lt r t n; h ng
ur n ry l tr lyt
r
r
r f und nd r l ng d r l
l gy f l t
ut r m mbr n
yt dh r n
n, h ng
r fl t dy fun t n l r n l tubul r tr n
n
nt t w th
rum nd
rt.
(Beller 2002, 565-567)
7.2.Bl
d V lum
nd
t d n th
d
t t
r v u
d
nd ng n th
dm n tr t n. M t
hy rv l m
ng t n n
t n, bl
t g
d v lum v r
nd
v r ty f nf t n nd flu d
t nt w th f br l d
ttr but d t
yt m v
r hy rv l m . D v l m nt f
d l t n ndu ng r l
nd ld t r n , wh h n turn r ult n
(Michael 2004, p. 88-102) Hy v l m , n rm v l m
b n b rv d n
t nt w th m l r . t h
u u lly n rm l n th
m d r t ly
rly t g
d flu d nt k
d v l m nt f hy v l m
w th m t b l
d
rum m l r .
d t t d th
v n n
fm l r
b n
f DH,
d um nd w t r r t nt n.
nd hy rv l m
m
t nt w th
n
r wh n nf t n
m ld.
nd l rg n n bl flu d l
t nt w th
f bl
tt rn. By
d v lum n
ll
t nt w th
dv
ul r
l d t th
v r m l r l nf t n. Hy v l m
nd r n l dy fun t n r
tud
h v
n lud d th t bl d v lum
v r m l r l nf t n r g n r lly hy rv l m . n r
rm b l ty, d r
f l
n d ff r nt nf t u
mm n n fr
t nt w th l t
ntr t, n rm v l m h
n h ldr n w th
r
h v
b n b rv d n m l r ,
v r nf t n f ll w ng flu d dm n tr t n. (Michael 2002,
34
p. 16-20) L
f flu d thr ugh th g tr nt t n l tr t
hy v l m
n tr
ld
n th r m
ld
by
th t
u
v r hy t n
r f und n th
7.3.R
n
n
bl d v lum t dr
n. M l r
hy v l m but d
t
tw d
flu d l d ng
n
n
t r
r
f
n th
t g ry.
m d gr
f
d r
f
dd ng fur
md
t nt w th f l
l
, my
blunt d nd d l y d r
v r
n
t
nf t n, wh h v
n
n
uld ult m t ly l d t
ft n b rv d n th
v d flu d
'f d
mn t d r
v rl d nd
r n l v
r n l
tt ng. Flu d
ulm n ry d m .
ul r r
t n
nd
n r m t ur n fl w, th r by r v nt ng flu d r t nt n.
n nh n
th r
rum m l r
mm n n
Th r h v b n
n rm l.(Legesse 2002, p. 335-
DH nd ld t r n (F gur 3). Th r
ut u ly t
ur
t d w th m n m l
t n , r n l bl d fl w nd gl m rul r f ltr t n r t ,
r r n l f lur , wh h
'
r n l d
bl
tub r ul
f
n , th r f r , l
t nt w th m d r t t
ul r r
dm n t r d
dm n t r ng
l d ng
th
l nf t n
f lur .(Lietman 2006, p. 395) Hy n tr m
n r
u
l hy t n
t flu d l d ng
b rv d n
d l m l v l
mu t b
f rm
dly, w th r ult ng h k ndu d
r
t d, m ld tr
t nt
d yt m v
nd
r
r th thr
t t . (Bundy 1992, p. 168-179)
h ng , r
343) Th m j r ty f
rly
f
T Flu d L d ng
h m dyn m
w th n r
nd l t
l w rr t . ln
t nt w th un m l
d r
u
. (Marti 1996, p. 477)
D ngu h m rrh g f v r, nt t n l nthr x nd h l r
tr
rt nt
r l t
r
, n m
rt
f n
r r t
. n
r
n
fl
r t n f DH n
n um n l nf t n, m l r ,
yndr m , r l g nn r 'd
m r
r d r
t nt w th th r nf t u d
n lr
l m
n .(Lucas 1972, p. 391) n
n w th
t
r
w t r
v r ty.
t nt w th
qu r d mmun d f
r t ly h gh l m
DH l v l d
n y
t
35
hy n tr m h v b n b rv d n 67% f
35% f
f
f DH l v l h
. n r
hy v l m
v r
dult m l r . Th
f
r
n ntr t n
r r l t v hy
v l m
f
DH
dm l r
nd n
l v t n
w r n t tud d n th r
uld b
u d by v
f ll w ng tr tm nt f th und rly ng d
h ldh
m h n m und rly ng th
n t b n lu d t d; h m dyn m
d l m
v r
n
r
r t r
d l t n. Hy n tr m
rt d
n
r
t
lv
. (Legesse 2004, p. 134-138)
Source: Hitoshi K. et al., 2008 p. 20
lyur
und rly ng
n un mm n f tur
th hy
l gy n r
f tr
rt d
n hr g n .(Leach 1997, p. 356-352) n
ld
. th
w
d b t
tudy n
b n ugg t d th t th
n
uth fr
du , th r
f 411
ntr l r
t nt w th
36
f l
rum m l r , 175 h d
v r m l r
lyur (ur n fl w >2 ml/kg
l v l
(21% f
v r
r h ur) dur ng th f r t 24 h ft r dm
nd th
w th ut.
w th m l r wh d v l
ntr l d b t
dd
n
m n t d ntr v
n.39 Tr tm nt w th v
r
du h
b nd
ul r
n m r v d th
)h d
n.
f DH w r n t d t rm n d. M rt l ty d d n t d ff r b tw n
lyur
l
nd 37 f th
t nt w th
rb d n
gul t n nd
t nt'
rum
t nt
tu t ry
lyur .(Canning 2006,
p. 499-504)
7.4.
th l l Tr n
V ry f w tr
m mbr n
rt f
l nf t n
f nt t n l
f h l r t xn l v
y l
. T
ff t
t
ll , th r by ff t ng hl r d tr n
ubun t 1, wh h nt r th
y l
f ll w d by
f flu d
rd y
n rly
n t
wh h m r w t r th n
r du ng th r t
th r f r ,
d um,
nb l t
f
th l l
t
tv t
tr n
d nyl t
rt f hl r d
ll nt th nt t n l lum n;
r ult f h l r d rrh . L
d um
rt. ubun t
um nd w t r, r ult ng n d rrh . U t 20l
l m , n
n
ll nd
M , wh h t mul t
l b rd r f nt t n l
hl r d
lD
th l l m mbr n . h l r t x n b nd t th
th l l
nv rt d t
thr ugh th
w t r
d um nd W t r n Tr
ntr t t d rrh
l t. Z n d r
f l tr lyt
du t
y l
th r d
dur ng
M l v l , th r by
r t n ndu d by h l r t x n.43 Z n
mm n n th m n g m nt f
nd
u
l m nt t n ,
t nt w th h l r .
(Kristof 2007, p. 52-58)
R n l x r
n f th
r d r
d n
d um/ t
tr n
(v th
d um/hydr g n x h ng r NH 3 nd th
t nt w th l t
um/ hl r d tr n
rt fr m th
th l l
lv l r
r
, wh r
rt r NK
2
thr ugh th
d um h nn l N
)
x r
n r
qu
rn Q 2
n f th
d. nt r t ngly,
l b rd r f th
d wn-r gul t d, wh r
lv l r
tr n
d um
th l um
rt f
37
d um,
t
lv l r
tr n
um nd hl r d
th l um thr ugh th b
yndr m ,
m l
t n
ulm n ry N
h m
r t ry
f flu d v rl d. ulm n ry
, [N . u .+],[k. u .+]- T
nd Q 5 r d wnr gul t d n
v r l t
ut r n l f lur
h m ty ,
th
m f rm
r
. Furth rm r ,
t d w th tr
f
n tr n
ld
rt dy r gul t n m ght
f Q 1 nd Q 5 r t n h v b n d t t d n d n v ru ut r
nf t u d
r t ry d tr
yndr m
n
m l
t
v r
n wh h th
m nfl mm t ry yt k n
nd m d t r
r l , t
bl th t dy r gul t n f
d um nd w t r
h v
h nn l n th lung
f
n
ut r
f
.
r
r
m nt f
d um
ur n m r th n 20% f
ur. R du d l v l
nf t d m
u r gul t d. Dy r gul t n f
unt f r th d v l
lly n th
ut r n l f lur ;
m tly f th
1 fr m th lung nt r t t um t th
l b rd r
rt n lung nd k dn y m ght
d tr
l t
n v NK
l
v r m l r
r
f tur
f th
m l
t d by
d
. n tr
ut r
r t ry d tr
n
l r g n , 21-24% f
yndr m .
(Kaul 2006, p. 62-69)
N tr
f
xd d r
th l l
nt rm d t
t n h nn l .
u h
dy r gul t n f
ulm n ry
d um tr n
y l -GM -m d t d nh b t n
nh n d r du t n f r
r xyn tr t d m g
lv l r
tv
xyg n--n tr g n
th l l
ll
nd
u
d um nd w t r h nn l n numb r f nfl mm t ry d
n tr n
rt h nn l n m l r h v n t b n tud d. rt un t , n
nt m l r l g nt, d r
th r t
tubul , l d ng t n tr ur
, wh h
t h l mn ,
rt n lung v
f NK
2-m d t d tr n
nh l t
r v nt flu d v rl d.
d rm l gr wth f t r, tum r n r
tr n f rm ng gr wth f t r-[ l h ]
(Jüni 1999, p. 1054–1060)
n u r gul t
rt n th r n l
f t r (TNF) nd
ulm n ry N
.
.
38
Th u
f
mb n t n f fur
r r n l r
rly r n l f lur
l r
Fur
m d , by nh b t ng NK
b
f
d
ld
m r t n l. D
lr t
nd r n l d
nd tr
tr
d r
nd
md
2, r m t
d ur
n ur nd r n
rt fr m th nt r t t um nt
n
u
hy k l m
l ff t
nd hy
fd
.
, nd by nh b t ng NK
n, th r f r , b
nd mmun l g
n rur l
r n l h m dyn m
ll , th r by g n r t ng m r f v r bl gr d nt f r
lv l r lum n. ulm n ry d m
t nt w th
mm n r t
mn m r v
d um tr n
mn n
1
lv l r
d um tr n
th l l
rt fr m th
r v nt d. Th
dv r
m n , nd th f t th t fur
l m , mu t, h w v r, b t k n nt
md
n d r t n.
(Ch n 2009, p. 2)
7.5. h ng
n
rum l tr lyt
Hy n tr m h
b t r , v ru
b n b rv d n numb r f nf t u d
nd
d um n m t
67% f
r
r
d um du t d r
tr
.
d v l
r t n f
m r
rly h
r ult f r n l v
u
ld
f
f
mm n
v r m l r . Th
r d dr n
rt
d l t n. Th
llul r nflux f
dl v l
r
n y
n y
u d by
n th
. 51 N tr ur
nd
n ff t
nd v l
n y n
f
f d rrh ,
f hy n tr m
f ll w d by d r
f dr n l n uff
l fun t n
d um,
l nf t n, tul r m
nd ry dr n l n uff
urr n
u
rum
, ff t ng 30-
n t l dur ng b ut
t nt w th l t
f r k tt
n
t v ty, n r
d um l
th m t
u d by
r ll l th
, n lud ng l
d um nd hl r d . dr n l n uff
t nt ; r m ry nd
r fl t m
rum hl r d
mm n n tr
t r.
l t n th ur n
dur ng th
rh
v r l
r t ry d rrh ,
d um
n
d [N . u .+],[k. u .+]- T
tt ng f
rt ul rly
t . h ng
. Hy n tr m
t nt . Th r
DH nd r
Hy n tr m
ndfly f v r,
d ur n ry
m
n
t nt w th
t nt w th
qu tr t n f
v r ly ll
r
v r m l r
tz d
39
rythr yt
nb
m
n th
dr n l gl nd r hy th l m
tt nu t d by n r
r d
rt
n ntr t n
m mbr n ,
d um
n
ur n
l w th l t
r
,
n rythr yt m mbr n
t nt w th m l r
d
nh n
f nf t n r
u
nh n d
m r
l
f
ll
fun t n f
ut r m mbr n
r .
nd nh b t n f [N . u .+],[k. u .+]- T
d um nt th
, T
t v ty
n
ll . n f t, dur ng ny
nb d r
d by t
d l t n du t v
u
d l t ng
n nd r l t v hy v l m , t mul t ng th r l
f
th t r m t w t r r t nt n. D lut n l hy n tr m
ur
r t n f DH n th
t r h
tt ng
n lly b n r
d um n t
f th l t
u
r r t r
rt d t
l dur ng d rrh
mm n
n
v r ty f nf t n.
u
n .R
tt ng f
hy n tr m . n dd t n t
nd n d qu t ly m n g d n tr ur
f hy n tr m
n
,
t nt w th tr
lt nd
l
.(Juan 2002, p. 193-196)
Unl
d um d l t n m n f t
r m , hy n tr m
r
ll
lt nd w t r r t nt n nd u u lly r fl t th
w t r r t nt n r
d
by th
t t , yt m v
hy t n
d um nd h rm n
th r ult f
th t ff t th
d um nflux nt
nflux f
h m . n nf t u d
m d t r
f r ul t ng nt rl uk n-6 ( L-6) nd
t nt w th d
nh b t n f [N . u .+],[k. u .+]- T
v r
t t
r ult f th r m mbr n njury r nh b t n f [N . u .+],[k. u .+]-
. n
h ng
rt l y t m; th
l m t b l m.(Jüni 2001, p. 303)
llul r nflux f
T
d
tu t ry
lv
n
wh n th d
w th d r
dr
n
hy n tr m w th
n
ld
u u lly
ntr ll d. Hy n tr m
wh n ntr v n u flu d
v rl d, wh h
ut tr
hy v l m , hy t n
t w t r l d ng. n th r
dm n t r d t
u
ym t m t
nd r d ly
n, h w v r, b
t,
n t
un mm n nd h
t d
ut n mu t b
t nt w th hy n tr m
ulm n ry d m , d
r br l ym t m
n nd mu ul r
x r
d
th t flu d
ur. M rk dly ym t m t
nly r r ly b n r
rt d
40
t b
t d w th m l r . Hy n tr m w th n
d um
n ntr t n h
Wh th r hy n tr m
r br l
lt l
DH n th
hy
h
r
l g
du t th
n lly n
yndr m
f n
f n
lr
n
f
h l t , hy t n
t hy t n
t nt w th r b
r r t
n t b n l rly lu d t d. Th r
n
w th l w l v l
b n b rv d
r r t ly h gh ur n ry
.
r t n f DH r
rt dly nh n d
n nd my
rd t
r t n f
nb
n tru d
n. n r b d d g , hy n tr m
d um n th ur n du t
t d
lt nd w t r d l t n.
(Charoenlarp 1993, p. 712-716)
7.6.Hy rn tr m
Hy rn tr m
un mm n n
t nt w th tr
m h n m und rly ng th d v l
hy rn tr m
r
nt, t nd
nd n d qu t flu d nt k
nf t n, u h
gn f
d rrh
m nt f th r t
t
u
rd b t
n
du w th
. n d qu t w t r r l
fr m wh m m r w t r th n
d um
th
u u lly nt t. Wh n
r br l nv lv m nt w th l
m l r w th hy th l m l
r r gn
l nf t n b
lyur
f
u d by
n . Hy rn tr m
m nt n
l t
n
un
v r
, th r f r ,
t nt w th n n
n l
r t ry
u
hy rn tr m .(Chirac 2006, p. 1560-1561)
7.7.Hy k l m
Hy k l m
m nly t r
n
b rv d n 38% f
r t ry lk l
tudy f 38 h ldr n w th
ntr
llul r
t
nd
ttr but d
nd ry t hy rv nt l t n.
v r m l r , 40% f
hy k l m w th n 4-8 h f dm
nd ry t qu n n
t nt w th f br l d
dm n tr t n h
t nt h d d v l
d
n nd n t t n f tr tm nt. Hy r n ul n m
b n b rv d, wh h
um h ft. l m l v l
fk t n
nd l t t
uld
r
u
n
l v t d n
41
t nt w th m l r . x r t n f th
x r t n f
t
d um nd
um n t
g d x m l
n hr
t
f
h
n 26-45% f
n ntr t n
d m unt f
nd d r
th r t
d um d l v r d t th
tr n
ntr t t
r
nt r
t l. th t NK
w th l t
r
; th
l
u
tr n
rt by ndr d
v r
ur n ry
um l
,
. h l r
.
. nh b t n f
ntr
llul r
d um r b r t n. Th
d um
t nt l n th tubul r lum n f r
n
m n d by
rt n th th k
nd ng l mb
n th ur n . Th f nd ng
2
u r gul t d n
uld r fl t d ff r n
n
t nt
n th d
mm n f nd ng n tr
ld
,
n
by nh b t ng [N . u .+]-[k. u .+]-2[ l. u .-]
n w r n hy k l m
x m l , v ll g r n rur l r
u
f
rt. (John 2003, p. 52-95)
D t ry f t r
b
um l
nfl t ng f nd ng
h l t t j und
t
r
m rtm nt. Tubul nt r t t l l
t
tud d.
untr
ll t ng du t nh n
, g n r t ng n g t v
rt nt th
r
f tubul r
f H nl furth r nh n
t g
l
r l ut r m mbr n n r
nh b t n f [N . u .+]-[k. u .+]-2[ l. u .-]
f th l
um gr d nt. L
t nt w th l t
l w th l t
by th l t
r b r t n thr ugh n
um tr n
t
mm n n tr
b n b rv d n
[N . u .+],[k. u .+]- T
t
m n d by
nd t n n wh h hy k l m r ult n hy k l m
Hy k l m d v l
n r
n th ur n
um w th h gh tr n tubul r
l du t d rrh l d
thy. K l ur
d um
ub t n
f l w d t ry
t d w th tr
f n rth
t
ld
t rn Th l nd d v l
.F r
hy k l m
um nt k . (da Silva 2003, p. 547-551)
7.8.Hy rk l m
n th
b n
f r n l f lur , hy rk l m
t d w th ntr v
hy rk l m
n th tr
ul r h m ly
r
n k ,w
n nf t u d
r rh bd my ly
r h rn t b t
.
u u lly
mm n
u
nd h t tr k . n
f
t nt
42
w th m l r , hy rk l m u u lly
ur n th
r
t d w th h gh m rt l ty. Th h gh n d n
d hydr g n
d f
n y n th tr
ntr v
ul r h m ly
m l r
nd l t
n th
r
n
u
r
r d
n
n
fm t b l
f glu
-6- h
d f
nd
h t
nt nd v du l t
f nf t n r wh n u ng
ntr v
d
ul r h m ly
rt n drug . B th
nd rh bd my ly
.
(Devereaux 2001, p. 2000-2003)
7.9. h ng
Th
n
rum M n r l
tt rn f h ng
n
l um, m gn
t nt w th d ff r nt tr
ld
. Th
dur ng m t f br l lln
.
n
hy m gn
h
h t m
m
nd hy
m l r , but th
h ldr n w th
7.10.Hy
Hy
v r
r
l um
h t l v l d ff r b tw n
n ntr t n f ur n
ul t n w th
, hy
ff t m r th n 30% f
r n t u u lly
mm n r
v r
t d w th ny d l t r u
nt ng f tur n m l r ,
rt ul rly m ng
l m
l m
nb
n rt f t f hy
nd
d
lbum n m , but t
l
t d w th
t v ty f [N . u .+],[k. u .+]- T
r thyr d h rm n , nd r du d l v l
f [N . u .+]-[
. u .2+] x h ng
[N . u .+],[k. u .+]- T
n ntr t n , wh h n r
Hy
l m ,
t nt w th
l m
tr n
b rv d n 15% f
n l
l v l l dt
th r t
nt nd r
lv
t nt w th l t
l v t d ntr
wh n nf t n
. n
. u .2+]-
llul r
,
l m . n r
ntr but (d r
f [N . u .+]-[
r
,[
f 1[ l h ]-hydr xyl
l t n n, L-1, L-6 nd TNF, r f t r th t und rl hy
r t
l w
n m . (Druilhe 2005, p. 359-362)
v r nf t n.5,6 D r
T
t nt
l wmn r ll v l
ff t . Hy r l m
um nd h
d
d um
. u .2+] x h ng ).
ntr ll d. Hy
tudy f 60
t nt w th
l m
d
43
m l
t d m l r , 25 (45%) h d hy
mm l/1[8 mg/dl]),
nv r
r l t nh
m r d w th 28% f th
b tw n
n ntr t n, th r f r , h
r h vy
r
th
26
l um l v l
tudy f 100
l m
t nt
nd
x r n d
nvul
r
t dm l r .
t l d w
n nd
b rv d;
t r f
t nt w th f l
t d w th
n ntr t n <2.0
w th un m l
r gn t v lu
t m . n
t nt h d hy
l m ( l um
r l ng d
m l
n
l um
t dm l r
rum r v v x m l r , 26
rr t d QT nt rv l.
n (f ur w th mu l
ght f
m) nd 18 d v l
d
ut r n l f lur . (Egger 2003, p. 1-76)
Th
ln
l gn f
n
f hy
l m
b v , th
nd t n
r l ng d
rr t d QT nt rv l m ght b
t nt w th
u u lly
v r m l r ,
t g th r w th hy m gn
nt r t ngly, d r
r n l f lur n
v n m,
t d w th
uld
r thyr d
t nt w th
m nt n d
v r nf t n. Hy
l m w th
t v ty
d r
d.
ntr but t th d v l
rd t x
m nt f hy
v r nf t n. Wh n r n l f lur
th dr
nr t
l um h nn l bl k r h v
ty. n
r thyr d f lur ,
t v ty m ght tt nu t th d v l
r thyr d t my tt nu t
gl m rul r f ltr t n.
d but,
r k f t r f r qu n n
r thyr d
m ,
d
n t w ll und r t
l m .
m nt f
ut
ndu d by n k
f r n l bl
d fl w nd
m l r ff t .
(Jancloes 1979, p. 111-122)
7.11.Hy r l m
Hy r l m h
d
. Th
n m
b n b rv d n
nd t n w
n dm
f ll w ng ly
d gn
t n w th numb r f tr
d n 31% f h ldr n w th
n. Hy r l m h
f
r
n ntr t n. Hy v l m - ndu d n r
r n l tubul
gr nul m
r
ntr but ng f t r.
th t r du
v r m l r
b n ttr but d t th r l
t z d rythr yt , wh h h v
m tr
nr t
h gh ntr
f
l nf t u
f
lu
l um
llul r
l um
l um r b r t n n
l nf t u d
u
1,25[( H). ub.2]-v t m n [D. ub.3]. r du t n f gr t r
44
m unt
f 1,25[( H). ub.2]-v t m n [D. ub.3] by
hy r l m
l r y,
nm t
. Tub r ul
tv t dm r h g
,h t l m
,
nd d
,n
D , yt m g l v ru nf t n nd n um y t j r v
n um y t
r n ) nf t n h v
ll b n r
rt d t
u
u
rd
,
(f rm rly kn wn
hy r l m .
(Ehrenberg 2005, p. 19)
7.12.Hy
h
Hy
h t m
th
h
h t m
ut - h
b rv d n
r
n
mm n f nd ng n
th
yndr m (Jada 1996, p. 1-12). Hy
tudy f 227
h
ff t d 80% f
t nt
h t m w
r
t nt w th m l r
lk l
r
th m t
n ntr
rb hydr t
rum h
r
n
m
yt k n
Th r
u
h
h t m
. Th n r
und ndu
n ntr
llul r h
h
v r l h rm n
n ntr t n .
n
h t m
h t
r t ry lk l
h
h t m
yt k n
h t n ur n
r
.R
r t ry
t nt w th
. Th
h ryl t d
h ft, th r by l w r ng
n nt n
ut - h
, L-6, r nfl mm t ry
rt
l nd
nd l v l
t h l mn .
f TNF, L-6 nd L-
m rk dly d r
t nt w th m l r
h t nflux nt th
n ntr t n f h
v r lf t r
dl d f h
n lud ng glu g n ,
w th th
h
n
h t m , th r f r , r fl t
dm n tr t n f qu n n t
, wh h nh n
r
h
w th l t
gly ly
rr l t n b tw n hy
tt ng, th
f hy
nf t n m d t d by r
nd
ut - h
v r ty f
h t m , wh h ff t b tw n 6% nd 30%
tv t
1[b t ]. nj t n f m
r l
h
n nt f
h t m
ff t 11.4%. Hy
nd m r th n 20% f th
h t l v l . Hy
t
h
m
tud d by d ff r nt nv t g t r .
mm n
llul r H
n
nd m ght r d t th
ut ly ll w th
rt d t
t nt w th
und rl th d v l m nt f hy
f
v r nf t n
t nt w th b t r l n um n
nd t n. n
yndr m , hy
t nt w th
rum h
t mul t
ll t g th r w th glu
d r
h t
n ul n
. n th
d. Hy rv l m du t
45
nf t n r ntr v n u flu d dm n tr t n
x r t n nd l d t hy
h
ur h v b n r
th r t
h t m . Th ur n ry
t nt w th nf t n th r f r v r
gly
n n r
rt d n
. Hy r h
f ur n ry h
n ntr t n f h
h tur , hy rur
t nt w th l t
r
h t
h t n
ur
nd
. (Ioanidis 2001, p. 437-
443)
Th
ln
l gn f
d r
Hy
h t m
wh
rrhythm
r
l
. h
u u lly
hy
h
ym t m t
h t m
n
r
nd t n
m nt f hy
l m .
t nt w th m l r .
t n n r
uld
t nt w th
dr k fd v l
ng
rd
u l m nt t n m ght b r qu r d.(Elaine 2002, p. 10-20)
ut w d
ll t g th r w th
ul r h m ly
t d w th
7.14.Hy m gn
r d
t
nd 50% f th
th l g
l t
r
llul r njury th t
ld
u
mm n
h
u
u u lly
h t t b r l
h m
nd w th l t
d
r rh bd my ly
d
h t m
nd
nb
.(Hotez 2006, p.102)
m
w th m l r
r n l
n tr
th r nf t n r t x n . Hy r h
v r nt t n l
m
f
h t m
um. Th m t
, du t
Hy m gn
mm n n
t nt w th tr
w th l t
t nt w th m l r v r
r
,
. M gn
ld
. Th
rh
l h ng . Hy rm gn ur w
nd ng l mb f th l
u
n t kn wn. Th
ntr but t th d v l
f r n l f lur , hy r h
t d w th
n th ur n
h t m
h t m
b n
ntr v
h
t v ty nd
h t
7.13.Hy r h
fr m
f hy
r thyr d
h
n th
n
n r
f hy rm gn ur . r v u r
n ntr t n f m gn
rt n t th d gr
n t d n 75% f 20
um r b r t n n th r n l tubul
f H nl ; th k
, ff t ng 30% f th
f
t nt w th
ur m nly n th th k
nd ng l mb dy fun t n
rt nd
um
r b bly
t th t dy fun t n f th n hr n
46
gm nt r d wnr gul t n f NK
Hy m gn
h m
m , thr ugh v
n tr t n,
ut r n l f lur . M gn
tyl y t n h
hy rm gn
ll w
7.15.Tr
r t tv
ttr but d t h m ly
r
.
mb n t n w th
ff t
rum m l r
f
r
ntr but t th d v l m nt f
g n t th
tudy f 80 dult w th f l
m
r
uld
um u l m nt t n n
b n h wn t b
nt r t ngly, n
f
h m .
nNg r ,
t z d nd n n r
t z d r d bl d
rt d. (Hotez 2007, p. 1018-1027)
El m nt
nf t n
n r du
rum l v l
n rm l mmun fun t n, l w
mmun r
f l
t d w th l t
n
. Th
rum m l r . m
u r x d d mut
fun t n
n qu n
nd
rum l v l
r.
r
f th tr
l m nt
n ntr t n f
r n
rm nt f nzym t
nt x d nt d f n
t v ty, h
u r x d d mut
fzn
b nd
t v ty
d
rb d n
rum
n
d r
rt nt t
m r m
d n
r, m
d
r
rum
l w th
,
lly
t nt w th f l
nd nt n
f th d r
m
rum m l r .
rm nt f th
nzym '
n ntr t n.(Xia 1992, p.
279)
Zn
m
n nt - nfl mm t ry nd nt x d nt g nt. D f
r mmun fun t n nd r
t d w th thr f ld n r
n m rk dly r du
d
.Zn
l
2004, p. 799-807)
t n
t
nf t n. L w l v l
th
t d w th
l m nt
f l m zn
n H V-r l t d m rt l ty.99 Z n
th m rb d ty nd m rt l ty
r du
n y f th tr
r
u l m nt t n
ut nf t u
m unt f flu d l t dur ng h l r d rrh .(Hotez
47
8.DISEASE SEVERITY
Flu d, l tr lyt
nd m n r l
d
.M l r
nd l t
d
b
tud
u
th
r
f th r tr
d--b
t tu , h ng
lt r t n
f nflu n
nd m n r l
th d ff r n
n th
th g n
m
r
l m , hy
f
l um nd m gn
t
h
nd
d r ng m nt n m l r
nd l t
h t m
nd l t
rt
, nfl mm t ry
rt, h v b n
w th th
r hy m gn
h ng
r
m l r, d
nd hy k l m
l m , hy
h
h t m
v r .
t nt w th
ft n d v l
m . Ur n l v l
f h
h t ,
n ur n ry l tr lyt
nd
. Hy
t
uld
nd m n r l
ym t m t
ntr t t
t
t nt w th
n ntr t n
r u u lly
n
n flu d,
r
l h ng . Flu d, l tr lyt
m
v r ty f
f d r ng m nt f
nd hy m gn
d. Th d ff r n
r
l
rum l tr lyt
. Hy n tr m
d, wh r
ntr ll d, n
(Weshe 1994, p. 41-85)
k ng, th
r Gr m-n g t v b t r
um r d r
f tr
f
rr l t d w th th d gr
h t m , hy n tr m
th l g
h
d t rm n nt v r
ndfly f v r. Hy
tv
r fl t v r t n n r n l
hy
r
m ld, nd h v b n b rv d n
um r n r
lv wh n th d
u
dd t n lly b rv d wh n nf t n
th r Gr m-
hy
r
mm n
f th tw d
l nf t n, tul r m
d um nd
f th
l
l r g n . Th r h v b n f w
n m mbr n
n ntr t n n m l r
mm n wh n nf t n
du t
ubj t f m t tud
nd m n r l l v l . G n r lly
l tr lyt
nd hy m gn
,
t nt w th tr
nd dy fun t n l r n l tr n
v r ty , th r f r ,
flu d, l tr lyt
mm n n
mm n n tr
. N v rth l
d nt f d. Th d gr
r k tt
r
ld
m d t r , h m dyn m
nf t n. D
r
h v b n th
nd t n
lt r t n , u h
r
rturb t n
nd qu kly
l m ,
r r gn
.
48
9.TROPICAL MEDICINE
Tr
lm d
n
br n h f m d
n rn d w th h lth r bl m
w rld. Th d
d
ln
f tr
n
m ny th r thr t n d th
d
urr ng n tr
l n t
l r ubtr
r m r ly
lr g n
d r m r ly
r
f th
n
t
u h
y ll w f v r, m l r , f l r
nd th f n n
l nt r t
f th
ur
n
, nd
w r
n d r bl n nt v t b tt r und r t nd, r v nt, nd tr t th
.B
ub
tz n
,
nd ntr r n ur dur ng th r tr v l t
nd u n th r r turn. lln
nd r t d
t n m m l
lm d n d v l
n unt r d by ur
th tr
n th t,
u
tr
ld
lty f tr v l m d
m d n ,
r
ft n n unt r d dur ng tr v l, th
n , n lud ng r -tr v l, tr v l, nd
ft n ub um d w th n th
lty f tr
t-tr v l l n
l
l m d n (M h l, 2004,
p. 4).
tw
n
th ught th t tr
r g n du t th
ndu v t th
nly
ld
d ff r d fr m d
l m t , fl r , nd f un
r d f
rt n ty
nd m r d n
tr n m t d
t lm t
n m l nd n
f
( l n 2002, p. 6). Th
m tr
t
l r
u h
h u ng r m r m
m r v d
r n l hyg n ,
rt nt d t rm n nt
r h m t
ul t n wh h m y h rb r nd
t hum n (M h l 2002, p. 4). H w v r, t
h lth nt rv nt n
tr n m
l r g n wh h r m r
f nf t u d
rt lly tru . Th w rm, m
m r dv r
f tr
f und n t m r t
n w l r th t ubl
n t t n, d qu t d t, nd
f nf t u d
r v l n
nd
n th n l m t (M h l 2002, p. 3).
n f t, m ny “tr
l” d
ld r
u h
t m r t
r
u h
but w r
ntr ll d nd l m n t d
ndu tr lly d v l
d
nd
r l
r
untr
untr
m l r
nd h l r w r
th Un t d K ngd m,
r l
t d n tr
rly n th 20th
nd m
n
n d , nd th Un t d t t ,
ntury. Th r
t d nt m r t
l r ubtr
n
r
n th t m t
, wh l m t d v l
l z n , r v ry
ng
m l x nd
49
ntr v r
l but r
h lth. Th
l
ly r l t d t f t r th t nflu n
- lt
-
n m f t r
nfr tru tur , v l b l ty f m d
d
l
lm d
b
t t t
n r l
f
ntly ff t ubl h lth
r , nd du t n—th m n d t rm n nt
wh h f ll nt th r lm f tr
tr
gn f
th d t rm n nt
lm d n .
r ult, th d
ln
n m th d fr m ubl h lth f ld , n lud ng
, h lth r m t n, nd d
r v nt n, t
mb t th
f
f
d m l gy,
d
(J hn,
2003 p. 6).
nf t u d
f tr
u h
v ru
, b t r , fung , nd
l m d n . th r r
r n wr
v ng m r
nf t u d
, u h
u
t
nutr t n l d
tt nt n n tr
t
r
t ll th m n t y
nd d
lm d n
hum n uff r ng, lln
r
urr ul
t rr
n ,
th y nt r t w th
, nd d th. (World Health
Organization 2007, p. 49-50)
r
t d
, n lud ng w rm th t nf t th nt t n l y t m, th
bl d, r m t ft n th
x lu v r lm f tr
f rly r r n d v l
untr
r
t
d
but v ry
t ng n
l r w t r. Th
m l t th r l f y l n n w h t
m
m
gg
rt nt th n f
n dd t n, th
r
nn t urv v n
d hyg n
d
nd
nb
r n
r
untr
. nt t n l
r th n ng t d nd
ym t m t
ld nv r nm nt , tr
n t t n n th tr n m
ly d gn
ng
th y r n w
nt m n t f d r w t r
gg
u ng d
u
rr g .
l lm t
f rl
n f nt t n l
r
d nd tr t d f d qu t
t .
r m ry
v l bl .(Hotez 2006, p. 23-33)
M l r , bl d
m qu t
mm n n d v l
r m t ft n tr n m tt d wh n nf t d
w th w rm gg by d f
Wh l
lm d n b
k n, nd th
r
wh h w r
n rth rn ur
t n w l
n
n d r d tr
mm n n th Un t d t t ,
(G rg , 2000, p. 414). Th d
m qu t br d ng r
ld
, tr t ng
fd
w
,
tr n m tt d by
n d , nd
rt
f
ntr ll d by l m n t ng
, nd n ur ng d qu t h u ng
50
wh h x lud d m qu t
d v l
ng
untr
r v nt n,
fr m h m
t n ght wh n th y r m t
, n d qu t h u ng nd
f d th
r y r fr m m l r
D l ng w th n w nd m rg ng d
(
R ) nd
nd m
m d n
d
r du t n r g rd ng m qu t b t
mb n d w th l ng r br d ng
t m ll n
n n r
nd
nd t
u h
l t wh und r t nd th
tr n m
n
nflu nz r qu r th
m l r
n th
ut r
v ru
l
r
nt n w h ll ng
l
f
r
fr
l
rt n t ly ff t
n try n my
hm n
,m l r ,
try n my
th thr
n l
h t
rd n l
d
r qu r
t
th f u mu t b
ur t th d
(M h l 2004, p. 41). Th
m l
ng hum n
u h
m -qu t -b rn
t d th
t
nd n urb n r
nt b t
du t th r
l t.
l” d
th t
ul t n . Th
d
r
), d ngu f v r (br k-b n f v r),
, tub r ul
, h g
d
), lym h t f l r
( m r
, nd n h
n
r
).(World Health Organization 2002, p. 12-20)
ntr l f th
r du ng x
kn
r
nd n r
lm d n
ng
m
fd
mult d
l n ry
r
—th h t, th d
d t th tr d t n l f u
d
t n
d nt f d 10 “tr
), l r y (H n n' d
(r v r bl ndn
Th
( fr
l
m y rgn t
fd
r nd m rg n l z d
f tr
d m l gy nd nf t u
d
ng r
t tr
Th W rld H lth rg n z t n h
d
r t ry yndr m
nd d ngu f v r wh h r n w f und t h gh r lt tud
wh r th y w r n v r f und b f r . n r
r ,l d
v r
t n nd k ll
tt rn
l
t n (G rg , 2000, p. 10).
f th w rld wh r th
h ng
m d
m l
rt
rn
r
m l fy (G rg , 2000, p. 15). Th w rm ng gl b l l m t
ttl m nt h v l d t th
t v . n m ny
n tr t ng l n
n r v nt ng d
h wh h ddr
g nt, nd th
ld
, n
by r du ng th d
, nd r du ng th h t u
r d f hum n mmun d f
r v nt n nd tr tm nt f m ny tr
nv r nm nt.
mb t ng th
v t r,
t b l ty t d
n y v ru (H V) h
ld
wh h w r
51
r
ntly und r
m rg n
tub r ul
ntr l, nd h
f mult drug-r
r
l
t x d h lth y t m t th r br k ng
-t nt (MDR) nd xt n v ly drug-r
ubl h lth
n rn r l t d t tr
nt. Th
t nt (XDR)
l m d n .(World Health
Organization 2009, p. 45-98)
10.METHODOLOGY
Qualitative research means a non numerical data collection or explanation based on
the attributes of the graph or source of data. Qualitative research often categorizes
data into patterns as the primary basis for organizing and reporting results. Qualitative
research typically rely on the following methods of gathering information: participant
observation, non-participant observation, notes, journals, books, analysis of
documents and materials, interviews. Qualitative researchers may use different
approaches in collecting data, such as the grounded theory practice, narratology,
storytelling, classical ethnography, or shadowing. Grounded Theory, is an inductive
type of research, based or “grounded” in the observations or data from which it was
developed; it uses a variety of data sources, including quantitative data, review of
records, interviews, observation and surveys. My research is a grounded theory
qualitative research in which I’ve used quantitative data also. Mainly for representing
the Randomized Controlled Trials RCTs) and the chapters presenting Flu d,
l tr lyt
nd m n r l
rturb t n .A randomized controlled trial (RCT) is a
type of scientific experiment most commonly used in testing the efficacy or
effectiveness of healthcare services (such as medicine or nursing) or health
technologies (such as pharmaceuticals, medical devices or surgery). RCTs are also
employed in other research areas, such as judicial, educational, international
development and social science research. As their name suggests, RCTs involve the
random allocation of different interventions (treatments or conditions) to subjects. As
52
long as the numbers of subjects are sufficient, randomization is an effective method
for balancing confounding factors between treatment groups. Randomized controlled
trials (RCT) are currently being used by a number of international development
experts to measure the impact of development interventions worldwide. Development
economists at a number of research organizations including Poverty Action Lab and
Innovations for Poverty Action (IPA) have used RCTs to measure the effectiveness of
poverty and health programs in the developing world. Randomized controlled trials
can be highly effective in policy evaluation since they allow researchers to isolate the
impacts of a specific program from other factors such as: other programs offered in
the region, general macroeconomic growth, and short-term events such as a favorable
harvest. Randomized Controlled Trials also help control for differences in personal
qualities that might make one individual more successful than another. By identifying
a group of participants and separating them randomly into otherwise similar control
and treatment groups, randomized trials allow researchers to reliably conclude
whether a particular program is responsible for generating positive changes in income,
health, education, or other poverty-related areas. For development economists, the
main benefit to using randomized controlled trials compared to other research
methods is that randomization guards against selection bias, a problem present in
many current studies of development policy.
Methodology can be defined as:
•
"the analysis of the principles of methods, rules, and postulates employed by a
discipline";¨
•
"the systematic study of methods that are, can be, or have been applied within
a discipline";or
"a particular procedure or set of procedures." (wikipedia.org)
•
53
10.1.
m l
l t n
Negle ted Tr i l Di e e (NTD )
he lth burden , ffe ting rim rily e
e tim ted ne billi n e
extreme
re
n titute ne f the m t eri u
le living n le
th n U $2 er d y. n
le re infe ted with ne r m re NTD .
verty f ffli ted
ubli
i l tigm ,
ul ti n , nd rel tively l w m rt lity re
me f the
n f r the negle t f the e di e e .
in e the l te 1990 , devel
f ffi i l devel
ment
ing
untrie h ve re eived in re ing m unt
i t n e ( D ) f r he lth ur
e . H wever, n t ll
di e e h ve benefited equ lly fr m thi in re e. Until re ently, id f r di e e
ntr l h
been imed rim rily t fighting HIV/ ID , m l ri , tuber ul i
li .
m rehen ive n ly i
f re e r h nd devel
negle ted di e e whi h were defined
nd di rrhe l di e e
h w
kinet l tid di e e (try n
HIV/ ID , tuber ul i
ment (R&D)
nd
ending n
in luding HIV/ ID , m l ri , tuber ul i
l w h re f funding f r NTD
u h
helminthi i ,
mi e , lei hm ni e ), Buruli ul er nd tr h m .
nd m l ri , h wever,
unted f r m re th n 76% f the
U $2.56 billi n inve ted n R&D n negle ted di e e in 2007.
The l k f funding f r NTD
ntr l r gr m h
been n ted by the W rld
He lth rg niz ti n (WH ),
demi
nd n n-g vernment l rg niz ti n .
H wever, the
f D
mmitted t NTD
e ifi
m unt
ev lu ted em iri lly. Thi
f r infe ti u di e e
er ttem t t d
ntr l h ve n t been
by n lyzing D
ntr l derived fr m the E D redit r Re
mmitment
rting y tem
( R ) d t b e.
The g l f ur n ly i i t identify D dedi ted t he lth
e ifi lly t NTD
ntr l f r the eri d 2003 t 2007. The b e of n ly i
n the E D R d t b e whi h
member
ue
f E D' Devel ment
lle t
nd
f D
D d t fr m d n r , in luding ll 22
it n e
mmittee (D
) nd — n
54
v lunt ry b i — fr m n n-D
untrie
Gl b l Fund t Fight ID , Tuber ul i
mmitment in te d f di bur ement
mmitment
b ut 90%
re ne rly 100%
u h
The
nd M l ri . The f u was n d n r ’
, f r the eri d
n idered, D
m lete in the d t b e while di bur ement
re nly
m lete.
F ll wing the
teg riz ti n u ed by the E D re
He lth, we in luded ll D
ul ti n
li ie / r gr mme
f r infe ti u di e e
rt Me uring id t
mmitment th t were m de in the e t r ‘He lth nd
nd Re r du tive He lth’
1). In rder t identify D f r NTD
I have
nd multil ter l gen ie
D f r he lth (T ble
ntr l, we tudied nnu l D
mmitment
ntr l in det il.
r h d M DL N (1966 thr ugh Jun 2007) f r R T
tr tm nt f r n gl t d tr
ld
. Wh n th
r hw
tudy ng r l drug
n tlmt dt
l ngu g , I f und 4 tr l th t w r n t ubl h d n ngl h: 2 n h n
wh h tud d h kw rm, r undw rm, nd wh w rm (1763
rt
nt
,
h f
nd 166
rt
nt ); 1 n Fr n h, wh h tud d h kw rm, r undw rm, nd wh w rm (186
rt
nt ); nd 1 n Ru
rt
nt ). B
u
t t l numb r f
rt
n, wh h tud d h kw rm nd r undw rm (119
th r w r f w n n– ngl h-l ngu g tr l d nt f d nd th
nt n th
m l , I l m t d my tudy t
tr l w
m ll r l t v t th t t l numb r n my
ngl h-l ngu g R T
nly.
I have n lud d nly th m t r v l nt n gl t d tr
WH h
d nt f d th
x t n
f ff t v
d t , th 7 m t r v l nt n gl t d tr
r v r bl ndn
, r undw rm,
l r y
tr t bl w th r l drug , t
l
h t
m
ld
f r wh h th
r l drug th r y. B
ld
r
l h nt
d n 2007 WH
, h kw rm,
, tr h m , nd wh w rm. (Wh l
n t
h ghly r v l nt. I n lud d R T
th t tud d mult n u tr tm nt f mult l n gl t d tr
ld
w th n
55
r l drug th r y ( , ngl drug r
mb n t n f drug th r
R T by wh th r 4, 3, r 2 n gl t d tr
10.2. ut m M
ur
ld
f N gl t d Tr
). I rg n z d th
w r t rg t d.
lD
M n g m nt
I have n lud d nly R T th t u d ur r t , n d n , r r v l n
nt rv nt n w r
t th
m
tud d un f rmly
r
ur
uld b
rd d th
n gl t d tr
m rb d ty m
ul t n l g bl
ld
tud
ur , u h
.I
r
h l
th r m
th
ld
.I l
ful tr tm nt
n v r ty f th r m
f
rt nt
rd d m rb d ty m
n ll th
m
ur
ur
r
rt d
r n nt n ty f
ur m nt v r d b tw n nd v du l R T
.R T
.R.K., nd W.W.) t h v m t th n lu
nd
n d r d by ll 3 uth r (M.R.,
n r t r w r n lud d. Th r w r n
gr m nt r g rd ng wh h R T m t th n lu
Definiti n
u
r m t r n h ldr n (h ght nd w ght),
rf rm n . I r
ld
b
h tr l. u
l ff t
uld n t n lud d t l
f r d ff r nt n gl t d tr
ur
ll 7 n gl t d tr
r x lud d fr m
gr wth
nf t n ( , w rm burd n)
d
ut m m
m yh v b n f
h m gl b n l v l , nd
n th
mmun ty l v l)
( g, wh n
f NTD u ed by different in tituti n
n rt r .
nd uth r v ry. F r ex m le,
WH li t 20 di e e t be ddre ed by the Gl b l l n t
mb t Negle ted
Tr i l Di e e . The Gl b l Netw rk f r Negle ted Tr i l Di e e in lude 13
di e e in it li t f NTD while the Negle ted Tr i l Di e e
t rget 5 di e e . F r ur ur
wh u e ne f the m t
with
e , we define NTD in
m rehen ive li t
ntr l r gr m
rd n e with H tez et l.,
f 37 NTD in luding 13
me f the highe t di e e burden (T ble 2).
re NTD
56
11.RELIABILITY AND QUALITY OF RESEARCH
It was
l ul ted r nge in te d f
in e we were n t lw y
ble t identify the
r je t were l beled with generi
di e e
n t
r je t title
me
n n-NTD
th t w
well
ll
b und f r
e , when
NTD
m unt
ex li itly identified
ent. In
me
e,
e, we
ndu ted internet nd
e ifi
ur
e f the
mmitment were m de f r r je t th t in luded
ntr l
tivitie , we
ntr l D
NTD
mmitment
e , e e i lly when the n me f the re i ient
ted t NTD . The number re
ible NTD
ntr l
nd h rt de ri ti n , e.g. infe ti u
e ified, we were n t ble t identify the
mmitment. In ther
NTD
e ifi
ntr l. In rder t identify the r je t' ur
liter ture e r he . H wever, in
w
ingle number f r NTD
uld n t identify the h re f funding
rted in T ble 3 re re ent the u er
they in lude ll
ntr l, (2) were identified
ntr l nd (3) h d n un e ified ur
mmitment th t (1) were
b th n n-NTD
e. T ble 5 r vide
ntr l nd
det iled
bre kd wn.
The he lth e t r in devel
ing
untrie h
ex erien ed
te dy in re e in D
mmitment in re ent ye r . Between 2003 nd 2007, t t l D f r he lth h
ri en
fr m U $8.73 billi n t U $14.38 billi n (T ble 3). The in re e f U $5.65 billi n
ver 5 ye r im lie
ur
e
n ver ge nnu l gr wth r te f 10.5%. N ne f the he lth
n lyzed h
different
e . M l ri
l t funding in b lute term but they h ve gr wn t very
ntr l nd tuber ul i
ntr l h d the l rge t ver ge
nnu l gr wth r te , t 29.6% nd 20.3%, re e tively. Funding f r HIV/ ID
ntr l r e by higher-th n- ver ge 18.0%. NTD
f 9.9%.
ntr l h d n nnu l gr wth r te
mmitment f r he lth e t r devel ment grew t nly 1.6%, the l we t
nnu l r te.
n ver ge, 36.3% f t t l he lth D w
mmitted t the
the eri d 2003–2007 (T ble 4). M l ri , tuber ul i
nd NTD
ntr l f HIV/ ID in
ntr l ttr ted
57
ver ge h re
f 3.6%, 2.2% nd 0.6%, re e tively. The h re f r je t
ddre ing
HIV/ ID r nged between 30.9% nd 47.2% f t t l D f r he lth between 2003
nd 2007. lth ugh flu tu ting ye r-t -ye r, m l ri
l
gener lly re eived ri ing h re
f
ntr l nd tuber ul i
D . The h re f D f r the
infe ti u diseases ther th n HIV/ ID , tuber ul i , m l ri
fr m 9.5% in 2003 t 7.6% in 2007. The h re f
l rgely
ntr l
ntr l f
nd NTD de re ed
D f r NTD
ntr l rem ined
n t nt r und 0.6%.
H ndling f
tient ttriti n h uld lw y be
e ed when ev lu ting the qu lity f
n R T, nd u e f intenti n-t -tre t n ly i
n hel t minimize bi
by redu ing
vere tim ti n f tre tment effe tivene . Re e r her inde endently r ted R T
e h f the e item . The in t n e
f di greement were re lved by di u i n. If n
R T r vided n inf rm ti n b ut qu lity riteri n, the item w
n t been erf rmed nd theref re
numeri l
re, we re ent d t
red
r meter de ribed by I nnidi
re
rted, whether the number w
e r tely f r e h R T.
rting f dver e drug event u ing
nd L u. The re e r her l
nd di
deemed t h ve
n . R ther th n r vide n rbitr ry
n e h f the e 6 element
dditi n lly, tri l were ex mined f r re
the number f withdr w l
n
ntinu ti n
et f
determined whether
f tudy tre tment due t t xi ity w
given f r e h
e ifi ty e f dver e event
le ding t withdr w l, nd whether the everity f the dver e event w
defined. There were n in t n e in whi h ne f the uth r
dequ tely
n idered the re
rting
dequ te nd the ther in dequ te.
The number f r NTD
ible
ntr l re
mmitment t thi
rted in T ble 4 re re ent the u er b und f
u e. T ble 5 h w
mmitment th t (1) ex li itly im t NTD
NTD
ntr l, (2) im t n n-NTD
ntr l nd (3) h d n un e ified ur
with un e ified ur
bre kd wn f the e number int
e nd r je t th t f u
well
e. Even when in luding ll r je t
n b th n n-NTD nd NTD
ntr l,
58
NTD
ntr l
uld nly ttr t between 0.37% (2006) nd 1.01% (2005) f t t l D
f r he lth. When ex luding un e ified r je t , the h re f NTD
ntr l r nge
between 0.18% (2006) nd 0.97% (2005).
Qu l ty
m nt f R T
nt l n
but g ld t nd rd f R T qu l ty
h v b n d nt f d
qu n
n
m nt d
rt nt m
g n r t n( ,u
r nd m z t n);
d qu t
m
ur
f n
ut m
m th d f bl nd ng h uld b
t n
n
nt
r r t
f nt nt n-t -tr t n ly
f tr tm nt ff t v n
t m . Th n t n
.R
fd
rf rm d nd th r f r
nd d
r
nt d t
n
dd t n lly, tr l w r
r m t r d
nh l t mnmz b
th numb r f w thdr w l
lv d by d
6 l m nt
nd L u. Th r
nd d
nt nu t n
d qu t
nd th
nt n
r bl nd d, th
u
gv nf r
th r n d qu t .
h f th
n. f n R T r v d d
n rb tr ry num r
r t ly f r
f th
t f
d t rm n d wh th r
f tudy tr tm nt du t t x
h
l
h R T.
drug v nt u ng
r h r l
v r ty f th
n wh h n
n
d m dt h v n tb n
rt ng f dv r
nn d
l d ng t w thdr w l, nd wh th r th
d f n d. Th r w r n
tr ngly
by r du ng v r t m t n
n . R th r th n r v d
h f th
rt d, wh th r th numb r w
ut ; nd
rt l . H ndl ng f
nd ntly r t d R T
gr m nt w r r
x mn df rr
r b d by
nd dr
r
r b d n th
f
d wh n v lu t ng th qu l ty f n R T, nd
r h r nd
r d
qu n
nt bl nd ng;
r ut m
nf rm t n b ut qu l ty r t r n, th t m w
r ,w
rt
t n
lm nt nd d ubl -bl nd ng r
rt
t nt ttr t n h uld lw y b
r
t n; d qu t
r bl nd ng; h ndl ng f w thdr w l
. ll
ll
r r t m th d t g n r t th
r l t d t tr tm nt ff t . f th
n
n t x t. Th 6 t m I v lu t d
f R T qu l ty: d qu t
l d tr tm nt ll
nt nt n-t -tr t n ly
u
ndu t ng m n ngful y t m t r v w ,
ty w
f ty
f dv r
v nt
dv r
v nt w
d qu t ly
uth r
n d r d th r
rt ng
59
Numb r f
rt
nt wh w r r nd m z d
h tr l w r d t rm n d. R nd m z d
rt
nt numb r unl
w ll
rt
th numb r wh
nt w r u
f r
n R T r v d d nly th numb r f
m l t d
l ul t n
rt
ft t l
nt wh
m l t d th tr l.
12.RESULTS
ll 13 n gl t d tr
nd w rldw d
ld
r v l n
, th r l n
r d
ld
r t n , g gr h d tr but n ,
r b d n T bl 1. Th 7 n gl t d tr
th t r th m t r v l nt nd tr t bl w th r l drug
d r
ng r v l n
(T bl 1). Th
r l t d n rd r f
nd t n r ng fr m r undw rm (1.2 b ll n
l nf t d w rldw d ) t r v r bl ndn
F r th 7 m t r v l nt n gl t d tr
(37 m ll n
ld
l nf t d w rldw d ).
, w d nt f d 29 R T th t
nr ll d t t l f 25 749 nd v du l . Th F gur : A h w th
r
Th
tudy
l t n
.(Wesche 1994, p. 7-11)
r v l n
f nd v du l n gl t d tr
th R T du t d ff r nt
tt ng
nd
ld
t nt
v r d
ul t n .
n d r bly m ng
ght R T
h ldr n nd dult ( g d >=20 y r ) nd th r m n ng 21 R T
nly. N R T
dv r
tud d b th
tud d h ldr n
v lu t ng r l drug tr tm nt f r mult l n gl t d tr
tud d r v r bl ndn
v nt w r
d qu t ly d
ld
r tr h m .
rly r
rt d n ll th R T . N n
nd d
nt nu t n
f tudy tr tm nt du t t x ty, nd
r b d th
v r ty f r
rt d dv r
numb r f w thdr w l
n n
ld
f th tr l r
rt d th
v nt . Valve 2008, p. 47-
85)
D
nd ng n th tr l, nd v du l n d d t
nd m f r th
r
rt d), b
rt ul r n gl t d tr
rt f gr u ( ,
ld
th r l v n
mmun ty th t w
tud d ( r v l n
h l h ldr n) n r g n th t w
r n d n
nd m f r th
60
n gl t d tr
f r tl
ld
tud d ( r v l n
t 1 f th n gl t d tr
ur r t
w r r
r n d n
ld
r
rt d), r t t
tud d ( n wh h
R T
d
, r v l n
r
rt d).(Hotez 2005, p. 208)
12.1.Drug Th r y nt rv nt n T rg t ng 4 N gl t d Tr
Thr
tv
lD
v lu t d drug th r y nt rv nt n th t t rg t d 4 n gl t d tr
l
mult n u ly nd n lud d 3775 nd v du l (T bl 2). ll 3 R T m t 4
f ur 6 qu l ty r t r , n lud ng d qu t d
r t n f th g n r t n f r nd m
ll
rt
t n
qu n
(T bl 3). N n
nd d qu t bl nd ng f
f th R T
nt
nd ut m
rf rm d nt nt n-t -tr t n ly
r
.(Utzinger 2006, p.
112)
l h nt
, H kw rm, R undw rm, nd Wh w rm. F x t l v lu t d
h l h ldr n n H t nd
d thyl rb m z n ,
l
r b tr tm nt ll
r v l n
ff
31.9%,
v r
r b d w thdr w l
nd dr
t n. lb nd z l
f ll 4 d
u
1.3%,
( ll
dv r
ut but d d n t
< .05) (T bl 2). lb nd z l
mb n t n th r y t r du ng th
< .05). dv r
drug v nt r
v nt w r r
f
lly
r; th
dv r
f h kw rm (8.1% t
tudy t t d th t “n
v nt. F v r w
v d lb nd z l
v d lb nd z l
n td
l nd
l n w
nt ,” but n d f n t n w
rt d m r fr qu ntly n nd v du l wh r
v r ty nd fr qu n y f f v r w
n
< .05), nd wh w rm (51.9% t
rt
v r
wh r
r v l n
rt ng w
rt d by
n t tut d
d thyl rb m z n th n th
lu d thyl rb m z n ), nd
lu d thyl rb m z n r du d th
< .05), r undw rm (28.4% t 0.9%,
t wh t
r
mb n t n th r y ( lb nd z l
b . Th tr l d
d
m r d 4 tr tm nt gr u : lb nd z l ,
r b d.
r vd d
t t dt b
lu
l n ( = .007), but th
61
B
h t l l
v rm t n,
tudy d
ll
tud d
h
l h ldr n n H t nd
mb n t n th r y ( lb nd z l
r b d w thdr w l
t n. lb nd z l
nd dr
lu v rm t n), nd l
ut but d d n t d
lu v rm t n r du d th
h kw rm, r undw rm, nd wh w rm ( ll
l
r du d th
t 5.6%,
r v l n
fh
r; y t m
yt m
dv r
r
t nw
h t
hl
lb nd z l , r z qu nt l,
w thdr w l
< .05) but w
dv r
r
t n w r
l n
gn f
ntly l
drug
t t d n th tr l t h v
v r ty n h ldr n tr t d w th
f d fnt n f
m
, nd Wh w rm. ld
n
t l tud d
n , nd K ny u ng 4 nt rv nt n :
mb n t n tr tm nt ( lb nd z l
rb d
r dr
,
n t r v d d.(Sundar 2007, p. 45-46)
h l h ldr n n h n , th
b . Th tr l d
f l h nt
< .05), r undw rm (28.3%
lu v rm t n r v rm t n l n , but th
H kw rm, R undw rm,
l
r v l n
l d tr tm nt
lu v rm t n ( < .05). dv r
urr d m r fr qu ntly nd w th gr t r
lb nd z l
n
b . Th
< .05) (T bl 2). lb nd z l
< .05), nd wh w rm (42.5% t 18.1%,
rt ng w
rb
kw rm (5.5% t 0%,
ff t v f r wh w rm th n lb nd z l
v nt r
m r d 4 gr u : lb nd z l ,
l d tr tm nt ll
ut . F rty-f v d y
ft r
lu
r z qu nt l), nd
t n but d d n t d t l
mm n m nt f tr tm nt,
lb nd z l r du d th
r v l n
f h kw rm nd r undw rm ( <.001), nd
r z qu nt l r du d th
r v l n
f
l
w
h t
m
b (T bl 2). Th r du t n n r v l n
r t
n t
bl t
( <.001)
w
n tr
m r d w th
rt d by
nt r r t wh th r tr tm nt ff t l t d 1 y r b
untry. t
u
m r
l w r r -tr t d t 6 m nth . n 1 t (K j w , K ny ), lb nd z l
r du d th
r v l n
Th
t t d th t th
uth r
r ult ng fr m th
f wh w rm, lth ugh th
ur r t
f rh
x t r v l n
w
kw rm, r undw rm, nd
mb n t n f lb nd z l
nd r z qu nt l w r th
l
n t t t d.
h t
m
m
th
62
ur r t
gv n
dv r
r ult ng fr m dm n tr t n f
f
lly f r th
drug v nt r
rt ng w
r. dv r
l
( bd m n l
b . lb nd z l
v nt th n l
v nt w r n t
w r n t t t d. U
mb n t n w th lb nd z l , w
v nt r t
r t ly, but n
v lu w
mb n t n tr tm nt.(Hopkins 1989, p. 669-675)
nd th r nd v du l fr qu n
dv r
h drug
f
lly d f n d
f r z qu nt l, l n
t t dt b
t d w th gn f
r n
ntly h gh r
n nd h d h ) th n th r lb nd z l
l n w
n tr
rt d t
r du
gn f
l n
ntly m r
r
dv r
b .(Stephenson 1989, p. 41)
12.2.Drug Th r y nt rv nt n T rg t ng 3 N gl t d Tr
Tw nty R T
lD
v lu t d drug th r y nt rv nt n f r 3 n gl t d tr
ld
nd n lud d 18 201 nd v du l (T bl 4). Th qu l ty f th 20 R T th t tud d 3
n gl t d tr
d
ld
w
g n r lly ub t m l (T bl 3) nd n n
r b d nt nt n-t -tr t n ly
ur 6 qu l ty r t r . ll 5 f th
wh w rm. It was d
f th tr l
. It was d nt f d 5 R T th t m t 3 r m r
tr l
f
tud d h kw rm, r undw rm, nd
r b th 4 tr l th t h d gn f
nt f nd ng .(Sorensen 1996, p.
41)
lb n
l v m
l
t l tud d
l , m b nd z l ,
b . Th
b
m r
n r du ng th
.001) (T bl 4). L v m
gn f
mb n t n th r y (l v m
ff
u th n th
r v l n
l
l n
nt r du t n n r v l n
m b nd z l
m r d 4 tr tm nt gr u :
l
lu m b nd z l ), nd
tudy m t 5 f ur 6 qu l ty r t r (T bl 3). L v m
m b nd z l w
l
h l h ldr n n Z nz b r nd
th r 2 drug r g m n
l
lu
m r d w th
f h kw rm, r undw rm, nd wh w rm ( ll
nd m b nd z l
f ll 3 d
l n
l
, but th l v m
h r ult d n
l
lu
mb n t n r du d gr t r r du t n n h kw rm r v l n
<
63
m r d w th th r drug l n ( < .001). N
dv r
v nt w r r
rt d n ny
drug tr tm nt gr u .(Shridharan 2009, p. 41-85)
n th r tudy by lb n
x nt l, nd l
b . Th
d qu t ly bl nd
w th l
rt
m r d m b nd z l , yr nt l-
tudy m t 3 f ur 6 qu l ty r t r (T bl 3); t d d n t
nt
rd
r b w thdr w l
b , yr nt l- x nt l w
r v l n
m r
ff
nd dr
l
gn f
ntly r du d th
ut . Wh n
r v l n
< .001) (T bl 4).
f ll 3 d
m r d
b , but yr nt l- x nt l h d h gh r r du t n n r v l n
( < .01). nd v du l r
v ng tr tm nt r
h ldr n w r w gh d f r d
m r d
u th n m b nd z l n r du ng th
f h kw rm, r undw rm, nd wh w rm ( ll
M b nd z l
w th l
t l n Z nz b r
rt d n
dv r
n wh w rm
v nt f r th r drug.
t m t n f yr nt l- x nt l.(Sinniah 1981, p. 315-
321)
n
t l tud d nd v du l
g d 3 t 40 y r n Fr n
m r ng lb nd z l w th l
r t
m r th n l
rb
b f r ll 3 d
n
,
b . Th y f und th t lb nd z l m r v d th
ur
(94.2% f r h kw rm, 95.9% f r
r undw rm, nd 64.1% f r wh w rm). Th
ddn td
nd W t fr
l d tr tm nt ll
(T bl 3). lb nd z l h d n m r
dv r
tudy m t 3 f ur 6 qu l ty r t r
t n rd
r b w thdr w l
v nt th n l
nd dr
nd
ut
b .(Hollis 1999, p. 670-
674)
F n lly, Y ng
g d 3 t 61 y r
t l
m r d flub nd z l w th m b nd z l n U
nd f und th t b th drug h d h gh ur r t
r undw rm, nd h d m l r ur r t
4). Th
tudy l
g n r t n f ll
nd v du l
f r h kw rm nd
f r th tr tm nt f wh w rm ( > .05) (T bl
nly m t 3 f ur 6 qu l ty r t r
nd d d n t d
t n
lm nt (T bl 3). Th
t t d th t nd v du l r
qu n
rt d “n
r ll
gn f
t n
n
nt dv r
r b th
tudy
v nt ” f r th r drug but n
64
d fnt n f
f
gn f
lly d
nt dv r
gn d t
ddr
v nt w
r v d d. Furth rm r , th R T w
u
f qu v l n .(Schultz 1995, p. 408-412)
th
12.3.Drug Th r y nt rv nt n Targeting 2 N gl t d Tr
xR T
v lu t d nt rv nt n f r 2 n gl t d tr
n t
lD
ld
mult n u ly nd
v lu t d 3773 nd v du l (T bl 5). Th qu l ty f th tr l w
r w th n n
fulf ll ng m r th n 2 f ur 6 qu l ty r t r (T bl 3). n R T v lu t d drug
th t
n l ng r v l bl
th tr l d
nd 5 R T
r b d w thdr w l
Th qu l ty f th
tud
tr tm nt r g m n
r vd dn d t
nd dr
ut
m k t d ff ult t
tud d n th
r
n dv r
v nt . N n
f
rf rm d nt nt n-t -tr t n ly
nt r r t th
ff
y nd
.
f ty f ny
tr l .
13.CONCLUSIONS
The r ult nd
t th t x t ng r l drug th r
f th m t r v l nt n gl t d tr
m t r v l nt n gl t d tr
mb n t n, b
r
n gl t d tr
ld
drug tr tm nt
uld
1977. The f nd ng
d
ld
v l bl th t
t
H lth nd
m y b tr t d w th
uld
u
rt th
r l drug
n , nd K ny . r l
r r
ld
w
ngl
r l
ubl h d n
mult n u tr tm nt f mult l n gl t d tr
r
h. The w rk
n nt gr t d tr t gy t
ld
hl
ngl
t nt lly tr t th 7 m t r v l nt
ntr l 2 r m r n gl t d tr
u ng x t ng drug th r
N gl t d tr
mult n u ly nd th t 4 f th 7
nd v du lly, nd th f r t R T h w ng th t
; th t , n nt gr t d
th t dv
ld
d n r ult fr m H t , h n , th
drug tr tm nt
d
uld b u d t tr t 2 r m r
n
t nt w th gl b l n t t v
ntr l th m t r v l nt n gl t d tr
.(Schistosomiasis 2009, p. 10-25)
gn z d
v rty r nt gr lly r l t d, nd
b ng
gn f
l
nt
u
ntr ll ng n gl t d tr
f
v rty.
ld
l
65
m yb
n r l t
M ll nn um D v l
nt rn t n l
xtr m
tr t gy t h l
lmn t
m nt G l ,
r
v rty. Th Un t d N t n '
f bj t v t rg t
nd r d by th
mmun ty, n lud th g l f h lv ng th numb r f
v rty by 2015.(Hoang 1993, p. 27-28)
n gl t d tr
ld
r
n t t v th t f u
r f und d ff r n
ld
rt f
m nt G l ) l t
m l nt rv nt n th t
urv v l nd qu l ty f l f . nt rv nt n
h uld b
fund m nt l
u d by w rm , nd th M ll nn um r j t ( n
h l- g d h ldr n
t
l l v ng n
x f th 7 m t r v l nt
n m l m nt ng th M ll nn um D v l
r gul r d w rm ng f
tr
xtr m
g n t n gl t d
n d r d nv tm nt n hum n
l n t r du
b n f t t th nd v du l w th th
uld m k
t l nd f rm
gl b l
v rty. n dd t n t th
d
, th
bv u h lth
nt rv nt n r ult n n rm u
n m b n f t by m r v ng du t n l ut m
nd w rk r r du t v ty.
(Savioli 2003, p. 5-6)
numb r f m
n gl t d tr
gn
ur
h v r
ld
f n r
ntly b n n t t d t r du
nd ubl
w r n
ld
ntr l. n
r v l n
f n gl t d tr
ng. Th U g v rnm nt h
n gl t d tr
th
ld
mm tt d $15 m ll n t
t b r 2006, th
h w
u
lD
m
rt f n gl t d tr
d
r m t ng n nt gr t d
ntr l ff rt . n D
r
h rm
h
ntr l, wh
mb r 2006, th B ll & M l nd G t
nn un d $46.7 m ll n n gr nt t w rd d v l
r
h
ng v d n
n ff t v m th d f l m n t ng n gl t d tr
ut
r qu r d f r th
l
m n
l
F und t n
th t n nt gr t d
ld
.
mm tt d t d n t ng ll f th drug th r
nt gr t d tr tm nt
th n U $1 b ll n nd
nb u dt
h v
rt
l nt n Gl b l n t t v
h l d l un h th Gl b l N tw rk f r N gl t d Tr
n n lud
f
r
h. Th drug d n t n
r v lu d t m r
n t tut th l rg t drug d n t n n h t ry. th r drug th t
ntr l th 7 m t r v l nt n gl t d tr
ld
r
66
n x n v . F r x m l , th Gl b l N tw rk f r N gl t d Tr
ntr l
tm t
lb nd z l
th t d thyl rb m z n
t
r x m t ly $0.02
nf t n , nd h rm
u d f r th
l
ut
l
d n t d. F nw k t l
n gl t d tr
n nnu l
ld
r x m t ly U $0.01
wh n u d f r th
d n t th drug fr
rd
,
ntr l f w rm
f h rg wh n t
. v rm t n, m b nd z l , nd r z qu nt l r
t m t th t
n fr
t fl
rd
m n
ntr l f l h nt
t
lD
r x m t ly 500 m ll n
l
tr kf r
uld b tr t d w th 4 ff t v drug th r
th n U $0.40
r
t
r n, n lud ng d tr but n nd d l v ry
t . (Hall 1994, p. 110-112)
14.FUTURE RESEARCH DIRECTIONS
The r v w h
h wn th t urr ntly v l bl
mult n u ly t rg t
r t n lr
r v d ng th
m ny
r h
r
r
t
lD
h l. tud
n d d f r th r n gl t d tr
f ty
v nt w r
th
b n
w
hb
r r qu r d n th
d nt fy r t
d tr tm nt l n . Th ty
R T n ur n ly
t rt d t
ul t n m y b d ff ult t r
r lmt dt
dd t n lly, drug
. H w v r, m r
l m th d t
fr
ld
n m rt nt
r hh
x l r th
u
th y l v n r m t
ff t d r g n wh r
rd n t
b n
u .
nd x ut th
rf rm d f r tr h m
nd
.(Farahmandian 1997, p. 98-105)
n rn. dv r
v nt r
rt ng n ll f th
r. T n f th 29 R T d d n t t t wh th r dv r
d, nd b n
fr
rt ng f dv r
v nt
f u h v nt . n th 14 tr l n ur r v w th t r
v nt fr qu n y nd
f r
ul t n l v l. Th Gl b l N tw rk f r
ntr l nd WH h v
r d n t tt nd
ur
ld
n
n d d t d t rm n th b t m l m nt t n tr t g
F r x m l , t-r k
r
4 n gl t d tr
r l drug th r
N gl t d Tr
m l drug tr tm nt
v r ty w r n t
f d. Th
n t qu v l nt t
rt d dv r
r qu l ty f th r
v nt ,
rt ng f
67
dv r
v nt
n t un qu t n gl t d tr
qu nt ty f drug
f ld .
n
f ty r
f ty r
r h
n dt b
rt ng
n d r d. N gl t d tr
ul t n th t
r r ty. x rt
m l t d, th r k
tr tm nt n r
nb
t WH
nd m f r h
ld
n d d,
r
l
r u d
ld
n 2002
m d
ld
ur
t r k f r drug t x
f n tr tm nt
ty, m k ng
n lud d th t unt l furth r
rt
utw gh th r k
kw rm, r undw rm,
wh w rm, but furth r tudy f u ng n th
tr
r h—th qu l ty nd
rt ng h v b n f und l rg ly n d qu t
r d m n ntly n vuln r bl
r
r
bl drug nt r t n wh n drug f r n gl t d tr
mb n t n l
drug
ld
h t
m
f
, nd
f ty f drug tr tm nt f r n gl t d
rt ul rly f r h ldr n nd w m n.(George 2000, p. 12-
20)
n
h ll ng r
tr tm nt
d by th m
th t th d
ng f
dm n tr t n f n gl t d tr
l , r z qu nt l, yr nt l- x nt l) r qu r
h ght,
lly n h ldr n. Furth r ff rt
, dur t n f tr tm nt, nd d
m
f th
drug
ng
nd v du l z t n by w ght r
r r qu r d t d t rm n th
h dul
n d ff r nt
u
Th r
r
l
f
h uld n t b g v n t vuln r bl gr u , u h
n rn r l t d t drug ff
wh r drug r
m rg ng, nd t
m yb
t n
(
y. Furth r r
f drug
bl
bl
r h
r m t ff
n qu n
d nt fy r g n w th h gh r t
n m th d f d l y ng th
2000, p. 12-20)
r gn nt
r h
n d dt
t m l drug d l v ry.(Greene 2000, p. 715-722)
rt ul r g gr h r g n wh r
r
tm l
tt ng . Furth rm r ,
w m n, nur ng m th r , r v ry y ung h ldr n. H gh-qu l ty r
ddr
drug
v r l drug ( g, d thyl rb m z n , v rm t n,
l v m
d
ld
fm
u ,t
d nt fy
d nt fy
drug dm n tr t n)
f r nf t n.
urr n
n d dt
f drug r
mb n t n th r y
t n .(George
68
Futur R T
u h
m r ng 2 r m r drug tr tm nt m y n d t
th r
ut
qu v l n . Th
wh th r 2 drug th r
tr
ld
but d ff r n t rm
h ldr n). n x m l
d m n tr t d th t
n n nf r r t
f drug r
r ll
hm n
tr
m
r
ld
nd
F n lly, th
n
und r w y f r
u r
m
r ult
n v nb
bl
dm n t r, w
fh
t l z t n, f r th
. Futur R T
n f th
h v d
ld
ld
d
m n g m nt h uld g
ld
d
n d n
l ly w th n n h rm
u
l
ntr l
ntr l nd
nn t
h v
w th ut n ll ry
n lud fund m nt l ubl
l n w t r nd d qu t
d nt
n d v l m nt,
, nd m rb d ty
. Drug-b
ff rt l d by f rm r r
r m r ly b
h uld
rt f n nt gr t d drug th r y tr t gy t
f th n gl t d tr
t
nd tr h m )
th r m t r v l nt n gl t d
lut n. L ng r-t rm g l n lud v
u h
x m l f d by th
gl b lly,
th
truly nt gr t d tr tm nt l n mu t l
ur
qu v l n
.(Fincham 2003, p. 315-333)
rm n nt r du t n n n gl t d tr
h lth m
v rl
ld
th
ul t n
(r v r bl ndn
t f nt gr t ng n gl t d tr
n f tr n m
ur .
w k
ld
nd tr h m
b y nd drug th r y
ut
nv n nt t
n b tr t d w th r l drug th r
tr t mult l n gl t d tr
l
n nd .(Fox 2005, p. 115-121)
f g gr h
n lud r v r bl ndn
m
m r
f th 7 m t r v l nt n gl t d tr
ur n th
y n d ff r nt
t n ), r n
f n R T th t v lu t d th r
r m my n, wh h
u
ntr ll ng n gl t d
v nt r f l , ff
m h t r n B, wh h ft n r qu r
tr tm nt f v
Tw
f dv r
n r
gn
rt ul rly m rt nt wh n v lu t ng
r t w rk qu lly w ll f r
g gr h r g n ( u h
(u h
u
n d rd
n t t n. x
l g
lm
ur ,
rt r t
r d
t Gu n
t n l
w rm
r b ng du t d t f lt r w t r w th
m h l th r r t u .(Fenwick 2005, p. 1029-1030)
69
15.LIMITATIONS
T
rm t r
- tudy
m r
n , I n lud d nly tud
r v l n , r ur r t . lth ugh n gl t d tr
b n f
l r du t n n m rb d ty m
m
ur
v r ly d
uld n t n lud
ld
rt d n m
v
ld
ll f th m n
ur
f m rb d ty. Th
ntr l. N gl t d tr
n , m rb d ty r du t n
ld
w ll
ld
r
lb n ftt
ft n hr n
r
ff t v
nd
ur
n d r n v lu t ng
f n gl t d tr
ld
th r r m ry ut m . n d n , r v l n ,
m rb d ty r
ntr l. Futur
r k y
n d r d n ny tudy
ld
tr tm nt . th r tud
ntr l h v u d m rb d ty l n
nd ur r t
rt
th r
nd m ng nd v du l
bl ng but n t mm d t ly l f -thr t n ng. Unt l th r
n gl t d tr
tr
tr tm nt m y r m t
( g, h ght, w ght, nd h m gl b n) th t h uld b
f n gl t d tr
u h
ld
ur , I
v lu t n v r d f r d ff r nt n gl t d tr
R T . nly 4 f th 29 tr l r
th t x m n d n d n ,
tud
ll m rt nt
h uld
t
f urr nt n gl t d
n d r n lud ng t nd rd z d
m rb d ty ut m .
n th r m
ur
d d n t n lud
f nf t n t
d
.
r
nt d n n
ny u h m
t ntly w
ur . Futur
tur th full r ng
nt n ty f nf t n; 3 f th 29 R T
tud
f ff t
h uld
n d r n lud ng nt n ty
f tr tm nt f r n gl t d tr
l
70
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1
APPENDICES
Figure: A
Identification of RCTs of Oral Drug Therapy of Multiple Neglected
Tropical Diseases - RCTs indicates randomized controlled trials.
Pild l J, Ch n W, Hr bj rtss n , F rf ng , ltm n DG, G tzsch PC. pril 7,
2005]. BMJ. 2005; 330(7499): 1049.
2
T bl 1
Continued… .
3
T bl 1
R hm n W . C mp r tiv tri ls using lb nd z l
nd m b nd z l in th tr tm nt
f s il-tr nsmitt d h lminths in sch lchildr n n P n ng, M l ysi .
S uth st si n J Tr p M d Public H lth. 1996, p. 765–767.
4
T bl 2
R ssign l JF, M is nn uv H. lb nd z l : pl c b -c ntr ll d study in 870 p ti nts
with int stin l h lminthi sis. Tr ns R S c Tr p M d Hyg. 1983, p. 707–711.
5
T bl 3
S chs JD, Mc rthur JW. Th Mill nnium Pr j ct: pl n f r m ting th Mill nnium
D v l pm nt G ls. L nc t. 2005; 365(9456): 347–353.
6
Table 4
Continued...
7
Table 4
S chs JD, Mc rthur JW. Th Mill nnium Pr j ct: pl n f r m ting th Mill nnium
D v l pm nt G ls. L nc t. 2005; 365(9456): 347–353.
8
Table 5
S chs JD, Mc rthur JW. Th Mill nnium Pr j ct: pl n f r m ting th Mill nnium
D v l pm nt G ls. L nc t. 2005; 365(9456): 347–353.