UNIVERSITY OF LONDON

FACULTY OF MEDICINE
MSc EXAMINATION for Internal Students of the London School of Hygiene & Tropical Medicine

MSc Tropical Medicine & International Health (TMIH) PAPER 1 Monday 18th June 2007 10.00 13.00

INSTRUCTIONS TO CANDIDATES
DO NOT REMOVE THIS EXAMINATION PAPER FROM THE EXAM HALL

1. Answer FOUR of the following TEN questions. 2. Write your answers in the answer books provided NOT on the question paper. Answer each question in a SEPARATE answer book. 3. It is strongly recommended that you write in black pen.

Questions should NOT begin on the front page. Electronic calculators may be used. These should be of a hand-held nonprogrammable (where relevant) type and the name and model should be stated CLEARLY on the front of your answer book.

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Answer 4 questions.
1. Write short notes on the transmission and distribution of four of the following: a. Trichomonas vaginalis b. Strongyloides c. Loa loa d. Paragonimus e. Trypanosoma cruzi f. Yellow fever g. Scrub typhus 2. Write short notes on four of the following: a. Candidate vaccines against helminths b. Sensitivity, specificity, positive predictive value c. Drugs used for treatment of schistosomiasis d. Metronidazole e. Control of cysticercosis f. Mansonia g. Hypnozoites 3. What are the advantages and disadvantages of larviciding, compared to other methods of vector control? Illustrate your answer with reference to mosquitoes (Anopheles, Culex, Aedes) and blackflies.

4. Compare and contrast the mechanisms of disease in cutaneous and visceral leishmaniasis. 5. What are the main diseases caused, triggered or transmitted by lice, fleas and mites? How are they controlled or prevented? 6. What strategies are currently being used to control helminth infections? Evaluate their current achievements and the foreseeable threats to future success. An outbreak of malaria is suspected in a newly established refugee camp in Asia. What steps would you take to confirm that there is local transmission of Plasmodium vivax and/or Plasmodium falciparum? How would you control the outbreak? Explain, using a range of examples, the various ways in which parasitic infections may cause anaemia

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9. A new class of insecticide is being tested for use on nets, as an alternative to the commonlyused pyrethroids. Describe how you would design and conduct a trial testing whether individuals sleeping under nets treated with the new compound are protected from malaria and mosquito biting. Specify in your answer (i) which indicators you would measure (ii) what would be a suitable control group (iii) how the roles of chance, bias and confounding would be minimised.

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10. A study was conducted to look at antibodies to S.haematobium from blood samples taken from adult patients attending hospital with schistosomiasis. A total of 149 blood samples were taken (68 women and 81 men), and the following data about antibody concentration, transformed into appropriate units, were obtained: Males (n = 81) 12.5 5.1 1.1 8.5 12.4 16.6 22.1 Females (n = 68) 11.0 4.7 1.2 8.4 10.7 14.2 22.2

Mean Standard deviation Minimum First quartile Median Third quartile Maximum

(a) Draw a box-whisker plot to summarise and compare the antibody concentrations between men and women. Comment on the findings (15 marks) (b) Using the data from the 81 men, calculate the standard error of the mean antibody concentration in men, and obtain the 95% confidence interval (95% CI) of this sample mean. (15 marks) (c) Explain the meaning of the 95% confidence interval you have obtained, stating what population your sample results represent. (15 marks) (d) Calculate the difference in the mean antibody concentration between men and women. (5 marks) (e) A two sample t-test is suggested to compare the mean antibody concentration between men and women. What is the null hypothesis for this test? (5 marks) (f) The t-test gives a P-value of p=0.085. How would you interpret this result? (10 marks) (g) State two assumptions for this test to be appropriate. Based on the results above, explain why you think the test is or is not appropriate for analysis of this data set? (15 marks) (h) Age (in years) is also recorded in the study. What statistical and/or graphical procedures would you use to examine whether antibody concentration increased with age? (20 marks)