Surveillance of HIV and syphilis infections among antenatal clinic attendees in Tanzania-2003/2004

Background

SPARCLE is a nine-centre European epidemiological research study examining the relationship of participation and quality of life to impairment and environment (physical, social and attitudinal) in 8–12 year old children with cerebral palsy. Concepts are adopted from the International Classification of Functioning, Disability and Health which bridges the medical and social models of disability.

Methods/Design

A cross sectional study of children with cerebral palsy sampled from total population databases in 9 European regions. Children were visited by research associates in each country who had been trained together. The main instruments used were KIDSCREEN, Life-H, Strength and Difficulties Questionnaire, Parenting Stress Index. A measure of environment was developed within the study. All instruments were translated according to international guidelines. The potential for bias due to non response and missing data will be examined. After initial analysis using multivariate regression of how the data captured by each instrument relate to impairment and socio-economic characteristics, relationships between the latent traits captured by the instruments will then be analysed using structural equation modelling.

Discussion

This study is original in its methods by directly engaging children themselves, ensuring those with learning or communication difficulty are not excluded, and by studying in quantitative terms the crucial outcomes of participation and quality of life. Specification and publication of this protocol prior to analysis, which is not common in epidemiology but well established for randomised controlled trials and systematic reviews, should avoid the pitfalls of data dredging and post hoc analyses.     

Hydatid disease in Toposaland, Southern Sudan

A total of 1010 people in Toposa-land Southern Sudan were screened for hydatid disease using a portable ultrasound scanner. The prevalence of the disease was shown to be 3.5% with a majority of the cysts (60%) being located in the liver. Unlike the situation observed among the Turkana people, the level of hydatid infection within various age groups depict progressive linear increase. In addition, the level of the disease infection in both sexes show no significant difference whereas in Turkana the prevalence in women is twice that found in men. The occurrence of such differences within two culturally closely related communities is an enigma requiring further investigations. In the absence of guaranteed source of funding on a long term basis which is essential for a hydatid control programme, the control measures recommended include incorporation of hydatid education into the school and health curriculum.     

Echinococcus granulosus: ultrastructural effect of albendazole therapy

The effects of the anthelmintic Albendazole against Echinococcus granulosus hydatid cysts in Turkana patients given orally were studied by means of ultrasound as well as light microscopy, scanning and transmission electron microscopy. The treatment generally reduced the size of the cyst mass, making the patients feel well. The drug therapy caused collapse of the cyst wall and daughter cyst. The pathological changes on the germinal layer of Albendazole-treatment cysts differed widely from the untreated control hydatid tissue. The effects included morphological changes of the protoscolices, presence of lamellated bodies, necrosis with detachment of the germinal layer from the laminated layer. However, some parts of the Albendazole-treated hydatid tissue remained unaffected.     

Sexually transmitted infections and risk factors among truck stand workers in Dhaka, Bangladesh

OBJECTIVE: This study was conducted to determine the prevalence of selected sexually transmitted infections (STIs) and their risk factors among workers in and near a truck stand in Dhaka, Bangladesh. STUDY DESIGN: A random sample of 696 men and 206 women were recruited into a cross-sectional study using a census that enumerated transport agents, motor mechanics, laborers, and vendors in Tejgaon truck stand. RESULTS: The prevalence rates of syphilis (rapid plasma reagin and Treponema pallidum hemagglutination), gonorrhea (polymerase chain reaction [PCR]), and chlamydial infections (PCR) among men were 4.1%, 7.7%, and 2.3%, respectively, and among women were 2.9%, 8.3%, and 5.2%. Multivariable analysis revealed that having >or=2 sex partners in the last month, never using a condom with sex workers, and ever injecting narcotics were significant predictors of STI among men. Being never married, working as a laborer, older age, and living within the truck stand were significant predictors of practicing high-risk behaviors among men, but none predicted infection with STIs. CONCLUSIONS: Both behavioral and STI data suggest that truck stand workers should be included in the STI/HIV intervention programs.     

Changing Mother’s Hygiene and Sanitation Practices in Resource Constrained Communities: Case Study of Turkana District, Kenya

Lack of adequate sanitation, hygiene and safe portable water are serious global health problems that contribute to deaths of many children under the age of 5?years annually, mainly due to diarrhoeal diseases. This study was set out to determine the extent to which sanitation and hygiene promotion influenced mothers’ and children’s health in Turkana District; one of the arid Northern frontier Districts of Kenya. A repeat cross-sectional study design with multi-stage sampling method was used. A total of 300 mothers were randomly sampled for interviews in a baseline survey carried out in 2007 and in a post-intervention survey carried out in 2008. Data were collected using questionnaires and analyzed using SPSS for frequencies, cross tabulations and regression amongst other tests. Significant improvements were observed in hand washing practice, presence of hand washing soap at household and refuse pit ownership. In Kakuma Division the proportion of those who washed hands regularly increased from 48.8 to 91.3?% (χ²?=?7.28, P?=?0.122), in Lodwar Central, those who wash hands regularly increased from 85.5 to 89.9?% (χ2?=?10.85, P?=?0.028) while in Lokichogio, the proportions increased from 77.5 to 93.8?% (χ2?=?15.56, P?=?0.004). For hand washing soap at household, there was an increase in proportion of those who wash hands with soap from 65 to 78?% (χ2?=?3.87, P?=?0.049) within the group with no formal education. There was significant reduction of diarrhoea prevalence in children aged less than 5?years. Sanitation and hygiene promotion based on community participatory approaches can lead to significant reduction of diarrhoea in children.     

Typhoid intestinal perforations at a University teaching hospital in Northwestern Tanzania: A surgical experience of 104 cases in a resource-limited setting

Background

Typhoid intestinal perforation is still prevalent in many developing countries. Despite the advances in the management, the outcome in these patients in resource limited countries is still very poor. This study was to review our experiences on the surgical management of typhoid intestinal perforation and to determine the prognostic factors for mortality in our local setting.

Methods

This was a combined retrospective and prospective study of patients who were operated for typhoid intestinal perforation at Bugando Medical Centre between August 2006 and September 2011. Data collected were analyzed using SPSS computer software version 15.

Results

A total of 104 patients were studied representing 8.7% of typhoid fever cases. Males were affected twice more than the females (2.6:1). Their ages ranged from 8 to 76 years with a median age of 18.5 years. The peak age incidence was in the 11-20 years age group. Fever and abdominal pain were the most common presenting symptoms and majority of the patients (80.8%) perforated between within 14 days of illness. Chest and abdominal radiographs revealed pneumoperitonium in 74.7% of cases. Ultrasound showed free peritoneal collection in 85.7% of cases. Nine (10.2%) patients were HIV positive with a median CD4+ count of 261 cells/μl. The perforation-surgery interval was more than 72 hours in 90(86.5%) patients. The majority of patients (84.6%) had single perforations and ileum was the most common part of the bowel affected occurring in 86.2% of cases. Simple closure of the perforations was the most commonly performed procedure accounting for 78.8% of cases. Postoperative complication rate was 39.4% and surgical site infection was the most frequent complication in 55.5% of cases. Mortality rate was 23.1% and it was statistically significantly associated with delayed presentation, inadequate antibiotic treatment prior to admission, shock on admission, HIV positivity, low CD4 count (< 200 cells/μl), high ASA classes (III-V), delayed operation, multiple perforations, severe peritoneal contamination and presence of postoperative complications (P < 0.001). The median overall length of hospital stay was 28 days.

Conclusion

Typhoid intestinal perforation is still endemic in our setting and carries high morbidity and mortality. This study has attempted to determine the factors that statistically influence mortality in typhoid perforation in our environment. Appropriate measures focusing at these factors are vital in order to deliver optimal care for these patients in this region.     

Inter- and intra-genic intersubtype HIV-1 recombination in rural and semi-urban Uganda.

OBJECTIVE: To investigate the number and variety of viruses with discrepant subtypes between env and gag and within gag in two cohorts in Uganda. METHODS: Sequences were generated from PCR products amplified directly (without cloning) from patient blood and compared in the v3/v4 region of env and the p17 and p24 regions of gag to reference subtype strains by phylogenetic analysis. Gag sequences with a discrepant subtype between p17 and p24 were analysed further to indicate approximate sites of recombination. RESULTS: Envelope subtypes D and A were predominant, but subtypes B, C and G were also found. From analysis of three short regions of the HIV genome we found 15 different combinations of subtype assortment, including 11 different recombinant permutations. Approximately 30% of viruses (29/104) in this part of Uganda appear to be recombinants between the env and gag genes and 10% (11/104) are recombinant within the gag gene. There was no clear pattern of crossover points within the gag gene. There seems to be no evidence of new circulating recombinant forms. CONCLUSION: Both inter-genic and intra-genic inter-subtype recombination appear to be a relatively common occurrence in this geographical region where two subtypes of virus co-circulate. These results have implications for cross-clade vaccine design.     

Effects of Hygiene and Sanitation Interventions on Reducing Diarrhoea Prevalence Among Children in Resource Constrained Communities: Case Study of Turkana District, Kenya

Worldwide, lack of access to safe drinking water together with inadequate sanitation and hygiene is an overwhelming contributor to approximately 4 billion cases of illness annually. This study was set out to understand the effects of hygiene and sanitation interventions on targeted health outcomes including diarrhoeal prevalence in children’s of Turkana District, Kenya. The interventions undertaken included capacity building and empowerment approach to trigger communities to demand hygiene and sanitation facilities. Three hundred mothers were randomly sampled in a baseline survey carried out in 2007 and in a post-intervention survey carried out in 2008 (a repeat cross-sectional study design). Specimens were collected for microbiological tests of key diarrhoea related pathogens. Overall, Faecal coliform counts per 100?ml sample had significant variations between 2007 and 2008; in Kakuma, reduced from 88 to 30.2 colony units (P?=?0.005), Lodwar Central where the number reduced from 91 to 17.3 units (P?=?0.003), and in Lokichogio Division, the number reduced from 63.8 to 23.6 units (P?=?0.006). From the 230 stool samples examined, the proportion of children from whom infectious pathogens of Proteus spp. was isolated reduced from 16 to 7?% while Escherichia coli reduced from 54 to 41?%. Overall, prevalence of diarrhoea related microbes in children aged <5?years reduced from 91.3?% in 2007 to 78.3?% after intervention (2008). It is notable that sanitation and hygiene promotion leads to significant reduction of diarrhoea prevalence in children aged <5?years. Its application should therefore be up-scaled in resource constrained areas.