HIV/AIDS among pastoralists and refugees in north-east Africa: a neglected problem

The eight member states (Djibouti, Eritrea, Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda) of the Intergovernmental Authority for Development (IGAD) have the largest proportions of cross-border mobile pastoralists and refugees in Africa. Although all IGAD countries have had national HIV/AIDS prevention, care and treatment programmes since the late 1980s, the IGAD Regional HIV & AIDS Partnership Program was (IRAPP) established in 2007 to mitigate the challenges of HIV among neglected pastoral and refugee communities. This article assesses vulnerability of pastoralists and refugee communities to HIV and interventions targeting these groups in the IGAD countries. Outcomes from this study may serve as a baseline for further research and to improve interventions. Published articles were accessed through web searches using PubMed and Google Scholar engines and unpublished documents were collected manually. The search terms were HIV risk behaviour, vulnerability, HIV prevalence and interventions, under the headings pastoralists, refugees, IGAD and north-east Africa for the period 2001–2014. Of the 214 documents reviewed, 78 met the inclusion criteria and were included. Most HIV/AIDS related studies focusing of pastoral communities in IGAD countries were found to be limited in scope and coverage but reveal precarious situations. Sero-prevalence among various pastoral populations ranged from 1% to 21% in Ethiopia, Kenya, Somalia and Uganda and from 1% to 5% among refugees in Sudan, Kenya and Uganda. Socioeconomic, cultural, logistic, infrastructure and programmatic factors were found to contribute to continuing vulnerability to HIV. Interventions need to be further contextualised to the needs of those impoverished populations and integrated into national HIV/AIDS programmes. HIV/AIDS remains a major public health concern among the pastoral and refugee communities of IGAD countries. This calls for IGAD to collaborate with national and international partners in designing and implementing more effective prevention and control programmes. Furthermore, interventions must extend beyond the health sector and improve the livelihood of these populations.     

Colocalization of nitric oxide synthase and NADPH-diaphorase in rat adrenal gland.

The distribution and colocalization of nitric oxide synthase (NOS) and reduced nicotinamide adenine dinucleotide phosphate (NADPH)-diaphorase was studied in the neuronal elements of the adrenal gland of the rat. Ganglion cells and many nerve fibres in the gland showed both NOS-immunoreactivity and NADPH-diaphorase staining. The adrenal cortical cells showed NADPH-diaphorase staining but were not immunoreactive for NOS. Positive labelling for both NADPH-diaphorase and NOS was found in bundles and in single fibres with varicosities, preferentially located around the noradrenaline (NA)-storing cells. Adrenaline (A)-storing cells and ganglion cells in the medulla, along with the cortical cells and blood vessels in the zona glomerulosa, received relatively fewer positive fibres.     

Patterns of childhood mortality in three districts of north Gondar Administrative Zone. A community based study using the verbal autopsy method

This community based study was undertaken to determine the infant and child mortality rates, causes of childhood mortality and examine the utilization patterns of health services in north Gondar Administrative Zone. The study was conducted from November 1994 to May 1995. A pretested questionnaire based on criteria suggested for diagnosis of childhood mortality in developing countries, using verbal autopsy, was administered to mothers or care takers whose under five children died within five years prior to data collection. A total of 5,001 households were visited and 428 deaths were identified. Infant and child mortality rates were estimated as 103 per 1000 live births and 41 per 1000 children respectively. The most common causes of mortality were respiratory tract infections, diarrhoea and malnutrition. The method of verbal autopsy if used with well tested and validated criteria may be of great help in describing mortality patterns in places where there is no regular surveillance of mortality. Based on the results, intervention packages on the most common causes of mortality at different levels of health care can be devised.     

Age-related changes in the localization of P2X (nucleotide) receptors in the rat adrenal gland

Observation of the changes in the occurrence and distribution of nucleotide (P2X) receptors in the adrenal gland during development and ageing, and correlation with the changes in adrenal status at similar stages may give morphological insights into the functions of purine nucleotides in the gland. Age-related changes in the localization of all seven subtypes of the P2X receptor in the adrenal gland of rat were therefore investigated immunohistochemically. In the adrenal glands of prenatal rats, immunoreactivity to P2X receptor subtypes was not observed. In glands of the postnatal rat at the developmental stages studied, only immunoreactivity for the P2X(5) receptor subtype was observed. A small number of faintly P2X(5)-immunoreactive chromaffin cells were found in the adrenal glands of 1-day-old rats; the frequency of localization and intensity of staining of immunoreactive cells had increased by day 4 and was further increased at day 7. P2X(5) immunoreactivity was not observed in the adrenal glands from 14- and 21-day-old rats. At 8 weeks of age, immunoreactivity with a specific distribution for each of the seven receptor subtypes was observed. Except for the P2X(4) receptor, adrenal glands at 24 months showed a similar pattern of immunoreactivity for the receptor subtypes as that observed at 8 weeks. Immunoreactivity for P2X(4) was first observed in the adrenal cortical cells of the zona reticularis at 8 weeks, but was absent in 24-month-old rats. However, several P2X(4)-immunoreactive chromaffin cells appeared at 24 months. Such immunoreactive cells were not seen in rats of any of the other ages studied. It was concluded that the greater expression of P2X(5) receptor at an early developmental stage and of P2X(4) in ageing might reflect functional roles for purines in cellular proliferation and/or differentiation, and in cellular degeneration, respectively, in adrenal glands of rat.     

Potential for integrated control of neglected tropical diseases in Ethiopia

Ethiopia is one of the poorest and least developed countries in the world, endemic for many neglected tropical diseases (NTDs). The Ministry of Health is successfully controlling onchocerciasis through community-directed treatment with ivermectin and has implemented health system changes that would allow extension of integrated NTD control to schistosomiasis, lymphatic filariasis, soil-transmitted helminthiasis and trachoma. Funds are now needed to gain a better understanding of the endemicity and co-endemicity of these diseases and to formulate and pilot integrated packages for mass drug administration (MDA). Based on the experience gained, MDA may then be scaled-up to all NTD-endemic areas.     

Prevalence of Bacteria and Intestinal Parasites among Food-handlers in Gondar Town, Northwest Ethiopia

Food-handlers with poor personal hygiene working in food-service establishments could be potential sources of infection due to pathogenic organisms. The study was undertaken to determine the prevalence of bacteria and intestinal parasites among 127 food-handlers working in the cafeterias of the University of Gondar and the Gondar Teachers Training College, Gondar, Ethiopia. Fingernail contents of both the hands and stool specimens were collected from all the 127 food-handlers. The samples were examined for bacteria and intestinal parasites following standard procedures. Coagulase-negative staphylococci were the predominant bacteria species (41.7%) isolated from fingernail contents, followed by Staphylococcus aureus (16.5%), Klebsiella species (5.5%), Escherichia coli (3.1%), Serratia species (1.58%), Citrobacter species (0.8%), and Enterobacter species (0.8%). Shigella species were isolated from stool samples of four food-handlers (3.1%). None of the food-handlers was positive for Salmonella species and Shigella species in res-pect of their fingernail contents. No intestinal parasites were detected from fingernail contents. Intestinal parasites detected in the stools of the food-handlers included Ascaris lumbricoides (18.11%), Strongyloides stercoralis (5.5%), Entamoeba histolytica/dispar (1.6%), Trichuris trichiura (1.6%), hookworm species (0.8%), Gardia lamblia (0.8%), and Schistosoma mansoni (0.8%); 1.6% of the study subjects were positive for each of A. lumbricoides, T. trichiura, hookworm, and G. lamblia. The findings emphasize the importance of food-handlers as potential sources of infections and suggest health institutions for appropriate hygienic and sanitary control measures.Key words: Bacteria, Cross-sectional studies, Diarrhoeal diseases: Food-handlers, Hygiene, Intestinal diseases, Parasitic, Parasites, Ethiopia     

Pridominant isolates of urinary tract pathogens and their antimicrobial susceptiblity patterns in Gondar University Teaching Hospital, nothwest Ethiopia

BACKGROUND: Urinary tract infection (UTI) is one of the most common bacterial infections encountered by clinicians in developing countries. Although UTI seldom leads to complications, it can cause significant morbidity and mortality. OBJECTIVE: To identify the etiologic agents of UTIs and to assess their antimicrobial susceptibility pattern. METHODS: A retrospective analysis of 1420 mid-stream urine specimens processed fobr culture and antimicrobial susceptibility testing in the bacteriology laboratory of Gondar University Teaching Hospital between September 2002 and August 2003 was conducted RESULTS: Significant bacteriuria (cultures with > 10(5) colony forming units of bacteria per ml of urine) was observed in 399 (28.1%) of the specimens. Two bacteria each were isolated from 14 specimens, making the number of bacteria isolated to be 413 with the isolation rate of 29.1%. The most commonly isolated bacteria were Escherichia coli 166 (40.2%), Staphylococcus aureus 60 (14.5%), Klebisella species 42 (10.2%) and Citrobacter species 34 (8.2%). Among Gram-positive organisms S. aureus showed high level qf drug resistance for tetracycline 48 (80%), corimoxazole 32 (53.3%), chloramphenicol 32 (53.3%), amnpicillin 26 (43.3%) and penicillin 22 (36.7%). Of the Gram-negative bacteria, extremely high resistance patterns were found in Salmonella species for ampicillin 5 (100%), erythromycin 5 (100%), penicillin 5 (100%), co-trimoxazole 3 (60%), tetracycline 3 (60%) and 3 chloramphenicol (60%). Multiple drug resistance was observed in 85.7% of the isolates. Only 5.1% of the isolates were found to be sensitive to all antibiotics tested. CONCLUSION: Resistance to the commonly used antibiotics was found to be very high among the isolates leaving clinicians with very few choices of drugs or the treatment of UTIs. It is therefore, critical that the use of antimicrobial agents with in a hospital and all other responsible institutions he reviewed     

Diarrhoea-associated parasites in HIV-1 seropositive and sero-negative patients in a teaching hospital, Northwest Ethiopia

OBJECTIVE: to determine the prevalence and type of intestinal parasites in HIV infected and uninfected patients with diarrhea. DESIGN: A cross-sectional study was conducted at Gondar University hospital, Northwest Ethiopia, between March 2003 and October 2004. PATIENTS AND METHODS: A total 312 consecutive diarrheic patients were included in the study. Stool specimens were collected and examined for intestinal parasites following direct, formol-ether concentration and modified acid fast staining methods. RESULTS: Among the patients, 63.8% were found to be HIV seropositive. The prevalence of intestinal parasites in HIV seropositive and seronegative diarrheic patients was 30.6% and 33.6%, respectively. The most prevalent parasites were Strongyoides stercoralis (9.0%) and Entamoeba histolytica (8.3%) followed by Ascaris lumbricoides (5.4%) and Cryptosporidium species (5. 1%). CONCLUSION AND RECOMMENDATION: The prevalence of intestinal parasites in diarrheic patients was very high. Institution of appropriate intervention measures are needed to reduce morbidity in such patients.     

Occupational environment as perceived by workers at a textile mill in Bahir Dar, northwest Ethiopia

This cross sectional study was conducted among textile mill workers in Bahir Dar town in 1995/96. The main objective of the study was to investigate how workers perceive their work environment and explore their state of satisfaction with their work. A pretested questionnaire was administered by trained health workers to 394 production workers. The majority of the workers (53.6%) claimed the work environment to be hot. For 66.8%, the physical conditions around the working departments was worst during the hot season. The work place was perceived as dusty and noisy by 47.2% and 36.0% of the respondents respectively. The distribution of adverse environmental complaint by work department was not the same. A higher proportion of the workers in the spinning department complained of inadequate air movement (64.5%) and dusty work place (53.3%); whereas those in the weaving department complained the work place to be hot and noisy (60.5%, 53.5% respectively). Aprons were used by 95.7%, but other personal protectors such as ear protectors, gloves and goggles were used rarely. In general, 228 (57.9%) workers were satisfied but the rest were dissatisfied with their work environment. In order to improve the hygienic conditions in the work place, 71.2% suggested use of different kinds of personal protectors. In conclusion, personal protectors should always be used, environmental hygiene should be conducted and health education should be provided to workers.