Recognition and management of patients with high-risk vesicovaginal fistulas: Implications for teaching and research

Vesicovaginal fistulas (VVFs) occurring as a result of obstetric trauma are a vast problem in Nigeria and Ghana, where at least 20 000 women await repair, and fewer than 50 physicians have the necessary expertise. Through a series of conferences those VVFs that are at high risk and those at low-risk for repair failure, were identified. A clinic was established where repair of low-risk VVFs was done on an ongoing basis in a remote region of Ghana. A visiting surgical team was utilized to repair the difficult, or high-risk, VVFs, which included 4–6 cm VVFs (3), recurrent VVF (1), combined VVF and RVF (rectovaginal fistula), a large 5 cm juxtacervical VVF (1), and a vesicouterine fistula (1). Management of these patients and others with VVF repair complications is discussed.     

Biochemical and Hematologic Parameters for Children in the Middle Belt of Ghana

Reference values derived from developed countries are used in many countries in Africa for interpretation of laboratory results obtained during routine healthcare and clinical trials. Use of locally derived reference values has been recommended. The purpose of the study was to establish age- and sex-specific reference values for children in the middle belt of Ghana. Reference values were determined for 21 biochemical and 18 hematologic parameters by using Clinical and Laboratory Standards Institute C28-A3 guidelines in a sample of 1,442 healthy children. Hemoglobin, hematocrit, mean cell volume, erythrocytes, urea, and creatinine were lower when compared with values from northern countries but alanine aminotransferase, aspartate aminotransferase, and total bilirubin were higher. A panel of locally relevant age- and sex-specific reference values was established for commonly used biochemical and hematologic tests in children in the middle part of Ghana. This will help in interpretation of laboratory results for clinical management of patients, screening, and safety monitoring during clinical trials.     

Effectiveness of permanet in Côte d'Ivoire rural areas and residual activity on a knockdown-resistant strain of Anopheles gambiae

The effectiveness of long-lasting preimpregnated nets of Permanet type (deltamethrin, 50 mg/m2) erected in households in rural areas of C?te d'Ivoire was tested on two laboratory strains of Anopheles gambiae s.s.: the Kisumu susceptible strain and the Vk per pyrethroids resistant strain with >70% kdr allelic frequency. Treated nets were distributed in households in three villages of Danan6 forest area in western part of C?te d'Ivoire. In each village, a net was sampled for bioassays. Three Permanets also were erected in the laboratory, serving as control samples. From May 2001 to July 2002, the effectiveness of these deltamethrin-pretreated nets was monitored using World Health Organization-cone tests on the two strains of An. gambiae. Mortality rates were recorded 24 h postexposure. Knockdown times for 50 and 95% mosquitoes (kdT50 and kdT95, respectively) were estimated by means of WIN DL software. One-way analysis of variance was used to compare the knockdown times. Times to failure of nets were analyzed using Cox model. The kdT50 of the Kisumu susceptible strain with both laboratory samples and nets used in the field varied around 10 min. No significant difference was recorded between the kdT50 of the Kisumu susceptible strain with laboratory kept nets and samples of nets used in the field. The kdT95 values were in the same scale with the two types of nets. The kdT50 of the Vk per resistant strain when exposed to used nets were twofold that of the Kisumu susceptible strain at the beginning of the trial, and they increased to fivefold 15 mo later. These latter kdT50 significantly differed to those of the Kisumu susceptible strain tested with laboratory and field samples of nets. The kdT95 significantly differed from those of the Kisumu strain with laboratory kept nets and with field kept nets. Baseline bioassay mortality rates were always 99-100% with the Kisumu susceptible strain, and they did not show any significant difference between laboratory-kept nets and field-used nets during the 15-mo trial. With the Vk per resistant strain, the expected long-lasting activity was not achieved. A high decrease of mortality rates was observed from 69 to 75% in the first 3 mo to 2% at the month 15. This mortality was associated with significant differences between Vk per resistant strain tested with field-used nets compared with Kisumu susceptible strain tested with both laboratory kept-nets and field-used nets. This study emphasized the actual long-lasting effectiveness of Permanet against the An. gambiae Kisumu susceptible reference strain and a rapid decrease of residual activity against a strain with kdr-based resistance to pyrethroids.     

Directed transport of bacteria-based drug delivery vehicles: bacterial chemotaxis dominates particle shape

Several attenuated and non-pathogenic bacterial species have been demonstrated to actively target diseased sites and successfully deliver plasmid DNA, proteins and other therapeutic agents into mammalian cells. These disease-targeting bacteria can be employed for targeted delivery of therapeutic and imaging cargos in the form of a bio-hybrid system. The bio-hybrid drug delivery system constructed here is comprised of motile Escherichia coli MG1655 bacteria and elliptical disk-shaped polymeric microparticles. The transport direction for these vehicles can be controlled through biased random walk of the attached bacteria in presence of chemoattractant gradients in a process known as chemotaxis. In this work, we utilize a diffusion-based microfluidic platform to establish steady linear concentration gradients of a chemoattractant and investigate the roles of chemotaxis and geometry in transport of bio-hybrid drug delivery vehicles. Our experimental results demonstrate for the first time that bacterial chemotactic response dominates the effect of body shape in extravascular transport; thus, the non-spherical system could be more favorable for drug delivery applications owing to the known benefits of using non-spherical particles for vascular transport (e.g. relatively long circulation time).     

Nursing care delivered at academic community-based nurse-managed center

The academic community-based nurse-managed center (CNC) in this study represents an innovative "nontraditional" model of primary healthcare that seeks to improve access for vulnerable uninsured urban populations. This article describes the nature of the services delivered by an academic CNC, the users of these services, and interventions provided by nurses in the CNC.     

Effect of Prenatal Zinc Supplementation on Birthweight

Although iron and zinc deficiencies are known to occur together and also appear to be high in Ghana, a few supplementation studies addressed this concurrently in pregnancy. In a double-blind, randomized controlled trial, 600 pregnant women in Ghana were randomly assigned to receive either a combined supplement of 40 mg of zinc as zinc gluconate and 40 mg of iron as ferrous sulphate or 40 mg of elemental iron as ferrous sulphate. Overall, there was no detectable difference in the mean birthweight between the study groups, although the effect of iron-zinc supplementation on the mean birthweight was masked by a strong interaction between the type of supplement and the iron status of participants [F (1,179)=5.614, p=0.019]. Prenatal iron-zinc supplementation was effective in increasing the mean birthweight among anaemic and iron-deficient women but not among women with elevated iron stores in early pregnancy.Key words: Birthweight, Double-blind method, Impact studies, Prospective studies, Randomized controlled trials, Iron supplementation, Zinc supplementation, Ghana     

Seasonality of the dietary dimension of household food security in urban Burkina Faso

Food insecurity is affecting an increasing number of urban poor in the developing world. Yet seasonal characteristics of food intakes have rarely been studied in West African cities. The objective of the present study was to assess the seasonality of the dietary dimension of household food security in Ouagadougou (Burkina Faso). In 2007, two sets of data were collected during the lean and post-harvest seasons, respectively, on a representative sample of 1056 households. At each season, two non-consecutive 24 h recalls were performed at the household level. Food prices were also recorded. Household food security was assessed by the household's mean adequacy ratio (MAR) for energy and eleven micronutrients. Changes in the MAR according to the season were analysed by mixed multivariate linear regression. Results showed that intakes of energy and of ten micronutrients were significantly lower during the lean season than during the post-harvest season, leading to a lower MAR in the lean season (49·61 v. 53·57, P < 0·0001). This was related to less frequent consumption and consumption of smaller amounts of vegetables and of foods prepared at home. Food security relied heavily on food expenses (P < 0·0001) and on the price of meat/fish (P = 0·026). Households with economically dependent adults (P = 0·021) and larger households (P < 0·0001) were the most vulnerable, whereas education (P = 0·030), social network (P = 0·054) and urban origin other than Ouagadougou (P = 0·040) played a positive role in food security. To achieve food security in Ouagadougou, access to micronutrient-dense foods needs to be ensured in all seasons.