Declining HIV prevalence and risk behaviours in Zambia: evidence from surveillance and population-based surveys

OBJECTIVE: To examine trends in HIV prevalence and behaviours in Zambia during the 1990s. METHODS: The core Zambian system for epidemiological surveillance and research has two major components: (i) HIV sentinel surveillance at selected antenatal clinics (ANC) in all provinces; and (ii) population-based HIV surveys in selected sentinel populations (1996 and 1999). The former was refined in 1994 to improve the monitoring of prevalence trends, whereas the latter was designed to validate ANC-based data, to study change in prevalence and behaviour concomitantly and to assess demographic impacts. RESULTS: The ANC-based data showed a dominant trend of significant declines in HIV prevalence in the 15--19 years age-group, and for urban sites also in age-group 20--24 years and overall when rates were adjusted for over-representation of women with low education. In the general population prevalence declined significantly in urban women aged 15--29 years whereas it showed a tendency to decline among rural women aged 15-24 years. Prominent decline in prevalence was associated with higher education, stable or rising prevalence with low education. There was evidence in urban populations of increased condom use, decline in multiple sexual partners and, among younger women, delayed age at first birth. CONCLUSIONS: The results suggested a dominant declining trend in HIV prevalence that corresponds to declines in incidence since the early 1990s attributable to behavioural changes. Efforts to sustain the ongoing process of change in the well-educated segments of the population should not be undervalued, but the modest change in behaviour identified among the most deprived groups represents the major preventive challenge.     

Proposed guidelines for the management of nodding syndrome

Nodding Syndrome is a poorly understood neurologic disorder of unknown aetiology that affects children and adolescents in Africa. Recent studies have suggested that the head nods are due to atonic seizures and Nodding Syndrome may be classified as probably symptomatic generalised epilepsy. As part of the Ugandan Ministry of Health clinical management response, a multidisciplinary team developed a manual to guide the training of health workers with knowledge and skills to manage the patients. In the absence of a known cause, it was decided to offer symptomatic care. The objective is to relieve symptoms, offer primary and secondary prevention for disability and rehabilitation to improve function. Initial management focuses on the most urgent needs of the patient and the immediate family until ‘stability’ is achieved. The most important needs were considered as seizure control, management of behavioural and psychiatric difficulties, nursing care, nutritional and subsequently, physical and cognitive rehabilitation. This paper summarises the processes by which the proposed guidelines were developed and provides an outline of the specific treatments currently being provided for the patients.     

Effects of graded mechanical compression of rabbit sciatic nerve on nerve blood flow and electrophysiological properties

Entrapment neuropathy is a frequent clinical problem that can be caused by, among other factors, mechanical compression; however, exactly how a compressive force affects the peripheral nerves remains poorly understood. In this study, using a rabbit model of sciatic nerve injury (n = 12), we evaluated the time-course of changes in intraneural blood flow, compound nerve action potentials, and functioning of the blood–nerve barrier during graded mechanical compression. Nerve injury was applied using a compressor equipped with a custom-made pressure transducer. Cessation of intraneural blood flow was noted at a mean compressive force of 0.457 ± 0.022 N (±SEM), and the compound action potential became zero at 0.486 ± 0.031 N. Marked extravasation of Evans blue albumin was noted after 20 min of intraneural ischemia. The functional changes induced by compression are likely due to intraneural edema, which could subsequently result in impairment of nerve function. These changes may be critical factors in the development of symptoms associated with nerve compression.     

Metaphyseal‐Loading Anterolaterally‐Flared Femoral Stem in Cementless Total Hip Arthroplasty: Five‐ to Eleven‐Year Follow‐Up Evaluation

Using a nonlinear three‐dimensional finite element analysis simulating loading conditions, we designed a new type of proximal‐fitting, anterolaterally‐flared, arc‐deposit hydroxyapatite‐coated anatomical femoral stem (FMS‐anatomic stem; Japan Medical Materials, Osaka, Japan) for cementless total hip arthroplasty (THA) for Japanese patients with dysplastic hip osteoarthritis. The aim of the present study was to analyze the clinical and radiographic outcomes of the new stem. We reviewed 143 consecutive patients (164 hips; 13 men, 14 hips; 130 women, 150 hips; age at surgery, 56.6 ± 7.6 years, mean ± SD, range, 30–74) who underwent cementless THA using the FMS‐anatomic stem at a single institution, with a follow‐up period of 7.6 ± 1.6 years (range, 5.3–11.0). Harris Hip score improved from 46.1 ± 12.6 before surgery to 90.0 ± 8.9 points post‐THA. The 7.6‐year survival rate of the stem was 99.0% after revision for aseptic loosening. Radiographs at follow‐up confirmed the stability of the femoral stems within the femoral canal in all cases, with sufficient bone ingrowth. None of the patients had subsidence of the stem exceeding 2.0 mm within the femoral canal or changes in varus or valgus position of more than 2.0°. The FMS‐anatomic stem provided excellent results in patients with dysplastic hip osteoarthritis. Our analysis confirmed reduced radiolucency around the stem in Gruen zones, minimal subsidence, appropriate stress shielding, and promising medium‐term stability within the femoral canal in our patients.     

Predominant human herpesvirus 6 variant A infant infections in an HIV‐1 endemic region of Sub‐Saharan Africa

Human herpesvirus 6, HHV‐6, commonly infects children, causing febrile illness and can cause more severe pathology, especially in an immune compromised setting. There are virulence distinctions between variants HHV‐6A and B, with evidence for increased severity and neurotropism for HHV‐6A. While HHV‐6B is the predominant infant infection in USA, Europe and Japan, HHV‐6A appears rare. Here HHV‐6 prevalence, loads and variant genotypes, in asymptomatic compared to symptomatic infants were investigated from an African region with endemic HIV‐1/AIDS. DNA was extracted from blood or sera from asymptomatic infants at 6 and 18 months age in a population‐based micronutrient study, and from symptomatic infants hospitalised for febrile disease. DNA was screened by qualitative and quantitative real‐time PCR, then genotyped by sequencing at variable loci, U46 (gN) and U47 (gO). HIV‐1 serostatus of infants and mothers were also determined. HHV‐6 DNA prevalence rose from 15% to 22% (80/371) by 18 months. At 6 months, infants born to HIV‐1 positive mothers had lower HHV‐6 prevalence (11%, 6/53), but higher HCMV prevalence (25%, 17/67). HHV‐6 positive febrile hospitalized infants had higher HIV‐1, 57% (4/7), compared to asymptomatic infants, 3% (2/74). HHV‐6A was detected exclusively in 86% (48/56) of asymptomatic HHV‐6 positive samples genotyped. Co‐infections with both strain variants were linked with higher viral loads and found in 13% (7/56) asymptomatic infants and 43% (3/7) HIV‐1 positive febrile infants. Overall, the results show HHV‐6A as the predominant variant significantly associated with viremic infant‐infections in this African population, distinct from other global cohorts, suggesting emergent infections elsewhere. J. Med. Virol. 81:779–789, 2009. © 2009 Wiley‐Liss, Inc.     

HIV type 1 infection is a risk factor for mortality in hospitalized Zambian children with measles.

BACKGROUND: Measles remains a significant cause of vaccine-preventable mortality in sub-Saharan Africa, yet few studies have investigated risk factors for measles mortality in regions of high human immunodeficiency virus type 1 (HIV-1) prevalence. METHODS: Between January 1998 and July 2003, children with clinically diagnosed measles who were hospitalized at the University Teaching Hospital in Lusaka, Zambia, were enrolled in an observational study. Demographic and clinical information was recorded at enrollment and at discharge or death. Measles was confirmed by detection of antimeasles virus immunoglobulin M antibodies, and HIV-1 infection was confirmed by detection of HIV-1 RNA. RESULTS: Of 1474 enrolled children, 1227 (83%) had confirmed measles and known HIV-1 infection status. Almost one-third of the HIV-1-infected children with measles were <9 months of age, the age of routine measles vaccination, compared with one-fourth of the uninfected children (P = .07). Death occurred during hospitalization in 23 (12.2%) of the HIV-1-infected children and 45 (4.3%) of the HIV-1-uninfected children (p < .001) with measles. After adjusting for age, sex, and measles vaccination status, HIV-1 infection (odds ratio, 2.5; 95% confidence interval, 1.4-4.6), < or =8 years of maternal education (odds ratio, 2.4; 95% confidence interval, 1.2-4.8), and the presence of a desquamating rash (odds ratio, 2.2, 95% confidence interval, 1.3-3.6) were significant predictors of mortality due to measles. CONCLUSIONS: In a region of high HIV-1 prevalence, coinfection with HIV-1 more than doubled the odds of death in hospitalized children with measles. Increased mortality among HIV-1-infected children is further evidence that greater efforts are necessary to reduce transmission of the measles virus in regions of high HIV-1 prevalence.     

Bacteriuria among adult non-pregnant women attending Mulago hospital assessment centre in Uganda

Background

Urinary tract infections (UTIs) in women are a common problem in primary health care settings. Resistance of bacterial uropathogens to commonly used antibiotics is common in many places.

Objectives

To determine the prevalence of UTI, associated uropathogens and their antimicrobial susceptibility.

Methods

A cross section study carried out at Mulago hospital outpatients'' department. Midstream urine samples (MSU) were collected from 399 women, who gave informed consent and fulfilled other study criteria. Quantitative culture method, identification of uropathogens and antibiotic susceptibility testing using the Kirby-Bauer disc diffusion technique were applied to the isolates.

Results

Out of 399 MSU samples, 40 pure significant bacterial growths (≥10⁵ colony forming units (cfu)/ml of urine) were isolated and these included Escherichia coli, 23 (57.5%), Staphylococcus aureus, 9 (22.5%), Enterococci spp, 6 (15%) and Klebsiella pneumoniae, 2 (5.0%). Overall, sensitivities were: nitrofurantoin (98.3%), cefuroxime (89.3%), and cotrimoxazole (20%) by all uropathogens isolated.

Conclusions

Culture positive UTI among adult non-pregnant women are a common problem, occurring in 10% of the study population. Most bacterial uropathogens showed high sensitivity to nitrofurantoin but low sensitivity to SXT.

Recommendations

Nitrofurantoin should be considered as drug of choice for empirical treatment of community acquired uncomplicated UTI in adult non-pregnant women.