Dietary patterns and nutrient intakes of a South African population and asymptomatic people infected with Human Immunodeficiency Virus: The transition health and urbanisation in South Africa (Thusa) study

There is increased emphasis on the quality of food and the overall pattern of micronutrient intake as an integral consideration for food security particularly among people living with HIV/AIDS (PLWHA). However, limited data exist on food consumption and nutrient intakes for populations in sub-Saharan Africa. The study examined dietary patterns and their relationship with nutrient intakes in HIV uninfected (HIV-) and infected (HIV+) adults in North-West Province, South Africa. In this cross-sectional study, dietary and nutrient intakes were assessed with Quantitative Food Frequency Questionnaire (QFFQ) and FoodFinder software, respectively. Dietary patterns were determined using Principal Component Analysis. Participants’ scores for the dietary patterns were related to nutrient intakes using Spearman Rank correlation and Generalised Linear Modelling (GENLIN). Four main dietary patterns were found in each population. The first three patterns were similar between the HIV- and HIV+ populations: “animal-based”, associated with intake of foods of animal origin; “recommended” associated with a varied diet; and “staple-based”. The fourth pattern was described as either ‘eggs-and-breakfast-cereals’ for the HIV- group or ‘legumes-and-vegetables’ for HIV+ group. Scores for animal-based pattern showed strongest correlations (r) with nutrient intakes for both populations, notably zinc (r=0.54), calcium (r=0.5), potassium (r=0.54), vitamin A (r=0.5), and vitamin C (r=0.5), (p<0.001 for all). In the HIV+ group, the legumes-and-vegetables pattern was strongly associated with energy (r=0.64), vitamins D (r=0.51), E (0.51) and B1 (r=0.55) (p<0.001 for all). Compared with the other patterns, the Staple-based and the recommended patterns showed the weakest associations with nutrient intakes. Generalised Linear Modelling confirmed stronger positive linear associations between scores of the animal-based diet and nutrients intake, compared with the other patterns. The findings suggest that the animal-based pattern was strongly associated with nutrients intake in both HIV + and HIV- populations. This raises the need for studies into dietary recommendations for promoting nutritional wellbeing for PLWHA in sub-Saharan Africa.Keywords: Dietary patterns; HIV/AIDS; THUSA, Nutrient

Health-seeking behaviour of tuberculosis patients and related factors in the central region of Ghana

The health seeking behaviour of TB patients and health service related barriers have been cited to have an influence on the management of the disease in countries with high incidence of TB. Using close and open-ended questionnaires, an assessment of the health seeking behaviour of 302 TB patients selected from 24 DOTS centres in six districts in the Central  Region of Ghana was carried out. Under service-related barriers, distance from home to DOTS centre significantly impacted on the management of TB among sufferers (p=0.025). Though not significant, patients  acknowledged the good reception by staff at treatment centres with 99.3% of them being comfortable with staff and services provided at centres. Majority (46.7%) of patients perceived TB to be caused by the oral route while only 9.3% knew the causative agent to be bacteria. Compared with males, quite a number of women did not have adequate knowledge on TB (p<0.05). More than half of the respondents sought treatment elsewhere as first point of treatment before reporting to the DOTS centre. Health insurance played an important role in the health seeking behaviour of respondents; 45.9% of TB patients with health insurance visited the health facility as 1st provider whilst 49.4% without health insurance visited prayer camps (p=0.001). Our study has revealed that factors such as staff  attitude, distance to treatment centres, gender, employment and education are key factors that affect the health-seeking behaviour of TB patients in the Central Region of GhanaKeywords: Tuberculosis, Health, barriers, Central Regio

Missed Opportunities for the Diagnosis of Pulmonary Tuberculosis in Ashanti and Western Regions of Ghana; Polymerase Chain Reaction, A Better Tool

The diagnosis of Pulmonary Tuberculosis (PTB) has mainly relied on sputum microscopy and culture. The use of molecular techniques such as the Polymerase Chain Reaction (PCR) and its overwhelming advantages compared with conventional diagnostic methodologies cannot be overemphasized. The main aim of this work was to compare the diagnostic sensitivities of microscopy, culture and PCR. Suspected PTB sputum samples were prospectively collected from six hospitals in the Ashanti and Western regions of Ghana. Microscopy was carried out on all samples at the field sites. Apart from culture and PCR, repeat sputum microscopy was carried out in the laboratories of the Kumasi Centre for Collaborative Research (KCCR). Out of the total 425 cases recruited for the study, 123 (29.0%) were smear positive on site in contrast to 275 (64.7%) positivity rate at KCCR. Regarding culture, 254 (59.9%) samples were culture positive whilst PCR technique using INS 1&2 and PR 8&9 primers were positive in 59.9 % and 56% of cases respectively. The proportion of missed positive cases of microscopy were 131 (51%) compared with culture and 1.1% missed cases when compared with PCR. The sensitivity and specificity of microscopy were 123/254 (48.4%) and 154/302 (50.99%). The study confirms the superiority of PCR in the diagnosis of PTB and indicates that a substantial proportion of PTB cases are missed when microscopy alone is used. In areas where the incidence of PTB is high and at referral hospitals, PCR can be done to augment the diagnosis of TB.Keywords: Pulmonary Tuberculosis, Sputum Microscopy, Culture, Polymerase Chain Reactio

Do salivary bypass tubes lower the incidence of pharyngocutaneous fistula following total laryngectomy? A retrospective analysis of predictive factors using multivariate analysis

Salivary bypass tubes (SBT) are increasingly used to prevent pharyngocutaneous fistula (PCF) following laryngectomy and pharyngolaryngectomy. There is minimal evidence as to their efficacy and literature is limited. The aim of the study was to determine if SBT prevent PCF. The study was a multicentre retrospective case control series (level of evidence 3b). Patients who underwent laryngectomy or pharyngolaryngectomy for cancer or following cancer treatment between 2011 and 2014 were included in the study. The primary outcome was development of a PCF. Other variables recorded were age, sex, prior radiotherapy or chemoradiotherapy, prior tracheostomy, type of procedure, concurrent neck dissection, use of flap reconstruction, use of prophylactic antibiotics, the suture material used for the anastomosis, tumour T stage, histological margins, day one post-operative haemoglobin and whether a salivary bypass tube was used. Univariate and multivariate analysis were performed. A total of 199 patients were included and 24 received salivary bypass tubes. Fistula rates were 8.3% in the SBT group (2/24) and 24.6% in the control group (43/175). This was not statistically significant on univariate (p value 0.115) or multivariate analysis (p value 0.076). In addition, no other co-variables were found to be significant. No group has proven a benefit of salivary bypass tubes on multivariate analysis. The study was limited by a small case group, variations in tube duration and subjects given a tube may have been identified as high risk of fistula. Further prospective studies are warranted prior to recommendation of salivary bypass tubes following laryngectomy

Beyond equilibrium climate sensitivity

ISSN:1752-0908ISSN:1752-089

Profile of fungal contaminants of maize (Zea mays) intended for consumption and their potential health implications in the Ho municipality of Ghana

Maize is a principal food crop used extensively by both humans and animals in Africa and across the globe. Unfortunately, maize is highly susceptible to fungal contamination, especially with toxicogenic species. The contamination is exacerbated subsequently by mycotoxins of these fungi, which is indeed a major concern to governments and the international community, as it renders the food unsafe for human and animal consumption. Whole maize was sampled from 10 different sites in the Ho municipality, Ghana, and evaluated for moisture contents, fungal count, and species diversity. The fungal analysis was conducted at three points per location. Fungal species were cultured and identified on the two media used; Sabouraud Dextrose Agar (SDA) and Dichlor Rose Bengal Chloramphenicol (DRBC). A total of sixteen (16) fungal species belonging to eleven (11) genera were identified in this study. They included Aspergillus niger, A. flavus, A. fumigatus, A. tamarii, A. ochraceous, and A. parasiticus, Cladosporium herbarium, Curvularia lunata, Penicillium citrinum, Fusarium moniliforme, Eurotium sp., Mucor racemosus, Rhizopus stolonifer, Paecilomyces variotii, Neurospora sitophilia and Rhodotorula sp. The genus Fusarium was found to be the most overriding fungus. The overall decreasing order of ranking of occurrence was Fusarium>Penicillium>Aspergillus. Fungal counts of the maize samples ranged between 2.77±1.01- 4.1±0.81 Log10 CFU/g and 3.00±1.13-4.08±1.22 Log10 CFU/g for SDA and DRBC respectively and showed no significant differences (p>0.05). The moisture content of the maize grains ranged between 12.06 ±1.17- 16.71 ± 2.65 %. Generally, there was a weak association between moisture content and fungal counts, which showed a poor fit to the linear equations (R2= 0.1989, R2= 0.0047 for SDA and DRBC respectively). Our results underscore that consumers and farmers should be up-to-date on the danger of fungal contamination in maize. The outcomes of this paper would be worthwhile in advising policy makers to particularly stress on in adopting international legislations on food quality parameters and to use tools that will change the frame of mind of the population on risks involving fungal intoxication

Insecticide resistance in malaria vector mosquitoes at 5 selected districts in Ghana, West Africa

Background: The application of insecticides targeted at vector mosquitoes through Indoor Residual Spraying has been adopted as one of the most effective ways of reducing the burden of malaria. However, key to the success of such a strategy is baseline information about local vector population and their profiles to any of the chemicals applied. This paper presents baseline resistance and susceptibility profiles of mosquitoes collected from 5 districts in Ghana earmarked for Indoor Residual Spraying.Methods: We collected mosquitoes using hand-held aspirators and determined their susceptibility to the four classes of insecticides approved by the WHO for IRS. We further used morphological identification tools to identify the species of the mosquitoes collected.Results: Out of the total of 5500 mosquitoes collected, 5113 (93.0%) and 387 (7.0%) belonged to the Anopheles gambiae and An. funestus complexes respectively. Overall, mosquitoes collected showed susceptibilities ranging from 97-100% to the Organophosphates and the Carbamates (94.3-100%) but were highly resistant to the Organochlorides (32.2-57.8%) and Pyrethroids (27.7-72.3%).Conclusion: Our data clearly highlights the importance of prior knowledge of local mosquito populations to any of the recommended classes of insecticides before IRS is incorporated as part of any intended or existing malaria vector control strategy.Key words: Anopheles gambiae, resistance, susceptibility, Indoor residual sprayin