Risk factors of preterm delivery of low birth weight (plbw) in an African population

More than 20 million infants in the world (15.5% of all births) are born with low birth weight. Ninety-five percent of them are in developing countries. The objective of this study was to examine different factors which may contribute to preterm delivery of low birth weight (PLBW) in a recent sample of Rwandan birth. The study sample included 200 randomly selected women admitted to the department of obstetrics-gynecology of the teaching hospital of Butare in Rwanda. Mothers were asked to complete a questionnaire and obstetrics records were used in order to identify factors which might pose a health risk to them and their infants. Maternal weight, height, history of previous preterm and healthy conditions of the children in the family showed a significant relationship with PLBW. Maternal level of education, number of pregnancies of the mother, urinary tract infection, sexually transmitted disease, antibiotic administration, diabetes, history of heart disease, alcohol consumption and smoking showed a relationship with PLBW but the relationship was not significant. More studies are required for a better understanding of the mechanism leading to preterm delivery of low birth infants.National Research Foundation of South Afric

A molecular investigation of the prevalence of suspected periodontopathogens and their association with preterm birth

Philosophiae Doctor - PhDMore than 20 million infants in the world (15.5 % of all births) are born with low birth weight. Ninety-five % of them are in developing countries. Oral colonization of Gramnegative anaerobes has been implicated as a risk factor for preterm delivery of low birth weight (PLBW) infants. The objective of this study was to investigate the association between periodontal pathogens and pre-term delivery of low birth weight (PLBW) infants. The study sample included 200 randomly selected women admitted to the department of obstetrics-gynecology of the teaching hospital of Butare in Rwanda. Mothers were asked to complete a questionnaire in order to identify factors which might pose a health risk to them and their infants. Gingival crevicular fluid (GCF) was collected from each quadrant of the mother’s month (using paper points) within 24 hours of delivery. Ten ml of foetal cord serum samples were collected at delivery and 10 ml of maternal serum samples were collected within 48 of delivery. GCF was examined by PCR for the presence of 5 periodontopathogens and ELISA was used for the evaluation of cytokines (IL-6 and IL-10) and immunoglobulins (IgM, IgG) in foetal cord and maternal blood against the periodontopathogens. P. intermedia showed significant associations either on its own or in combinations with most indicators of periodontal disease used in this study, while Aa and members of the red complex were significantly associated with gum bleeding and reduced frequency of tooth brushing. A strong association between PLBW and maternal and foetal cord serum sample levels of IL-10 was observed. Also, a good association was observed between PLBW and FCB sample levels of IL-6. Significant associations were observed between PLBW and maternal IgG against the different peridontopathogens. The findings of this study may suggest that the levels of maternal IgG and foetal IgM against the different periodontopathogens are associated with dissemination of maternal periodontopathogens to the foetus thereby illiciting an inflammatory response which contributes to PLBW.South Afric

"A molecular investigation of the prevalence of suspected periodontopathogens and their association with preterm birth"

Philosophiae Doctor - PhDMore than 20 million infants in the world (15.5 % of all births) are born with low birth weight. Ninety-five % of them are in developing countries. Oral colonization of Gramnegative anaerobes has been implicated as a risk factor for preterm delivery of low birth weight (PLBW) infants. The objective of this study was to investigate the association between periodontal pathogens and pre-term delivery of low birth weight (PLBW) infants. The study sample included 200 randomly selected women admitted to the department of obstetrics-gynecology of the teaching hospital of Butare in Rwanda. Mothers were asked to complete a questionnaire in order to identify factors which might pose a health risk to them and their infants. Gingival crevicular fluid (GCF) was collected from each quadrant of the mother’s month (using paper points) within 24 hours of delivery. Ten ml of foetal cord serum samples were collected at delivery and 10 ml of maternal serum samples were collected within 48 of delivery. GCF was examined by PCR for the presence of 5 periodontopathogens and ELISA was used for the evaluation of cytokines (IL-6 and IL-10) and immunoglobulins (IgM, IgG) in foetal cord and maternal blood against the periodontopathogens. P. intermedia showed significant associations either on its own or in combinations with most indicators of periodontal disease used in this study, while Aa and members of the red complex were significantly associated with gum bleeding and reduced frequency of tooth brushing. A strong association between PLBW and maternal and foetal cord serum sample levels of IL-10 was observed. Also, a good association was observed between PLBW and FCB sample levels of IL-6. Significant associations were observed between PLBW and maternal IgG against the different peridontopathogens. The findings of this study may suggest that the levels of maternal IgG and foetal IgM against the different periodontopathogens are associated with dissemination of maternal periodontopathogens to the foetus thereby illiciting an inflammatory response which contributes to PLBW

Examination of maternal gingival crevicular fluid for the presence of selected periodontopathogens implicated in the pre-term delivery of low birthweight infants

Background: Reports show that more than 20 million infants world-wide are born prematurely with 95% of all pre-term births occurring in developing countries. Oral colonization of Gram-negative anaerobes has been implicated as a risk factor for preterm delivery of low birth weight infants. Results: Association of bacterial species with the risk of periodontal disease and thus the risk of preterm delivery was only observed when they occurred in pairs or groups of three or more. Aa appeared to be a necessary co-factor for significant associations of bacterial groups with the variables recorded. Materials and Methods: This study comprised 200 women admitted to the department of obstetrics and gynecology of the teaching hospital of Butare in Rwanda. Gingival crevicular fluid was collected from each quadrant of the mother’s mouth (using paper points) within 24 hours of delivery. A dichotomous score of presence or absence of gingival inflammation was recorded for each patient along with demographic data such as age, marital status etc. Samples were examined by PC R for the presence of Aggregatibacter actinomycetemcomitans and selected members of the red and orange complexes described by Socransky et al. (1998), and their presence associated with age, gingival inflammation and pregnancy outcomes.National Research Foundation of South AfricaWeb of Scienc

Prevalence of Entamoeba histolytica in stool specimens at Muhondo Health Center, Rwanda

Entamoeba histolytica is a protozoan parasite causing amebiasis. It occurs usually in the large intestine and causes internal inflammation as its name means (histo = tissue, lytic = destroying). Between 40 and 50 million people are infected worldwide, mostly in tropical countries, in areas of poor sanitation. The infection occurs by ingestion of mature cyst in fecally contaminated food, water or hands. The disease shows different symptoms including vomiting, abdominal pain, nausea, watery and bloody diarrhea. While the infection becomes extra intestinal, it may cause abscess in other organs such as liver, kidney, brain and lungs.The present study was carried out to determine the prevalence of E. histolytica in stool specimens at Muhondo Health Center. A total of 103 fecal specimens were collected over a period of three months. Out of 103 specimens, only 26 (25.2%) were positive for E. histolytica. Out of the 26 specimens positive for E. histolytica, 17 (16.5%) and 9 (8.7%) were from males and females respectively. Furthermore, of the 26 Specimens positive for E. histolytica, 15 (14.6%) and 11 (10.7%) were from people ≤ 15 and >15 years of age respectively. Entamoeba histolytica was more prevalent 26 (25.2%) than other parasites including Giardia with 15 (14.6%), Ascaris sp with 5 (4.9%), Trichomonas intestinalis with 16 (15.5%) and Entamoeba coli with 1 (1%). In order to reduce Entamoeba histolytica contamination and infections, the following recommendations were pointed out: (i) improving personal hygiene (washing hand before eating and after using latrines) ; (ii) avoiding fecal contamination of food, water, and utensils ; and (iii) boiling drinking water before consumption.Keywords: Parasites, Prevalence, Entamoeba histolytica, amebiasis, Stool specimens, Muhondo Health Cente

Hospital acquired infections in pediatrics unit at Butare University Teaching Hospital (CHUB)

Background: Hospital acquired infection (HAI) also called nosocomial infection is an infection acquired in hospital or other healthcare facilities. HAIs are a major public health problem all over the world, but particularly in developing nations and they are among the major causes of death and increased morbidity among hospitalized patients. It was found that HAI in sub-Saharan Africa is the major cause of illness and death in children.Aim: The aim of this study was to provide knowledge on the prevalence of hospital acquired infection in pediatric unit of the University Teaching Hospital of Butare (Rwanda).Methods: Hospital acquired infections surveillance method and definition of infections described by CDC/NHSN were used.Results and conclusion: This study showed that the prevalence of HAI was very high (12.1 %) and the main bacteria causing NIs in pediatric unit were Kleblesiela pneumonia, followed by E. coli and Staphylococcus aureus. Low Respiratory HAIs were the most prevalent.Keywords: Prevalence, Hospital Acquired infection, Pediatric

The Use of Benzoyl-Dl-Arginine-Naphthylamide (Bana) Test as A Screening Test for Mother at Risk for Delivery of Pre-Term and Low Birth Weight in A Rwandan Population

Oral infections can act as the site of origin for dissemination of periodonto-bacteria and their toxins as well as induce inflammatory mechanisms to distant body sites, thus linking periodontal diseases to pre-term delivery of low birth weight (PLBW) infants. Periodontal disease is an infection of the tissues surrounding and supporting the teeth. Researchers showed that between 18 and 50 % of all pre-term deliveries are associated with periodontal disease. Porphyromonasgingivalis, Treponema denticola and Tannerella forsythia are among the subgingival microflora most frequently associated with periodontal disease. The presence of these bacteria can be identified by their ability to hydrolyse BANA. BANA is a rapid and effective diagnostic aid shown to correlate well with the clinical indices used to diagnose periodontal disease. The objective of this study was to investigate the association between the presence of member of the red complex (BANA positive species) in subgingival plaque and pre-term delivery of low birth weight in a Rwandan population. Three clinical indices (PI,GI and PD) were measured for each patient. Plaque sample were collected by inserting a sterile probe into the base of the pocket and this served for the measurement of the BANA enzyme test. The age of the population study was between 18 and 47 years with a mean of 30.8(+or-5.34). Among the 450 women examined, 57.1 % had a PI score of 2, 56.0 % had GI score of 2 and 89.6 % had a PD between 4-6 mm. At a level of 5%, a significant association of p-value=0.000 was found between PI vs BANA, GI vs BANA and PD vs BANA. No significant association (p-value=0.073) was found between BANA and mothers who delivered preterm of low birth weight (PLBW). In conclusion, findings of this study showed that BANA cannot be used for now as screening test for mother at risk for preterm delivery, while waiting for a multicenter study which will help to verify the cause of these discrepancies of results. In the other hand we can recommend BANA to be used as a routine test for the detection of periodontal disease due it strong relationship with clinical indices used to diagnose periodontal disease

malaria infection among schoolchildren in highland Rwanda

Background Plasmodium infection and malaria in school children are increasingly recognized as a relevant public health problem, but data on actual prevalence and health consequences are insufficient. The present study from highland southern Rwanda aimed at estimating infection prevalence among children attending school, at identifying associated factors and at assessing the clinical consequences of these infections. Methods In a survey including 12 schools in the Huye district of Rwanda, 1089 children aged 6–10 years were clinically and anthropometrically examined, malaria parasites were diagnosed by microscopy and PCR, haemoglobin concentrations were measured, and socio- economic and behavioural parameters as well as medical histories were obtained. Results Upon examination, the vast majority of children was asymptomatic (fever 2.7%). Plasmodium infection was detected in 22.4% (Plasmodium falciparum, 18.8%); 41% of these were submicroscopic. Independent predictors of infection included low altitude, higher age, preceding antimalarial treatment, and absence of electricity or a bicycle in the household. Plasmodium infection was associated with anaemia (mean haemoglobin difference of −1.2 g/dL; 95% CI, −0.8 to −1.5 g/dL), fever, underweight, clinically assessed malnutrition and histories of fever, tiredness, weakness, poor appetite, abdominal pain, and vomiting. With the exception of underweight, these conditions were also increased at submicroscopic infection. Conclusion Malaria infection is frequent among children attending school in southern highland Rwanda. Although seemingly asymptomatic in the vast majority of cases, infection is associated with a number of non-specific symptoms in the children´s histories, in addition to the impact on anaemia. This argues for improved malaria surveillance and control activities among school children

The Prevalence of Members of the “Red Complex” in Pregnant Women as Revealed by PCR and BANA Hydrolysis.

Magister Scientiae (Medical Bioscience) - MSc(MBS)Increased levels of oestrogen and progesterone during pregnancy may lead to periodontal disease. The anaerobic Gram-negative bacteria called red complex (Porphyromonas gingivalis, Tannerella forsythensis and Treponema denticola) are frequently associated with periodontal disease. Periodontopathogens produce toxins and enzymes which can enter the bloodstream and cross the placenta to harm the foetus. The response of the mother’s immune system to infection by these periodontopathogens, brings about the release of inflammatory mediators which may trigger preterm labour or result in low birth-weight infants. The purpose of this study was to examine the prevalence of red complex, using BANA and PCR in subginginval plaque samples from pregnant women. Subgingival plaque samples were obtained from pregnant women between the ages of 17 to 45 years attending a Mitchells Plain ante-natal clinic. Plaque samples were analyzed by the enzymatic BANA-test for detection of the presence of red complex and DNA was extracted and analyzed using 16 rDNA-Polymerase Chain Reaction (PCR). Seventy-nine percent of pregnant women showed gingival index scores of ≥ 1 of which 74.24% harboured by at least one of the members of the red complex. P.gingivalis was the most prevalent of the three members of the red complex. Findings of this study confirmed a need for dental preventive measures in pregnant women and microbial monitoring of suspected periodontopathogenes. This could be achieved by joint cooperation between Maternity Obstetric Units (MOU), Dentistry and oral microbiology departments. The results of this study revealed that although PCR is more sensitive than BANA in detecting members of the red complex, BANA showed a better association with the indices used to diagnose periodontal disease.South Afric

Reduced efficacy of albendazole against Ascaris lumbricoides in Rwandan schoolchildren

Control of human soil-transmitted helminths (STHs) relies on preventive chemotherapy of schoolchildren applying the benzimidazoles (BZ) albendazole or mebendazole. Anthelmintic resistance (AR) is a common problem in nematodes of veterinary importance but for human STHs, information on drug efficacy is limited and routine monitoring is rarely implemented. Herein, the efficacy of single dose albendazole (400 mg) was evaluated in 12 schools in the Huye district of Rwanda where Ascaris is the predominant STH. Ascaris eggs were detected by wet mount microscopy and the Mini-FLOTAC method to assess cure rate (CR) and faecal egg count reduction (FECR). Blood and faecal samples were analysed for co-infections with Plasmodium sp. and Giardia duodenalis, respectively. Ascaris positive samples collected before and after treatment were analysed for putatively BZ-resistance associated β-tubulin gene single nucleotide polymorphisms. The overall CR was 69.9% by Mini-FLOTAC and 88.6% by wet mount microscopy. The FECR was 75.4% and the 95% calculated confidence intervals were 50.4–87.8% using sample variance, 55.4–88.8% by bootstrapping, and 75.0–75.7% applying a Markov Chain Monte Carlo Bayesian approach. FECR varied widely between 0 and 96.8% for individual schools. No putative BZ-resistance associated polymorphisms were found in the four Ascaris β-tubulin isotype genes examined. Since FECR