Thrombocytopenia in Haart naive HIV infected patients attending the comprehensive care clinic at Kenyatta national hospital

Background: Haematological abnormalities are common in HIV infected patients. Thrombocytopenia has been associated with progression of disease. The presence of thrombocytopenia is significantly associated with decreased survival and is a predictor of mortality.Objective: To determine the prevalence of thrombocytopenia and clinical characteristics of HIV infected patients who are HAART naive attending the Kenyatta National Hospital Comprehensive Care Clinic..Design: Cross-sectional descriptive Study.Setting: Kenyatta National Hospital Comprehensive Care Clinic.Subjects: HIV positive HAART naive patients.Results: Three hundred and forty HIV infected HAART naive patients with a mean age of 37.3years and range of 18years to 72years were recruited. The male to female ratio was 1:1.6.The study population comprised mostly of; young patients (39.9% between 30-40yrs), females (61.6%) in WHO clinical stage I (57.6%) and with CD4 count between 200-500 cell/mm3. The mean platelet count was 230,000 cells/ul. The prevalence of thrombocytopenia in this population was 3.8%. Most of the patients (66.7%) with thrombocytopenia had a bicytopenia with the rest having isolated thrombocytopenia or pancytopenia. Bleeding tendencies were observed more in the thrombocytopenia group (p= 0.011). Patients with CD4 count < 200cells/mm3 were more likely to have thrombocytopenia (p <0.050).Conclusion: The prevalence of thrombocytopenia is low among ambulant HIV infected HAART naive patients attending the Kenyatta National Hospital Comprehensive Care Clinic. This could be attributed to young age, predominant female gender and early disease WHO Stage 1 in the study population. Other studies found older age, male gender and advanced HIV infection population to be determinants where higher prevalence of thrombocytopenia have been reported

Sweet potato wastes in major pig producing districts in Uganda: An opportunity for investment in silage technologies

This study was undertaken to assess the potential for sweet potato silage making business by estimating sweet potato vines and root wastage and assessing the economic feasibility of investing in sweet potato silage. Information was collected through key informant interviews, secondary data review, sweet potato root peeling and weighing, focus group discussions with pig and sweet potato producers covering a sample of 180 farmers. Semi-structured interviews with 240 respondents (120 sweet potato farmers, 60 pig farmers and 60 sweet potato traders) were also conducted. The results showed that sweet potato production is seasonal with substantial wastage of sweet potato components existing across the various nodes of the sweet potato value chain. The study concludes that there is an opportunity for investment in sweet potato silage business that has the potential to reduce wastage of sweet potato and bridge the feed scarcity gap faced by pig farmers

Birth data accessibility via primary care health records to classify health status in a multi-ethnic population of children: an observational study

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The impact of maternal infection with Mycobacterium tuberculosis on the infant response to bacille Calmette-Guérin immunization.

Bacille Calmette-Guérin (BCG) immunization provides variable protection against tuberculosis. Prenatal antigen exposure may have lifelong effects on responses to related antigens and pathogens. We therefore hypothesized that maternal latent Mycobacterium tuberculosis infection (LTBI) influences infant responses to BCG immunization at birth. We measured antibody (n = 53) and cellular (n = 31) responses to M. tuberculosis purified protein derivative (PPD) in infants of mothers with and without LTBI, in cord blood and at one and six weeks after BCG. The concentrations of PPD-specific antibodies declined between birth (median [interquartile range (IQR)]) 5600 ng ml(-1) [3300-11 050] in cord blood) and six weeks (0.00 ng ml(-1) [0-288]). Frequencies of PPD-specific IFN-γ-expressing CD4(+)T cells increased at one week and declined between one and six weeks (p = 0.031). Frequencies of IL-2- and TNF-α-expressing PPD-specific CD4(+)T cells increased between one and six weeks (p = 0.019, p = 0.009, respectively). At one week, the frequency of PPD-specific CD4(+)T cells expressing any of the three cytokines, combined, was lower among infants of mothers with LTBI, in crude analyses (p = 0.002) and after adjusting for confounders (mean difference, 95% CI -0.041% (-0.082, -0.001)). In conclusion, maternal LTBI was associated with lower infant anti-mycobacterial T-cell responses immediately following BCG immunization. These findings are being explored further in a larger study

STD/HIV control in Malawi and the search for affordable and effective urethritis therapy: a first field evaluation.

OBJECTIVES--To evaluate gonococcal (GU) and nongonococcal urethritis (NGU), chlamydia antigen, and serostatus for syphilis and human immunodeficiency virus (HIV) among males attending a Malawian STD clinic with complaints of urethral discharge and/or dysuria. To collect demographic and behavioural data and to determine the effectiveness of five treatments for urethritis. METHODS--Urethritis was diagnosed using microscopy and culture for Neisseria gonorrhoeae. Sera were screened with rapid plasma reagin (RPR) and if reactive, with microhaemagglutination for Treponema pallidum (MHA-TP). HIV antibodies and chlamydia antigen were detected using enzyme immunoassay. Patients were randomised for treatment, cure was assessed 8-10 days later. RESULTS--At enrolment, GU was diagnosed in 415 (80.3%) and NGU in 59 (11.2%) of 517 males. Chlamydia antigen was found in 26 (5.2%) of 497 specimens tested. Syphilis seropositivity rate (RPR and MHA-TP reactive) was 10.7%. Overall HIV seroprevalence was 44.2%; 71.7% of men with reactive syphilis serology were HIV(+) compared with 40.9% of syphilis seronegatives (OR: 3.6, p < 0.001). Trimethoprim 320 mg/sulphamethoxazole 1600 mg by mouth for 2 days (TMPSMX), or the combination of amoxicillin 3 gm, probenicid 1 gm, and clavulanate 125 mg by mouth once (APC), failed to cure gonorrhoea effectively. Amoxicillin 3 gm, probenicid 1 gm, and clavulanate 125 mg, by mouth once with doxycycline 100 mg BID for 7 days (APC-D), gentamicin 240 mg IM once (GENT), ciprofloxacin 250 mg by mouth once (CIPRO) cured 92.9% to 95% of gonorrhoea. APC-D treatment did not generate less NGU at follow-up. HIV serostatus did not affect cure of urethritis. CONCLUSION--All patients presenting with urethritis should be treated syndromically using a simple algorithm and screened for syphilis seroreactivity for appropriate treatment and counselling

Rates of Anti-Tuberculosis Drug Resistance in Kampala-Uganda Are Low and Not Associated with HIV Infection

Background: Drug resistance among tuberculosis patients in sub-Saharan Africa is increasing, possibly due to association with HIV infection. We studied drug resistance and HIV infection in a representative sample of 533 smear-positive tuberculosis patients diagnosed in Kampala, Uganda. Methods/Principal Findings: Among 473 new patients, multidrug resistance was found in 5 (1.1%, 95% CI 0.3-2.5) and resistance to any drug in 57 (12.1%, 9.3-15.3). Among 60 previously treated patients this was 7 (11.7%, 4.8-22.6) and 17 (28.3%; 17.5-41.4), respectively. Of 517 patients with HIV results, 165 (31.9%, 27.9-36.1) tested positive. Neither multidrug (adjusted odds ratio (ORadj) 0.7; 95% CI 0.19-2.6) nor any resistance (ORadj 0.7; 0.43-1.3) was associated with HIV status. Primary resistance to any drug was more common among patients who had worked in health care (ORadj 3.5; 1.0-12.0). Conclusion/Significance: Anti-tuberculosis drug resistance rates in Kampala are low and not associated with HIV infection, but may be associated with exposure during health car

Smallholder pig value chains transformation in Uganda: Results, lessons and insights

Irish Ai