Plasma levels of DDE/DDT and liver function in malaria control personnel 6 months after indoor residual spraying with DDT in northern Uganda, 2008

Objective. We investigated the relationship between plasma levels of dichlorodiphenyltrichloroethane (DDT) and liver function in malaria control personnel 6 months after one round of DDT indoor residual spraying (IRS).Method. This was a cross-sectional study in the districts of Apac and Oyam of Lango, northern Uganda. Volunteers were clinically examined, and 5 ml samples of venous blood were taken in heparinised tubes for a 6-month post-spray screening for DDT and plasma markers of liver function and internal organ disease. DDE/DDT was assayed using ELISA kits (Abraxis, USA); plasma enzyme activity concentrationsof amylase, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma glutamyl transpeptidase(GGT) were analysed using routine clinical chemistryautomatedmethods (Konelab, Vantaa, Finland).Results. All 96 plasma samples analysed for xenobiotics contained DDE/DDT in the empirical range of 24.00 - 128.00 parts per billion (ppb) with a mean (SD) of 77.00 (±26.00) ppb. All 119 plasma samples studied for the markers exhibited enzyme activity concentration values within the population reference ranges, with empirical means (SD) of amylase 71.86 (34.07), AST 23.83 (12.71), ALT 7.84 (10.01) and GGT 58.37 (62.68) ìg/l.Conclusion. Six months after IRS with DDT, the spray team had an average concentration of plasma DDE/DDT of 77 ppb. This had no deleterious effect on liver function. We recommend continued use of DDT for IRS disease control in Uganda until better practical alternatives are available

Regularity of laboratory supplies and delivery of histopathology services in the department of Pathology, Makerere University College of Health Sciences, Uganda, between January 2002 and April 2003

A retrospective study was undertaken in the department of Pathology, Makerere University College of Health Sciences and Mulago Hospital, Uganda, between January 2002 and April 2003 to determine the regularity of laboratory supplies and delivery of histopathology services. The requisition forms and dates of final reporting were obtained from department of Pathology records. The information on delivery of supplies was retrieved from Mulago hospital stores. Formalin (450 L) and isopropyl (2,505 L) were requisitioned, but only 145 L (32.2%) and 70 L (2.8%) respectively were received. Xylene 5L (11.1%) were issued out of 45 L requisitioned. Paraffin wax (900 Kg) was ordered and 200 Kg (22.2%) were supplied. Hematoxylin (850 gms) and silver nitrate (3,700 g) were ordered and none of each was issued. Eosin (100 gms) was supplied out of 200 g requisitioned. Microscope slides (721 packets) and cover slips (520 packets) were requisitioned, only 127 packets (17.6 %) and 90 packets (17.3 %) respectively were supplied. Surgical blades (2,836) were requisitioned and 760 (26.8 %) were given. No detergents and disinfectants were supplied. On average, it took 5 days to get supplies. Turnaround time of making diagnosis was 9 days. Approximately 52 specimens were either lost or misplaced out of 6,700 samples processed during this period. The amount of supplies received was far much lower than the amount requested. Give the high turnaround time in the histopathology service, a computerized laboratory logistics and inventory management systems (LMIS) should be established at the health settings in the country in order to ensure continuous availability of laboratory supplies and improve the turnaround time in laboratory services.KEY WORDS: Laboratory; Supplies; Histopathology; Service

Medical audit on problem analysis and implementing changes at the Health Unit level

Background: Decentralization is one of the reforms the Uganda government adopted to improve public services delivery. However, human resource numbers and capacities in local governments remain below the required level and this coupled with severe resource constraints make it increasingly difficult to deal with enormous workload in public health units. The authors responded to these human resource demands and needs in health service delivery by introducing hospital medical audit on problem analysis and implementation of changes through continuing medical education to health care workers. The main objective of this study was to introduce hospital medical audit on problem analysis and implementation of changes in health units in order to reduce morbidity and mortality.Methods: A feasibility study was done to find out the effects of decentralization on the health service delivery and to assess the need for continuing medical education. Twelve problematic clinical areas were identified, modules developed, tested and eventually used to train selected health care workers on hospital medical audit to improve health service delivery.Results: A total of 270 health care workers and 400 paramedical students were trained on hospital medical audit by identifying causes of complications associated with common clinical procedures done in their health units and then provide solutions that can be implemented. On prevention of HIV/AIDS and malaria spread, three different levels at which the two could be prevented from spreading were identified and discussed. Infection control and continuing medical education committees were formed where they did not exist.Conclusion/Recommendation: Hospital medical audit on problem analysis and implementation of changes in health units is highly effective in stimulating and empowering health care workers and hospital administrators to analyze their own situations and provide implementable solutions to their health care problems. There is need to introduce hospital medical audit in all the districts in Uganda to improve health services delivery

Vitamin C as well as β-carotene attenuates experimental liver fibrosis after intoxication with carbon tetrachloride in rats

The therapeutic effects of vitamin C and β-carotene on chronic liver diseases have not yet been fully demonstrated and their application as dietary intakes or supplements lacks strong experimental backing. We aimed at investigating the therapeutic efficacy of these vitamins on hepatic fibrogenesis caused by carbon tetrachloride (CCl4)-intoxication in rats. Four groups of albino rats were used: group 1 (control) received only saline, whereas groups 2-4 were injected intraperitoneally with 0.5 mL/kg body weight CCl4 every 3 days plus pentobarbital (0.3 mg/L) in drinking water for 10 weeks; after which CCl4 and pentobarbital were stopped and the animals in group 2 were allowed to rest, while those in groups 3 and 4 were treated with intramuscular injections (100 mg/kg/day) of vitamins C and β-carotene, respectively, for further 2 weeks. CCl4 plus pentobarbital resulted in well established fibrosis associated with notable steatosis and ballooning. Treatment with vitamin C or β-carotene modulated CCl4-induced liver pathology, as reflected by significantly lower histological scores (p<0.05). Vitamin C intervention was also associated with significantly lower levels of liver enzymes, unlike β-carotene. We conclude that compared to β-carotene, vitamin C significantly ameliorated both biochemical and histological changes in CCl4-induced liver disease and that both vitamins separately attenuated liver fibrosis.Keywords: Albino rats, liver enzymes, hepatic fibrosis, histological scores, CCl

Zinc adjunct therapy reduces case fatality in severe childhood pneumonia: a randomized double blind placebo-controlled trial

<p>Abstract</p> <p>Background</p> <p>Pneumonia is a leading cause of children's deaths in developing countries and hinders achievement of the fourth Millennium Development Goal. This goal aims to reduce the under-five mortality rate, by two thirds, between 1990 and 2015.</p> <p>Few studies have examined the impact of zinc adjunct therapy on the outcome of childhood pneumonia. We determined the effect of zinc as adjunct therapy on time to normalization of respiratory rate, temperature and oxygen saturation. We also studied the effect of zinc adjunct therapy on case fatality of severe childhood pneumonia (as a secondary outcome) in Mulago Hospital, Uganda.</p> <p>Methods</p> <p>In this double blind, randomized, placebo-controlled clinical trial, 352 children aged 6 to 59 months, with severe pneumonia were randomized to zinc (20 mg for children ≥12 months, and 10 mg for those < 12 months) or a placebo once daily for seven days, in addition to standard antibiotics for severe pneumonia. Children were assessed every six hours. Oxygen saturation was normal if it was above 92% (breathing room air) for more than 15 minutes. The respiratory rate was normal if it was consistently (more than 24 hours) below 50 breaths per minute in infants and 40 breaths per minute in children above 12 months of age. Temperature was normal if consistently below 37.5°C. The difference in case fatality was expressed by the risk ratio between the two groups.</p> <p>Results</p> <p>Time to normalization of the respiratory rate, temperature and oxygen saturation was not significantly different between the two arms.</p> <p>Case fatality was 7/176 (4.0%) in the zinc group and 21/176 (11.9%) in the placebo group: Relative Risk 0.33 (95% CI 0.15 to 0.76). Relative Risk Reduction was 0.67 (95% CI 0.24 to 0.85), while the number needed to treat was 13. Among HIV infected children, case fatality was higher in the placebo (7/27) than in the zinc (0/28) group; RR 0.1 (95% CI 0.0, 1.0).</p> <p>Among 127 HIV uninfected children receiving the placebo, case fatality was 7/127 (5.5%); versus 5/129 (3.9%) among HIV uninfected group receiving zinc: RR 0.7 (95% CI 0.2, 2.2). The excess risk of death attributable to the placebo arm (Absolute Risk Reduction or ARR) was 8/100 (95% CI: 2/100, 14/100) children. This excess risk was substantially greater among HIV positive children than in HIV negative children (ARR: 26 (95% CI: 9, 42) per 100 versus 2 (95% CI: -4, 7) per 100); <it>P</it>-value for homogeneity of risk differences = 0.006.</p> <p>Conclusion</p> <p>Zinc adjunct therapy for severe pneumonia had no significant effect on time to normalization of the respiratory rate, temperature and oxygen saturation. However, zinc supplementation in these children significantly decreased case fatality.</p> <p>The difference in case fatality attributable to the protective effect of zinc therapy was greater among HIV infected than HIV uninfected children. Given these results, zinc could be considered for use as adjunct therapy for severe pneumonia, especially among Highly Active Antiretroviral Therapy</p> <p>naïve HIV infected children in our environment.</p> <p>Clinical trials registration number</p> <p>clinicaltrials.gov <a href="http://www.clinicaltrials.gov/ct2/show/NCT00373100">NCT00373100</a></p

Assessment of exposure to DDT and metabolites after indoor residual spraying through the analysis of thatch material from rural African dwellings

This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.[Introduction] We report on the analysis of 4,4′-dichlorodiphenyltrichloroethane (4,4′-DDT) and its metabolites in thatch and branch samples constituting the wall materials of dwellings from South African subtropical areas. This approach was used to assess the exposure to DDT in the residents of the dwellings after indoor residual spraying (IRS) following recommended sanitation practices against malaria vectors.[Discussion] Examination of the distributions of DDT compounds (2,4′-DDT, 4,4′-DDT and its metabolites) in 43 dwellings from the area of Manhiça (Mozambique) has shown median concentrations of 19, 130, and 23 ng/g for 2,4′-DDT, 4,4′-DDT, and 4,4′-DDE, respectively, in 2007 when IRS implementation was extensive. The concentrations of these compounds at the onset of the IRS campaign (n = 48) were 5. 5, 47, and 2. 2 ng/g, respectively. The differences were statistically significant and showed an increase in the concentration of this insecticide and its metabolites. Calculation of 4,4′-DDT in the indoor air resulting from the observed concentrations in the wall materials led to the characteristic values of environments polluted with this insecticide. © 2011 The Author(s).Funding was received from MICINN (INMA G03/176, Consolider Ingenio GRACCIE, CSD2007-00067), CSIC (PIF06-053), and ArcRisk EU Project (FP7-ENV-2008-1-226534).Peer reviewe

Prevalence of dyslipidaemia and associated risk factors in a rural population in south-western Uganda : a community based survey

BACKGROUND: The burden of dyslipidaemia is rising in many low income countries. However, there are few data on the prevalence of, or risk factors for, dyslipidaemia in Africa. METHODS: In 2011, we used the WHO Stepwise approach to collect cardiovascular risk data within a general population cohort in rural south-western Uganda. Dyslipidaemia was defined by high total cholesterol (TC) ≥ 5.2 mmol/L or low high density lipoprotein cholesterol (HDL-C) 6% (men aOR=3.00, 95%CI=1.37-6.59; women aOR=2.74, 95%CI=1.77-4.27). The odds of high TC was also higher among married men, and women with higher education or high BMI. CONCLUSION: Low HDL-C prevalence in this relatively young rural population is high whereas high TC prevalence is low. The consequences of dyslipidaemia in African populations remain unclear and prospective follow-up is required

The accuracy of self monitoring blood glucose meter systems in Kampala Uganda

Background: Many blood glucose self-monitoring systems are privately and publicly used by people in Uganda and technical and human errors may occur during their operation. Many patients were referred to Kololo polyclinic laboratory to have their blood glucose checked because the values obtained on the patients' glucose meter systems did not tally with familiar clinical signs and symptoms. This prompted an experimental set up to check glucose meter systems using a larger number of patients. Objective: The objective was to collate the technical conditions and standing operational procedures of four common glucose meter systems; observe the time, ambient temperature and humidity at which the meter systems operate locally; and compare the performance of three meter systems A, B, and C with the Sensorex glucose meter system on a number of capillary blood samples. Setting: Kololo polyclinic laboratory – a privately run facility in Kampala, Uganda. Design: An experimental set up to compare four glucose meter systems. Methods: Instruction manuals of the four glucose monitoring systems were studied and used to familiarize with the meter operations. One hundred and fourteen capillary blood specimens were assayed for blood glucose. Blood glucose values were instantly read off the four randomly set meter systems A, B, C, and Sensorex, noting the time, ambient temperature and humidity. Results from meter systems A, B, and C were regressed against those of Sensorex using Epi-Info computer program. Results: Blood glucose concentration levels on meter system A tallied with those on Sensorex meter system. However, those on meter system B and C were significantly lower and different. Temperature and humidity adversely affected the analytical performance of meter systems B and C in the Kampala environ. Conclusion: Some of the blood glucose monitoring systems in Kampala, Uganda are poor performers and may lead to the mismanagement of patients. There is need for a system to ensure national quality control of blood glucose monitoring systems. African Health Sciences 2003; 3(1): 23-3

Plasma cholesterol and related lipid levels of seemingly healthy public service employees in Kampala, Uganda

Background: As Uganda's economy improves, many people tend to adopt western diets and sedentary life styles that predispose to cardiovascular diseases including hypertension. These may be in silent danger without any typical symptoms to send early warning signals. In Uganda, cardiovascular diseases (CVD) and diabetes mellitus are rapidly emerging as major causes of morbidity and mortality. Objective: This study was conducted to determine spot levels of plasma lipid indicators of CVD in seemingly healthy public service employees in Kampala, Uganda. The purpose of this study was achieved through analysis of fasting plasma samples for the following: Total cholesterol (TC), Triacylglycerols (TG), High density lipoprotein cholesterol (HDL), Low density lipoprotein cholesterol (LDL), and molar ratios of LDL/HDL, TC/ HDL, and TC/TG. Methods: One hundred and seventy four fasting executives 85 males and 89 females employed in public service in Kampala, Uganda, were investigated to determine enzymatically spot levels of TC, TG, HDL, and LDL from which their mutual ratios were calculated. Results: In each of the 7 parameters studied, the samples showed risk factors for CVD at the following rates :HDL 10% ,LDL/HDL 12%, TG 47%, LDL 48%, TC/HDL 53% TC 66%, TG/HDL 68%,. Conclusions: In all the cut off points used, each analyte had a significant percentage of public service employees at risk of CVD. It is therefore concluded that hypercholesterolaemia and other dyslipidemias exist among seemingly healthy public service employees in Kampala, Uganda, and this needs urgent intervention at both individual and national levels. African Health Sciences Vol. 6(3) 2006: 139-14

Blood loss and contributing factors in femoral fracture surgery

Background: Substantial blood losses frequently accompany orthopedic procedures. Methods: We prospectively noted peri-operative hemoglobin changes in 93 patients undergoing surgery for femoral fracture with an aim of establishing blood loss and related factors. Results: The mean total blood loss assessed 72 hours after the surgical procedure was 3.31 (SD 1.56) units of whole blood. A multiple regression analysis revealed diathermy use and a simple fracture pattern as significant factors in reducing blood loss (p<0.01). Conclusions: Open intramedullary fixation of femur fractures leads to considerable peri-operative blood loss. This is can be reduced by use of diathermy during surgery