An instance of cyclonic upwelling in the southern offshore waters of Lake Victoria

Evidence is presented that cyclonic upwelling took place in the southern offshore waters of Lake Victoria on the 22nd to the 23rd March, 1969. Before this, the main upper thermocline was tilted downwards in the leeward northern half of the lake in response to the accumulation of epilimnetic water. Cyclonic upwelling might be quite common because of the frequent occurrence of storms on Lake Victoria, and probably on other tropical African lakes. However, to my knowledge, it has never been reported from any lake

The relevance of limnological information in the development and management of inland fisheries

The purpose of this paper is not to justify the existence of limnologists in fishery science, but to illustrate the now well accepted view that limnology holds the key to the understanding of fish production, and that an understanding of environmental relationships and the modification rates at all trophic levels must be the basis of enlightened management

Opportunities for improving the efficiency of paediatric HIV treatment programmes

Objectives: To conduct two economic analyses addressing whether to: routinely monitor HIV-infected children on antiretroviral therapy (ART) clinically or with laboratory tests; continue or stop cotrimoxazole prophylaxis when children become stabilized on ART. Design and methods: The ARROW randomized trial investigated alternative strategies to deliver paediatric ART and cotrimoxazole prophylaxis in 1206 Ugandan/Zimbabwean children. Incremental cost-effectiveness and value of implementation analyses were undertaken. Scenario analyses investigated whether laboratory monitoring (CD4 tests for efficacy monitoring; haematology/biochemistry for toxicity) could be tailored and targeted to be delivered cost-effectively. Cotrimoxazole use was examined in malaria-endemic and non-endemic settings. Results: Using all trial data, clinical monitoring delivered similar health outcomes to routine laboratory monitoring, but at a reduced cost, so was cost-effective. Continuing cotrimoxazole improved health outcomes at reduced costs. Restricting routine CD4+ monitoring to after 52 weeks following ART initiation and removing toxicity testing was associated with an incremental cost-effectiveness ratio of $6084 per quality-adjusted life-year (QALY) across all age groups, but was much lower for older children (12+ years at initiation; incremental cost-effectiveness ratio =$769/QALY). Committing resources to improve cotrimoxazole implementation appears cost-effective. A healthcare system that could pay $600/QALY should be willing to spend up to$12.0 per patient-year to ensure continued provision of cotrimoxazole. Conclusion: Clinically driven monitoring of ART is cost-effective in most circumstances. Routine laboratory monitoring is generally not cost-effective at current prices, except possibly CD4 testing amongst adolescents initiating ART. Committing resources to ensure continued provision of cotrimoxazole in health facilities is more likely to represent an efficient use of resources

The challenges of treating HIV-infected adolescents

Adolescents and young people represent a growing share of people living with HIV worldwide. In 2020 alone, 410,000 [194,000-690,000] young people between the ages of 10 to 24 were newly infected with HIV, of whom 150,000 [44,000-310,000] were adolescents between the ages of 10 and 19. To compound this, most recent data indicate that only 25 per cent of adolescent girls and 17 per cent of adolescent boys aged 15-19 in Eastern and Southern Africa – the region most affected by HIV – have been tested for HIV in the past 12 months and received the result of the last test. The testing rates in West and Central Africa and South Asia are even lower. If current trends continue, hundreds of thousands more will become HIV-positive in the coming years, and without knowing their status, adolescents will miss out on life-saving treatment. Additionally, a large population of children infected with HIV perinatally over the last decade are growing into adolescence

Tuberculosis incidence is high in HIV-infected African children but is reduced by co-trimoxazole and time on antiretroviral therapy

BACKGROUND: There are few data on tuberculosis (TB) incidence in HIV-infected children on antiretroviral therapy (ART). Observational studies suggest co-trimoxazole prophylaxis may prevent TB, but there are no randomized data supporting this. The ARROW trial, which enrolled HIV-infected children initiating ART in Uganda and Zimbabwe and included randomized cessation of co-trimoxazole prophylaxis, provided an opportunity to estimate the incidence of TB over time, to explore potential risk factors for TB, and to evaluate the effect of stopping co-trimoxazole prophylaxis. METHODS: Of 1,206 children enrolled in ARROW, there were 969 children with no previous TB history. After 96 weeks on ART, children older than 3 years were randomized to stop or continue co-trimoxazole prophylaxis; 622 were eligible and included in the co-trimoxazole analysis. Endpoints, including TB, were adjudicated blind to randomization by an independent endpoint review committee (ERC). Crude incidence rates of TB were estimated and potential risk factors, including age, sex, center, CD4, weight, height, and initial ART strategy, were explored in multivariable Cox proportional hazards models. RESULTS: After a median of 4 years follow-up (3,632 child-years), 69 children had an ERC-confirmed TB diagnosis. The overall TB incidence was 1.9/100 child-years (95 % CI, 1.5-2.4), and was highest in the first 12 weeks following ART initiation (8.8/100 child-years (5.2-13.4) versus 1.2/100 child-years (0.8-1.6) after 52 weeks). A higher TB risk was independently associated with younger age (<3 years), female sex, lower pre-ART weight-for-age Z-score, and current CD4 percent; fewer TB diagnoses were observed in children on maintenance triple nucleoside reverse transcriptase inhibitor (NRTI) ART compared to standard non-NRTI + 2NRTI. Over the median 2 years of follow-up, there were 20 ERC-adjudicated TB cases among 622 children in the co-trimoxazole analysis: 5 in the continue arm and 15 in the stop arm (hazard ratio (stop: continue) = 3.0 (95 % CI, 1.1-8.3), P = 0.028). TB risk was also independently associated with lower current CD4 percent (P <0.001). CONCLUSIONS: TB incidence varies over time following ART initiation, and is particularly high during the first 3 months post-ART, reinforcing the importance of TB screening prior to starting ART and use of isoniazid preventive therapy once active TB is excluded. HIV-infected children continuing co-trimoxazole prophylaxis after 96 weeks of ART were diagnosed with TB less frequently, highlighting a potentially important role of co-trimoxazole in preventing TB

Experiences of young adults growing up with innate or early acquired HIV infection--a qualitative study

Aim. To explore the experience of young adults growing up and living with HIV in urban Sweden. Background. HIV has become a widespread pandemic. Effective antiretroviral treatment has dramatically increased the survival rate of infected individuals such that HIV-infection is currently considered a chronic disease where treatment is available. Data concerning the experience of living with HIV since early childhood is scarce and more empirical knowledge is needed in order to direct the development of adequate care and interventions for this growing demographic. Design. Exploratory qualitative study. Method. Semi-structured interviews were conducted with ten HIV-infected young adults over the period from January to August 2008. Transcripts of the interviews were analysed using qualitative content analysis. Findings. The analysis revealed five categories illustrating the experiences of growing up and living with HIV in Sweden: 1) to protect oneself from the risk of being stigmatised, 2) to be in control, 3) losses in life but HIV is not a big deal, 4) health care/health care providers, and 5) belief in the future. Conclusion. It is essential to offer a safe, trustworthy and professional health-care environment during the upbringing of HIV-infected children. Evidence-based interventions are needed to improve care and support, particularly regarding the handling of stigma and discrimination

Prevalence, clinical pattern and immediate outcomes of HIV-infected children admitted to Al Sabah Children’s Hospital, South Sudan

Introduction: HIV continues to be a major global health issue. There were approximately 2.1 million infected children aged &lt;15 years in 2017 and most were in sub-Saharan Africa. South Sudan with its low prevention of mother to child transmission (PMTCT) coverage has a greater risk of high transmission rates of HIV from mothers to their children.Objective: To determine the prevalence of HIV infection, the clinical pattern, and the immediate outcomes of children admitted to Al Sabah Children’s Hospital.Method: This was a cross sectional descriptive study, with a longitudinal component for the immediate outcome. A total of 828 children were recruited: 424 aged &lt;18 months and 424 aged ≥ 18 months. HIV rapid tests were done to confirm the HIV infection for children aged ≥18 months, while HIV DNA-PCR was done to confirm the HIV infection for children aged &lt;18 months found to be HIV exposed.Results: Twenty four children tested HIV positive giving an overall HIV prevalence of 2.8% (95% CI 1.8 – 4.2). The clinical characteristics associated with HIV infection were: a history of cough (p=0.001), weight loss (p &lt;0.001), oral thrush (p &lt;0.001), lymphadenopathy (p=0.001), ear discharge (p &lt;0.001), skin lesion (p &lt;0.001), hepatomegaly (p &lt;0.001), and splenomegaly (p &lt;0.01). Factors associated with prolonged hospital stay were history of weight loss (OR=4.96, 95% CI 2.68-9.18), skin lesions (OR=3.60, 95% CI 1.36-9.56), and weight for height/length z score&lt;-3SD (OR=8.67, 95% CI 4.70-15.99).Conclusion: The prevalence of HIV among this hospital based population of children aged less than 15 years was 2.8%. Children who presented with cough, weight loss, oral thrush, lymphadenopathy, ear discharge, skin lesion, hepatomegaly, and splenomegaly in this setting were likely to have HIV infection and should therefore raise suspicion for testing and early diagnosis.Keywords: HIV infection, clinical characteristics, children, hospital stay, South SudanSouth Sudan Medical Journal Vol 12 No 3 August 201

GOVERNMENT REGULATION AND SUSTAINABILITY OF KENYA\u27S INSURANCE COMPANIES

Purpose: The study investigated government regulation and sustainability of Kenya\u27s insurance companies. Methodology: The study adopted the positivist research philosophy and employed a descriptive research design. The target population of the study was the 51 insurance companies registered by the Insurance Regulatory Authority (IRA) of Kenya as at 31st December 2016. The study took a proportionate sample of 30 companies from 10 life, 15 general and 5 composite companies. The primary data collection was through a structured questionnaire with closed questions. A pilot study was carried out before questionnaire distribution, which ensured the research instrument validity and reliability, before distribution through both hand delivery and email, followed by a telephone call to the respondents and a research assistant later visiting the respondents to collect the filled questionnaires. The raw data was cleaned, edited, coded and analyzed to generate descriptive statistics of ANOVA and T-test and inferential statistics of mean, standard deviation and frequencies, &nbsp;while secondary data was collected using data collection sheets. Study Findings: The findings showed that there is a moderating effect of government regulation on drivers of sustainability of insurance companies in Kenya. While there was positive and significant effect of government regulation on capital adequacy, management capability and sensitivity to risk, government regulation had no moderation on asset quality as management of other variables of management quality, capital adequacy and risk sensitivity would address the quality of capital. Unique Contribution: The study recommends that IRA opens up the RBC measurement tool to bring in sustainability and management indices. Further, IRA should review regulation to support the insurance companies to enhance innovation and customer service delivery, which are key for growth, and sustainability of the various insurance companies in the country

Mortality and clinical outcomes in children treated with antiretroviral therapy in four African vertical programs during the first decade of paediatric HIV care, 2001-2010

Objective: To assess mortality and clinical outcomes in children treated with antiretroviral therapy (ART) in four African vertical programmes between 2001 and 2010. Methods: Cohort analysis of data from HIV-infected children (<15 years old) initiating ART in 4 sub-Saharan HIV programs in Kenya, Uganda and Malawi, between December 2001 and December 2010. Rates of mortality, program attrition and first-line clinico-immunological failure were calculated by age group (<2, 2-4 and 5-14 years), 1 or 2 years after ART initiation and risk factors were examined. Results: A total of 3,949 children, 22.7% aged <2 years, 32.2% 2-4 years, 45.1% aged 5-14 years, were included. At ART initiation 60.8% had clinical stage 3 or 4, and 46.5% severe immune-suppression. Overall mortality, attrition and 1-year failure rates were 5.1, 10.8 and 9.0 per 100 person-years, respectively. Immunosuppression, stage 3 or 4 and underweight were associated with increased rates of mortality, attrition and treatment failure. Adjusted estimates showed lower mortality hazard ratios (HR) among children aged 2-4 years (HR=0.57, 95%CI 0.42-0.77 compared to 5-14 years). One-year treatment failure incidence rate ratios (IRR) were similar regardless of age (IRR=0.91, 95%CI 0.67-1.25 for <2 years; 1.01, 95%CI 0.83-1.23 for 2-4 years, compared to 5-14 years). Conclusions: Good treatment outcomes were achieved during the first decade of HIV pediatric care despite the late start of therapy. Encouraging early HIV infant diagnosis in and outside prevention of mother-to-child-transmission programs, and linkage to care services for early ART initiation are needed to reduce mortality and delay treatment failure