Asthma Prevalence, Knowledge, and Perceptions among Secondary School Pupils in Rural and Urban Costal Districts in Tanzania.

Asthma is a common chronic disease of childhood that is associated with significant morbidity and mortality. We aimed to estimate the prevalence of asthma among secondary school pupils in urban and rural areas of coast districts of Tanzania. The study also aimed to describe pupils' perception towards asthma, and to assess their knowledge on symptoms, triggers, and treatment of asthma. A total of 610 pupils from Ilala district and 619 pupils from Bagamoyo district formed the urban and rural groups, respectively. Using a modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, a history of "diagnosed" asthma or the presence of a wheeze in the previous 12 months was obtained from all the studied pupils, along with documentation of their perceptions regarding asthma. Pupils without asthma or wheeze in the prior 12 months were subsequently selected and underwent a free running exercise testing. A >= 20% decrease in the post-exercise Peak Expiratory Flow Rate (PEFR) values was the criterion for diagnosing exercise-induced asthma. The mean age of participants was 16.8 (+/-1.8) years. The prevalence of wheeze in the past 12 months was 12.1% in Bagamoyo district and 23.1% in Ilala district (p < 0.001). Self-reported asthma was found in 17.6% and 6.4% of pupils in Ilala and Bagamoyo districts, respectively (p < 0.001). The prevalence of exercise-induced asthma was 2.4% in Bagamoyo, and 26.3% in Ilala (P < 0.002). In both districts, most information on asthma came from parents, and there was variation in symptoms and triggers of asthma reported by the pupils. Non-asthmatic pupils feared sleeping, playing, and eating with their asthmatic peers. The prevalence rates of self-reported asthma, wheezing in the past 12 months, and exercise-induced asthma were significantly higher among urban than rural pupils. Although bronchial asthma is a common disease, pupils' perceptions about asthma were associated with fear of contact with their asthmatic peers in both rural and urban schools

A global framework for action to improve the primary care response to chronic non-communicable diseases: a solution to a neglected problem.

BACKGROUND: Although in developing countries the burden of morbidity and mortality due to infectious diseases has often overshadowed that due to chronic non-communicable diseases (NCDs), there is evidence now of a shift of attention to NCDs. DISCUSSION: Decreasing the chronic NCD burden requires a two-pronged approach: implementation of the multisectoral policies aimed at decreasing population-level risks for NCDs, and effective and affordable delivery of primary care interventions for patients with chronic NCDs. The primary care response to common NCDs is often unstructured and inadequate. We therefore propose a programmatic, standardized approach to the delivery of primary care interventions for patients with NCDs, with a focus on hypertension, diabetes mellitus, chronic airflow obstruction, and obesity. The benefits of this approach will extend to patients with related conditions, e.g. those with chronic kidney disease caused by hypertension or diabetes. This framework for a "public health approach" is informed by experience of scaling up interventions for chronic infectious diseases (tuberculosis and HIV). The lessons learned from progress in rolling out these interventions include the importance of gaining political commitment, developing a robust strategy, delivering standardised interventions, and ensuring rigorous monitoring and evaluation of progress towards defined targets. The goal of the framework is to reduce the burden of morbidity, disability and premature mortality related to NCDs through a primary care strategy which has three elements: 1) identify and address modifiable risk factors, 2) screen for common NCDs and 3) and diagnose, treat and follow-up patients with common NCDs using standard protocols. The proposed framework for NCDs borrows the same elements as those developed for tuberculosis control, comprising a goal, strategy and targets for NCD control, a package of interventions for quality care, key operations for national implementation of these interventions (political commitment, case-finding among people attending primary care services, standardised diagnostic and treatment protocols, regular drug supply, and systematic monitoring and evaluation), and indicators to measure progress towards increasing the impact of primary care interventions on chronic NCDs. The framework needs evaluation, then adaptation in different settings. SUMMARY: A framework for a programmatic "public health approach" has the potential to improve on the current unstructured approach to primary care of people with chronic NCDs. Research to establish the cost, value and feasibility of implementing the framework will pave the way for international support to extend the benefit of this approach to the millions of people worldwide with chronic NCDs

Allergic Rhinitis and its Associated Co-Morbidities at Bugando Medical Centre in Northwestern Tanzania; A Prospective Review of 190 Cases.

Allergic rhinitis is one of the commonest atopic diseases which contribute to significant morbidity world wide while its epidemiology in Tanzania remains sparse. There was paucity of information regarding allergic rhinitis in our setting; therefore it was important to conduct this study to describe our experience on allergic rhinitis, associated co-morbidities and treatment outcome in patients attending Bugando Medical Centre. This was descriptive cross-sectional study involving all patients with a clinical diagnosis of allergic rhinitis at Bugando Medical Centre over a three-month period between June 2011 and August 2011. Data was collected using a pre-tested coded questionnaire and analyzed using SPSS statistical computer software version 17.0. A total of 190 patients were studied giving the prevalence of allergic rhinitis 14.7%. The median age of the patients was 8.5 years. The male to female ratio was 1:1. Adenoid hypertrophy, tonsillitis, hypertrophy of inferior turbinate, nasal polyps, otitis media and sinusitis were the most common co-morbidities affecting 92.6% of cases and were the major reason for attending hospital services. Sleep disturbance was common in children with adenoids hypertrophy (χ2 = 28.691, P = 0.000). Allergic conjunctivitis was found in 51.9%. The most common identified triggers were dust, strong perfume odors and cold weather (P < 0.05). Strong perfume odors affect female than males (χ2 = 4.583, P = 0.032). In this study family history of allergic rhinitis was not a significant risk factor (P =0.423). The majority of patients (68.8%) were treated surgically for allergic rhinitis co morbidities. Post operative complication and mortality rates were 2.9% and 1.6% respectively. The overall median duration of hospital stay of in-patients was 3 days (2 - 28 days). Most patients (98.4%) had satisfactory results at discharge. The study shows that allergic rhinitis is common in our settings representing 14.7% of all otorhinolaryngology and commonly affecting children and adolescent. Sufferers seek medical services due to co-morbidities of which combination of surgical and medical treatment was needed. High index of suspicions in diagnosing allergic rhinitis and early treatment is recommended

Informe de la Campaña ARGELIA0203-DP para la evaluación de recursos demersales profundos en las costas de Argelia (Mediterráneo Sud-Occidental)

RESUMEN: Del 5 al 24 de marzo de 2003 se llevó a cabo la campaña de prospección pesquera con arrastre de fondo ARGELIA0203-DP en aguas de Argelia, a bordo del B/O Vizconde de Eza. Se realizaron 55 pescas (3 nulas) entre 200 y 800 m de profundidad. Se presentan los resultados de las capturas realizadas en esta campaña y se analizan los índices de abundancia y biomasa de las especies más importantes, por sector y área geográficos y estrato batimétrico, así como su distribución de tallas por sector geográfico y estrato batimétrico. Se comparan los rendimientos y las tallas obtenidos con los de otras campañas realizadas en el Mediterráneo (MEDITS y BALAR)RÉSUME: Rapport de la campagne ARGELIA0203-DP portant evaluation des ressources demersales des côtes Algeriennes (Mediterrane sud-occidental).- Du 05 au 24 Mars 2003, s’est réalisée une campagne de prospection par chalutage du fond ARGELIA0203-DP des côtes Algériennes, abord du B/O Vizconde de Eza. 55 traits de pêche (3 annulées) ont été effectue entre 200 et 800 m de profondeur. Les résultats des captures réalisées durant cette campagne et l’analyse des indices d’abondance et biomasse des espèces les plus importantes sont présentés, par secteur, par aire géographique et strate bathymétrique, ainsi que leurs distributions de tailles par secteur géographique et strate bathymétrique. Les rendements et les tailles obtenus ont fait l’objet d’une comparaison avec les autres campagnes réalisées dans la Méditerranée (MEDITS et BALAR)ABSTRACT: Report of the ARGELIA0203-DP survey for the assessment of the deep-sea demersal resources off Algerian coasts (southwestern Mediterranean).- From March 5th to 24th 2003 the bottom-trawl survey ARGELIA0203-DP was developed in waters off Argelia, on board R/V Vizconde de Eza. Fifty-five hauls (3 null) were carried out between 200 and 800 m depth. The results of the captures obtained during this survey are shown and abundance and biomass indexes of the most important species are analyzed by geographic sector and area, and bathymetric stratum, as their size distribution by geographic sector and bathymetric stratum. Yields and sizes obtained are compared to those from other surveys carried out in the Mediterranean (MEDITS and BALAR)

Informe de la campaña ARGELIA0204 para la evaluación de recursos demersales en las costas de Argelia (Mediterráneo sud-occidental)

RESUMEN: Del 5 de Febrero al 8 de Marzo de 2004 se llevó a cabo la campaña de prospección pesquera con arrastre de fondo ARGELIA0204 en aguas de Argelia, a bordo del B/O Vizconde de Eza. Se realizaron 114 pescas (6 nulas) entre 40 y 760 m de profundidad. Se presentan los resultados de las capturas realizadas en esta campaña y se analizan los índices de abundancia y biomasa de las especies más importantes, así como su distribución de tallas, por sector geográfico y estrato batimétrico. Se comparan los rendimientos y las tallas obtenidos con los de la campaña realizada en 2003 en la misma área y con otras campañas realizadas en el Mediterráneo.RÉSUME: Rapport de la campagne ARGELIA0204 portant évaluation des ressources demersaux des côtes Algériennes (Méditerranée sud-occidental).- Du 05 du Février au 8 du Mars 2004, s’est réalisée une campagne de prospection par chalutage du fond ARGELIA0204 des côtes Algériennes, a bord du B/O Vizconde de Eza. 114 traits de pêche (6 annulées) ont été effectue entre 40 et 800 m de profondeur. Les résultats des captures réalisées durant cette campagne et l’analyse des indices d’abondance et biomasse des espèces les plus importantes sont présentés, par secteur, par aire géographique et strate bathymétrique, ainsi que leurs distributions de tailles par secteur géographique et strate bathymétrique. Les rendements et les tailles obtenus ont fait l’objet d’une comparaison avec les autres campagnes réalisées dans la Méditerranée.ABSTRACT: Report of the ARGELIA0204 survey for the assessment of the deep-sea demersal resources off Algerian coast (south-western Mediterranean).- From 5 February to 8 March 2004 the bottom-trawl survey ARGELIA0204 was developed in waters off Argelia, on board R/V Vizconde de Eza. 114 hauls (6 null) were carried out between 40 and 800 m depth. The results on the captures obtained during this survey are shown and abundance and biomass indexes of the most important species are analyzed by geographic sector and area, and bathymetric stratum, as their size distribution by geographic sector and bathymetric stratum. Yields and sizes obtained are compared to those from other surveys carried out in the Mediterranea

The impact of the nelfinavir resistance-conferring mutation D30N on the susceptibility of HIV-1 subtype B to other protease inhibitors

The human immunodeficiency virus type 1 (HIV-1) protease mutation D30N is exclusively selected by the protease inhibitor (PI) nelfinavir and confers resistance to this drug. We demonstrate that D30N increases the susceptibility to saquinavir (SQV) and amprenavir in HIV-1 subtype B isolates and that the N88D mutation in a D30N background neutralizes this effect. D30N also suppresses indinavir (IDV) resistance caused by the M46I mutation. Interestingly, in patients with viruses originally containing the D30N mutation who were treated with IDV or SQV, the virus either reversed this mutation or acquired N88D, suggesting an antagonistic effect of D30N upon exposure to these PIs. These findings can improve direct salvage drug treatment in resource limited countries where subtype B is epidemiologically important and extend the value of first and second line PIs in these populations

Combined impact of healthy lifestyle factors on risk of asthma, rhinoconjunctivitis and eczema in school children: ISAAC phase III

Background Asthma is not the key focus of prevention strategies. A Healthy Lifestyle Index (HLI) was developed to examine the combined effect of modifiable lifestyle factors on asthma, rhinoconjunctivitis and eczema using data from the International Study of Asthma and Allergies in Childhood (ISAAC) phase III. Methods Information on symptoms of asthma, rhinoconjunctivitis, eczema and several lifestyle factors was obtained from children aged 6-7 years through written questionnaires. The HLI combined five lifestyle factors: no parental smoking, child's adherence to Mediterranean diet, child's healthy body mass index, high physical activity and non-sedentary behaviour. The association between the HLI and risk of asthma, rhinoconjunctivitis and eczema was evaluated using multilevel mixed-effects logistic regression models. Findings Data of 70 795 children from 37 centres in 19 countries were analysed. Each additional healthy lifestyle factor was associated with a reduced risk of current wheeze (OR 0.87, 95% CI 0.84 to 0.89), asthma ever (OR 0.89, 95% CI 0.87 to 0.92), current symptoms of rhinoconjunctivitis (OR 0.95, 95% CI 0.92 to 0.97) and current symptoms of eczema (OR 0.92, 95% CI 0.92 to 0.98). Theoretically, if associations were causal, a combination of four or five healthy lifestyle factors would result into a reduction up to 16% of asthma cases (ranging from 2.7% to 26.3 % according to region of the world). Conclusions These findings should be interpreted with caution given the limitations to infer causality from cross-sectional observational data. Efficacy of interventions to improve multiple modifiable lifestyle factors to reduce the burden asthma and allergy in childhood should be assessed

Modelling imperfect adherence to HIV induction therapy

Abstract Background Induction-maintenance therapy is a treatment regime where patients are prescribed an intense course of treatment for a short period of time (the induction phase), followed by a simplified long-term regimen (maintenance). Since induction therapy has a significantly higher chance of pill fatigue than maintenance therapy, patients might take drug holidays during this period. Without guidance, patients who choose to stop therapy will each be making individual decisions, with no scientific basis. Methods We use mathematical modelling to investigate the effect of imperfect adherence during the inductive phase. We address the following research questions: 1. Can we theoretically determine the maximal length of a possible drug holiday and the minimal number of doses that must subsequently be taken while still avoiding resistance? 2. How many drug holidays can be taken during the induction phase? Results For a 180 day therapeutic program, a patient can take several drug holidays, but then has to follow each drug holiday with a strict, but fairly straightforward, drug-taking regimen. Since the results are dependent upon the drug regimen, we calculated the length and number of drug holidays for all fifteen protease-sparing triple-drug cocktails that have been approved by the US Food and Drug Administration. Conclusions Induction therapy with partial adherence is tolerable, but the outcome depends on the drug cocktail. Our theoretical predictions are in line with recent results from pilot studies of short-cycle treatment interruption strategies and may be useful in guiding the design of future clinical trials