The motives behind Swazi men's increasing interest in circumcision

The demand for circumcision in Swaziland has dramatically increased since it was reported that circumcision ensures 60% protection against HIV infection. The aim of this study was to explore the reasons for, and the motives behind, this increasing interest in undergoing circumcision. A generic qualitative research design was used, in which 17 circumcised men selected by convenience sampling at FLAS Clinic, Mbabane, participated. In-depth unstructured face-to-face interviews were used to collect data. The results showed that the main reasons for circumcision are perceived health, hygiene and sexual benefits, community influences, as well as medical reasons. It was concluded that the major motives underlying circumcision are personal and partner safety and satisfaction during sex. These motives were found to be both promotive and threatening to the interests of public health. After evaluating the risks and benefits, it was recommended that mass circumcision be promoted alongside reinforced and accurate health education on circumcisionHealth StudiesM.A. (Public Health

Swazi men’s perception of the protective effect of male circumcision and its implications for HIV prevention strategy

Background: For years, male circumcision (MC) has been known to reduce the risk of sexually transmitted infections (STIs). Of late, MC has been recognised and recommended as a complementary HIV preventive measure in high prevalent areas. The objective of this study was to to assess the perceptions of Swazi men about the protective effect of circumcision against STIs including HIV, and its implication to the mass MC strategy for HIV prevention.Methods: An explorative qualitative study was conducted targeting men aged ≥18 years seeking services at Family Life Association of Swaziland clinic in Mbabane, Swaziland. Unstructured individual face-to-face interviews were conducted for 17 men.Results: Results showed that Swazi men perceived the protective effect of MC differently, ranging from perceptions of ineffectiveness and unworthy, especially against HIV, to perceptions of total protection and a solution to all STIs. Perceptions were influenced by the ongoing circumcision campaigns, individual knowledge of biological sciences, misconceptions as well as life experiences. Promiscuous men were more likely to have a positive perception and acceptance of the procedure than their non-promiscuous counterparts.Conclusion: Swazi men hold mixed perceptions about MC, accounting for its relatively low uptake. The relatively low uptake of circumcision does not necessarily imply failure of the strategy but rather a natural selection of the most relevant and at-risk portion of the population. It is recommended that more effort be put towards correcting misconceptions and convincing those who still hold a negative perception about the procedure

A model to promote the uptake of male circumcision as an HIV-preventive measure in high HIV and low male circumcision prevalence settings

Background: Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) remain the leading global burden of disease, especially in Southern Africa. As such, efforts to develop innovative preventive and curative measures continue to be a global priority. Of late, the World Health Organization recognised and recommended mass male circumcision (MC) as an adjunct HIV-preventive measure in 14 selected sub-Sahara African countries. However, despite efforts to promote the uptake of MC in these countries, the uptake remains significantly below set targets. Aim: The purpose of this article is to describe the process that was followed in developing, describing and evaluating a model to promote the uptake of MC as an HIV-preventive measure in high HIV and low MC settings. Setting: The model is designed for all settings of high HIV and low MC prevalence. Method: A theory-generative, qualitative, exploratory, descriptive and contextual research design was used. The process involved four distinct steps, namely concept analysis, description of relationship statements, and description and evaluation of the model using the criteria of clarity, simplicity, generality, accessibility and importance. Results: The central concept was identified as ‘promote the uptake of MC’, and three integral constituents were identified for the process, such as transforming men’s mindsets about MC, facilitating accessibility and utilisation of MC services, and maintaining a supportive social system. These formed the basis for the model. Conclusion: The model provides a framework of reference for healthcare providers in promoting the uptake of MC as an HIV-preventive measure in high HIV and low MC settings

Carbapenem resistance expressed by Gram-negative bacilli isolated from a cohort of Libyan patients

Background and objectives: Carbapenem-resistant Enterobacteriaceae (CRE) and other Gram-negative bacteria are among the most common pathogens responsible for both community and hospital acquired infection. The global spread of cephalosporinases in Enterobacteriaceae has led to the increased use of carbapenems resulting in the emergence and rapid spread of CRE. This has become an alarming public health concern, yet the condition in Libya remains unclear. The aim of this study was to obtain a better understanding of CRE strains prevalent in Libyan patients by investigating their phenotypic characteristics and antibiograms. Methods: Gram-negative bacterial species were collected from Misrata Central Hospital, Misrata Cancer Centre and Privet Pathology Laboratories. Clinical samples and swabs were obtained from hospitalised and non-hospitalised patients and from mechanical ventilation and suction machines. Patients who had received antibiotic therapy for at least three days prior to the study were excluded. The identification and characterization of the isolated species were achieved using the growth characteristics on MacConkey and blood agar, spot tests and API 20E or API 20NE biochemical testing systems. Screening for carbapenem resistance was performed using the disk diffusion method with carbapenem 10 μg and cephalosporin 30 μg disks and minimum inhibitory concentrations (MIC) determined using the Sensititre Gram-negative Xtra plate format (GNX2F). All strains demonstrating resistance or reduced susceptibility to one of the four carbapenems were subjected to carbapenememase activity detection using the RAPIDEC CARBA NP test, Modified Hodge test and carbapenem inactivation methods. Results: A total of one hundred and forty isolates representing fourteen bacterial species were isolated from 140 non-duplicated specimens. Clinical specimens included urine samples (96/140, 68.57%), sputum (15/140, 10.71%), surgical wound swabs (18/140, 12.85%), foot swabs from diabetes mellitus (DM) patients (6/140, 4.29%), ear swabs (3/140, 2.14%) and wound swabs (2/140, 1.43%). Thirty-four (24.29%) isolates demonstrated resistance to at least one of the four carbapenems with Klebsiella pneumoniae representing 73.53% (25 isolates) of all carbapenem resistant species, followed by 8.82% for Pseudomonas aeruginosa (3 isolates), 5.88% for both Proteus mirabilis (2 isolates) and Escherichia coli (2 isolates) and 2.94% for both Citrobacter koseri (1 isolate) and Rahnella aquatilis (1 isolate). The other isolates were either susceptible or cephalosporinase producers. Conclusion: This study has revealed the high rate of carbapenem resistance amongst Libyan patients and emphasizes the crucial need for accurate screening, identification and susceptibility testing to prevent further spread of nosocomial and community acquired resistance. This may be achieved through the establishment of antibiotic stewardship programmes along with firm infection control practices.National Research Foundation of South Africa; Libyan GovernmentWeb of Scienc

Investigation into the pharmacodynamics of ethanol as a nerve blocking agent

Ethanol is a known nerve-blocking agent, yet its clinical use is minimal. This is partly due to unclear dosage levels and not enough knowledge of its pharmacodynamics and overwhelming dominance of its psychomotor properties. This research intended to investigate into the pharmacodynamics of ethanol as a nerve blocking agent, try and establish an effective dose that can be used clinically, as well as comparing its effects on various parts of the motor unit. A total of 105 sciatic nerve – gastrocnemius muscle specimens were isolated from frogs, Xenopus laevis. Ethanol at concentrations of 40%, 55% and 70%, each at doses of 1.5g/kg, 2.0g/kg and 2.5g/kg body weight (BW) was administered intraperitoneally, intramuscularly (into the gastrocnemius) and topically (onto the sciatic nerve). Using EPIC system to monitor muscle contractions, action potential and/or electromyogram the nerve block effects of each dose / concentration combination were assessed. The effects on the nerve, neuromuscular junction and muscle were assessed separately and compared, then as a single unit. Results showed that intraperitoneally administered ethanol had no effect on neuromuscular function. Intramuscular injections took 2.5 to 9.0 minutes to attain complete paralysis, and lasted for 29.5 to 61.0 minutes, depending on concentration and dose (>/= 55%; >/= 2.0g/kg BW). Topically applied ethanol took 15 to 30 seconds to block the nerve completely, depending on the concentration (>/= 40%). The blockade lasted for 5 to 10 minutes. Intramuscularly injected ethanol reduced the amplitude of indirectly elicited electromyography more than the directly evoked one. It was concluded that to achieve a complete and sustained ethanol nerve block, at least 55% concentration, 2.0g/kg BW dose and intramuscular route are required. The duration of blockade depends on concentration and dose administered. Ethanol affects both nerve and muscle. The effect is more pronounced and instant on the nerve than on muscle