9. Effect of insecticide-treated bed nets on haemoglobin values, prevalence and multiplicity of infection with Plasmodium falciparum in a randomized controlled trial in Tanzania

A randomized controlled trial of insecticide-treated bed nets (ITNs) was conducted in an area of high malaria transmission in Tanzania in order to assess the effects of ITNs on infection and anaemia. One hundred and twenty-two children, aged 5 to 24 months, were randomly allocated to 2 groups, one of which received ITNs. Outcome measures were assessed in 6 consecutive months with monthly cross-sectional surveys. These measures were haemoglobin values, Plasmodium falciparum prevalence and density, and multiplicity of infection determined by polymerase chain reaction-restriction fragment length polymorphism analysis (PCR-RFLP) of the msp2 locus. There was a significant increase in mean heamoglobin values and a significant decrease of 16·4% in microscopically determined P. falciparum prevalence in children in the ITN group six months after the start of the trial. Both effects were more pronounced in younger children. However, no significant difference was observed in parasite density or multiplicity of infection among infected children. Comparison with PCR results indicated that microscopically subpatent parasitaemia was more frequently found in children in the ITN group. This, together with the observed similar multiplicity in the 2 groups, suggests that infections are maintained despite ITN use, owing to the chronicity of infections. This study shows that ITNs reduce the risk of anaemia in highly exposed young children. The virtually unchanged multiplicity of infection indicates that the potentially protective concomitant immunity is not compromise

Prevalence of Hepatitis B surface antigen among pregnant women attending antenatal clinic at Nyamagana District Hospital Mwanza, Tanzania

In developing countries there is no routine screening of hepatitis B virus (HBV) infection among pregnant women resulting into limited data on its magnitude. The objective of this study was to determine the prevalence and risk factors associated with active HBV infection among pregnant women attending antenatal clinic (ANC) in Mwanza City, Tanzania. A total of 211 pregnant women were serially enrolled between May and July 2014. Hepatitis B surface antigen (HBsAg) was determined using a rapid Immuno-chromatographic assay. The median age of the study population was 23 years (IQR 20-29 years).  Of 211 pregnant women, 61.6% (130/211) were multigravidae. Eight (3.8%) of the pregnant women were positive with HBsAg. There was a significant difference in prevalence between primigravidae and multigravidae (0.8% vs. 8.6%, p=0.017). Active hepatitis B infection among pregnant women in Mwanza city is low and associated with multigravidity. Despite low prevalence of acute hepatitis B infection routine screening of HBsAg and anti HBsAg antibodies, coupled with the vaccination of those at risk should be introduced to prevent hepatitis B infection complications.

Risk factors for Coronavirus disease 2019 (Covid-19) death in a population cohort study from the Western Cape province, South Africa

Risk factors for coronavirus disease 2019 (COVID-19) death in sub-Saharan Africa and the effects of human immunodeficiency virus (HIV) and tuberculosis on COVID-19 outcomes are unknown. We conducted a population cohort study using linked data from adults attending public-sector health facilities in the Western Cape, South Africa. We used Cox proportional hazards models, adjusted for age, sex, location, and comorbidities, to examine the associations between HIV, tuberculosis, and COVID-19 death from 1 March to 9 June 2020 among (1) public-sector “active patients” (≥1 visit in the 3 years before March 2020); (2) laboratory-diagnosed COVID-19 cases; and (3) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19, comparing adults living with and without HIV using modeled population estimates.Among 3 460 932 patients (16% living with HIV), 22 308 were diagnosed with COVID-19, of whom 625 died. COVID19 death was associated with male sex, increasing age, diabetes, hypertension, and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR], 2.14; 95% confidence interval [CI], 1.70–2.70), with similar risks across strata of viral loads and immunosuppression. Current and previous diagnoses of tuberculosis were associated with COVID-19 death (aHR, 2.70 [95% CI, 1.81–4.04] and 1.51 [95% CI, 1.18–1.93], respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95% CI, 1.96–2.86); population attributable fraction 8.5% (95% CI, 6.1–11.1)

Nutritional status of under fives attending maternal and child health clinics in Dar es Salaam, Tanzania

We designed a study to assess the nutritional status of children under five years of age attending MCH clinics in Dar es Salaam. This was a cross-sectional anthropometric study involving children 6-24 months who from July to August 1993 were attending Magomeni MCH clinic and those aged 18 months to five years who were attending Lugalo and Mwananyamala MCH clinics for routine growth monitoring and for vaccination between May to August 1994. The data collected included age, birth weight, sex, weight, height, breastfeeding status and HIV-1 serostatus. Of the 1854 children enrolled (961 boys and 893 girls) 31.6% were stunted, 14.6% were underweight and 2.9% were wasted. The highest percentage of stunting and wasting was observed between 11 and 25 months and 36 to 40 months. Of the 849 children tested for HIV-1,14 (1.7%) were seropositive and two out of 770 (0.3%) were born with low weight. HIV seropositivity and low birthweight were both associated with stunting and wasting. We conclude that malnutrition is still a sizeable problem among children attending urban MCH clinics in Dar es Salaam especially among those aged less than three years, to whom special malnutrition control strategies should be targeted. There is also a need to identify factors responsible for the observed decline in MCH attendance with age and correct the situation.link_to_subscribed_fulltex

Nutritional status of under fives attending maternal and child health clinics in Dar es Salaam, Tanzania

We designed a study to assess the nutritional status of children under five years of age attending MCH clinics in Dar es Salaam. This was a cross-sectional anthropometric study involving children 6-24 months who from July to August 1993 were attending Magomeni MCH clinic and those aged 18 months to five years who were attending Lugalo and Mwananyamala MCH clinics for routine growth monitoring and for vaccination between May to August 1994. The data collected included age, birth weight, sex, weight, height, breastfeeding status and HIV-1 serostatus. Of the 1854 children enrolled (961 boys and 893 girls) 31.6% were stunted, 14.6% were underweight and 2.9% were wasted. The highest percentage of stunting and wasting was observed between 11 and 25 months and 36 to 40 months. Of the 849 children tested for HIV-1,14 (1.7%) were seropositive and two out of 770 (0.3%) were born with low weight. HIV seropositivity and low birthweight were both associated with stunting and wasting. We conclude that malnutrition is still a sizeable problem among children attending urban MCH clinics in Dar es Salaam especially among those aged less than three years, to whom special malnutrition control strategies should be targeted. There is also a need to identify factors responsible for the observed decline in MCH attendance with age and correct the situation.link_to_subscribed_fulltex

L\'antibiotherapie de premiere intention dans le traitement de l\'empyeme pleural de l\'enfant en milieu Africain (Yaoundé-Cameroun).

We examined 125 pleural fluids collected, 67 cultures that represented 53.6% were positive. The three main germs isolated in order of decreasing frequency were Streptococcus pneumoniae (41.7%), Staphylococcus aureus (35.3%) and Haemophilus influenzae (7.5%). The most active antibiotics against each of these bacteria were : for S. pneumoniae, second and third generation cephalosporins with 100% sensitivity, amoxicilline + clavulinic acid (96.4% sensitivity), first generation cephalosporins (95% sensitivity) and 46.4% resistance to penicilline G; for S. aureus, céfuroxime, vancomycine and pristinamycine with 100% sensitivity, whereas gentamicin and tobramycin had only 91.3% sensitivity, and there was 13.8% resistance to oxacilline ; for H. influenzae, amoxicillin + clavulinic acid, first, second and third generation cephalosporins, and quinolones all showed 100% sensitivity with 100% and 60% resistance to cotrimoxazole and chloramphenicol respectively. To cover all these three germs in our environment, we recommend as first line antibiotherapy for empyema thoracis in children either of the following antibiotic combinations: amoxicillin/clavulinic acid with gentamicin or cefuroxime with gentamicin or vancomycin alone if available, against S. aureus infection.Nous avons prélevé et mis en culture 125 liquides pleuraux dont 67 soit 53,6% ont poussé. Les trois principaux germes isolés étaient dans l'ordre de fréquence décroissante : Streptococcus pneumoniae (41,7%) Staphylococcus aureus (35,3%) et Haemophilus influenzae (7,5% ). Les principaux antibiotiques actifs sur ces différents germes étaient : vis à vis de S. pneumoniae les céphalosporines de 2è et 3è génération (100%), amoxicilline+acide clavulanique (96,4%) les céphalosporines de 1ère génération (95%). La résistance à la pénicilline G était de 46,4% ; vis à vis de S. aureus, le céfuroxime, la vancomycine et la pristinamycine étaient actives à 100% contre 91,3% pour la gentamicine et la tobramycine, alors que l'oxacilline avait une résistance de 13,8% et enfin vis à vis de H. influenzae l'amoxicilline+acide clavulanique, les céphalosporines des trois générations et les quinolones avait une activité de 100% et le cotrimoxazole une résistance de 100% contre 60% pour le choramphénicol. Pour couvrir ces trois germes dans notre environnement nous proposons de prescrire en première intention dans l'empyème pleural de l'enfant l'une des deux associations suivantes : soit amoxicilline + acide clavulanique et gentamicine soit céfuroxime et gentamicine ou alors vancomycine seule en cas de S. aureus si ce dernier antibiotique est disponible. Keywords: Antibiotherapy - Child - Empyema thoracis -Yaounde - Cameroon.Clinics in Mother and Child Health Vol. 4 (1) 2007: pp. 641-64

Detection of anti-HIV-1 IgG antibodies in whole saliva by Gacelisa and Western Blot assays

The present study, based on 158 HIV seropositives and 167 HIV seronegatives, demonstrates that saliva collected with the Omni-SAL™device and tested with GACELISA (an IgG antibody capture ELISA) is an effective non-invasive alternative to serum for anti-HIV IgG antibody screening. The study also shows that a conventional serum Western blot kit can be used, with slight modifications, for confirmatory testing of saliva specimens. Collecting saliva with the Omni-SAL™ device had a very good acceptance rate among Tanzanian subjects, and although this diagnostic method is not yet known by the general public, 65% of the study participants preferred to give saliva instead of blood for HIV testing.link_to_subscribed_fulltex

Detection of anti-HIV-1 IgG antibodies in whole saliva by gacelisa and western blot assays.

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