Test offering, not additional information, may increase HIV testing uptake in a knowledgeable population

A CAJM journal article.Objectives: To evaluate patient HIV knowledge and testing experience and assess the effect of an HIV informational handout on HIV testing propensity. Design: Cross sectional, descriptive techniques were employed to assess demographics, HIV knowledge and HIV testing experience. A randomized controlled trial was performed to determine if an HIV/AIDS information sheet influenced testing propensity. Setting: Blantyre Adventist Hospital Outpatient Clinic. Subjects: Non-emergency patients over 18 years old attending during consulting hours. Interventions: All subjects answered a questionnaire. For the randomized controlled trial component, half received an HIV information handout. Main Outcome Measures: Proportions were calculated to evaluate testing experience. Logistic regression was used to assess impact of written information and demographics on HIV testing propensity. Results: 490 participants were recruited, of whom 57% had never been tested for HIV. Of the untested, 88% had never been offered an HIV test. Of those that had never been offered a test, 46% desired one. The sample was highly knowledgeable about HIV. Reading an information sheet had no impact on HIV knowledge (p=0.736 to 0.788) or desire for testing (p=0.387). However, age (OR=0.97,95%CI (0.95,0.99)) and gender (OR=1.85, 95%CI (1.06, 3.23)) significantly correlated with testing propensity. Conclusions: A large percentage of patients who have never been offered HIV testing desire testing. More frequent HIV test offering by clinicians could improve testing rates. Clinician education programmes should be developed to increase test offering. Furthermore, written health information in a setting of high HIV/AIDS knowledge may not change behaviour. Alternative methods should be employed to encourage HIV testing uptake

Under-reporting of gravidity in a rural Malawian population

Background: Mis-reporting of data by study participants in a questionnaire-based study is an important source of bias in studies. Objective: To determine the prevalence and factors influencing mis-reporting of gravidity among rural women in Malawi. Materials and Methods: Data from cross sectional study conducted in 2004 were analysed using logistic regression analysis and the logit modeling. Results: 7118 women were in the reproductive age group, 2387(33.5%) had ever attended school, 4556 (64.0%) had never and results for 175 (2.5%) were missing. Of those who attended school, 94.9% (2297) had attained a maximum primary level, 5.04% (122) secondary level and 0.08% (2) tertiary level. 81.6% of the women were aged between 12 and 36 years of age, mean was 26.1 years (SD 10.05 years). The remaining 18.4% were aged between 37 and 49 years of age. The mean number of pregnancies attained was 4.0 (SD 3.4), live births was 3.0 (SD 3.2), mean number of stillbirths was almost zero (SD 0.9) and the mean number of children alive was 2.0 (SD 2.3). The prevalence of mis-reporting of gravidity was 7.9%. Factors influencing the risk of under-reporting gravidity were: previous experience of a still-birth, young age, not being married and having ever attended some level of education. Conclusions: We suggest that women who perceived that the community expected them, or they expected themselves to have fewer or no pregnancy at all, censured themselves in reporting low number of pregancies. Researchers using questionnaires should keep in mind possibility of mis-reporting of number of pregnancies among women as this may introduce error in research results. Incorporating multiple questions asking the same thing but in a different way has potential to identify biases as these other questions serve as consistency checks. African Health Sciences Vol. 5 (4) 2005: pp. 335-33

Leprosy in Nkhotakota District Hospital

Objective: To study the profile of leprosy cases at Nkhotakota District Hospital in Central Region of Malawi. Design: Retrospective cross-sectional study of all registered cases of leprosy from records over a nine year period (January 1992 to April 2001) Setting: Nkhotakota District Hospital-Central Region of Malawi. Results: In total 526 cases of leprosy were identified from the records. The prevalence rates gradually increased from 0.998 per 10,000 cases in 1992 to 3.39 cases per 10,000 in 1995. There was however a gradual decline of prevalence rates from 1997/1998 that had 3.17 cases per 10,000 to 1.3 cases per 10,000 in 2001. 1996 registered 2.34 cases per 10,000. Fifty seven cases (10.8%) were found with children of the age of 14 or below and 469 (89.2%) cases were of adults. Paucibacillary leprosy presented with more cases than multibacillary leprosy (

Anaemia in human African trypanosomiasis caused by Trypanosoma brucei rhodesiense

Objective: To find out if indeed anaemia is a major sign in human trypanosomiasis caused by Trypanosoma brucei rhodensiense. Design: A one year cross-sectional study of all admitted and surveyed Trypanosoma brucei rhodensiense infected patients (June 2001-June 2002) Setting: Nkhotakota District Hospital-Central Region of Malawi. Results: After survey and investigations, 28 patients (16 males and 12 females) were admitted to Nkhotakota District Hospital with a parasite positive Trypanosoma brucei rhodensiense infection. Twenty four (85.7%) of them were anaemic. Their mean haemoglobin was 8.96 ± 3.07 g/dl compared to controls that had a mean haemoglobin concentration of 12.17 ± 1.35 g/dl (p < 0.000001, 95% CI -4.342 to -2.0785) (n = 45). None of the trypanosomiasis infected individuals had schistosomiasis or hookworms. Two patients had malaria. One of them was an 18-year-old pregnant woman with hepatosplenomegaly, who developed ante partum haemorrhage. She was jaundiced and had haemoglobin of 10 g/dl. She died after two weeks following the diagnosis and treatment. The other was a two-year-old girl who had haemoglobin of 8.4 g/dl. She also had hepatosplenomegaly. All the other patients looked well nourished with no other signs of chronic diseases. Hepatosplenomegaly was significantly related to the severity of illness (p = 0.011) but not to anaemia. Conclusion: Though basic, this study has shown that anaemia is indeed a complication of human Africa trypanosomiasis caused by Trypanosoma brucei rhodensiense. There is need for further investigation to investigate the type of anaemia that is caused by this disease. East African Medical Journal Vol.81(10) 2004: 505-50

LEPROSY IN NKHOTAKOTA DISTRICT HOSPITAL

ABSTRACTObjective: To study the profile of leprosy cases at Nkhotakota District Hospital in CentralRegion of Malawi.Design: Retrospective cross-sectional study of all registered cases of leprosy fromrecords over a nine year period (January 1992 to April 2001)Setting: Nkhotakota District Hospital-Central Region of Malawi.Results: In total 526 cases of leprosy were identified from the records. The prevalencerates gradually increased from 0.998 per 10,000 cases in 1992 to 3.39 cases per 10,000in 1995. There was however a gradual decline of prevalence rates from 1997/1998 thathad 3.17 cases per 10,000 to 1.3 cases per 10,000 in 2001. 1996 registered 2.34 casesper 10,000. Fifty seven cases (10.8%) were found with children of the age of 14 orbelow and 469 (89.2%) cases were of adults. Paucibacillary leprosy presented with morecases than multibacillary leprosy (p&lt;0.0000001). There were 80 (15.2%) cases ofmultibacillary leprosy compared to 446 (84.8%) cases of paucibacillary leprosy. Inaddition more males were affected by multibacillary leprosy than females (p &lt;0.0001)and females were more affected by paucibacillary leprosy (p&lt;0.01) than males.Conclusion: The results show that paucibacillary leprosy though minor in Malawi canbecome endemic as paucibacillary leprosy is a reflection of leprosy contacts in thepopulation. We therefore recommend continued epidemiological surveys of leprosy.Training in leprosy detection should be encouraged so that this disease can be totallyeradicated in Malawi

Atrioventricular node ablation in langendorff-perfused porcine hearts using carbon ion particle therapy

Particle therapy, with heavy ions such as carbon-12 (12 C), delivered to arrhythmogenic locations of the heart could be a promising new means for catheter-free ablation. As a first investigation, we tested the feasibility of in vivo atrioventricular node ablation, in Langendorff-perfused porcine hearts, using a scanned 12C beam. Methods and Results-Intact hearts were explanted from 4 (30-40 kg) pigs and were perfused in a Langendorff organ bath. Computed tomgraphic scans (1 mm voxel and slice spacing) were acquired and 12 C ion beam treatment planning (optimal accelerator energies, beam positions, and particle numbers) for atrioventricular node ablation was conducted. Orthogonal X-rays with matching of 4 implanted clips were used for positioning. Ten Gray treatment plans were repeatedly administered, using pencil beam scanning. After delivery, positron emission tomography-computed tomgraphic scans for detection of β + (11 C) activity were obtained. A 12 C beam with a full width at half maximum of 10 mm was delivered to the atrioventricular node. Delivery of 130 Gy caused disturbance of atrioventricular conduction with transition into complete heart block after 160 Gy. Positron emission computed tomgraphy demonstrated dose delivery into the intended area. Application did not induce arrhythmias. Macroscopic inspection did not reveal damage to myocardium. Immunostaining revealed strong γH2AX signals in the target region, whereas no γH2AX signals were detected in the unirradiated control heart. Conclusions-This is the first report of the application of a 12 C beam for ablation of cardiac tissue to treat arrhythmias. Catheter-free ablation using 12C beams is feasible and merits exploration in intact animal studies as an energy source for arrhythmia elimination

Atrioventricular node ablation in Langendorff-perfused porcine hearts using carbon ion particle therapy: methods and an in vivo feasibility investigation for catheter-free ablation of cardiac arrhythmias.

Particle therapy, with heavy ions such as carbon-12 ((12)C), delivered to arrhythmogenic locations of the heart could be a promising new means for catheter-free ablation. As a first investigation, we tested the feasibility of in vivo atrioventricular node ablation, in Langendorff-perfused porcine hearts, using a scanned 12C beam. Intact hearts were explanted from 4 (30-40 kg) pigs and were perfused in a Langendorff organ bath. Computed tomographic scans (1 mm voxel and slice spacing) were acquired and (12)C ion beam treatment planning (optimal accelerator energies, beam positions, and particle numbers) for atrioventricular node ablation was conducted. Orthogonal x-rays with matching of 4 implanted clips were used for positioning. Ten Gray treatment plans were repeatedly administered, using pencil beam scanning. After delivery, positron emission tomography-computed tomographic scans for detection of β(+) ((11)C) activity were obtained. A (12)C beam with a full width at half maximum of 10 mm was delivered to the atrioventricular node. Delivery of 130 Gy caused disturbance of atrioventricular conduction with transition into complete heart block after 160 Gy. Positron emission computed tomography demonstrated dose delivery into the intended area. Application did not induce arrhythmias. Macroscopic inspection did not reveal damage to myocardium. Immunostaining revealed strong γH2AX signals in the target region, whereas no γH2AX signals were detected in the unirradiated control heart. This is the first report of the application of a (12)C beam for ablation of cardiac tissue to treat arrhythmias. Catheter-free ablation using 12C beams is feasible and merits exploration in intact animal studies as an energy source for arrhythmia elimination