Assessment of Peer-Based and Structural Strategies for Increasing Male Participation in an Antenatal Setting in Lilongwe, Malawi

In sub-Saharan Africa, although male involvement in antenatal care is associated with positive outcomes for HIV-infected women and their  infants, men rarely accompany female partners. We implemented a project to increase the number of male partners attending an antenatal clinic at Bwaila Hospital in Lilongwe, Malawi. We evaluated changes in the  proportion of women who came with a partner over three periods. During period 1 (January 2007 – June 2008) there was didactic peer education. During period 2 (July 2008 – September 2009) a peer-led   male-involvement drama was introduced into patient waiting areas. During period 3 (October 2009 – December 2009) changes to clinical infrastructure were introduced to make the clinic more male-friendly. The proportion of women attending ANC with a male partner increased from 0.7% to 5.7% to 10.7% over the three periods. Peer education through drama and  male-friendly hospital infrastructure coincided with substantially greater male participation, although further gains are necessary. Afr J Reprod Health 2014; 18[2]: 97-104).Keywords: HIV, antenatal, male involvement, HIV counseling and testing, disclosure, prevention of mother to child transmission, coupl

Breeding in bambara groundnut (Vigna subterranea (L.) Verdc.): strategic considerations

Bambara groundnut (Vigna subterranea (L.) Verdc.) has a large number of landraces throughout Africa where small-scale farmers have preserved its genetic diversity on-farm. To date, the full genetic diversity of the crop remains largely unexploited. Until recently bambara groundnut never received any appreciable research effort, especially for its genetic improvement. Until then, only selection breeding was practised in which existing landraces were evaluated and their seeds multiplied. However, no new combinations resulting from hybridisation had ever been produced. Recently, collaborative research efforts involving partners from Africa and Europe have produced the first crosses of bambara groundnut. The creation of these crosses is a significant scientific and practical achievement and opens up the possibility of breeding true varieties of this crop. This paper shows how different strategies have been combined to establish the basis of a strategic breeding programme in bambara groundnut. The paper also illustrates the use of landraces in the bambara groundnut breeding programme, as an example of the contribution that landraces can make to increasing productivity in marginal environments and the conservation of a crop's genetic resources on-farm.African Journal of Biotechnology Vol. 4 (6), pp. 463-471, 200

Effect of a Type II Collagen Fragment on the Expression of Genes of the Extracellular Matrix in Cells of the Intervertebral Disc

Knowledge of factors regulating the turnover, repair, and degeneration of the intervertebral disc (IVD) is lacking. Although type II collagen (CII) fragments accumulate in the degenerative IVD, little is known of how they affect the degenerative process. A better understanding of the cellular interactions with fragments of matrix molecules are a key factor in promoting therapies for degenerative disc diseases. In the present study, we have investigated the effect of the CII (245-270) peptide on the expression of matrix molecules, proteinases, and interleukin genes in cells of the IVD. Cells isolated from the nucleus pulposus (NP) and annulus fibrosus (AF) of adult bovine tails were cultured up to 8 days in the absence (control) or presence of the CII (245-270) peptide. RT-PCR was used to analyze the expression of the different genes. Exposure of these cells to the CII (245-270) peptide led to a transient up-regulation of the aggrecan gene in AF cells while this up-regulation was maintained for a longer time in NP cells. The fragment also enhanced a transient up-regulation of the type II collagen gene in AF cells but had no effect in NP cells. The peptide enhanced transiently the expression of matrix metalloproteinase (MMP)-1 and cathepsin K genes in both AF and NP cells whereas it increased MMP-13 expression only in NP cells. The peptide up-regulated tissue inhibitor of metalloproteinase (TIMP)-1, TIMP-2, and TIMP-3 gene expression on day 1 in AF cells but had very little effect on their expression in NP cells. Finally, the CII (245-270) peptide had no effect on IL-6 expression while IL-1α was not expressed in these cells. In conclusion, our results showed that the CII (245-270) peptide differentially alter the expression of genes in bovine AF and NP cells and suggest that degradation products of collagen may be involved in the regulation of IVD homeostasis

The Potential of N-Rich Plasma-Polymerized Ethylene (PPE:N) Films for Regulating the Phenotype of the Nucleus Pulposus

We recently developed a nitrogen-rich plasma-polymerized biomaterial, designated “PPE:N” (N-doped plasma-polymerized ethylene) that is capable of suppressing cellular hypertrophy while promoting type I collagen and aggrecan expression in mesenchymal stem cells from osteoarthritis patients. We then hypothesized that these surfaces would form an ideal substrate on which the nucleus pulposus (NP) phenotype would be maintained. Recent evidence using microarrays showed that in young rats, the relative mRNA levels of glypican-3 (GPC3) and pleiotrophin binding factor (PTN) were significantly higher in nucleus pulposus (NP) compared to annulus fibrosus (AF) and articular cartilage. Furthermore, vimentin (VIM) mRNA levels were higher in NP versus articular cartilage. In contrast, the levels of expression of cartilage oligomeric matrix protein (COMP) and matrix gla protein precursor (MGP) were lower in NP compared to articular cartilage. The objective of this study was to compare the expression profiles of these genes in NP cells from fetal bovine lumbar discs when cultured on either commercial polystyrene (PS) tissue culture dishes or on PPE:N with time. We found that the expression of these genes varies with the concentration of N ([N]). More specifically, the expression of several genes of NP was sensitive to [N], with a decrease of GPC3, VIM, PTN, and MGP in function of decreasing [N]. The expression of aggrecan, collagen type I, and collagen type II was also studied: no significant differences were observed in the cells on different surfaces with different culture time. The results support the concept that PPE:N may be a suitable scaffold for the culture of NP cells. Further studies are however necessary to better understand their effects on cellular phenotypes

Effect of Dexrazoxane and Amifostine on the Vertebral Bone Quality of Doxorubicin Treated Male Rats

Doxorubicin (DOX) is widely used in combination cocktails for treatment of childhood hematological cancers and solid tumors. A major factor limiting DOX usage is DOX-induced cardiotoxicity. However, it is not known whether protectants like dexrazoxane (DXR) and amifostine (AMF) can prevent DOX-mediated bone damage. The present study investigated whether administration of AMF alone or in combination with DXR would prevent any DOX-mediated bone damage. Male rat pups were treated with DOX, DXR, AMF, and their combinations. On neonate day 38, the bone mineral density (BMD), bone mineral content (BMC) and the micro-architecture of the lumbar vertebrae were analyzed. We have shown that when male rats are treated with DOX, DXR, DOX+DXR, AMF, DOX+AMF or DOX+DXR+AMF, there is a decrease in lumbar vertebral BMD (p<0.05). Furthermore, the relative bone volume (BV/TV) was decreased by DXR, DOX+DXR, and DOX+AMF treatments. Interestingly, DOX+AMF significantly increased BV/TV when compared to DXR treatment (p<0.04). The trabecular number (Tb.N) decreased with DXR and DOX+DXR and increased with DOX+AMF treatments. This information will be useful in designing better cancer combination therapies that do not lead to vertebrae deterioration

TST positivity in household contacts of tuberculosis patients : a case-contact study in Malawi

This work was supported by a Wellcome Trust Fellowship awarded to DJ Sloan (086757/Z/08/A) a Malawi Liverpool Wellcome Trust (MLW) Core grant awarded by the Wellcome Trust and by a grant from the European Union Action for Diseases of Poverty Program (Sante–2006–105-061).Background:  Screening household contacts of active tuberculosis (TB) patients is recommended for TB control. Due to resource constraints this rarely occurs in lower income countries. Demographic and clinical features of index cases may influence the likelihood of onwards TB transmission. It has also been proposed that accumulation of intracellular lipid bodies within M. tuberculosis cells may also enhance bacterial transmissibility. This study explored whether clinical and bacteriological observations recorded at baseline in TB cases in Malawi could help identify those with the highest risk of onwards transmission, to prioritise contact tracing. Methods:  In this case-contact study, data on clinical presentation, sputum bacterial load and the percentage of lipid body positive acid-fast bacilli (%LB + AFB) on sputum smears were recorded in adults with sputum smear and culture positive pulmonary TB before initiation of therapy. The Tuberculin Skin Test (TST) was used to detect infection with M. tuberculosis amongst household contacts under the age of 15 years. TST positivity of the child contacts was related to characteristics of the index case. Results:  Thirty four index cases brought 56 contacts (median: 1, range: 1–4 contacts each). 37 (66%) of contacts had a positive TST. Cavities or a high percentage of lung affected on index patient CXRs were associated with TST positivity. Multivariate analysis of non-radiological factors showed that male sex, HIV-negative status and raised peripheral blood white blood count (WBC) in index patients were also independent risk factors of TST positivity. Lower %LB + AFB counts were associated with TST positivity on univariate analysis only. Conclusion:  TST positivity is common amongst household contacts of sputum smear positive adult TB patients in Malawi. Contact tracing in this high risk population could be guided by prioritising index cases with CXR cavities and extensive radiological disease or, in the absence of CXRs, those who are HIV-negative with a raised WBC.Publisher PDFPeer reviewe

Why does community-based disaster risk reduction fail to learn from local knowledge? Experiences from Malawi

It is often taken as given that community-based disaster risk reduction (CBDRR) serves as a mechanism for the inclusion of local knowledge (LK) in disaster risk reduction (DRR). In this paper, through in-depth qualitative analysis of empirical data from Malawi, we investigate the extent to which CBDRR in practice really takes into account LK. This research argues that LK is underutilised in CBDRR and finds that current practice provides a limited opportunity for the inclusion of LK, due to five prime obstacles: i) current approach to community participation, ii) financial constraints and capacity of external stakeholders, iii) the donor landscape, iv) information consolidation and sharing, and v) external stakeholders attitudes towards LK. In CBDRR, a strong dichotomy between local and scientific knowledge is maintained, and further re-examination of community-based approaches in practice is needed to make them truly transformative

Why community-based disaster risk reduction fails to learn from local knowledge? Experiences from Malawi

This contributing paper aims to investigate the extent to which community-based disaster risk reduction (CBDRR) in practice really takes into account local knowledge (LK). It is often taken as given that CBDRR serves as a mechanism for the inclusion of local knowledge (LK) in disaster risk reduction (DRR). But the reality from the ground suggests that this increased attention does not result in practical inclusion of communities nor their LK in DRR. Through in-depth empirical qualitative data from Malawi, the paper explores the dynamics between the inadequate inclusion of LK and approaches to DRR. This study argues that LK is underutilised in CBDRR and finds that current practice provides a limited opportunity for the inclusion of LK, due to five prime obstacles: i) current approach to community participation, ii) financial constraints and capacity of external stakeholders, iii) the donor landscape, iv) information consolidation and sharing, and v) external stakeholders attitudes towards LK. In CBDRR, a strong dichotomy between local and scientific knowledge is maintained, and further re-examination of community-based approaches in practice is needed to make them truly transformative

HIV treatment and monitoring patterns in routine practice: a multi-country retrospective chart review of patient care [version 3; referees: 1 approved, 2 approved with reservations]

Background: A study of patient records in four HIV clinics in three sub-Saharan African countries examined routine clinical care patterns and variations. Methods: Clinic characteristics were described, and patient data extracted from a sample of medical records. Data on treatment, CD4 count and viral load (VL) were obtained for the last visit in the records, dates mainly between 2015 and 2017, patient demographic data were obtained from the first clinic visit. Results: Four clinics, two in Nigeria, one in Zambia and one in Uganda, all public facilities, using national HIV treatment guidelines were included. Numbers of patients and health professionals varied, with some variation in stated frequency of testing for CD4 count and VL. Clinical guidelines were available in each clinic, and most drugs were available free to patients. The proportion of patients with a CD4 count in the records varied from 84 to 100 percent, the latest median count varied from 269 to 593 between clinics. 35% had a record of a VL test, varying from 1% to 63% of patients. Lamivudine (3TC) was recorded for more than 90% of patients in each clinic, and although there was variation between clinics in the choice of antiretroviral therapy (ART), the majority were on first line drugs consistent with guidelines.  Only about 2% of the patients were on second-line ARTs. In two clinics, 100% and 99% of patients were prescribed co-trimoxazole, compared with 7% and no patients in the two other clinics. Conclusions: The wide variation in available clinic health work force, levels and frequency of CD4 counts, and VL assessment and treatment indicate sub-optimal adherence to current guidelines in routine clinical care. There is room for further work to understand the reasons for this variation, and to standardise record keeping and routine care of HIV positive patients