The bactericidal activity of moxifloxacin in patients with pulmonary tuberculosis

Patients in whom acid-fast bacilli smear-positive pulmonary tuberculosis was newly diagnosed were randomized to receive 400 mg moxifloxacin, 300 mg isonaizid, or 600 mg rifampin daily for 5 days. Sixteen-hour overnight sputa collections were made for the 2 days before and for 5 days of monotherapy. Bactericidal activity was estimated by the time taken to kill 50% of viable bacilli (vt(50)) and the fall in sputum viable count during the first 2 days designated as the early bactericidal activity (EBA). The mean vt(50) of moxifloxacin was 0.88 days (95% confidence interval [Cl], 0.43-1.33 days) and the mean EBA was 0.53 (95% CI 0.28-0.79). For the isoniazid group, the mean vt(50) was 0.46 days (95% Cl, 0.31-0.61 days) and the mean EBA was 0.77 (95% Cl, 0.54-1.00). For rifampin, the mean vt(50) was 0.71 days (95% Cl, 0.48-0.95 days) and the mean EBA was 0.28 (95% Cl, 0.15-0.41). Using the EBA method, isoniazid was significantly more active than rifampin (p < 0.01) but not moxifloxacin. Using the vt(50) method, isoniazid was more active than both rifampin and moxifloxacin (p = 0.03). Moxifloxacin has an activity similar to rifampin in human subjects with pulmonary tuberculosis, suggesting that it should undergo further assessment as part of a short course regimen for the treatment of drug-susceptible tuberculosis

Survey on prevalence and risk factors on HIV-1 among pregnant women in North-Rift, Kenya: a hospital based cross-sectional study conducted between 2005 and 2006

<p>Abstract</p> <p>Background</p> <p>The HIV/AIDS epidemic in Kenya is a major public-health problem. Estimating the prevalence of HIV in pregnant women provides essential information for an effective implementation of HIV/AIDS control measures and monitoring of HIV spread within a country. The objective of this study was to determine the prevalence of HIV infection, risk factors for HIV/AIDS and immunologic (lymphocyte profile) characteristics among pregnant women attending antenatal clinics in three district hospitals in North-Rift, Kenya.</p> <p>Methods</p> <p>Blood samples were collected from pregnant women attending antenatal clinics in three district hospitals (Kitale, Kapsabet and Nandi Hills) after informed consent and pre-test counseling. The samples were tested for HIV antibodies as per the guidelines laid down by Ministry of Health, Kenya. A structured pretested questionnaire was used to obtain demographic data. Lymphocyte subset counts were quantified by standard flow cytometry.</p> <p>Results</p> <p>Of the 4638 pregnant women tested, 309 (6.7%) were HIV seropositive. The majority (85.1%) of the antenatal attendees did not know their HIV status prior to visiting the clinic for antenatal care. The highest proportion of HIV infected women was in the age group 21–25 years (35.5%). The 31–35 age group had the highest (8.5%) HIV prevalence, while women aged more than 35 years had the lowest (2.5%).</p> <p>Women in a polygamous relationship were significantly more likely to be HIV infected as compared to those in a monogamous relationship (p = 0.000). The highest HIV prevalence (6.3%) was recorded among antenatal attendees who had attended secondary schools followed by those with primary and tertiary level of education (6% and 5% respectively). However, there was no significant relationship between HIV seropositivity and the level of education (p = 0.653 and p = 0.469 for secondary and tertiary respectively). The mean CD4 count was 466 cells/mm³(9–2000 cells/mm³). Those that had less than 200 cells/mm³accounted for 14% and only nine were on antiretroviral therapy.</p> <p>Conclusion</p> <p>Seroprevalence of HIV was found to be consistent with the reports from the national HIV sentinel surveys. Enumeration of T-lymphocyte (CD4/8) should be carried out routinely in the antenatal clinics for proper timing of initiation of antiretroviral therapy among HIV infected pregnant women.</p

Hormonal contraception, sexual behaviour and HIV prevalence among women in Cameroon

<p>Abstract</p> <p>Background</p> <p>Data on the effect of contraceptive methods, other than the condom, on HIV acquisition is not clear. The aim of this study was to describe hormonal contraceptive use, sexual behaviour and HIV prevalence among women in Cameroon in order to provide baseline information for future analytical studies.</p> <p>Methods</p> <p>This is a cross-sectional descriptive study based a nationally representative sample of 4486 sexually active women aged 15–49 years who participated in the 2004 Cameroon Demographic and Health Survey.</p> <p>Results</p> <p>The overall HIV prevalence was 7.4% (332/4486). The HIV prevalence was higher in the 25–35 year age group (10.03%), urban residents (9.39%), and formerly married (18.48%), compared to their compatriots. The prevalence was lower in women with five or more living child (3.67%), women in the low wealth index category (3.79%) and women who had no formal education (3.37%). The HIV prevalence was higher among women who had two or more partners in the last 12 months (10.26%) and women who reported to have had four or more partners in their lifetime (12.40%). The prevalence of HIV was higher among current hormonal contraceptive users (6.63%) compared to the current non-users (3.06%), among ever users of hormonal contraception (13.27%) compared to the never users (7.11%).</p> <p>Conclusion</p> <p>We conclude that the prevalence of HIV among sexually active women in Cameroon varies according to sociodemographic characteristics, sexual behaviour and hormonal contraceptive use. Our findings underscore the need to counsel women using hormonal contraception to be aware that hormonal methods do not protect against HIV infection. Given the biologic plausibility of the link between hormonal contraception and HIV infection, future research should focus on carefully designed prospective studies to establish the temporal relationship and estimate the incidence of HIV infection among women using and not using hormonal contraceptive methods.</p

Food Insecurity and Sexual Risk in an HIV Endemic Community in Uganda

Food insecurity has been linked to high-risk sexual behavior in sub-Saharan Africa, but there are limited data on these links among people living with HIV/AIDS, and on the mechanisms for how food insecurity predisposes individuals to risky sexual practices. We undertook a series of in-depth open-ended interviews with 41 individuals living with HIV/AIDS to understand the impact of food insecurity on sexual-risk behaviors. Participants were recruited from the Immune Suppression Clinic at the Mbarara University of Science and Technology in Mbarara, Uganda. Interviews were recorded, transcribed verbatim, translated, and coded following the strategy of grounded theory. Four major themes emerged from the interview data: the relationship between food insecurity and transactional sex for women; the impact of a husband’s death from HIV on worsening food insecurity among women and children; the impact of food insecurity on control over condom use, and the relationship between food insecurity and staying in violent/abusive relationships. Food insecurity led to increased sexual vulnerability among women. Women were often compelled to engage in transactional sex or remain in violent or abusive relationships due to their reliance on men in their communities to provide food for themselves and their children. There is an urgent need to prioritize food security programs for women living with HIV/AIDS and address broader gender-based inequities that are propelling women to engage in risky sexual behaviors based on hunger. Such interventions will play an important role in improving the health and well-being of people living with HIV/AIDS, and preventing HIV transmission

Durability associated efficacy of long-lasting insecticidal nets after five years of household use

<p>Abstract</p> <p>Background</p> <p>Long-lasting insecticidal nets (LLINs) have been strongly advocated for use to prevent malaria in sub-Saharan Africa and have significantly reduced human-vector contact. PermaNet^®2.0 is among the five LLINs brands which have been given full approval by the WHO Pesticide Evaluation Scheme (WHOPES). The LLINs are expected to protect the malaria endemic communities, but a number of factors within the community can affect their durability and efficacy. This study evaluated the durability, efficacy and retention of PermaNet^®2.0 after five years of use in a Tanzanian community.</p> <p>Method</p> <p>Two to three day- old non blood-fed female mosquitoes from an insectary susceptible colony (<it>An. gambiae </it>s.s, this colony was established at TPRI from Kisumu, Kenya in 1992) and wild mosquito populations (<it>An. arabiensis </it>and <it>Culex quinquefasciatus</it>) were used in cone bioassay tests to assess the efficacy of mosquito nets.</p> <p>Findings</p> <p>The knockdown effect was recorded after three minutes of exposure, and mortality was recorded after 24 hours post-exposure. Mortality of <it>An. gambiae </it>s.s from insectary colony was 100% while <it>An. arabiensis </it>and <it>Cx.quinquefasciatus </it>wild populations had reduced mortality. Insecticide content of the new (the bed net of the same brand but never used before) and used PermaNet^®2.0 was determined using High Performance Liquid Chromatography (HPLC).</p> <p>Conclusion</p> <p>The results of this study suggest that, in order to achieve maximum protection against malaria, public health education focusing on bed net use and maintenance should be incorporated into the mass distribution of nets in communities.</p

Predation efficiency of Anopheles gambiae larvae by aquatic predators in western Kenya highlands

Abstract Background The current status of insecticide resistance in mosquitoes and the effects of insecticides on non-target insect species have raised the need for alternative control methods for malaria vectors. Predation has been suggested as one of the important regulation mechanisms for malaria vectors in long-lasting aquatic habitats, but the predation efficiency of the potential predators is largely unknown in the highlands of western Kenya. In the current study, we examined the predation efficiency of five predators on Anopheles gambiae s.s larvae in 24 hour and semi- field evaluations. Methods Predators were collected from natural habitats and starved for 12 hours prior to starting experiments. Preliminary experiments were conducted to ascertain the larval stage most predated by each predator species. When each larval instar was subjected to predation, third instar larvae were predated at the highest rate. Third instar larvae of An. gambiae were introduced into artificial habitats with and without refugia at various larval densities. The numbers of surviving larvae were counted after 24 hours in 24. In semi-field experiments, the larvae were counted daily until they were all either consumed or had developed to the pupal stage. Polymerase chain reaction was used to confirm the presence of An. gambiae DNA in predator guts. Results Experiments found that habitat type (P &lt; 0.0001) and predator species (P &lt; 0.0001) had a significant impact on the predation rate in the 24 hour evaluations. In semi-field experiments, predator species (P &lt; 0.0001) and habitat type (P &lt; 0.0001) were significant factors in both the daily survival and the overall developmental time of larvae. Pupation rates took significantly longer in habitats with refugia. An. gambiae DNA was found in at least three out of ten midguts for all predator species. Gambusia affins was the most efficient, being three times more efficient than tadpoles. Conclusion These experiments provide insight into the efficiency of specific natural predators against mosquito larvae. These naturally occurring predators may be useful in biocontrol strategies for aquatic stage An. gambiae mosquitoes. Further investigations should be done in complex natural habitats for these predators

Wealth and sexual behaviour among men in Cameroon

BACKGROUND: The 2004 Demographic and Health Survey (DHS) in Cameroon revealed a higher prevalence of HIV in richest and most educated people than their poorest and least educated compatriots. It is not certain whether the higher prevalence results partly or wholly from wealthier people adopting more unsafe sexual behaviours, surviving longer due to greater access to treatment and care, or being exposed to unsafe injections or other HIV risk factors. As unsafe sex is currently believed to be the main driver of the HIV epidemic in sub-Saharan Africa, we designed this study to examine the association between wealth and sexual behaviour in Cameroon. METHODS: We analysed data from 4409 sexually active men aged 15–59 years who participated in the Cameroon DHS using logistic regression models, and have reported odds ratios (OR) with confidence intervals (CI). RESULTS: When we controlled for the potential confounding effects of marital status, place of residence, religion and age, men in the richest third of the population were less likely to have used a condom in the last sex with a non-spousal non-cohabiting partner (OR 0.43, 95% CI 0.32–0.56) and more likely to have had at least two concurrent sex partners in the last 12 months (OR 1.38, 95% CI 1.12–1.19) and more than five lifetime sex partners (OR 1.97, 95% CI 1.60–2.43). However, there was no difference between the richest and poorest men in the purchase of sexual services. Regarding education, men with secondary or higher education were less likely to have used a condom in the last sex with a non-spousal non-cohabiting partner (OR 0.24, 95% CI 0.16–0.38) and more likely to have started sexual activity at age 17 years or less (OR 2.73, 95% CI 2.10–3.56) and had more than five lifetime sexual partners (OR 2.59, 95% CI 2.02–3.31). There was no significant association between education and multiple concurrent sexual partnerships in the last 12 months or purchase of sexual services. CONCLUSION: Wealthy men in Cameroon are more likely to start sexual activity early and have both multiple concurrent and lifetime sex partners, and are less likely to (consistently) use a condom in sex with a non-spousal non-cohabiting partner. These unsafe sexual behaviours may explain the higher HIV prevalence among wealthier men in the country. While these findings do not suggest a redirection of HIV prevention efforts from the poor to the wealthy, they do call for efforts to ensure that HIV prevention messages get across all strata of society

The role of cow urine in the oviposition site preference of culicine and Anopheles mosquitoes

<p>Abstract</p> <p>Background</p> <p>Chemical and behavioural ecology of mosquitoes plays an important role in the development of chemical cue based vector control. To date, studies available have focused on evaluating mosquito attractants and repellents of synthetic and human origins. This study, however, was aimed at seasonal evaluation of the efficiency of cow urine in producing oviposition cues to <it>Anopheles gambiae </it>s.l. and <it>Culex quinquefasciatus </it>in both laboratory and field conditions.</p> <p>Methods</p> <p>Oviposition response evaluation in laboratory conditions was carried out in mosquito rearing cages. The oviposition substrates were located in parallel or in diagonal positions inside the cage. Urine evaluation against gravid females of <it>An. arabiensis </it>and <it>Cx. quinquefasciatus </it>was carried out at Day 1, Day 3 and Day 7. Five millilitres (mls) of cow urine was added to oviposition substrate while de-chlorinated water was used as a control. In field experiments, 500 mls of cow urine was added in artificial habitats with 2500 mls of de-chlorinated water and 2 kgs of soil. The experiment was monitored for thirty consecutive days, eggs were collected daily from the habitats at 7.00 hrs. Data analysis was performed using parametric and non-parametric tests for treatments and controls while attraction of the oviposition substrate in each species was presented using Oviposition Activity Index (OAI).</p> <p>Results</p> <p>The OAI was positive with ageing of cattle urine in culicine species in both laboratory and field experiments. The OAI for anopheline species was positive with fresh urine. The OAI during the rainy season was positive for all species tested while in the dry season the OAI for culicine spp and <it>Anopheles gambiae </it>s.l., changed with time from positive to negative values.</p> <p>Based on linear model analysis, seasons and treatments had a significant effect on the number of eggs laid in habitats, even though the number of days had no effect.</p> <p>Conclusion</p> <p>Oviposition substrates treated with cow urine in both laboratory and field conditions have shown that cow urine left to age from 1-7 days has an influence on oviposition behavioural response in mosquitoes. The analysis of microbial colonies for decaying urine should be investigated along with its associated by-products.</p