Impact of introducing human immunodeficiency virus testing, treatment and care in a tuberculosis clinic in rural Kenya

SETTING: In July 2005, Médecins Sans Frontières and the Ministry of Health, Kenya, implemented an integrated tuberculosis-human immunodeficiency virus (TB-HIV) programme in western Kenya. OBJECTIVE: To evaluate the impact of an integrated TB-HIV programme on patient care and TB programme outcomes. DESIGN: Retrospective evaluation of three time periods: before (January-June 2005), shortly after (January-June 2006) and medium term after (January-December 2007) the implementation of the integrated programme. RESULTS: Respectively 79% and 91% of TB patients were HIV tested shortly and at medium term after service integration. The HIV-positive rate varied from 96% before the intervention to respectively 88% (305/347) and 74% (301/405) after. The estimated number of HIV-positive cases was respectively 303, 323 and 331 in the three periods. The proportion of patients receiving cotrimoxazole prophylaxis increased significantly from 47% (142/303) to 94% (303/323) and 86% (285/331, P < 0.05). Before the intervention, 87% (171/197) of the TB-HIV patients would have been missed when initiating antiretroviral treatment, compared to respectively 29% (60/210) and 36% (78/215) after the integration. The TB programme success rate increased from 56% (230/409) to 71% (319/447) in the third period (P < 0.05); however, there was no significant decrease in the default rate: 20% to 22% (P = 0.66) and 18% (P = 0.37). CONCLUSION: Integrated TB-HIV care has a very positive impact on the management of TB-HIV patients and on TB treatment outcomes

Knowledge and attitude towards Buruli ulcer disease in Adjumani district, Northwestern Uganda

Background: Buruli ulcer is a devastating skin disease caused by Mycobacterium ulcerans. It produces a necrotissing toxin, which destroys the skin, subcutaneous tissue and bone, often leaving the patients with debilitating deformities. The mode of transmission of the disease is unclear, but water borne vectors may transmit M. ulcerans. Treatment is difficult and often involves extensive surgery, which is the current standard treatment, but it may result in scarring and subsequent physical limitations due to scar retraction. These physical limitations may result in psychosocial and economic problems. It was hypothesised that superstitious beliefs about the illness, and stigma were important determinants for health seeking behaviour. The consequences of the disease include social isolation and economic problems in family life.Objective: To explore the knowledge and attitude of the people affected by Buruli ulcer disease in Adjumani district, in northwestern Uganda.Design: A semi-structured questionnaire was administered to all the selected patients.Setting: Selected Health centres in Adjumani district, which included Adjumani hospital, Pakele HCIII, Dzaipi HCIII, Mungula HCIII and Opinjinji HCIII.Subjects: A total of Nineteen (19) clinically diagnosed patients with Buruli ulcer were consented and interviewed for this study.Results: A total of nineteen (19) patients were interviewed for this study. Of these, 10 (52.6%) were female and nine (47.4%) were male. Majority of the respondents were peasant farmers (N=9, 47.4%), mainly undertaking subsistence farming for home consumption. Most of the patients (N=16, 84.2%) had their lesions on either the upper or lower limbs. The majority (N=13, 68.4%) said they know the disease affecting them and only 6 (31.6%) patients did not know. Majority of patients 17 (89.5%) sought for medical and/or traditional therapy, while only two (10.5%) did not do anything about it. Of those who sought for help, nine (52.9%) opted for traditional herbal treatment, while 8 (47.1%) went for conventional medical treatment at a health unit. Most patients reported a wide range of stigma labeled against them, and these included; fear that they may infect others (N=2, 10.5%), fear that they have been bewitched or cursed (N=2, 10.5%), discrimination at school to the extent that he dropped out of school, and avoidance by others.Conclusion: This study has shown that patients with Buruli ulcer are still stigmatised as members of the community. It is important that educational programme on Buruli ulcer be developed which increases awareness of the disease and may also lower the level of stigma. These programme will also help in disease detection and hopefully improve the health seeking behaviour of patients

Effect Of Seasonal Rainfall And Other Environmental Changes, On Snail Density And Infection Rates With Schistosoma mansoni Fifteen Years After The Last Snails\' Study In Kigungu, Entebbe, Uganda

Background: The last study on snail population density in relation to rainfall pattern in Kigungu canoe landing and recreational sites on Lake Victoria shore was earlier carried out about fifteen years ago. This study also reviewed the influence of other environmental factors on the snails\' infection rate. Objective: To reassess the density dynamic of Biomphalaria (B) choanomphala and Biomphalaria (B) pfeifferi, which act as the intermediate host for S. mansoni and Bulinus (B) globosus, and Bulinus (B) tropicus, which act as intermediate host for S. haematobium. Design: Retrospective study. Setting: Busy canoe landing sites along Lake Victoria in Kigungu fishing village were selected for the snail sampling. Results: Nine thousand one hundred and ninety four B. choanomphala were collected over the study period. The numbers of B. choanomphala collected in each year was 4742 (51.6%) and 4452 (48.4%) in 2004 and 2005 respectively. Of the 4742 B.Choanomphala collected in 2004, 82 (1.7%) shed human cercariae and 329 (6.7%) shed non-human cercariae. Whereas in 2005, out of 4452 B. choanomphala collected 302 (6.85%) shed non-human cercariae and 82 (1.8%) shed human cercariae. Similarly, 4173 B. pfeifferi were also collected in the same period. Out of which 2224 (53.3%) were collected in 2004 and 1949 (46.7%) in 2005. For B. pfeifferi, 42 (1.9%) out of 2224 snails collected in 2004 shed human cercariae and 246 (11.1%) shed non-human cercariae. While in 2005, 33 out of 1949 snails (1.7%) shed human cercariae and 159 (8.2%) shed non-human cercariae. Other snails of medical importance collected included 292 B. globosus and 3094 B. tropicus. None of the Bulinus spp. collected shed any human cercariae but 37 (2.1%) and 30 (2.3%) B. tropicus shed non-human cercariae in 2004 and 2005 respectively. In 2004 and 2005, the area received, 1729mm and 1959mm of rainfall respectively. The mean rainfall during the year was 144.05 mm and 163.3 mm in 2004 and 2005 respectively. There was a negative correlation between rainfalls and snail density dynamic. Conclusion: We have found in this study that in spite of the bush clearing of the papyrus swamps which originally was the major habitats for B. choanomphala, B. pfeifferi and the Bulinus spp the intermediate host for schistosome at all canoe landing sites at Kigungu, these snails are still present. Moreover, that their population density dynamic and infection rate are inversely proportional to the rainfall pattern. East African Medical Journal Vol. 85 (11) 2008: pp. 556-56

Identification of simple sequence repeat markers for sweetpotato weevil resistance

The development of sweetpotato [Ipomoea batatas (L.) Lam] germplasm with resistance to sweetpotato weevil (SPW) requires an understanding of the biochemical and genetic mechanisms of resistance to optimize crop resistance. The African sweetpotato landrace, ‘New Kawogo’, was reported to be moderately resistant to two species of SPW, Cylas puncticollis and Cylas brunneus. Resistance has been associated with the presence of hydroxycinnamic acids esters (HCAs), but the underlying genetic basis remains unknown. To determine the genetic basis of this resistance, a bi-parental sweetpotato population from a cross between the moderately resistant, white-fleshed ‘New Kawogo’ and the highly susceptible, orange-fleshed North American variety ‘Beauregard’ was evaluated for SPW resistance and genotyped with simple sequence repeat (SSR) markers to identify weevil resistance loci. SPW resistance was measured on the basis of field storage root SPW damage severity and total HCA ester concentrations. Moderate broad sense heritability (H2 = 0.49) was observed for weevil resistance in the population. Mean genotype SPW severity scores ranged from 1.0 to 9.0 and 25 progeny exhibited transgressive segregation for SPW resistance. Mean genotype total HCA ester concentrations were significantly different (P < 0.0001). A weak but significant correlation (r = 0.103, P = 0.015) was observed between total HCA ester concentration and SPW severity. A total of five and seven SSR markers were associated with field SPW severity and total HCA ester concentration, respectively. Markers IBS11, IbE5 and IbJ544b showed significant association with both field and HCA-based resistance, representing potential markers for the development of SPW resistant sweetpotato cultivars

Vaccination against Bm86 Homologues in Rabbits Does Not Impair Ixodes ricinus Feeding or Oviposition

Human tick-borne diseases that are transmitted by Ixodes ricinus, such as Lyme borreliosis and tick borne encephalitis, are on the rise in Europe. Diminishing I. ricinus populations in nature can reduce tick exposure to humans, and one way to do so is by developing an anti-vector vaccine against tick antigens. Currently, there is only one anti-vector vaccine available against ticks, which is a veterinary vaccine based on the tick antigen Bm86 in the gut of Rhipicephalus microplus. Bm86 vaccine formulations cause a reduction in the number of Rhipicephalus microplus ticks that successfully feed, i.e. lower engorgement weights and a decrease in the number of oviposited eggs. Furthermore, Bm86 vaccines reduce transmission of bovine Babesia spp. Previously two conserved Bm86 homologues in I. ricinus ticks, designated as Ir86-1 and Ir86-2, were described. Here we investigated the effect of a vaccine against recombinant Ir86-1, Ir86-2 or a combination of both on Ixodes ricinus feeding. Recombinant Ixodes ricinus Bm86 homologues were expressed in a Drosophila expression system and rabbits were immunized with rIr86-1, rIr86-2, a combination of both or ovalbumin as a control. Each animal was infested with 50 female adults and 50 male adults Ixodes ricinus and tick mortality, engorgement weights and egg mass were analyzed. Although serum IgG titers against rIr86 proteins were elicited, no effect was found on tick feeding between the rIr86 vaccinated animals and ovalbumin vaccinated animals. We conclude that vaccination against Bm86 homologues in Ixodes ricinus is not an effective approach to control Ixodes ricinus populations, despite the clear effects of Bm86 vaccination against Rhipicephalus microplus

Schistosoma mansoni infection and the associated antibody immune response amongst residents of Kigungu Entebbe, Uganda

Background: There are many foci endemic for Schistosoma (S.) mansoni in Uganda. The immune responses to infection with the parasites in these areas have been found to vary with host sex, age and infection intensity.Objective: To determine the profile of antibody isotypes responses against S. mansoni crude soluble egg antigens (SEA) and soluble adult worm protein (SWAP) antigens that determine the host resistance or susceptibility to reinfection.Design: Cross Sectional, cohort study.Setting: Kigugu fishing village in Entebbe, Uganda.Subjects: Nine hundred and forty five (945) Kigungu residents reported for pre-treatment screening and enrolment and 626 cohorts report for post-treatment screening and enrolment 18 months later.Results: Pearson’s Chi-sq2 showed that increase in titres of anti (SWAP IgE, SEA IgE, and SEA IgG2) was not significant, but increase in anti SEA IgG3 was significant. Decrease in titres of anti (SWAP IgG1, SEA IgG1, and SEA IgG4) was not significant but decrease of anti (SWAP IgG2, SWAP IgG3 and SWAP IgG4) was significant. Positive correlation existed between age and anti SWAP IgE in before and after treatment sera. On the contrary, age was positively correlated with anti SWAP IgG4 in pre-treatment sera but was negatively correlated with anti SWAP IgG4 in the post-treatment sera. In addition there were positive correlation between higher egg counts and the immunoglobulin levels of anti SWAP IgG4 and anti SEA IgG4 but negative correlations were observed between anti SWAP IgE and anti SEA IgE. Conversely low egg counts were associated with high levels of anti SWAP IgE. Furthermore, IgG1-4, IgE antibody to SEA and SWAP antigens did not differ significantly according to sex.Conclusion: We concluded that praziquantel treatment of S. mansoni infected persons alter the immune responses that are influenced by age and intensity. A phenomenon that is useful in the effort to produce vaccine against schistosome

Evidence of Long Term Benefit of Praziquantel Treatment Against Schistosoma mansoni in Kigungu Fishing Village of Entebbe, Uganda

Praziquantel (PZQ) is efficacious against all species of schistosome: Schistosoma mansoni; Schistosoma haematobium; Schistosoma japonicum and other parasites like the Taenia species. This cross-sectional cohorts study was carried out in Kigungu fishing village along Lake Victoria shore in Entebbe Uganda. Our analysis was based on examining microscopically three slides from a single stool specimen from each of base line cohorts 945.These included children and adults, participants from both sexes in Kigungu fishing village in Entebbe Uganda. Nine hundred and one (901) of the cohorts were re-examined after six months and 625 of the same cohorts who were examined at the baseline and after six months were re-examined 18 months later. The slides were prepared using modified Kato/Katz (Odongo-Aginya) method. The infection proportion with Schistosoma mansoni at baseline was 448 (47.5%) but this was reduced to 244 (25.8%) 18 months after treatment with a single oral dose of praziquantel at 40mg/kg. However 495 (52.5%) were negative at the baseline study. The cure proportion after six was significant {(P=0.00), (OR4.63) CI at 95% (3.53-6.06)}. Similarly the cure proportion after 18 months was significant {(P=0.00), (OR2.2) CI at 95% (1.87-3.34)}. The force of re-infection after six months was significant {(P=0.0001), (OR 0.47) CI at 95% (0.31-0.71)}. Nevertheless the force of re-infection was not significant after 18 months {(P=0.766), (OR 0.95) CI at 95% (0.68-1.34)} eggs excretion did not reach the level of the pre-treatment intensity. The egg reduction was 69.3%. This was associated with age and pre-treatment intensity &lt; 400 eggs per gram (epg) of faeces and age groups &ge; 30 years. The egg reduction also resulted in marked decrease in clinical symptoms in the participants. Our study suggests evidence of long-term benefit of praziquantel in Kigungu and that the re-infection occurred more commonly in younger age group than in the older patients.Key words: Praziquantel; Schistosoma mansoni; Kigungu; Entebbe; Uganda

Propagation from meteorological to hydrological drought in the Horn of Africa using both standardized and threshold-based indices

There have been numerous drought propagation studies in data-rich countries, but not much has been done for data-poor regions (such as the Horn of Africa, HOA). In this study, we characterize meteorological, soil moisture and hydrological drought and the propagation from one to the other for 318 catchments in the HOA to improve understanding of the spatial variability in the drought hazard. We calculate the standardized precipitation index (SPI), standardized soil moisture index (SSMI) and standardized streamflow index (SSI). In addition, we use the variable threshold method to calculate the duration of drought below a predefined percentile threshold for precipitation, soil moisture and discharge. The relationship between meteorological and soil moisture drought is investigated by finding the SPI accumulation period that has the highest correlation between SPI and SSMI, and the relationship between meteorological and hydrological drought is analysed by the SPI accumulation period that has the highest correlation between SPI and SSI time series. Additionally, we calculated these relationships with the ratio between the threshold-based meteorological-drought duration and soil moisture drought duration and the relation between threshold-based meteorological-drought duration and streamflow drought duration. Finally, we investigate the influence of climate and catchment characteristics on these propagation metrics. The results show that (1) the propagation from SPI to SSMI and the mean drought duration ratio of meteorological to soil moisture drought (P / SM) are mainly influenced by soil properties and vegetation, with the short accumulation periods (1 to 4 months) of SPI in catchments with arable land, high mean annual precipitation, and low sand and silt content, while longer accumulations (5 to 7 months) are in catchments with low mean annual upstream precipitation and shrub vegetation; (2) the propagation from SPI to SSI and precipitation-to-streamflow duration ratio are highly influenced by the climate and catchment control, i.e. geology, elevation and land cover, with the short accumulation times in catchments with high annual precipitation, volcanic permeable geology and cropland and the longer accumulations in catchments with low annual precipitation, sedimentary rocks and shrubland; and (3) the influence of mean annual upstream precipitation is more important for the propagation from SPI to SSI than from SPI to SSMI. Additionally, precipitation accumulation periods of approximately 1 to 4 months in wet western areas of the HOA and of approximately 5 to 7 months in the dryland regions are found. This can guide forecasting and management efforts as different drought metrics are thus of importance in different regions.</p

Knowledge, attitudes and practices of prevention of mother to child transmision of HIV among women in Laroo Division Gulu Municipality, Uganda

This study is exploring the knowledge, attitudes and practices of Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) among child bearing women aged between 15- 45 years old in Laroo division in Gulu municipality. The goal of the study was to determine the level of attitude as well as of knowledge and belief about PMTCT and proportion of women practicing it among the child bearing women of Laroo Division. The Cross-sectional and Descriptive study design was applied in multistage sampling method with random selection of a parish followed by random selection of a village within the parish from which a sample of homesteads was randomly selected. From each homesteads, a single respondent was randomly selected and registered in the study. Questionnaires were given to respondents that had consented to take part in the study. A total of 208 respondents were registered and interviewed in a period of February to march 2011. There were 165 (79.3%) of the mothers who had knowledge about various PMTCT methods. Of these 86(52%) heard about PMTCT first from hospital. 50 (30%) knew about exclusive breast feeding, while another 50(30%) use of ART, 45(27%) knew about replacement feedings and only 21(13%) knew of elective caesarean section as method of PMTCT. However the majority of the mothers 159(96.5%) thought that PMTCT was beneficial. Nevertheless some mothers thought that PMTCT causes various counter indications including infertility 17 (10.5%) and abnormalities in children at birth 27 (16.7). Their HIV serostatus also varied. Of the 135(81.7%) screened for HIV 42(31.2%) tested HIV positive and only 27 (64.2%) used contraceptives to prevent pregnancy while they were HIV positive. However of the correspondents who tested positive in their last HIV tests, the majority (83%) had had at least a pregnancy after testing HIV positive of which 6.8% did not practice PMTCT. Our study suggests evidence that Knowledge, attitude and practice of PMTCT among women of reproductive age in Laroo Division in Gulu municipality in Northern Uganda is adequate.Nevertheless with the infection rate of 31.2% among them points out that there is a substantial burden of HIV in the women community