Where There Is No Health Research: What Can Be Done to Fill the Global Gaps in Health Research?

As part of a cluster of articles leading up to the 2012 World Health Report and critically reflecting on the theme of “no health without research," Martin McKee and colleagues examine the question of what to do to build capacity in the many countries around the world where health research is virtually non-existent

Geographical imagination and technological connectivity in East Africa

The paper analyses and compares two transformative moments of technologically-mediated change in East Africa, the construction of the Uganda railway between Mombasa and Lake Victoria (1896-1903) and the introduction of fibre-optic cables that landed into the ports of Dar Es Salaam and Mombasa in 2009. It uses discourse analysis to examine how technologically-mediated connectivity has been represented by political and economic actors during these transformative moments. In both cases, we explore the origins of the expectations of connectivity and the hope and fear associated with them. Building on Massey’s notion of power-geometry and Sheppard’s concept of positionality the paper focuses on power relationships in discussions of connectivity and asks how people understand the abilities of transformative technologies to modify positionalities and alter relational distance and proximity. Ultimately, by examining historical and contemporary expectations of connectivity in East Africa, this paper allows us to work towards creating more grounded and historicised understandings of the coming-together of technology and connectivity

Ethnic and mouse strain differences in central corneal thickness and association with pigmentation phenotype

The cornea is a transparent structure that permits the refraction of light into the eye. Evidence from a range of studies indicates that central corneal thickness (CCT) is strongly genetically determined. Support for a genetic component comes from data showing significant variation in CCT between different human ethnic groups. Interestingly, these studies also appear to show that skin pigmentation may influence CCT. To validate these observations, we undertook the first analysis of CCT in an oculocutaneous albinism (OCA) and Ugandan cohort, populations with distinct skin pigmentation phenotypes. There was a significant difference in the mean CCT of the OCA, Ugandan and Australian-Caucasian cohorts (Ugandan: 517.3±37 µm; Caucasian: 539.7±32.8 µm, OCA: 563.3±37.2 µm; p<0.001). A meta-analysis of 53 studies investigating the CCT of different ethnic groups was then performed and demonstrated that darker skin pigmentation is associated with a thinner CCT (p<0.001). To further verify these observations, we measured CCT in 13 different inbred mouse strains and found a significant difference between the albino and pigmented strains (p = 0.008). Specific mutations within the melanin synthesis pathway were then investigated in mice for an association with CCT. Significant differences between mutant and wild type strains were seen with the nonagouti (p<0.001), myosin VA (p<0.001), tyrosinase (p = 0.025) and tyrosinase related protein (p = 0.001) genes. These findings provide support for our hypothesis that pigmentation is associated with CCT and identifies pigment-related genes as candidates for developmental determination of a non-pigmented structure.David P. Dimasi, Alex W. Hewitt, Kenneth Kagame, Sam Ruvama, Ludovica Tindyebwa, Bastien Llamas, Kirsty A. Kirk, Paul Mitchell, Kathryn P. Burdon and Jamie E. Crai

Quality Of Blood Pressure Control In Hypertensive Patients Attending The Kigali University Teaching Hospital, Rwanda

Background: Kigali university teaching hospital (KUTH) is one of the referral hospitals that receive patients from all over the country. Hypertension is among others; an important risk factor for the development of cardiovascular diseases and a significant public health problem. We investigated the proportion of treated hypertensive patients with uncontrolled blood pressure. Objective: To determine the adequacy of blood pressure (BP) control in hypertensive patients and to investigate the burden of other cardiovascular risk factors and related cardiovascular diseases. Methods: From 1st July 2009 to 31st March 2010, 150 patients - after their informed consent to participate in the study - were included in our cross-sectional and descriptive study. We collected data on socio-demographic features, weight and height, cardiovascular risk factors and cardiovascular diseases. We also investigated the patients’ awareness of the disease and their compliance to treatment. Blood pressure values were recorded, as well as the duration of hypertension; the number of antihypertensive drugs used, and the compliance to treatment. Based on the guidelines of the European Society of Hypertension and the JNC-7, BP were considered controlled at a level below 140/90 mm Hg, and in diabetics if the systolic BP 5(sBP) <130 mmHg and the diastolic BP (dBP) <80 mmHg. Data were analyzed using SPSS 11.0, Pearson Chi-Square test, and the Fisher’s exact test. The statistical significant difference was considered at p < 0.05. Odds Ratio with 95 % CI. Results: 150 patients with Hypertension were enrolled, including 56% women and 44% men; sex-ratio (F/M) =1.27:1, with a mean age of 52.75± 6.08 years. Among the total cohort, 28% of patients (42) were diabetic, 15.3% had an elevated total cholesterol, and 24% were smokers or used to smoke in the past. Obesity (BMI≥30) was recorded in 22.7% of our sample and the mean BMI was 26.24±1.8. The duration of the disease is beyond 5 years for only 34% of our patients, the mean duration is 8.5±0.7. The mean number of drugs used was 1.84±0.7. Only 21.3% of our patients had a well controlled BP (<140/90 mm Hg and 130/80 for diabetics). Left ventricular hypertrophy on an Electrocardiogram (EKG-LVH) was present in 36% of the patients. Chronic renal failure was documented in 18%, but the proportion of patients with positive albuminuria was higher: 50 patients (33.3%), and 26 out of 50 were diabetic: p=0.000. The clinical diagnosis of stroke was made in 23 patients (15.3%). Almost a half of our patients (48%) had enough information about the arterial hypertension, its consequences and the need of a long term treatment; however, only 35.3% try to comply with both the pharmacological treatment and lifestyle modifications. Independent predictors of poor control were diabetes (aOR=3.367 ; 95% CI ; 1.103-10.287), smoking (aOR=6.145; 1.390-27.154), and poor compliance to treatment (OR=0.066; 0.025-0.177) Conclusion: We have a high rate of patients with poor BP control. Independent predictors of poor BP control were diabetes, smoking and poor compliance to treatment.The majority of our patients is not aware of their condition and they are not properly compliant to treatment. Target organ damages (cardiovascular diseases) though not prominent, are considerably present especially ECG-LVH and albuminuria.Préambule: le centre hospitalier universitaire de Kigali (CHUK) est l’un des hôpitaux de référence qui reçoivent des patients venant de partout dans le pays. L’hypertension artérielle est, entre autres, un facteur de risque important des maladies cardiovasculaires et un problème de santé publique. Nous avons étudié la proportion de patients hypertendus sous traitement ayant une tension artérielle non contrôlée. Objectif: Déterminer la qualité de contrôle de la tension artérielle chez les patients hypertendus et d’étudier l’importance des facteurs de risque ainsi que des maladies cardiovasculaires survenues. Méthodes: A partir du 1er Juillet 2009 au 31 Mars 2010, 150 patients, après un consentement éclairé à participer à l’étude, ont été inclus dans notre étude transversale et descriptive. Nous avons recueilli des données sur les caractéristiques sociodémographiques, le poids et la taille, des facteurs de risque cardio-vasculaires et les maladies cardiovasculaires. Nous avons également étudié la connaissance des patients sur la maladie et leur adhérence au traitement. Les valeurs de la tension artérielle ont été enregistrées, plus les données concernant la durée de l’Hypertension, le nombre de médicaments antihypertenseurs utilisés, et l’observance au traitement. Selon les recommandations de la Société européenne d’hypertension et la JNC-7, la tension artérielle était considérée comme contrôlée si <140/90 mm Hg, et chez les diabétiques ayant une tension artérielle systolique <130 mmHg et une tension artérielle diastolique <80 mmHg. Les données ont été analysées en utilisant le SPSS 11.0, les tests de Pearson Chi-carré, et le Fisher exact test. Les différences étaient considérées comme Statistiquement significatives si la valeur p <0,05. Odds Ratio avec IC à 95% Résultats: 150 patients hypertendus ont été inclus, dont 56% de femmes et 44% d’hommes; le sex-ratio (F / M) étant 1.27:1, avec un âge moyen de 52,75 ± 6,08 ans. Dans la cohorte, 28% des patients (42) étaient diabétiques, 15,3% avaient un taux de cholestérol total élevé, et 24% étaient des fumeurs. L’obésité (IMC ≥ 30) a été constatée dans 22,7% de notre échantillon et l’IMC moyen était 26,24 ± 1.8. La durée de la maladie est au-delà de 5 ans pour seulement 34% de nos patients, et la durée moyenne est de 8,5ans ± 0,7. Le nombre moyen de médicaments utilisés était de 1,84 ± 0,7. Seuls 21,3% de nos patients étaient bien contrôlés (<140/90 mm Hg et 130/80 pour les diabétiques). L’ECG-HVG était présente dans 36% des patients. L’insuffisance rénale chronique a été documentée chez 18%, mais la proportion de patients avec une albuminurie positive était plus élevée: 50 patients (33,3%), et 26 sur les 50 étaient diabétiques: p = 0,000. Le diagnostic clinique d’accident vasculaire cérébral a été fait chez 23 patients (15,3%). Près de la moitié de nos patients (48%) ont suffisamment d’informations sur l’hypertension artérielle, ses conséquences et la nécessité d’un traitement à long terme; mais seulement 35,3% d’entre eux essaient de se conformer à la fois au traitement pharmacologique et au changement de mode de vie. Les prédicteurs indépendants du non-contrôle de l’hypertension artérielle étaient le diabète [aOR= 3,367]; l’intervalle de confiance à 95%, de 1.103 à 10.287), le tabagisme (OR = 6,145; 1.390 à 27.154), et une mauvaise observance au traitement (OR = 0,066; 0.025 à 0.177) Conclusion: Nous avons un taux élevé de patients dont la tension artérielle n’est pas contrôlée. Les causes principales de ce mauvais contrôle ont été le diabète, le tabagisme et la mauvaise observance au traitement. La majorité de nos patients n’a pas assez de connaissances sur leur maladie et ils ne prennent pas correctement leur traitement. Les marqueurs des maladies cardio-vasculaires sont quand même présents surtout l’ECG-HVG et l’albuminurie

Tests for an early detection of pulmonary cryptococcosis by sputum culture36653

Cryptococcosis is a serious opportunistic infection occurring in acquired immunodeficiency syndrome (AIDS) patients. As the number of infected patients with the human immunodeficiency virus (HIV) in Central Africa and especially in Rwanda increases, the prevalence of cryptococcosis can also be expected to rise. An earlier diagnosis and treatment will improve the prognosis of cryptococcosis. As it is widely accepted that the lungs are the portal of entry for the yeast, 270 sputum samples coming from 230 patients attending the Centre Hospitalier de Kigali (CHK)--Rwanda for lung diseases, were investigated. Cr. neoformans var neoformans was cultured from 8 samples coming from 5 out of 230 patients. A retrospective review showed that 4 out of 5 patients were infected with HIV, a predisposing factor for cryptococcosis</p

Pulmonary-disease Associated With the Human-immunodeficiency-virus in Kigali, Rwanda - a Fiberoptic Bronchoscopic Study of 111 Cases of Undetermined Etiology

All human immunodeficiency virus type 1 (HIV-1) infected adult patients referred to the Division of Pulmonary Diseases of the Centre Hospitalier de Kigali, Rwanda for evaluation of a pulmonary disease of undetermined etiology (PDUE) were investigated by fiberoptic bronchoscopy using both bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB). During a 10-mo period 111 HIV-1 infected patients with PDUE were examined, of whom 47 (42%) fulfilled the World Health Organization (WHO) clinical case definition for acquired immunodeficiency syndrome (AIDS) and seven (6%) had an AIDS-defining illness. Nonspecific interstitial pneumonitis was diagnosed in 42 (38%) patients, tuberculosis in 25 (23%), cryptococcosis in 14 (13%), Kaposi's sarcoma (KS) in 10 (9%), Pneumocystis carinii pneumonia (PCP) in five (5%). The diagnosis remained undetermined in 18 (16%) patients. Chest radiograph patterns were generally nonspecific. TBB and BAL had diagnostic yields of 82 and 26% of all final diagnoses, respectively. Out study on Rwandese HIV-l-infected patients with PDUE provides evidence for a large spectrum of pulmonary diseases with relative frequencies differing strikingly from those in developed countries. Detailed investigations confirm the rarity of POP in Africa and highlight nonspecific interstitial pneumonitis as the predominant diagnosis of PDUE. Empiric antituberculosis treatment is justified in the absence of clinical manifestations suggestive of a specific diagnosis and while awaiting the results of the diagnostic procedures. Primary prophylaxis for PCP would not be appropriate in Africa