"Slash and Clear", a Community-Based Vector Control Method to Reduce Onchocerciasis Transmission by Simulium sirbanum in Maridi, South Sudan: A Prospective Study

Background: High ongoing Onchocerca volvulus transmission was recently documented in Maridi County, South Sudan. To complement community-directed treatment with ivermectin (CDTI) as the main onchocerciasis control strategy, we initiated a community-based vector control method “slash and clear” at the Maridi dam, a Simulium damnosum s.l. breeding site, to reduce O. volvulus transmission. Methods: Simulium damnosum s.l. biting rates were collected before and during the twenty months following the “slash and clear” intervention using the human landing catches. Black flies were dissected to measure parity rates before and twelve months after the intervention. Larvae and pupae of S. damnosum s.l. were collected from the dam for morphological and chromosomal characterization to identify the cytospecies involved. Results: Biting rates of S. damnosum s.l. close to the Maridi dam spillway decreased by >90% post-“slash and clear” for more than six months. Twelve months after the “slash and clear” intervention, the reduction in biting rates was still at <50% (p = 0.0007). Parity rates reduced from 13% pre-“slash and clear” (November 2019) to 5.6% post-“slash and clear” (November 2020). Larvae collected from the dam were identified as Simulium sirbanum. Conclusion: The “slash and clear” method was found to be an effective and cheap community-based method to reduce black fly biting rates caused by S. sirbanum. When repeated at least annually together with a high CDTI coverage, this intervention has the potential to considerably accelerate onchocerciasis elimination

Gender differences in coerced patients with schizophrenia

European Commission (Quality of life and Management of Living Resources Programme, contract number QLG4-CT- 2002-01036), Czech Ministry of Education research grant MSM002160849, and research grants PRVOUK–P26/LF1/4 and PRVOUK–P03/LF1/

African herbal medicines in the treatment of HIV: Hypoxis and Sutherlandia. An overview of evidence and pharmacology

In Africa, herbal medicines are often used as primary treatment for HIV/AIDS and for HIV-related problems. In general, traditional medicines are not well researched, and are poorly regulated. We review the evidence and safety concerns related to the use of two specific African herbals, which are currently recommended by the Ministry of Health in South Africa and member states for use in HIV: African Potato and Sutherlandia. We review the pharmacology, toxicology and pharmacokinetics of these herbal medicines. Despite the popularity of their use and the support of Ministries of Health and NGOs in some African countries, no clinical trials of efficacy exist, and low-level evidence of harm identifies the potential for drug interactions with antiretroviral drugs. Efforts should be made by mainstream health professionals to provide validated information to traditional healers and patients on the judicious use of herbal remedies. This may reduce harm through failed expectations, pharmacologic adverse events including possible drug/herb interactions and unnecessary added therapeutic costs. Efforts should also be directed at evaluating the possible benefits of natural products in HIV/AIDS treatment

Epidemiology of neurodegenerative diseases in sub-Saharan Africa: a systematic review

BACKGROUND:Sub-Saharan African (SSA) countries are experiencing rapid transitions with increased life expectancy. As a result the burden of age-related conditions such as neurodegenerative diseases might be increasing. We conducted a systematic review of published studies on common neurodegenerative diseases, and HIV-related neurocognitive impairment in SSA, in order to identify research gaps and inform prevention and control solutions. METHODS: We searched MEDLINE via PubMed, 'Banque de Donnees de Sante Publique' and the database of the 'Institut d'Epidemiologie Neurologique et de Neurologie Tropicale' from inception to February 2013 for published original studies from SSA on neurodegenerative diseases and HIV-related neurocognitive impairment. Screening and data extraction were conducted by two investigators. Bibliographies and citations of eligible studies were investigated. RESULTS: In all 144 publications reporting on dementia (n=49 publications, mainly Alzheimer disease), Parkinsonism (PD, n=20), HIV-related neurocognitive impairment (n=47), Huntington disease (HD, n=19), amyotrophic lateral sclerosis (ALS, n=15), cerebellar degeneration (n=4) and Lewy body dementia (n=1). Of these studies, largely based on prevalent cases from retrospective data on urban populations, half originated from Nigeria and South Africa. The prevalence of dementia (Alzheimer disease) varied between <1% and 10.1% (0.7% and 5.6%) in population-based studies and from <1% to 47.8% in hospital-based studies. Incidence of dementia (Alzheimer disease) ranged from 8.7 to 21.8/1000/year (9.5 to 11.1), and major risk factors were advanced age and female sex. HIV-related neurocognitive impairment's prevalence (all from hospital-based studies) ranged from <1% to 80%. Population-based prevalence of PD and ALS varied from 10 to 235/100,000, and from 5 to 15/100,000 respectively while that for Huntington disease was 3.5/100,000. Equivalent figures for hospital based studies were the following: PD (0.41 to 7.2%), ALS (0.2 to 8.0/1000), and HD (0.2/100,000 to 46.0/100,000). CONCLUSIONS: The body of literature on neurodegenerative disorders in SSA is large with regard to dementia and HIV-related neurocognitive disorders but limited for other neurodegenerative disorders. Shortcomings include few population-based studies, heterogeneous diagnostic criteria and uneven representation of countries on the continent. There are important knowledge gaps that need urgent action, in order to prepare the sub-continent for the anticipated local surge in neurodegenerative diseases

Prevalence of major depression in deliberate self- harm individuals in Harare, Zimbabwe

Objective: To investigate the prevalence of major depression in deliberate self-harm individuals. Design. A cross sectional descriptive study. Setting. Three tertiary health care centres in Harare, Zimbabwe. Subjects: Three hundred and eighty seven deliberate self-harm consecutive subjects were recruited from July 1, 1997 to December 31, 1997 for this study. Diagnostic procedures included complete medical history, physical and neurological examinations. The DSM-IV criterion for major depression was used for the diagnostic purpose. Main outcome measures: The prevalence of major depression, number of attempts and recent life events, methods used, feeling in deliberate self-harm individuals. Results: The prevalence of major depression was 20.7% (n=80, 95% CI= 16.7-24.2) according to the DSM-IV criterion. Sixty-two percent (95% CI= 57.2-66.8) of the subjects with DSH were age

PREVALENCE OF HIV/AIDS AND PSYCHIATRIC DISORDERS AND THEIR RELATED RISK FACTORS AMONG ADULTS IN EPWORTH, ZIMBAMBWE

ABSTRACTObjectives: To examine the prevalence of HIV infection, neuropsychiatric disorders,psychiatric symptoms/signs, alcohol use/misuse, CD4 cell counts and risk factors in adultpatients.Design: Cross-sectional study.Setting: Epworth, which is about 15km on the southeastern part of Harare, Zimbabwe.Subjects: Two hundred subjects were included in the study out of which six wereexcluded beacause of HIV-1 indeterminate results.Materials and Methods: A convenience sample of 200 subjects recruited in a crosssectionalstudy in Epworth, Zimbabwe. Six subjects had indeterminate HIV-I antibodyresults and were excluded from the study. The remaining 194 subjects of whom 101(52.1%) knew about their sero-status and were consecutively recruited, whereas, 93(47.9%) did not know about their sero-status and were recruited by a systematic randomsampling method (1-in-3). They were then interviewed about neuropsychiatric disordersusing BPRS, MADRS, AUDIT and MINI Mental State Test, including the risk factorsrelated to HIV infection. After ELISA tests' results, the two groups were combinedand then categorised into HIV positive (n=115) and HlV negative (n=79) subjects.Main outcome measures: Prevalence, neuropsychiatric disorders, increased CD4 cellcounts and risk factors associated with HIV infection.Results: The findings were that the overall point prevalence of the HIV infection was59.3% (115/194). Comparative analyses between seropositive and seronegative HIV/AIDSsubjects showed: over two thirds (71.3%) of the HIV positive subjects suffered frompsychiatric disorders, more than those with HIV negative 44.3% (OR= 3.12, 95% Cl=1.64-5.95, P=0.0002), and subjects aged 35 years and less were mostly HIV seronegatives(n= 77.2%, OR= 2.34, 95% CI= 1.18-4.75, P=0.014). The overall prevalence of alcoholuse/misuse was 41(21.1%), with higher prevalence rate among HIV positive subjects,28 (24.3%) than those who were HIV negative, 13 (16.5%). The commonest psychiatricsymptoms/signs (P&lt;0.05) were emotional withdrawal, depressed mood, suspiciousness,apparent sadness, reduced sleep and suicidal thoughts (specially among women).Conclusion: There is very high point prevalence of HIV/AIDS and psychiatric disorders,including a moderate prevalence rate of alcohol use/misuse in this less affluentcommunity that warranted intervention

Pulmonary alveolar microlithiasis: review of Turkish reports.

Pulmonary alveolar microlithiasis is a rare disorder, only 173 cases having been reported worldwide. Fifty two cases from Turkey are reported, 49 of which have previously been described only in Turkish publications. The mean age of the patients was 27 (SD 12) years, 34 were male, and 10 were symptomless. In 40 of the 52 cases diagnosis was confirmed histopathologically. Nineteen cases were diagnosed in siblings. This high rate suggests that pulmonary alveolar microlithiasis is a familial disease, which, though rare, is for unknown reasons most common in Turkey

Alcolhol consumption in HIV-1 infected persons: a study of immunological markers, Harare, Zimbabwe

No Abstract. Central African Journal of Medicine Vol. 45 (11) 1999: pp. 303-30