The pattern of mucocutaneous disorders in HIV – infected children attending care and treatment centres in Dar es Salaam, Tanzania

\ud \ud HIV/AIDS is associated with a wide range of mucocutaneous disorders some of which are useful in the clinical staging and prognosis of the syndrome. There is paucity of information regarding the prevalence and pattern of mucocutaneous disorders among HIV infected children attending paediatric Care and Treatment Centres (CTC) in Dar es Salaam. To determine the prevalence and pattern of mucocutaneous disorders among HIV infected children attending public paediatric 'Care and Treatment Centres' in Dar es Salaam. This was a cross sectional descriptive study involving public paediatric 'Care and Treatment Centres' in Dar es Salaam. Clinical information was obtained using a questionnaire. Dermatological examination was carried out in daylight. Investigations were taken as appropriate. Data was analysed using the Statistical Package for Social Sciences (SPSS) program version 10.0. Chi-squared and Fisher's exact tests were utilized. A p-value of less than 0.05 was considered statistically significant. Three hundred and forty seven HIV infected children (52% males) attending CTCs were recruited into the study. Mucocutaneous disorders were encountered in 85% of them. There was no gender difference in the prevalence of the infective mucocutaneous disorders but males had a higher prevalence of non-infective/inflammatory dermatoses (58%) than females (42%) (p = 0.02). Overall, mucocutaneous disorders (infective + non infective) were more prevalent in advanced stages of HIV disease. Children with advanced HIV disease had a significantly increased frequency of fungal and viral infections (43% and 25% respectively than those with less advanced disease; 24% and 13% respectively (p = 0.01). Seventy four percent of the HIV-infected children with mucocutaneous disorders were already on ART. Mucocutaneous disorders among HIV infected children attending Care and Treatment Centres are common and highly variable. Comprehensive management should also emphasize on the management of mucocutaneous disorders

Strategies for Diagnosis and Treatment of Suspected Leptospirosis: A Cost-Benefit Analysis

Symptoms and signs of leptospirosis are non-specific. A number of diagnostic tests for leptospirosis are available. We compared the cost-benefit of 5 management strategies: 1) no patients tested or given antibiotic treatment; 2) all patients given empirical doxycycline treatment; patients given doxycycline when a patient is tested positive for leptospirosis using: 3) lateral flow; 4) MCAT; 5) latex test. Outcomes were measured in duration of fever which is then converted to productivity losses to capture the full economic costs. Empirical doxycycline treatment was found to be the most efficient strategy, being both the least costly alternative and the one that resulted in the lowest average duration of fever. The significantly higher relative cost of using a diagnostic test as compared with presumptive treatment, and the limited sensitivity of all the diagnostic tests implied that only the latex test could be considered cost-effective when compared with the no-antibiotic-treatment option, and that all three tests were still inferior to empirical treatment

Development and psychometric testing of an instrument to compare career choice influences and perceptions of nursing among healthcare students

Background: With the availability of more healthcare courses and an increased intake of nursing students, education institutions are facing challenges to attract school leavers to enter nursing courses. The comparison of career choice influences and perception of nursing among healthcare students can provide information for recruitment strategies. An instrument to compare the influences of healthcare career choice is lacking. The purpose of this study is to develop and evaluate the psychometric properties of an instrument to compare the influences of healthcare career choice with perceptions of nursing as a career choice. Methods: The study was conducted in two phases. In phase one, two sets of scales with parallel items that measure the influences of healthcare career choice and perceptions of nursing as a career choice were developed through an earlier qualitative study, literature review, and expert validation. Phase two involved testing the construct validity, concurrent validity and reliability with a convenience sample of 283 first year healthcare students who were recruited at two education institutions in Singapore. Results: An exploratory factor analysis revealed 35-parallel items in a six-factor solution (personal interest, prior healthcare exposure, self-efficacy, perceived nature of work, job prospects, and social influences) that explained 59 and 64% of the variance for healthcare career choice and nursing as a career choice respectively. A high correlation (r = 0.76, p \u3c 0.001) was obtained with an existing tool, confirming the concurrent validity. The internal consistency was sufficient with Cronbach’s alpha of 0.93 for healthcare career choice and 0.94 for nursing as a career choice. The test-retest reliability was acceptable with an Intraclass Correlation Coefficient of 0.63 for healthcare career choice and 0.60 for nursing as a career choice. Conclusions: The instrument provides opportunities for understanding the differences between influences of healthcare career choice and perceptions of nursing as a career choice. This comparative understanding of career choice influences can guide educator and policy-makers on nursing recruitmen

Apparent ileal digestibility of amino acids in dietary ingredients for broiler chickens

The apparent ileal digestibility coefficients of amino acids in 107 samples representing 22 food ingredients were determined using 6-week-old broiler chickens. The ingredients assayed included five cereals ( barley, maize, sorghum, triticale and wheat), two cereal by-products ( rice polishings and wheat middlings), four oilseed meals ( canola, cottonseed, soyabean and sunflower meals), full-fat canola, maize gluten meal, four grain legumes ( chickpeas, faba beans,field peas and lupins) and five animal protein sources ( blood, feather,fish, meat and meat and bone meals). The mean ileal digestibility coefficients of amino acids in wheat and maize were higher than those in sorghum, triticale and barley. However, variations observed in individual amino acid digestibilities among samples within cereal type were greater than those determined between cereals. Threonine and lysine were the least digestible indispensable amino acids in the five cereals evaluated. The most digestible indispensable amino acid was phenylalanine in wheat and, leucine in maize and sorghum. In the case of the wheat middlings and rice polishings, threonine was the least digestible indispensable amino acid and arginine was the best digested. In the oilseed meals assayed, amino acid digestibility was highest for soya-bean and sunflower meals, intermediate for canola meal and lowest for cottonseed meal. Ileal digestibility coefficients of amino acids in lupins were found to be slightly lower than those in soya-bean meal. The amino acid digestibilities of field peas, faba beans and chickpeas were considerably lower than those of lupins. Digestibility of arginine was the highest and that of threonine was the lowest of the indispensable amino acids in oilseed meals and grain legumes, except in cottonseed meal. Lysine was the least digestible amino acid in cottonseed meal. In the animal protein sources assayed, digestibility coefficients of amino acids in blood meal were high, intermediate in fish meal, and low in meat meal, meat and bone meal and feather meal. Variation in amino acid digestibility coefficients determined for blood meal samples was small. However, wide variations in amino acid digestibilities were observed for other animal protein sources, highlighting significant batch-to-batch differences. In particular, marked variations were determined for meat meal and meat and bone meal samples. Cystine was the least digested amino acid in animal protein meals, with the exception of blood meal in which isoleucine had the lowest digestibility. The limitations of using apparent digestibility values in diet formulations and the concept of the standardized digestibility system to overcome these limitations are discussed