Ergonomics in the computer workstation

Background: Awareness of effects of long term use of computer and application of ergonomics in the computer workstation is important for preventing musculoskeletal disorders, eyestrain and psychosocial effects. Objectives: To determine the awareness of ºphysical and psychological effects of prolonged computer usage and application of ergonomics in the workstation. Design: One hundred and eighty one people were interviewed from tertiary educational institutions, telecommunications and media houses within Nairobi, Kenya. Subjects: Descriptive cross sectional study. Results: Majority (89.8%) of the respondents felt that prolonged computer use had an adverse effect on their health, with only 12.4% having received formal training on the same. Assessment of their workstations revealed the most applied ergonomic measure as feet placement on the floor: 100% (181) followed by correct monitor placement with 94.4% (171) fulfilling the requirements. The least applied ergonomic measures were non reflecting wall paint: 5% (9) and adjustable desk 9.9% (18). Conclusion: There is awareness among computer users on the effects of prolonged computer use but there is limited application of ergonomic measures

Enhanced prophylaxis with antiretroviral therapy for advanced HIV in Africa

Background: In sub-Saharan Africa, severely immunocompromised HIV-infected individuals have high mortality (10%) from infections shortly after starting antiretroviral therapy (ART). Methods: The REALITY factorial open-label trial (ISRCTN43622374) randomized Ugandan/Zimbabwean/Malawian/Kenyan ART-naïve HIV-infected adults and children ≥5 years with CD4&lt;100 cells/mm3 to ART with either enhanced-prophylaxis (continuous co-trimoxazole plus ≥12-weeks isoniazid/pyridoxine (co-formulated scored fixed-dose-combination tablet), 12-weeks fluconazole, 5-days azithromycin, single-dose albendazole), or standard-of-care co-trimoxazole. Two other randomizations investigated 12-week adjunctive raltegravir and supplementary food. The primary endpoint was 24-week mortality. Results: 1733(96.0%) adults and 72(4.0%) children/adolescents (median 36 years; 961(53.2%) male) were randomized to enhanced-prophylaxis (n=906) or standard-prophylaxis (n=899) and followed for 48 weeks (56(3.1%) lost-to-follow-up). Median baseline CD4 count was 37 cells/mm3 (IQR 16-63) but 854(47.3%) were asymptomatic or mildly symptomatic (stage 1/2 using the WHO clinical disease staging). 80(8.9%) individuals on enhanced-prophylaxis versus 108(12.2%) on standard-prophylaxis died before 24 weeks (hazard ratio[HR]=0.73 (95% CI 0.55-0.98) p=0.03), and 98(11.0%) versus 127(14.4%) respectively died before 48 weeks (HR=0.76 (0.58-0.99) p=0.04, number-needed-to-treat=29), with no evidence of interaction with other randomizations (p&gt;0.7). Enhanced-prophylaxis significantly reduced cases of tuberculosis (p=0.02), cryptococcal disease (p=0.01), oral/oesophageal candidiasis (p=0.02), deaths of unknown cause (p=0.03), and new hospitalisations (p=0.03) but not presumed severe bacterial infections (p=0.32). Serious (p=0.08) and grade-4 (p=0.09) adverse events were marginally less common with enhanced-prophylaxis. Viral suppression (p=0.80) and ART adherence (p=0.31) were similar between groups. Conclusions: Enhanced infection prophylaxis at ART initiation reduced mortality among HIV-infected individuals with advanced immunosuppression, without compromising viral suppression or increasing toxicity. </p

“Waiting for DAAs”: A retrospective chart review of patients with untreated hepatitis C in Rwanda

BACKGROUND:Access to treatment for hepatitis C virus (HCV) in sub-Saharan Africa is extremely limited. With the advent of direct acting antivirals (DAAs), highly effective and easy-to-deliver oral regimens are now available on the global market. This study was conducted to understand the background and characteristics of a national cohort of patients with HCV infection enrolled in care and awaiting therapy with DAAs. METHODS AND FINDINGS:We conducted a retrospective chart review of all adult patients with confirmed HCV infection who were currently enrolled in care and treatment at the four existing hepatitis referral centers in Rwanda. Patient charts at these centers were reviewed, and routinely collected data were recorded and analyzed. Overall, 253 patients were identified; median age was 56 years (IQR: 43, 65), and 149 (58.9%) were female. Median viral load was 688,736 IU/ml and 96.7% were HCV genotype 4. As classified by FIB-4 score, 64.8% of the patients had moderate to severe fibrosis. Fibrosis stage was associated with age (OR 1.12, CI 1.09-1.17), but not with time since diagnosis, gender, treatment center, or type of insurance. There was a low frequency of documented co-morbid conditions, including hypertension, diabetes, HIV, and hepatitis B virus. CONCLUSIONS:Compared to an estimated 55,000 patients eligible for HCV treatment in Rwanda, this study identified only 253 patients currently diagnosed and engaged in care, highlighting an immense treatment gap in HCV, likely due to the lack of accessible and affordable screening, diagnostic, and treatment modalities. The patients that were enrolled in care had a disproportionately advanced fibrosis stage, possibly indicating late presentation to care or lack of treatment options. In the context of newly available and effective treatment options, this study supports the overall need to accelerate access to HCV screening, diagnostics, and care and treatment services in resource-limited settings in sub-Saharan Africa