Baseline prevalence and incidence and risk factors for new-onset drug induced hearing loss in adults receiving drug-resistant tuberculosis (DR-TB) treatment in Khayelitsha, South Africa

Includes bibliographical references.Treatment for drug-resistant tuberculosis (DR-TB) is longer and associated with more significant side-effects than drug susceptible TB. Second line injectable therapy using kanamycin, amikacin or capreomycin is associated with irreversible hearing loss. There is a scarcity of literature regarding the frequency of hearing loss as well as associated risk factors, particularly with long term use. This study aimed to determine the incidence and risk factors for hearing loss among patients receiving second line injectable drugs

Population decrease : through family planning

9TH Annual ethics conference. Theme : Bioethics medical, legal, environmental and cultural aspects in healthcare ethics at STRATHMORE UNIVERSITY, 25-26 OCTOBER 2012.9TH Annual ethics conference. Theme : Bioethics medical, legal, environmental and cultural aspects in healthcare ethics at STRATHMORE UNIVERSITY, 25-26 OCTOBER 2012

Determinants of Livelihood Outcome Differentials among Urban Youth in Nairobi, Kenya

Youth livelihood outcomes (YLO) are important factors in the development of sustainable community livelihoods in Kenya.  The purpose of the study was to determine the predictors of urban youth livelihood outcomes in Nairobi, Kenya. The study was guided by the General Systems Theory by Bertalanffy (1968) and the Department for International Development (DFID) livelihoods framework (1999). A survey of 206 youths was conducted in Kamukunji Sub-County in Nairobi County. Results showed that there was a significant relationship between individual attributes and youth livelihood outcomes (χ2= 44.47; d.f. =14; ρ<0.01). Specifically, age (p<0.05), marital status (p<0.05), household headship (p<0.01), individual savings (p<0.05), individual assets (p<0.01) were important predictors of youth livelihood outcomes. Implications for formulating appropriate intervention programs to enhance youth livelihood outcomes are included. Keywords: capitals, individual attributes, livelihood strategies, youth livelihood outcome

Rates of switching antiretroviral drugs in a primary care service in South Africa before and after introduction of tenofovir

Introduction Antiretroviral changes (single drug substitutions and regimen switches) limit treatment options and introduce challenges such as increased cost, monitoring and adherence difficulties. Patterns of drug substitutions and regimen switches from stavudine (d4T) and zidovudine (AZT) regimens have been well described but data on tenofovir (TDF) are more limited. This study describes the patterns and risk factors for drug changes of these antiretroviral drugs in adults. Method This retrospective cohort study included HIV positive, antiretroviral treatment (ART) naïve adults aged ≥18 years who started ART with two nucleoside reverse transcriptase inhibitors (NRTIs) and a non-nucleoside reverse transcriptase inhibitor. Follow-up was censored at first drug change and analysis focused on NRTI changes only. RESULTS: Between September 2002 and April 2011, 5095 adults initiated ART in Gugulethu. This comprised 948 subjects on TDF, 3438 on d4T and 709 subjects on AZT. Virological suppression rates at 1 year, regimen switching due to virological failure and overall losses to the programme were similar across the three groups. TDF had the lowest incidence rate of drug substitutions (2.6 per 100 P/Ys) compared to 17.9 for d4T and 8.5 per 100 P/Ys for AZT. Adverse drug reactions (ADRs) accounted for the majority of drug substitutions of d4T. Multivariate analysis showed that increasing age, female sex and d4T exposure were associated with increased hazard of drug substitution due to ADRs. Conversely, TDF exposure was associated with a substantially lower risk of substitution (adjusted hazards ratio 0.38; 95% CI 0.20-0.72). CONCLUSION: Regimen switches and virological suppression were similar for patients exposed to TDF, d4T and AZT, suggesting all regimens were equally effective. However, TDF was better tolerated with a substantially lower rate of drug substitutions due to ADRs

Cases of antiretroviral-associated gynaecomastia reported to the National HIV & Tuberculosis Health Care Worker Hotline in South Africa

Background: Gynaecomastia is associated with exposure to antiretroviral therapy (ART), in particular efavirenz. There is limited data on clinical characteristics of patients with ART-associated gynaecomastia in resource-limited settings and little guidance on the optimal management of this adverse drug reaction (ADR). We describe the clinical characteristics, management and outcomes of gynaecomastia cases reported to the National HIV & Tuberculosis Health Care Worker Hotline in South Africa. Methods: We identified all gynaecomastia cases in adolescent boys and men on ART reported to the hotline between June 2013 and July 2014. We collected follow up data telephonically at monthly intervals to document clinical management and outcomes. Results: We received 51 reports of gynaecomastia between June 2013 and July 2014; 11% of the 475 patient-specific ADR queries to the hotline. All patients were on efavirenz-based ART. Mean age was 34 years (standard deviation 12) and seven were adolescents. The median onset of gynaecomastia was 15 months after efavirenz initiation (interquartile range 6–42). Gynaecomastia was bilateral in 29 patients (57%) and unilateral in 16 (31%). Serum testosterone was quantified in 25 of 35 patients with follow up data, and was low in 2 (8%). Efavirenz was replaced with an alternative antiretroviral in 29/35 patients (83%) and gynaecomastia improved in 20/29 (69%). Conclusions: Gynaecomastia was a frequently reported ADR in our setting, occurring with prolonged efavirenz exposure. Testosterone was low in the minority of tested cases. Most clinicians elected to switch patients off efavirenz, and gynaecomastia improved in the majority

Bio-based sustainable polymers and materials: from processing to biodegradation.

In the life cycle of a material, there will be either chemical or physical change due to varying environmental factors such as biological activity, light, heat, moisture, and chemical conditions. This process leads to polymer property change as pertains to functional deterioration because of the physical, biological, and chemical reactions that result in chemical transformations and bond scission and thus can be regarded as polymer degradation. Due to the present demand for sustainable polymers, bio-based polymers have been identified as a solution. There is therefore a need to compare the sustainability impacts of bio-based polymers, to maximize their use in functional use stage and still withhold the bio-degradation capability. This study focuses are poly (lactic acid) (PLA), Poly (ε-caprolactone) (PCL), polyhydroxyalkanoates (PHA), and polyamides (PA) as biopolymers of interest due to their potential in technological applications, stability, and biodegradability. For preparing bio-based value-added products, an appropriate selection of the fabrication or functional modification process is a very important factor for particular industrial or biomedical applications. The literature review indicates that in vivo is preferred to in vitro because it suits an overall study of the experiment's effects on a living subject. This study will explore these features in detail. In particular, the review will cover processing and biodegradation pathways for each of the biopolymers. In addition, thermal degredation and photodegradation are covered, and future trends and conclusions are drawn

Sero – epidemiology of brucellosis in people and their livestock:A linked human – animal cross-sectional study in a pastoralist community in Kenya

BACKGROUND: Brucellosis is associated with massive livestock production losses and human morbidity worldwide. Efforts to control brucellosis among pastoralist communities are limited by scarce data on the prevalence and risk factors for exposure despite the high human-animal interactions in these communities. This study simultaneously assessed the seroprevalence of brucellosis and associated factors of exposure among pastoralists and their livestock in same households. METHODS: We conducted a cross-sectional study in pastoralist communities in Marsabit County – Kenya. A total of 1,074 women and 225 children participated and provided blood samples. Blood was also drawn from 1,876 goats, 322 sheep and 189 camels. Blood samples were collected to be screened for the presence of anti-Brucella IgG antibodies using indirect IgG Enzyme-Linked Immunosorbent Assay (ELISA) kits. Further, Individual, household and herd-level epidemiological information were captured using a structured questionnaire. Group differences were compared using the Pearson's Chi-square test, and p-values < 0.05 considered statistically significant. Generalized mixed-effects multivariable logistic human and animal models using administrative ward as the random effect was used to determine variables correlated to the outcome. RESULTS: Household-level seropositivity was 12.7% (95% CI: 10.7–14.8). The individual human seroprevalence was 10.8% (9.1–12.6) with higher seroprevalence among women than children (12.4 vs. 3.1%, p < 0.001). Herd-level seroprevalence was 26.1% (23.7–28.7) and 19.2% (17.6–20.8) among individual animals. Goats had the highest seroprevalence 23.1% (21.2 – 25.1), followed by sheep 6.8% (4.3–10.2) and camels 1.1% (0.1–3.8). Goats and sheep had a higher risk of exposure OR = 3.8 (95% CI 2.4–6.7, p < 0.001) and 2.8 (1.2–5.6, p < 0.007), respectively relative to camels. Human and animal seroprevalence were significantly associated (OR = 1.8, [95%CI: 1.23–2.58], p = 0.002). Herd seroprevalence varied by household head education (OR = 2.45, [1.67–3.61, p < 0.001]) and herd size (1.01, [1.00–1.01], p < 0.001). CONCLUSIONS: The current study showed evidence that brucellosis is endemic in this pastoralist setting and there is a significant association between animal and human brucellosis seropositivity at household level representing a potential occupational risk. Public health sensitization and sustained human and animal brucellosis screening are required

Cases of antiretroviral-associated gynaecomastia reported to the National HIV & Tuberculosis Health Care Worker Hotline in South Africa

Background: Gynaecomastia is associated with exposure to antiretroviral therapy (ART), in particular efavirenz. There is limited data on clinical characteristics of patients with ART-associated gynaecomastia in resource-limited settings and little guidance on the optimal management of this adverse drug reaction (ADR). We describe the clinical characteristics, management and outcomes of gynaecomastia cases reported to the National HIV & Tuberculosis Health Care Worker Hotline in South Africa. Methods: We identified all gynaecomastia cases in adolescent boys and men on ART reported to the hotline between June 2013 and July 2014. We collected follow up data telephonically at monthly intervals to document clinical management and outcomes. Results: We received 51 reports of gynaecomastia between June 2013 and July 2014; 11% of the 475 patient-specific ADR queries to the hotline. All patients were on efavirenz-based ART. Mean age was 34 years (standard deviation 12) and seven were adolescents. The median onset of gynaecomastia was 15 months after efavirenz initiation (interquartile range 6–42). Gynaecomastia was bilateral in 29 patients (57%) and unilateral in 16 (31%). Serum testosterone was quantified in 25 of 35 patients with follow up data, and was low in 2 (8%). Efavirenz was replaced with an alternative antiretroviral in 29/35 patients (83%) and gynaecomastia improved in 20/29 (69%). Conclusions: Gynaecomastia was a frequently reported ADR in our setting, occurring with prolonged efavirenz exposure. Testosterone was low in the minority of tested cases. Most clinicians elected to switch patients off efavirenz, and gynaecomastia improved in the majority

Adult medical emergency unit presentations due to adverse drug reactions in a setting of high HIV prevalence

South Africa has the world's largest antiretroviral treatment programme, which may contribute to the adverse drug reaction (ADR) burden. We aimed to determine the proportion of adult non-trauma emergency unit (EU) presentations attributable to ADRs and to characterise ADR-related EU presentations, stratified according to HIV status, to determine the contribution of drugs used in management of HIV and its complications to ADR-related EU presentations, and identify factors associated with ADR-related EU presentation. Methods: We conducted a retrospective folder review on a random 1.7% sample of presentations over a 12-month period in 2014/2015 to the EUs of two hospitals in Cape Town, South Africa. We identified potential ADRs with the help of a trigger tool. A multidisciplinary panel assessed potential ADRs for causality, severity, and preventability