Challenges in the management of HIV-infected malnourished children in Sub-Saharan Africa

Infection with HIV, and oftentimes coinfection with TB, complicates the care of severely malnourished children in sub-Saharan Africa. These superimposed infections challenge clinicians faced with a population of malnourished children for whose care evidence-based guidelines have not kept up. Even as the care of HIV-uninfected malnourished children has improved dramatically with the advent of community-based care and even as there are hopeful signs that the HIV epidemic may be stabilizing or ameliorating, significant gaps remain in the care of malnourished children with HIV. Here we summarize what is currently known, what remains unknown, and what remains challenging about how to treat severely malnourished children with HIV and TB.Publisher PDFPeer reviewe

Estimating runoff from ungauged catchments for reservoir water balance in the Lower Middle Zambezi Basin

The Lower Middle Zambezi Basin is sandwiched between three hydropower dams; Kariba, Kafue (Itezhi-tezhi) and Cahora Bassa. The operation of the upstream dams impacts on the inflows into the downstream Cahora Bassa Dam which, in turn, affects the area inundated upstream of the Cahora Bassa Dam. This study applied a rainfall-runoff model (HEC-HMS) and GIS techniques to estimate both the gauged and ungauged runoff contribution to the water balance of Cahora Bassa. The rivers considered in the study are the Zambezi, Kafue, Luangwa, Chongwe, Musengezi and Manyame. Missing data were generated using the mean value infilling method. The DEM hydro-processing technique was used to determine the spatial extent of the ungauged area. A hydrological model, HEC- HMS, was used to simulate runoff from the ungauged catchments. Results from the study show that the ungauged catchment contributes about 12% of the total estimated inflows into the Cahora Bassa Dam. Averaged results over 30 years show total inflows of 71.73 x 109 m3/yr, total outflows of 52.25 x 109 m3/ yr and a residual storage of 20 x 109 m3/yr. The study successfully estimated the water balance of the Middle Zambezi Basin which, in turn, may help to inform the operation of the Cahora Bassa Dam and management of artificial floods in the basin.Keywords: Cahora Bassa, DEM hydroprocessing, HEC-HMS, remote sensing, reservoir operation, runoff simulatio

Taking up the cudgels against gay rights? Trends and trajectories in African Christian theologies on homosexuality

Against the background of the HIV epidemic and the intense public controversy on homosexuality in African societies, this article investigates the discourses of academic African Christian theologians on homosexuality. Distinguishing some major strands in African theology, that is, inculturation, liberation, women’s and reconstruction theology, the article examines how the central concepts of culture, liberation, justice, and human rights function in these discourses. On the basis of a qualitative analysis of a large number of publications, the article shows that stances of African theologians are varying from silence and rejection to acceptance. Although many African theologians have taken up the cudgels against gay rights, some “dissident voices” break the taboo and develop more inclusive concepts of African identity and African Christianity

New cut-off values for ferritin and soluble transferrin receptor for the assessment of iron deficiency in children in a high infection pressure area

Background: Due to the potential risk of iron supplementation in iron replete children, it is important to properly identify children who may require iron supplementation. However, assessment of the iron status has proven to be difficult, especially in children living in areas with high infection pressure (including malaria). Aims and Methods: Biochemical iron markers were compared to bone marrow iron findings in 381 Malawian children with severe anaemia. Results: Soluble transferrin receptor/log ferritin (TfR-F index), using a cut-off of 5.6, best predicted bone marrow iron stores deficiency (sensitivity 74%, specificity 73%, accuracy 73%). In order to improve the diagnostic accuracy of ferritin or sTfR as a stand-alone marker, the normal cut-off value needed to be increased by 810% and 83% respectively. Mean cell haemoglobin concentration (MCHC), using a cut-off of 32.1 g/dl, had a sensitivity of 67% and specificity of 64% for detecting iron stores deficiency. Conclusion: TfR-F index incorporated the high sensitivity of sTfR, a proxy for cellular iron need, and the high specificity of ferritin, a proxy for iron stores. In areas with a high infection pressure, the TfR-F index best predicted iron deficiency. However, in settings where diagnostic tests are limited, MCHC may be an acceptable alternative screening test

Sensitivity of selected organ dissection to diagnose Taenia solium cysticercosis in pigs from endemic areas

Taenia solium, also known as the pork tapeworm, is a neglected zoonotic parasite which is endemic in many developing countries, including Zambia. The tapeworm causes two disease conditions in humans: (1) taeniosis, which is the intestinal tapeworm infection, obtained after consumtion of raw/undercooked infected pork; and (2) cysticercosis, which is the metacestode larval stage infection, obtained after ingestion of tapeworm eggs. A human tapeworm carrier can excrete high numbers of eggs with the stool (100 000 eggs per day) and is thus an important source of environmental contamination. The transmission of cysticercosis is thus enhanced with poor sanitation and the lack of clean drinking water. After ingestion of the eggs, oncospheres hatch in the intestine and disseminate to several body tissues, including the central nervous system. Infection of the central nervous system with cysticerci is called neurocysticercosis, which is a major cause of acquired epilepsy worldwide

Processing and Characterization of Activated Carbon from Coconut Shell and Palm Kernel Shell Waste by H3PO4 Activation

Palm kernel shell and coconut shell are used as a precursor for the production of activated carbon, a way of mitigating the tons of waste produced in Ghana. The raw Palm kernel shell and coconut shell were activated chemically using H3PO4. A maximum activated carbon yield of 26.3 g was obtained for Palm kernel shell and 22.9 g for coconut shell at 400oC, an impregnation ratio of 1.2 and 1-hour carbonization time. Scanning electron microscopy reveals well-developed cavities of the H3PO4 activated coconut shell and Palm kernel shell compared to the non-activated carbon. Iodine number of 743.02 mg/g and 682.11 mg/g, a porosity of 0.31 and 0.49 and the electrical conductivity of 2010 μS/cm and 778 μS /cm were obtained for the AC prepared from the coconut shell and Palm kernel shell respectively. The results of this work show that high-quality activated carbon can be manufactured locally from coconut shell and Palm kernel shell waste, and a scale-up of this production will go a long way to reduce the tons of coconut shell and Palm kernel shell waste generated in the country

Constraints, Challenges, and Opportunities in Groundnut Production and Marketing in Malawi Report No. 4

Malawi is a landlocked country in southern Africa bordered by Tanzania, Mozambique, and Zambia and covers an area of about 118,000 km2. The country is a member of the Southern African Development Community (SADC) and the Common Market for Eastern and Southern Africa (COMESA) communities in addition to being part of the African Union (AU). It has a population of approximately 14 million people of which 51% are women. The country has one of the highest population densities in Africa and a population growth rate of about 2.4% (GoM 2005a)