African Health Sciences

Online ISSN: 1680-6905
Publications
Distribution by aetiologic factor 
Treatment modalities 
Article
Epistaxis is defined as a hemorrhage from the nostril, nasal cavity, or nasopharynx. Sufferers and clinicians may develop significant anxiety despite the fact that majority of patients are treated successfully by the first attending physician. To review aetiology and management outcomes of epistaxis in a resource constrained setting. A retrospective review of 101 patients seen with epistaxis at the National Ear Care Centre, Kaduna over 7years (January 2002- December 2008). The age of patients ranged between 2 and 75years. The incidence of epistaxis of 0.5% was recorded out of total patient visit and slight male preponderance with a male:female ratio of 1.4:1. Dry-hot and cold harmattan weather had the highest prevalence. Trauma and infections were the main aetiological factors identified but over 40% of cases are idiopathic in origin. About 25% presented with active bleeding and 11% required admission. All were managed conservatively. Less than 2% received blood transfusion. Epistaxis is a common emergency that requires prompt intervention to reduce further morbidity and prevent mortality. Non operative intervention was a satisfactory approach in this study.
 
Article
International expert committee on the use of HbA1c to diagnose diabetes mellitus in 2009 and World Health Organization (WHO) in 2011 has advocated the use of HbA1c to diagnose diabetes mellitus. To determine and compare the relationship between the new cut off value of HbA1c with established criteria. Thirty-one hypertensive subjects attending Lagos University Teaching Hospital were recruited for HbA1c and standard oral glucose tolerance test. Fasting plasma glucose (FPG) and two-hour plasma glucose (2hrpp) value of e"126 mg/ dl and ≥200 mg/dl were used as standard respectively for diagnosis of diabetes. The HbA1c of e"6.5% was used to diagnose diabetes. The performance and correlation of HbA1c with FPG and 2hrpp were calculated and results were compared. Mean age of the subjects was 53.97 ± 6.27 years. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), efficiency and correlation of FPG is 50%, 68%, 27%, 85%, 64% and 0.5 respectively while the sensitivity, specificity, PPV, NPV, efficiency and correlation of 2hrpp is 73.91%, 62.5%,85%, 41.66%, 70.97% and 0.73% respectively. There was a significant difference between FPG and 2hrpp in terms of sensitivity, PPV and NPV. The results of HbA1c with 2hrpp has better correlation, sensitivity, and PPV compared to HbA1c with FPG.
 
Article
Henoch Schonlein Purpura (HSP) is a systemic vasculitic disease which is common in children. It is very important to understand the clinical features of this disease for doctors and nurses. To study the clinical characteristics of HSP in children. Collect the clinical data of the HSP children, and analyze the clinical characteristics of these HSP patients. The ratio of M:F was 1.9:1. The mean age was 6.6 ± 1.6 years. The typical onset seasons were spring, winter and autumn. Infection and food allergy were the main etiological factors. The first symptom was skin purpura and these purpura mainly concentrated the lower extremities and buttocks. The dominant digestive clinical features were abdominal pains and vomiting. The knee joint and ankle joint were most frequently affected. The typical kidney symptoms were microscopic hematuria and albuminuria. An increased ESR was reported in 68 patients (56.7%). Serum C3 decreased in 13 cases (10.8%). ASO titer was higher in 57 children (47.5%). There were gender, season and area differences for the HSP patients. The etiological factors were diverse. HSP patients could have various clinical symptoms and rare complications.
 
Correlation between total lymphocyte counts and CD4 lymphocyte counts (r=0.73, p<0.0001). 
Receiver operator curves (ROC) for ability of TLC to predict CD4 < 200 cells/mm 3 , WHO stages 2 and 3 (N=100)
Article
Total Lymphocyte Count (TLC) has been found to be an inexpensive and useful marker for staging disease, predicting progression to AIDS and death and monitoring response to ART. However, the correlation between TLC and CD4 has not been consistent. Access to HAART is expanding in Kampala, Uganda, yet there are no published data evaluating the utility of TLC as inexpensive surrogate marker of CD4 cell count to help guide therapeutic decisions. To evaluate clinical illnesses and total lymphocyte count (TLC) as surrogate markers of the CD4 cell count in HIV infected persons being considered for ART. A total of 131 patients were enrolled and evaluated by clinical assessment, TLC and CD4 count. Clinical illnesses and TLC dichotomized at various cut-point values were used to determine the sensitivity, specificity, and positive and negative predictive values (PPV and NPV) for the diagnosis of CD4 count <200 cells/mm 3 among 100 participants fulfilling criteria for WHO clinical stage 2 and 3. A strong correlation was observed between TLC and CD4 (r = 0.73, p<0.0001). For all clinical syndromes, except pulmonary tuberculosis, the positive predictive values (PPV) for a CD4 count <200 cells/mm 3 were high (>80%) but the negative predictive values (NPV) were low. Using the WHO recommended TLC cut-off of 1200 cells/mm 3 to diagnose a CD4 less than 200 cells/mm 3 , the PPV was 100%, and the NPV was 32%. Our data showed a good correlation between TLC and CD4 cell count. However, the WHO recommended TLC cut-off of 1200 did not identify the majority of WHO stage 2 and 3 patients with CD4 counts less than 200 cells/mm 3 . A more rational use of TLC counts is to treat all patients with WHO stage 2 and 3 who have a TLC <1200 and to limit CD4 counts to patients who are symptomatic but have TLC of >1200.
 
CD4% during the 24 months follow-up: ANRS 12103/12167 clinical trial, Bobo-Dioulasso, Burkina Faso 2006-2008 
Laboratory abnormalities during the 24 months follow-up: ANRS 12103/12167 clinical trial, 2006-2008, Bobo-Dioulasso, Burkina Faso 
Article
There is no data on long-term benefit of once-a-day antiretroviral therapy (ART) with combination of DDI, 3TC and EFV to allow its use in future therapeutic strategies. To assess 24-month immuno-virological, adherence, tolerance, and effectiveness of a once-a-day ART with DDI, 3TC and EFV. A phase 2 open trial including 51 children aged from 30 months to 15 years, monitored a once-a-day regimen for 24 months from 2006 to 2008 in the Departement de Pediatrie du CHUSS, at Bobo-Dioulasso in Burkina Faso. We tested immunological and virological response, adherence, tolerance and resistance of the treatment. Children with CD4 >25% at 24 months were 67.4% (33/49) CI 95% [54%, 80%]. The proportion of children with viral plasma RNA <300 cp / ml at 24 months of treatment was 81.6 % (40/49) CI [68.0% 91.2%]. Good adherence was obtained with more than 88% adherence > 95% over the 24 months. Drugs were well tolerated. Given the limited number of antiretroviral drugs available in Africa and the inadequacy of laboratory monitoring in support program, once-a-day treatment and especially the DDI-based combination strategies could be an attractive operational option.
 
Article
Disseminated histoplasmosis is a rare fungal infection and most documented cases are in immune-compromised individuals such as those with acquired immuno-deficiency syndrome. To describe a case of disseminated histoplasmosis in an adolescent girl. We report a case of disseminated histoplasmosis in a 13-year-old adolescent girl. She was admitted for 16 days because of neck masses of 3 years duration, generalized body swelling of 3 months and reduction in urinary output of 2 months. She tested negative for human immunodeficiency virus antibodies. An autopsy was performed because a definitive diagnosis could not be made while the patient was still alive. The autopsy revealed central caseating areas in the lymph nodes and membranoproliferative glomerulonephritis. The periodic acid-Schiff staining technique for tissues showed viable yeast cells suggestive of histoplasmosis. Zeihl-Neelsen's staining for mycobacteria tuberculosis was negative. Undiagnosed case of disseminated histoplasmosis while the patient was alive is being reported in a 13-year-old girl. Disseminated histoplasmosis should be considered as a differential diagnosis of childhood chronic infections and malignancies as in Nigeria.
 
Prevalence of gall stones according to age and sex 
Article
SCA causes chronic haemolysis which is a risk factor for cholelithiasis. To determine the prevalence and outcome of children with SCA complicated with gallstones treated at the sickle cell clinic at the children emergency hospital Khartoum state. 261 patients age 4 months to 16 years were studied. AUS examination was carried out. The 30 patients in whom gall stones were detected followed prospectively from June 1996 to September 2009 when a second AUS examination was obtained. Gall stones occurred in 30 patients of whom four were lost to follow up in the first year. The overall prevalence of cholelithiasis was 11.5% and it increased with age. The youngest patient with cholelithiasis was 2 1/2 years old. Haematological variables, bilirubin and sex did not identify a subgroup of patients at higher risk for gallstones. All the patients were asymptomatic at the time of diagnosis. One patient developed symptoms 3years after the diagnosis and he was submitted to surgery. The 25 remaining asymptomatic patients were followed up for 13 years and none of them presented complications related to cholelithiasis during this period. The prevalence of cholelithiasis in Sudanese children and adolescents with SCA was significant. The large majority patients remained asymptomatic over a long period.
 
Percentage of positive skin test reactions to aeroallergens in asthmatics (n=85) and non- asthmatic controls (n=85) 
Logistic regression analysis of risk factors associated with asthma in 13-14 year old high school children in Southwest Nigeria
Comparative percentage of positive skin test reactions to aeroallergens (A) Rural children: asthmatics (n=58), non-asthmatic controls (n=58) (B) Urban children: asthmatics (n = 27), non-asthmatic controls (n=27) *p<0.05
Blood tests analysis in asthmatics and non-asthmatic control subjects
Home dust allergens in children's indoor environment
Article
The prevalence of asthma and role of atopy in asthma among children has not been clearly defined in Nigeria. To determine the prevalence of asthma and investigate risk factors related to allergy sensitization among urban and rural school children in southwest Nigeria. Validated ISAAC questionnaire was administered to 1736 high school children in randomly selected schools in rural and urban communities. Identified asthma cases were matched to controls. Allergy skin tests, blood eosinophil count, serum IgE and stool examination for parasites were performed. Dust samples from homes were also collected and analyzed for allergens. The prevalence of asthma was 7.5% (95% CI 6.0 to 9.2%) and 8% (95% CI 6.0-10.4%) in the rural and urban communities respectively . Risk factors for asthma included cigarette-smoking, cats in the home and family size. Eosinophil count (109/L) was elevated in asthmatics [0.70 (95% CI 0.48-1.11) vs. 0.32 (95% CI 0.19-0.69); p<0.01], but IgE levels were similar between the two groups (298±229 IU/mL vs. 288±257; p=0.97). Positive skin tests to cat hair, cockroach, mango blossom and mouse epithelium were more frequent in asthmatics than in healthy controls, especially in the rural communities. There was no correlation between allergens in dust collected from homes and skin test reactivity. Asthma prevalence is similar in rural and urban children in Southwest Nigeria and atopy with elevated IgE was not observed to be a major factor for asthma in our cohort of children in both communities.
 
Article
A 14-year-old secondary school girl presented with acute onset severe generalized headache associated with vomiting and diplopia. These followed an initial fever, which responded to chloroquine. She had been on peflacine for a left knee septic arthritis until onset of her symptoms. The main findings on physical examination were mild obesity, left abducent nerve palsy, bilateral papilledema and evidence of resolving arthritis of her left knee. The results of her investigations, including a brain CT scan were within normal limits. A diagnosis of IIH was made. She responded satisfactorily to oral acetazolamide with complete resolution of her symptoms and signs within 12 days of hospitalization and 2 weeks of follow-up.
 
Article
Bacterial vaginosis (BV) is a condition with diverse etiology. This condition predisposes women to increased susceptibility to sexually transmitted diseases, including human immunodeficiency virus (HIV) infections and preterm birth. The diagnostic methods currently adopted in the evaluation of patient samples for BV are arguably Amsel criteria, and Nugent score that require microscopy and expert interpretation. These two methods are still subjective. The objective of this study was to determine the organisms present in the vagina of 34 HIV negative Nigerian women diagnosed as having bacterial vaginosis by using molecular techniques. The vaginal samples were subjected to DNA extraction, and amplified with eubacterial primers via PCR. The PCR products were separated using denaturing gradient gel electrophoresis (DGGE). Bands were excised, re-amplified, purified and sequenced. Sequence identification was performed using the BLAST algorithm and Genbank data base. Mycoplasma hominis (12/34; 35%) was the most common isolate and 9 (26%) contained one of two clones of an unusual Rainbow Trout intestinal bacterium, while unculturable Streptococcus sp, and other bacteria made up the remaining isolates. The findings indicate further diversity in the etiological agents associated with BV, and raise the question as to whether diagnosis and management of this condition needs to be re-evaluated in countries like Nigeria. There is some controversy over the clinical importance of BV, as it was once regarded as a disease caused by Gardnerella and presenting as an odourous discharge condition, but is now diagnosed without necessarily the presence of these organisms or signs. With the incidence of BV aligned to an increased risk of HIV in a country ravaged by this virus, the effective eradication of BV can only be achieved if appropriate therapies are delivered.
 
Sensitivity, specificity and predictive values of the independent predictors of HIV infection 
Article
In Africa without antiretroviral treatment more than half of the HIV infected children die by 2 years. The recommended HIV virological testing for early infant diagnosis is not widely available in developing countries therefore a presumptive diagnosis is made in infants presenting with symptoms suggestive of HIV disease. To identify presenting signs and symptoms predictive of HIV infection in hospitalized children aged between 2- 18 months at Harare Hospital, Zimbabwe. In a cross sectional study the baseline clinical information was collected and HIV infection confirmed using DNA PCR. Multiple logistic regression analysis was used to identify significant predictors of symptomatic HIV infection. Diagnostic parameters (sensitivity, specificity) and their 95% confidence intervals were calculated. 355 children with an overall median age of 6 months (IQR: 3, 10.5 months) of whom 203 (57.2%) were HIV DNA PCR positive. Clinical signs independently predictive of HIV infection were cyanosis, generalized lymphadenopathy, oral thrush, weight for age z-score <-2 and splenomegaly. The sensitivity of these signs ranged from 43-49% with a higher specificity (ranging from 72.3-89.5%). Clinical identification using individual signs for probable HIV infection in hospitalized children below 18 months would provide an opportunity for early diagnosis, treatment.
 
Article
Schistosoma mansoni was observed and reported in Kuluva hospital Arua District in north western Uganda as early as 1902. S. mansoni is widely distributed in Uganda along permanent water bodies. To review the litreture on scistosomiasis in Uganda, since 1902. The core literature for this short review was searched from reports and publications by the British colonial Ministry of Health Districts Medical officers and Entomologists. Additional information was obtained from Makerere University Medical School library archives, London School of Hygiene and Tropical Medicine library archives, University of Antrwap, and post independence publications on schistosomiasis in Uganda in various journals. Since it was first detected in 1902 Schistosoma (S) mansoni is more widely distributed in Uganda than S. haematobium. However Schistosoma mansoni and S. haematobium are of public health importance in Uganda and the importance of migrants and fishermen in disseminating infections into non-infested areas and intensifying infection in areas already infested have been reported. S. mansoni has been on the increase in Uganda whereas S. haematobium is localized in sporadic foci in the north of Uganda. Treatment with praziquantel the drug of choice in Uganda used in schistosomiasis control programme has reduced development of severe schistosomiasis.
 
Article
The under five mortality rate (U5MR) is measure of wellbeing and decreasing the U5MR by two thirds is the target towards the achievement of the millennium development goal number four (MDG4). To describe the changes in U5MR in Uganda from 1954 to 2000 and use them to project future trends up to 2015. We did a retrospective analysis of the Uganda national censuses of 1969, 1991 and 2002. We calculated the percentage of the annual average reduction rate (AARR) of U5MR between the years 1954-1966, 1966-1975, 1975-1988 and from 1988 to 2000. The AARRs of U5MR between 1954 and 2000 were then compared to that of 4.4% required to achieve MDG4. The U5MR in Uganda between 1954 and 1966 decreased from 261 to 180 deaths per 1000 live births with an AARR of 3.05%. Between 1975 and 1988, the U5MR increased with AARR from 1966 to 1975 being -1.05% while the AARR from 1976 to 1988 was -0.11%. From 1988 to 2000 U5MR decreased from 205 to 152 deaths per 1000 live births with an AARR of 2.46%. The AARRs for the U5MR of -1.05-3.05% were below the 4.4% required to achieve MDG4.
 
Article
Since the genocide occurred in 1994, Rwanda has faced up to the challenge of rebuilding. Public health is a main field to understand this rebuilding. In this paper, the aim was to map the scientific research on public health in Rwanda after the genocide and to present the links between different financing systems. We used bibliographic analyses with Web of Science of papers published during the period 1975-2014. We performed analyses on journals, most cited articles, authors, publication years, organizations, funding companies, countries, and keywords. We obtained 86 articles between 1975 and 2014. Most articles were published after 2007. The main countries of research laboratories were the United States of America, Rwanda, England and Belgium and represented the main network collaboration. The relevant keywords were: HIV, woman, child, program, rural and violence. Public health research on Rwanda appeared 14 years after the genocide. A main field was emerging: the spread of HIV with mother-child transmission, and the policies to take this subject into account in rural zones. The network of institutions developing these studies was USA-Rwanda.
 
Article
To determine the relative frequency of prostate cancer among surgical specimens, and among prostate specimens received at the pathology department ,University Hospital Calabar. Histology records were reviewed for the following: total number of histology specimens received; total number of prostate specimens; total number of prostate cancer; and the total number of cancers in males during the study period. Histology sections 4-5microns thick were cut from paraffin blocks and stained by Haematoxylin and Eosin (H&E). Histopathologic specimens were classified using the grading system of tumour differentiation described by Gleason and associates. One hundred and twenty three cancers of the prostate were received, constituting 2% of the total surgical specimens and 31% of prostate specimens. Thirty three cases (27%) could not be analyzed; therefore the study is based on 90 prostate cancer specimens. Eighty nine (99%) cases were epithelial tumours (adenocarcinoma.) There was a single mesenchymal tumour (rhabdomyosarcoma) (1%). The commonest grade in this study was the high grade (Gleason grade IV). We observed that prostate cancer is a common among males (all sites) diagnosed at the University Hospital Calabar, with a peak incidence between the ages of 61 - 70 years (seventh decade).
 
Article
Drug-metabolizing enzymes (DMEs) inhibition based drug-drug interaction and herb-drug interaction severely challenge the R&D process of drugs or herbal ingredients. To evaluate the inhibition potential of wogonin (an important flavonoid isolated from the root of Scutellaria baicalensis) towards one of the most important phase II DMEs, UDP-glucuronosyltransferase (UGT) 1A9. Both recombinant UGT1A9-catalyzed 4-methylumbelliferone (4-MU) glucuronidation reaction and human liver microsomes (HLMs)-catalyzed propofol glucuronidation reaction were used as two different probe reactions. Wogonin noncompetitively inhibited recombinant UGT1A9-catalyzed 4-MU glucuronidation, and exerted competitive inhibition towards HLMs-catalyzed propofol glucuronidation. The inhibition kinetic parameters (Ki) were calculated to be 3.2 µM and 52.0µM, respectively. Necessary monitoring was needed when wogonin was co-administered with the clinical drugs mainly undergoing UGT1A9-mediated glucuronidation elimination. Additionally, probe reactions-dependent inhibition of wogonin towards the activity of UGT1A9 should be paid attention when translating these in vitro data into in vivo situation.
 
Article
HIV/AIDS epidemic and sexual assault have emerged as the most serious public health problems in South Africa. The country has about 5-million HIV infected individuals. About a million women are raped every year. To study the incidence of HIV infection in victims of sexual assaults. This is a retrospective descriptive study. There were 831 victims of sexual assault, who attended the Sinawe Centre during the 5-year (2000-2004) study period. Sinawe Centre is the only unit in this area which deals with cases of sexual assaults. Data were analyzed using PRISM R computer program. This is a retrospective descriptive study. There were 831 victims of sexual assault, who attended the Sinawe Centre during the 5-year (2000-2004) study period. Sinawe Centre is the only unit in this area which deals with cases of sexual assaults. Data were analyzed using PRISM R computer program. Eight hundred and thirty one cases of sexual assaults (rape) were reported in last 5-years (2000-2004). Increase in sexual assaults by three-times, and one-and-half-fold increase in HIV seropositivity has recorded over the period of 5 years. In 2000, 76 (9.7%) sexual assault cases were registered, and in 2004, 237 (28.5%) cases. Of them, 443 (53.3%) were children under 15-years of age. A total of 114 (13.7%) tested positive for HIV, and 23 (2.7%) were children less than 15 years. In 2000, only 8 (10.5%) tested positive for HIV, and this had climbed to 39 (16.5%) in 2004. There is significant difference in HIV seropositivity among children compared to adults, p<0.05, and Paired t=3.45 with 3df. There is an increasing incidence of HIV infection among victims of sexual assaults in this study.
 
Patient age and diagnosis 
Article
External dacryocystorhinostomy (DCR) is a surgical intervention aimed to treat blocked nasolacrimal ducts of almost all causes. To date there is only limited data available from the Sub Saharan African setting. This study aimed to provide further information of the outcomes of DCR in Africa. Records of all patients undergoing external DCR operations from January 2001 to April 2006 were systematically searched. 55 patients were identified and notes were available for 45 patients. Discharge and epiphora were resolved in 90.9% (30/33) and 84.4% (27/32) of patients respectively. Over half the cases (51.1%) were children. The commonest reason for operation was chronic dacryocystitis (51.1%). Outcomes for DCR were not significantly different for either children or adults and a clear improvement of symptoms was found in the vast majority of cases. This study provides information on the outcomes of DCR in the African population. An 84.4% cure rate of epiphora and 90.9% cure rate of discharge is comparable with findings in other developing countries. This study supports the continued use of this intervention in skilled hands for treatment of blocked nasolacrimal duct.
 
Article
El Niño phenomenon causing increased rainfall and flooding has been linked to flare ups and emergence of several disease outbreaks including cholera. The latter has been reported in many districts in Uganda in recent years. Therefore an understanding of factors influencing its pattern of occurrence is needed for effective control. To determine cholera disease status during six months of El Niño rains and assess serotypes and antibiotic sensitivity of isolates. A prospective study was conducted in five cholera "endemic districts" in Uganda. Results: Cholera outbreaks occurred in all the study districts coincident with the onset of the El Niño rains. There were 924 cholera suspect cases reported with 95 fatalities (case fatality rate 10.3%). A total of 388 clinical specimens were analyzed by culture and of these, 168 were positive for V. cholerae. Biochemical and serological analysis identified the isolates as V. cholerae O1, biotype EL Tor serotype Ogawa. Antibiotic sensitivity revealed that isolates were 100% sensitive to ciprofloxacin, tetracycline and erythromycin, whereas sensitivity was variable for other tested antibiotics. Unlike Kampala, where the disease was contained within three months, persistence occurred in other districts only dying out with end of El Niño rains, suggesting differences in disease control. These results show that El Niño rains cause increase in the number of cholera cases in Uganda, calling for preparedness and a need to emulate Kampala response incase of outbreaks in other districts.
 
Article
Case detection is an important component of tuberculosis control programmes. It helps identify sources of infection, treat them, and thus break the chain of infection. To determine the reasons of low tuberculosis case detection in Gokwe Districts, Zimbabwe. A descriptive cross sectional study was conducted. We used interviewer administered questionnaire for nurses and patients, checklists, key informant interviews. Thirty-eight nurses, forty-two patients and seven key informants were interviewed and 1254 entries in tuberculosis register were reviewed. Nurses correctly defined pulmonary tuberculosis, listed signs and symptoms, preventive measures and methods of tuberculosis diagnosis. Exit interviews showed 9/42 (21%) of patients presenting with cough were asked to submit sputa for examination and asked about household contacts with tuberculosis. About 27% of patients who were sputum positive in the laboratory register were not recorded in the district tuberculosis register. This contributed to the high proportion of early defaulters among tuberculosis suspects. Low tuberculosis case detection was because nurses were not routinely requesting for sputum for examination in patients presenting with a cough or history of previous treatment for cough. Nurses should routinely request for sputum for examination in patients presenting with a cough or history of recent treatment for cough.
 
Article
Sexually transmitted infections (STIs) remain a major public health problem in Zimbabwe. In Zvishavane, STI increased from 66 per 1,000 in 2002 to 97 per 1,000 in 2005, a 31% increase in cases. To determine the factors associated with contracting sexually transmitted infections (STI) among patients in Zvishavane. A frequency matched case control study was conducted. Cases were persons above 15 years diagnosed with STI at three health facilities in Zvishavane urban. Controls were patients who visited the same facilities for other ailments. We interviewed 77 cases and 154 controls. Both cases and controls were knowledgeable about STI. Risk factors for men included sex under the influence of alcohol OR=7.11 (95% CI 2.42-20.85), relationships less than one year, OR= 9.33 (95% CI 3.53-24.70), no condom use at first intercourse OR=5.17 (95% CI 1.64-16.25) and paying for sex OR= 23.65 (95% CI 6.23-89.69). For females the risk factors were non-use of condom at first intercourse OR=2.49 (95% CI 1.02-6.04) and relationships less than one year OR=3.19 (95% CI 1.41-7.23). Significant differences in attitudes were evident among cases and controls. Knowledge of STI did not provide protection from STI diagnosis. Limiting the number of partners, consistent condom use, and fidelity are important for both men and women.
 
15-year old male admitted on the 20th 
29 years old female admitted on the 25th of November 2009 with fever, alveolar hemorrhage 
Characteristics of fatal and non fatal cases
Article
To investigate the clinical and prognostic features of patients admitted to intensive care unit (ICU) with pandemic 2009 influenza A (H1N1) virus. Patients admitted to the intensive care unit for severe pneumonia associated with pandemic 2009 influenza A (H1N1) virus were evaluated. The study included 20 patients with the mean age of 36±13. Of the 20 subjects, 17 (85%) had underlying conditions. Of the 20 patients, 11(55%) were discharged and 9 (45%) died. Cardinal symptoms were fever, myalgia, and hemoptysis with the rates of 85 %, 75 % and 45 %, respectively. All patients had pneumonic infiltrations in their chest roentgenograms. Main laboratory findings were lymphopenia, high creatin phosphokinase (CPK) and Lactate dehydrogenase (LDH) levels. All patients had positivity on real time reverse transcription-polymerase chain reaction (RT-PCR). None of the patients had pandemic 2009 influenza A (H1N1) virus vaccination. None of them had taken oseltamivir within 48 hours. Main reasons for mortality were cardiovascular complications and ventilatory associated pneumonia due to Acynetobacter baumannii. Early diagnosis and antiviral treatment in these cases seem to be the best approach to avoid serious illness. Special attention should be given to patients having underlying conditions such as cardiovascular and pulmonary diseases and pregnancy.
 
Baseline characteristics and risk factors associated with Anti-HCV positivity
Article
Hepatitis viral infections are major health challenge leading to high morbidity and mortality worldwide. Although the magnitude of hepatitis in Pakistan has been well documented, information regarding the prevalence of hepatitis C virus (HCV) infection in Faisalabad, Pakistan is scarce. The present retrospective study was undertaken to determine the epidemiology of HCV in Faisalabad, Pakistan. Between May, 2010 and December, 2012, medical records of 39780 subjects visiting sexually transmitted infections (STIs) clinic, district headquarter (DHQ) hospital, Faisalabad, Pakistan were reviewed. Regression analysis was used to determine independent risk factors. HCV prevalence was 21.99%. With mean age of 49.5 ± 2.7 years (range 27-63 years), majority (67.15%) of the individuals were male. Marital status and low literacy rates were associated with HCV (P<0.05). Reference to the potential risk factors, the injection drug use was the major mode (72.77%) of infection transmission. Age (OR 1.5, 95% CI 1.2-1.9), male gender (OR 1.2, 95% CI 0.9-1.6) and injection use (OR 1.9, 95% CI 1.0-2.7) were significantly associated with HCV. Most important finding was higher HCV prevalence in Faisalabad region as compared to the previous assessments that demands an urgent need for preventive intervention strategies.
 
Heart rates during the running phase of the SRT protocol  
Diastolic blood pressure trends during the SRT protocol  
Article
To assess Cardio-respiratory fitness (CF) markers among university students using a 20m shuttle run test (SRT). Markers of CF were assessed in 80 males aged 21.4±1.8 years, randomly selected from Moi University, Kenya. Assessed at different stages of SRT protocol included heart rate (HR), systolic and diastolic blood pressure (SBP & DBP). VO2max was also determined. Data were analyzed using Stata v10. Comparisons were based on subjects exercise regimes. Subjects with either regular or irregular regimes attained lower HR in 4(th) minute of SRT compared to non-exercise group (174.5±11.6 and 172.2±10.8 vs 182.8±6.8 b/m; p=0.04 and p=0.01 respectively). Lower HRs were maintained among irregularly exercising after 5(th) minute (176.5±10.1 vs 186.7±6.3 b/m; p=0.02). Regularly exercising subjects obtained lowest DBP at exhaustion compared to irregular and non-exercising (58.58±15.0, 62.43±12.9 and 64.1±8.8 mmhg respectively). VO2maxpredictors included year of study (r=-0.40), age (r=-0.41) and weight (r=-0.23). The regularly exercising had higher VO2max than irregular (p<0.01) and non-exercising (p<0.001). No demonstrable difference in VO2max existed between irregular and non-exercise subjects. Exercise regimes should be emphasized amongst university students, albeit with less regard to regularity, which should be encouraged for those in higher study years and those with higher DBP at exhaustion.
 
Article
Congenital heart disease is an important cause of maternal morbidity and mortality during pregnancy. Pregnancy alters the circulatory and respiratory physiology with attendant deleterious effect on the mother with congenital heart disease and the foetus. Additional insult to the circulatory physiology by other factors coexisting together with congenital heart disease can further reduce the cardiac reserve in pregnancy and precipitate heart failure. These factors include anaemia, thromboembolism, hypertension, multiple pregnancy, strenuous physical activity, extremes of temperature and the normal physiological edema of pregnancy.Patent ductus arteriosus (PDA) can present for the first time in pregnancy. Moderate to large PDA result in significant volume overload, left ventricular dilation and dysfunction. In the woman with a hemodynamically important PDA, pregnancy may precipitate or worsen heart failure. We report a successful pregnancy in a 26 year old primigravida with previously undetected patent ductus arteriosus with preeclampsia who presented in heart failure. This case highlights the importance of intensive careful examination of pregnant patients to identify such conditions.
 
Article
Background: Inhibition of drug-metabolizing enzymes (DMEs) has been regarded as one of the most important reason for clinical drug-drug interaction. Aim: The aim of the present study is to evaluate the inhibition of bakuchiol towards UDP-glucuronosyltransferase (UGT) 2B isoforms. Methods: In vitro recombinant UGT2B-catalyzed 4-methylumbelliferone glucuronidation was used as the probe reaction. Dixon plot and Lineweaver-Burk plot were employed to determine the inhibition kinetic type, and nonlinear regression of data was utilized to calculate the inhibition kinetic parameter (Ki). In vitro-in vivo extrapolation (IVIVE) was carried out to predict in vivo inhibition magnitude. Results: Among the tested UGT2B isoforms, UGT2B7 was inhibited by the strongest intensity. The noncompetitive inhibition was demonstrated by the results obtained from Dixon plot and Lineweaver-Burk plot. The Ki value was calculated to be 10.7 µM. In combination with the reported concentration after an intravenous administration of bakuchiol (15 mg/kg) in rats, the high risk of in vivo inhibition of bakuchiol towards UGT2B7-catalyzed metabolism of drugs was indicated. Conclusion: All these results provide an important information for the risk evaluation of the clinical utilization of bakuchiol.
 
ROC for any current depressive episode among 115 study participants. 
ROC for past month suicidality among 115 study participants. 
Article
A 36-item version of the Response Inventory for Stressful Life Events (RISLE) was derived from the longer 100 item version. The 36-item version may be more appropriate for use in larger population sample. To compare the responses of the 36-item RISLE to interview derived psychiatric diagnoses and suicidal ideation in a sub-sample of the general population and student samples reported in the accompanying paper. Clinical interviews using the Mini International Neuropsychiatric Interview (MINI) were carried out on 67 members of the general population and 58 members of the student samples. Receiver Operating Characteristic (ROC) curves were constructed for the RISLE responses using current depressive disorder, any current psychiatric disorder, and past month suicidality variables. Sensitivities, specificities, predictive values and likelihood ratios were determined based on various cut-off points based on ROC curves. Kappa statistic was determined to evaluate the level of agreement between the result of questionnaire surveys and research clinical interviews at different cut-off points on the RISLE. The probability of correct detection of current depression was 79%, any current psychiatric disorder 83% and past month suicidality 83%. The optimal cut-offs for the general population was 10 and for the students 6. High scores on the 36-item RISLE were associated with a past history of suicide attempt and recent and past suicide ideation. The 36-item RISLE appears to have good concurrent validity and may be a reasonable screening instrument for psychological distress in the Ugandan population. The results suggest that the RISLE alone is capable of screening for both depressive mood and suicidal ideation effectively at different cut-off points. Thus the RISLE is capable of achieving what normally takes two scales such as the BDI and BSS to do separately. However, further validation work is required using larger population samples in clinical interviews in prospective studies.
 
Article
Day case surgery services are increasing all over the world. The prevalence of postoperative pain after day surgery is found to be high. Little is known about the prevalence of postoperative pain, in Kenya, after day case surgeries. To investigate the prevalence of postoperative pain after day surgery at Aga Khan University Hospital (AKUH), Nairobi, to determine the severity/intensity of postoperative pain following day case surgery. Consecutive sampling was carried out until sample size of one hundred and fifty patients was achieved. The purpose and nature of the study was explained to patients before informed consent was obtained. They were shown how to score their pain using a visual analogue scale prior to the surgical procedure. A questionnaire was used to collect data from the patients. Follow up information was obtained through telephone interviews at 24 and 48 hours, after discharge from the day surgery unit. The prevalence of postoperative pain after day care surgery was found to be 58% within 30minutes postoperatively, 55.3% after 24 hours, and 34.7% after 48 hours following surgery. The prevalence of moderate to severe postoperative pain was 13% after 24 hours, and 11.7% after 48 hours. The overall prevalence of postoperative pain after day surgery at the Aga Khan University Hospital, Nairobi was noted to be different from what has been reported in the literature. The prevalence of moderate and severe pain however, is less than reported in the literature.
 
Comparative anti-inflammatory effects of capsaicin in rats treated with Diclofenac and saline 
Article
The analgesic effect of capsaicin (the active ingredient in Capsicum frutescens Linn. [Solanaceae]) had been reported in several studies. Current research is being directed at producing analgesics, anti-inflammatory agents with better side effect profile. To investigate if either the ethyl acetate extract of Capsicum frutescens Linn. [Solanaceae] (CFE) or capsaicin (Fluka Biotechnika-CPF) (in addition to the known analgesic properties) has any anti-inflammatory effect comparable to nonsteroidal anti-inflammatory analgesics (NSAIDS). The effects of ethyl acetate extract of Capsicum frutescens Linn. [Solanaceae] (CFE) and capsaicin (Fluka Biotechnika-CPF) was examined on rat hind paw. Inflammation was induced in the rat's hind paw by subplantar injections of fresh egg albumin (0.5 ml/kg). Diclofenac (100 mg/kg) was used as the reference anti-inflammatory agent for comparison, while distilled water was used as the placebo. The leucocytes count, corticosterone and C - reactive protein (CRP) levels were measured as biomarkers of inflammation. Data obtained were pooled and analysed using repeated ANOVA, in a general linear model with the CPSS software. Sub-plantar injections of fresh egg albumin (0.5 ml/kg) produced profound and time-related oedema in the rat hind paw of the 'control' rats. Diclofenac (DIC, 100 mg/kg, i.p.) and reference capsaicin (CPF, 2.5 mg/kg, i.p.) significantly inhibited paw swelling at (p<0.05-0.001) (CI 95%) compared to distilled water-treated 'controls'. While the corticosterone levels were all very low in 7 rats treated with capsaicin, the leucocytes count was within normal range in 9 rats. However, in 16 specimens randomly assigned for CRP levels, there were very high CRP readings, up to a magnitude of 10 times the normal range. Capsaicin in both forms (CFE and CPF) produced anti-inflammatory effects that were comparable to diclofenac in the experimental rat model at p<0.05. It may be concluded that capsaicin has both analgesic and anti-inflammatory properties.
 
Representative Spoligopattern of the different genotypes of M. tuberculosis. The directrepeat (DR) region of M. tuberculosis was amplified with primers DRa (biotinylated at the 5 ' end) and DRb, and the amplified DNA was hybridized to inter-DR spacer oligonucleotides covalently bound to a membrane 
Article
The genotyping of Mycobacterium tuberculosis strains is important to have unique insights into the dissemination dynamics and evolutionary genetics of this pathogen and for TB control as it allows the detection of suspected outbreaks and the tracing of transmission chains. To characterize M. tuberculois isolates collected from newly diagnosed pulmonary TB patients in Addis Ababa One hundred and ninety two sputum samples were cultured on Löwenstein-Jensen (LJ) slants and isolates were heat killed for molecular genotyping. The isolates were characterized using spoligotyping and were compared with the International SpoIDB4 database. T genotype constitutes the most predominant in our study (95, 49.5%) followed by the CAS genotype (42, 21.9%). Other genotypes found were Haarlem (H) (24, 12.5%), the LAM (3, 1.5%), the Beijing genotype (1, 0.5%); four (2.1%) isolates were designated as Unknown. All the isolates belong to the modern lineage and there is high clustering in the genotype of isolates which indicated the presence of recent TB transmission. Therefore, the Tuberculosis Control Programme needs to do more in advocating and strengthening the health system for early detection and treatment of active TB cases as delay in treatment is the key factor in disease transmission.
 
Access to quality health services in relation to the mode of payment 
Article
Each year, 100 million people are impoverished globally as a result of expenditure on health. To assess the constraints and implications of out-of-pocket payment for health services among government employees in Abakaliki, Ebonyi State, south east Nigeria. This was a cross-sectional descriptive study. The study instrument was a pre-tested, semi-structured self administered questionnaire. Over half of the respondents (62.8 %) reported a history of illness in their household in the preceding four weeks before the study. Sixty-nine percent of these respondents relied on out-of-pocket payment in order to pay for health services at the moment of seeking medical treatment for themselves or their dependants; while 28.4 % and 2.6 % relied on a pre-payment package (National Health Insurance Scheme) and borrowed money respectively to pay for health services at the moment of seeking medical treatment for themselves or their dependants. The vast majority of respondents (63.6 %) who relied on out-of-pocket payment reported their difficulties in accessing quality health care services as a result of financial hardship at the moment of seeking medical treatment. Most of them (47.7 %) resolved to self medication, while 28.4 %, 17.1 % and 6.8 % of them delayed seeking health care, patronized herbalists and ignored their illness respectively. This study brings to the fore the fact that most government employees and their dependants in Abakaliki have difficulties in accessing quality health care services via paying for them out-of-pocket.
 
Waiting time and postoperative complications 
Waiting time for emergency abdominal operations
Waiting time and severity of complication
Characteristics of patients with or without post-operative complications
Results of logistic regression analysis of factors associated with severity of post-operative complications
Article
Management of surgical emergencies in Nigeria is characterised by mismatch between supply of facilities and demand for care. This study aimed to evaluate the waiting time between presentation at hospital with acute abdominal disease and operative intervention. We prospectively studied adult patients with abdominal diseases requiring emergency operation. The interval between presentation and first contact with emergency room doctors was defined as T1; time from contact to decision to operate as T2; time taken to resuscitate patient T3 and to commencement of operation T4. Causes of delay and its impact on outcome of treatment were noted. There were 488 patients, mean age 32 +/-1.7 SD years. TT ranged between 0.8 and 79.0 hours, mean 22.3 +/- 10.0 hours. In 81.6% operative intervention was delayed beyond 6 hours of which financial constraints accounted for 53.8%. T3 accounted for the longest delay (0.5 -53.0 hours). Patients of lower socio-economic class had longer T3 (p<0.005). Waiting for complementary investigations caused delay in 22.1%. Post-operative complications (p=0.0001) and their severity were higher in patients with longer TT. Prolonged TT (p<0.001), ASA grade (0.005) and time from onset of symptoms to admission (p=0.009) were associated with mortality. Patients whose operations were delayed beyond 24 hours had a longer hospital stay. Emergency abdominal operations were delayed in our patients mainly because of scarce financial resources. Delayed interventions were associated with higher morbidity and mortality.
 
Article
Diagnosis of blunt abdominal trauma is a real challenge even for experienced trauma surgeons. Diagnostic tools that help the treating doctor in optimum management of blunt abdominal trauma include; Focussed Assessment Sonography for Trauma (FAST), Diagnostic peritoneal lavage (DPL) and CT scan. the aim of this communication is to define the recent role of FAST and CT scan of the abdomen in the diagnosis of blunt abdominal trauma. FAST is useful as the initial diagnostic tool for abdominal trauma to detect intraabdominal fluid. With proper training and understanding the limitations of ultrasound, the results of FAST can be optimized. DPL is indicated to diagnose suspected internal abdominal injury when ultrasound machine is not available, there is no trained person to perform FAST, or the results of FAST are equivocal or difficult to interpret in a haemodynamically unstable patient. In contrast, in haemodynamically stable patients the diagnostic modality of choice is CT with intravenous contrast. It is useful to detect free air and intraperitoneal fluid, delineate the extent of solid organ injury, detect retroperitoneal injuries, and help in the decision for conservative treatment. Helical CT is done rapidly which reduces the time the patient stays in the CT scan room. Furthermore, this improves sagittal and coronal reconstruction images which are useful for detecting ruptured diaphragm.
 
Article
Subcutaneous or intrafascial wound infiltration of local anaesthetic with systemic opioids has been shown to enhance patient comfort with improved analgesia and reduced opioid requirements. To demonstrate improved pulmonary function when postoperative analgesia was provided by combined bupivacaine wound infiltration and systemic opioid. In a prospective, randomized, placebo-controlled study, 46 patients (23 per group) scheduled for elective gynaecological surgery under general anaesthesia had subcutaneous and intrafascial wound infiltration of 40 ml, 0.25% bupivacaine (study patients) or 40 ml 0.9% saline (control) just before the end of surgery. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and peak expiratory flow rate (PEFR) were done before surgery and at 6, 12 and 24 hours postoperatively. Student's T and chi-square tests were used for tests of significance set at P < 0.05. Postoperative analgesia was provided with intramuscular morphine 0.15mg/kg 4hourly and 10mg/kg of intravenous paracetamol as rescue analgesia. PEFR, FVC and FEV1 were reduced in both the control and study groups but the reduction was greater in the control group. Bupivacaine wound infiltration produced statistically significant elevations in pulmonary function tests results at all assessment periods.
 
Article
The prevalence of obesity is on the upward trend world-wide. This epidemic has challenging implications for anaesthetists, following the anthropometric changes associated with the disease. To highlight some of the challenges, the management and the lessons learnt during the management of this patient. This is a case report of a 52-year old super morbidly obese, diabetic, and hypertensive patient that presented for total abdominal hysterectomy. Surgery was carried out under a single-shot spinal anaesthesia with bupivacaine/fentanyl. Under bupivacaine/fentanyl anaesthesia, she became very drowsy and had moderate to severe respiratory depression. She was arousable but had an obstructive sleep apnoea. Surgery was carried out successfully A better understanding of the pathophysiology and complications that accompany obesity is needed to manage an obese patient under anaesthesia.
 
Article
Background: Neck circumference (NC) measurement is one of the simple screening measurements which can be used as an index of upper body fat distribution to identify obesity. Objectives: The aim of this study was to determine the relationship between neck circumferences and obesity. Methods: A total 411 volunteer adults participated in this study (174 men, 237 women). A questionnaire which consisted of anthropometric measurements and demographic features was used. Patients with NC ≥37 cm for men and ≥34 cm for women require evaluation of overweight status. Results: The percentages of the men and women with BMI ≥ 25 kg/m(2) were 55.2% and 27.0% respectively and with high neck circumferences were 85.1% and 38.8%, respectively. The percentages of the men and women with high waist circumference were 31.6% and 79.3%, respectively. In both gender there were positive significant correlations between neck circumference, body weight (men, r=0.576; women, r=0.702; p=0.000), waist circumferences (men, r=0.593; women r=0.667; p=0.000), hip circumferences (men, r=0.568; women, r=0.617; p=0.000) and BMI (men, r=0.587; women, r=0.688; p=0.000). Conclusions: This study indicates that NC was associated with body weight, BMI, waist and hip circumferences and waist/hip ratio for men and women. A significant association was found between NC and conventional overweight and obesity indexes. NC was associated with waist/hip ratio for men and women.
 
Past medical history versus tubal occlusion 
Article
Pelvic infection, unsafe abortion and previous laparatomy are risk factors for tubal infertility among Nigerian women. Reports on the relationship between these factors and tubal pathology seen on hysterosalpingography (HSG) from our environment have been few. To assess the prevalence of tubal occlusions among patients referred for HSG and examine the association between previous history of abdominopelvic surgery (including dilatation and curettage for abortion) and tubal occlusion. We studied one hundred and thirty women referred to the Radiology department for HSG because of infertility. HSG was performed during the early proliferative phase of the menstrual cycle. Information about type and duration of infertility, history of abdomino -pelvic surgery and history suggestive of previous pelvic infection, were obtained from the patients. The data obtained were analyzed using SPSS version 11. Test of association using the chi-square test was done where appropriate and differences were considered at p= 0.05. Sixty one women had bilaterally patent tubes; tubal pathology was seen in sixty nine women. Significant association exits between tubal pathology and history of pelvic surgery p=0.01, pelvic infection p=0.02 and duration of infertility p=0.04. Previous surgery especially dilation and curettage, PID duration and type of infertility are associated with tubal pathology among Nigerian women. Creative methods of lowering the cost of diagnosis and management of tubal occlusion need to be instituted.
 
Influence of demographic and social characteristics on the prevalence of enuresis 
Article
There is significant variability of the age at which children achieve dryness. We determine the age at achievement of micturational dryness and attitude of parents about enuresis among urban Nigerian children. A total of 346 questionnaires were administered to parents of children between the ages of 12 - 180 months who came for routine paediatric care at the outpatient unit of Federal Medical Centre, Abeokuta. At age 36 months, 86 (51.8 %) and 34 (20.5 %) out of 166 children had achieved dryness at daytime and night time respectively. Achievement of dryness was significantly related to low maternal education (p = 0.022) and low social class (p = 0.009). Twenty-four (26.7 %) children had nocturnal enuresis. Four (4.4 %) of these children also had diurnal enuresis. All the parents/guardians were aware about enuresis but only 9.8 % correctly identified it as a health problem. Even though none of the children with enuresis ever visited health facility for their problem, a statistically significant proportion of the parents desire to discuss with health practitioners (p = 0.015). The proportion of children achieving dryness by age 36 months is very small when compared with children from developed parts of the world. There is also a high prevalence of enuresis which are not reported. Therefore, health workers in the tropics should as a routine enquire about enuresis in their daily paediatric care particularly for those children from polygamous homes and high social class.
 
Article
Anaemia in pregnancy is a common problem in most developing countries and a major cause of morbidity and mortality especially in malaria endemic areas. In pregnancy, anaemia has a significant impact on the health of the foetus as well as that of the mother. 20% of maternal deaths in Africa have been attributed to anaemia. This study was therefore carried out to determine the prevalence of anaemia among pregnant women receiving antenatal care in two hospitals and a traditional birth home in order to obtain a broader prevalence data. Pregnant women were enrolled in the study at their first antenatal visit and were monitored through pregnancy for anaemia. Packed cell volume (PCV) was used to assess level of anaemia; Questionnaires were also administered to obtain demographic information. Three hundred and sixty five (76.5%) of the women were anaemic at one trimester of pregnancy or another. Anaemia were more prevalent among primigravidae (80.6%) than the multigravidae(74.5%)(P>0.05). Two hundred and eleven women (57.8%) had moderate anaemia while 147 (40.3%) had mild anaemia and 7(1.9%) were severely anaemic (5 (71.4%) of which were primigravidae). All severely anaemic women were under 30 years old. Women attending TBH for antenatal care were found to be more anaemic (81.2%) (Even at various trimesters of pregnancy) than those attending the hospitals (72.5%) (P<0.05). However, in all the antenatal centers more women were anaemic in the 2(nd) trimester of pregnancy. Forty-seven (9.8%) of the enrolled women booked for antenatal care in the first trimester, while 303(63.5%) booked in the second trimester and 127(26.6%) in the 3(rd) trimester of their pregnancies. 62.5% of these women were already anaemic at the time of antenatal booking, with a higher prevalence among the primigravidae (69.7%)(P < 0.05). Absence of symptoms of ill health was the major reason for late antenatal booking. Anaemia was higher among unemployed women and those with sickle cell traits. Educating women on early antenatal booking and including those in TBHs in health interventions is necessary to reduce the problem of anaemia in pregnancy in Nigeria.
 
Percentage distribution of parasite species among food vendors 
Percentage parasite distribution between adult and children food vendors. 
Article
Ingestion of infective eggs and cysts of faecal orally transmissible parasites has been linked with the level of environmental and personal hygiene. The possibility of contamination of food with eggs and cysts by infected food vendors has also been recorded. This study was aimed at assessing the prevalence of parasites with direct transmission and the level of hygiene among food vendors. Stools of randomly selected food vendors selling in schools and streets in Abeokuta were examined for ova and cysts of parasites using formo-ether concentration method. Questionnaires, interviews, and field observation were also used to assess the activities of food vendors. Ninety-seven (97%) percent of the food vendors were infected with one or more faecal-orally transmissible parasites while 3% were free from such parasites; Parasites observed were Entamoeba histolytica with a prevalence of 72% Ascaris lumbricoides (54%), Enterobius vermicularis (27%), Trichuris trichiura (24%) and Giardia duodenalis (13%). School food vendors recorded lower prevalence of infection (92%) than the street food vendors (98.7%) (P>0.05) Fifty-two percent (52%) of the food vendors have dewormed in the last four years; Eighty percent (80%) of this were school food vendors. Infections with helminthes were recorded in 63.5% of the dewormed food vendors. Food vendors involved in child care activities were found to be more infected than those not involved in such activities. Toilet facilities available to the vendors were mainly pit latrine and other related structure (75%) while 25% had access to water system closets. During hawking, dung hills were majorly used for defaecation. Hand washing after defaecation did not include the use of soap in the few vendors that were involved in hand washing. There is need to enact food handling policies and implementation of such policies ensured in order to reduce transmission of oral faecal parasites.
 
Article
Multi-drug resistant Escherichia coli has become a major threat and cause of many urinary tract infections (UTIs) in Abeokuta, Nigeria. This study was carried out to determine the resistant plasmids of multidrug resistant Escherichia coli isolated from (Urinary tract infections)UTIs in Abeokuta. A total of 120 Escherichia coli isolates were obtained from urine samples collected from patients attending inpatient and outpatient clinics presenting UTI; with their biodata. Antibiotics susceptibility was performed and multi-drug resistant isolates were selected for plasmid profiling. Plasmids were extracted by the alkaline lysis method, electrophoresed on 0.8% agarose gel and profiled using a gel-photo documentation system gel. Escherichia coli isolates obtained shows high resistance to cloxacillin (92.5%), amoxicillin (90.8%), ampicillin (90.8%), erythromycin (75.8%), cotrimoxazole (70.0%), streptomycin (70.0%) and tetracycline (68.3%) while 85.8% and 84.2% were susceptible to gentamycin and ceftazidime respectively. Sixteen Escherichia coli strains were observed to be resistant to more than two classes of antibiotics. The resistant plasmid DNA was detectable in 6(37.5%) of the 16 multidrug resistant Escherichia coli having single sized plasmids of the same weight 854bp and were all resistant to erythromycin, cefuroxime, cloxacillin, amoxicillin, ampicillin and cotrimoxazole. This study has highlighted the emergence of multidrug resistant R-plasmids among Escherichia coli causing urinary tract infections in Abeokuta, Nigeria. There is a high level of resistance to many antimicrobials that are frequently used in Abeokuta, Nigeria.
 
the association between sex, obesity, physical activity and abnormal lipid level 
Article
In many developing countries overweight, obesity and obesity-related morbidity are becoming a problem of increasing importance. Obese individuals are more likely to have elevated total cholesterol, triglycerides, low density lipoprotein (LDL) cholesterol and decreased high density lipoprotein (HDL) cholesterol. To determine the prevalence of obesity using the measure of body mass index (BMI) and abnormal lipid level and the association between obesity and abnormal lipid level among adults in Ogbomoso, Nigeria. A cross-sectional descriptive study of 400 adults aged 18 years and above was carried out at the Baptist Medical Centre, Ogbomoso, Nigeria. Participants were administered a standardized questionnaire and had measurements of weight, height and blood lipids taken. Four hundred subjects were randomly selected (221 females and 179 males) with a mean age of 48.65 ± 16.56 years. The overall prevalence of obesity was 14.75% (8.9% for males and 19.5% for females p<0.05). The female subjects were significantly more sedentary than the males (50.8% for males, 62.4% for females, p<0.05). Most of the subjects who were obese (88.1%) preferred high calorie food. The overall prevalence of abnormal lipid levels was 28.5% (26.8% for males and 29.9% for females). The prevalence of abnormal lipid levels among the subjects who were obese was 40.7%. Obesity in this environment is particularly significant among females and is associated with abnormal lipid level.
 
Article
Abnormal haemoglobin variants (HbSS,AS,AC,SC,etc) have been known to be common among blacks. Patients with sickle cell disease are often faced with the risk of alloimmunization from allogeneic blood transfusion. The study was designed to sample students population of African descents for the purpose of updating information on the prevalence of abnormal haemoglobin variants, ABO, and Rh blood groups and compare the results with previously published data. Standard electrophoretic and haemagglutination techniques were employed in testing the blood samples. Of the 620 students screened, 80.32% were HbAA and 19.68% HbAS. 22.9% were of blood group A, 17.10% group B, 4.84% group AB and 55.16% group O. 96.77% were Rh.D positive while 3.23% were Rh D negative. Sickle cell gene in homozygous state (HbSS) and other abnormal haemoglobin variants were not encountered in this students population,. Analysis of the students population revealed that 454(73.23%) were females while 166(26.77%) were males. Participants of the age group 26-30 years (35.7%) constituted the majority and in this age group, all blood groups were represented. There is a gradual decline in the prevalence of abnormal haemoglobin variants in our black population. The frequencies of ABO and Rh blood groups however appeared to be stable and consistent with previous published data.
 
Polymorphic chromosomal variants detected in couples with a history of recurrent pregnancy loss 
Article
Recurrent pregnancy loss (RPL) which is generally known as >3 consecutive pregnancy losses before 20 weeks' gestation is seen in 0.5-2% of women. To evaluate the association of parental and fetal chromosomal abnormalities with recurrent pregnancy loss in our area and to analyze the frequency of three types of hereditary thrombophilia's; (MTHFR C677T polymorphisms, FV Leiden G1691A mutation and Prothrombin (factor II) G20210A mutation) in these female patients. The present case-control retrospective study was performed between February 2007 and December 2011 on 495 couples, who had two or more consecutive pregnancy losses before 20 weeks' gestation. We used conventional cytogenetic analysis and polymerase chain reaction-restriction fragment length polymorphism. Parental chromosomal abnormality was detected in 28 cases (2.8% of all cases, 5.7% of the couples) most of which (92.9%) were structural abnormalities. All of the structural abnormalities were balanced chromosomal translocations. Chromosomal analysis performed from the abortion materials detected a major chromosomal abnormality in 31.9% of the cases. The most frequently observed alteration in the hereditary thrombophilia genes was heterozygote mutation for the MTHFR C677T polymorphisms (n=55). Balanced translocations are the most commonly detected chromosomal abnormalities in couples being evaluated for recurrent pregnancy loss and these patients are the best candidates for offering prenatal genetic diagnosis by the help of which there is a possibility of obtaining a better reproductive outcome.
 
Article
During the 2001 election campaign, President Yoweri Museveni announced he was abolishing user fees for health services in Uganda. No analysis has been carried out to explain how he was able to initiate such an important policy decision without encountering any immediate barriers. To explain this outcome through in-depth policy analysis driven by the application of key analytical frameworks. An explanatory case study informed by analytical frameworks from the institutionalism literature was undertaken. Multiple data sources were used including: academic literature, key government documents, grey literature, and a variety of print media. According to the analytical frameworks employed, several formal institutional constraints existed that would have reduced the prospects for the abolition of user fees. However, prevalent informal institutions such as "Big Man" presidentialism and clientelism that were both 'competing' and 'complementary' can be used to explain the policy outcome. The analysis suggests that these factors trumped the impact of more formal institutional structures in the Ugandan context. Consideration should be given to the interactions between formal and informal institutions in the analysis of health policy processes in Uganda, as they provide a more nuanced understanding of how each set of factors influence policy outcomes.
 
The effect of the methanolic leaves extract of A. aspera on the uterine weight of OVX rats 
Effect of the methanolic leaves extract of A. aspera on ovarian steroids of rats 
Article
The practice of traditional medicine for the control of fertility in rural Ethiopia is based on folk use of numerous antifertility herbs and Achyranthes aspera is one of these used for this purpose. Many plants are known to possess anti-fertility effect through their action on hypothlamo-pituitary-gonadal axis or direct hormonal effects on reproductive organs resulting in inhibition of ovarian steroidogenesis. The present study focused to investigate the effect of methanolic leaves extract of Achyranthes aspera L. on some indicators for anti-fertility activities such as abortifacient, estrogenesity, pituitary weight, and ovarian hormone level and lipids profile in female rats, in attempt to validate the traditional claim. The abortifacient effect of the methanolic extract of the leaves of Achyranthes aspera was determined by counting the dead fetuses in vivo. Effect on estrogenesity was assessed by taking the ratio of the uterine weight to body weight. The ratio of the pituitary weight to body weight was also calculated. The effect of the extract on the level of ovarian hormones and lipid profile was evaluated using electrochemiluminescence immunoassay. The extract showed significant (p<0.05) abortifacient activity and increased pituitary and uterine wet weights in ovarectimized rats. The extract, however, did not significantly influence serum concentration of the ovarian hormones and various lipids except lowering HDL at doses tested. The methanolic leaves extract of Achyranthes aspera possesses anti-fertility activity, which might be exploited to prevent unwanted pregnancy and control the ever-increasing population explosion.
 
Top-cited authors
Shehab Abd El-Kader
  • King Abdulaziz University
Maud Kamatenesi-Mugisha
  • Makerere University
Hannington Oryem-Origa
  • Makerere University
James Tumwine
  • Makerere University
Olufunmilayo I Fawole
  • University of Ibadan and University College Hospital, Ibadan