East African Journal of Public Health

Tuberculosis (TB)-human immunodeficiency virus (HIV) co-infection is an important public health problem. Diagnosis of TB in children usually follows discovery of an adult case, and relies on clinical presentation, sputum examination and chest radiograph. However, clinical features are non-specific, chest radiographs are difficult to interpret, and routine laboratory tests are not helpful. The aim of the current study was to determine the prevalence of TB in HIV-infected children below 14 years attending a tertiary hospital. A cross-sectional study was conducted in HIV-infected children below 14 years of age at Muhimbili National Hospital, in Dar es Salaam, Tanzania, between July 2008 and January 2009. Information on socio-demographic and anthropometric characteristics was collected using a structured questionnaire. Following assessment of clinical presentation, physical examination, tuberculin skin test, and chest radiograph were performed for each child. Two consecutive sputum specimens and blopd sample were collected for microscopy and culture, and CD4 T-lymphocyte percentage test, respectively. Chi-square test was used to compare differences in proportions. Odds ratio (OR) and their 95% confidence interval (CI) are presented as the risk estimator. Of 182 HIV-infected children enrolled in the study, 104 (57.1%) were males. Overall, thirty-seven (20.3%) children had TB. The prevalence of TB was highest in males (78.4%) compared to females (p = 0.003). There was a higher proportion of TB (45.9%) in the age group below 24 months compared to other age groups (p = 0.001). Male gender, history of positive TB contact and severe immunosuppression were found to be significant risk factors for TB while use of antiretroviral therapy was found to be associated with decreased risk for TB. One-fifth of children had TB/HIV co-infection. Presence of four or more clinical manifestations and a low CD4+ T-lymphocyte percentage can be used to predict active TB in HIV-infected children.

To determine the oral health knowledge and oral hygiene practices among school children in the study region This was a descriptive cross-sectional study carried out among primary school going children in Kapsaret Educational division, Uasin-Gishu District, Kenya. A researcher administered questionnaire was used to determine the oral health knowledge and practices in a random sample of 401 students in the period March to June 2002. 92% of the students claimed they brushed their teeth. About 48% brushed at least twice daily. More students (59.1%) reported using the chewing stick compared to those using commercial toothbrushes (p = 0.000).Female students brushed more frequently than their male counterparts (p = 0.000, chi2 = 24.65). 39.9% of the students knew the cause of tooth decay, 48.2% could state at least one method of prevention, while 16.5% knew the importance of teeth. Use of toothpaste was reported by 38.9% of the students. Less than half of the students knew the causes of tooth decay and how to prevent it. Only about half of the students brushed their teeth twice daily with the chewing stick being more frequently used. There is need to increase the oral health knowledge through well Planned school based oral health education programmes in the primary schools. This would hopefully lead to improvement on the oral hygiene practices.

A cross-sectional comparative study based on secondary data of 18 Demographic Health Surveys (DHS) carried out in Sub-Saharan Africa starting from 2003 was conducted to assess the protective effect of male circumcision from HIV infection and STDs. From all surveys, information on 70,554 males aged 15-59 years was extracted. The association between male circumcision and HIV infection and STD symptoms (Genital discharge or genital ulcer/sore) was assessed using binary logistic regression. Adjustment was made for sexual history and basic sociodemographic variables. The weighted prevalence of HIV among men 15-59 years was 3.1%. In the bivairate analysis being uncircumcised was significantly associated with risk of HIV with Odds Ratio (OR) of 4.12 aged (95% CI: 3.85-4.42). The association was even more significant, 4.95 (95% CI: 4.57-5.36), after adjustment for number of lifetime sexual partners and socio-demographic variables. The risk associated with uncircumcision is significantly lower among younger men aged 15-29 years than those in 30-59 years age category. About 5.5% of the study subjects reported either genital discharge or genital sore/ulcer in the preceding 12 months of the surveys. Circumcision was not significantly associated with either of the symptoms of STD with adjusted OR of 1.07 (95% CI: 0.99-1.15). The study concludes that male circumcision provides a strong protection against acquisition of HIV infection. Hence, it can be considered as a possible way of reducing the spread of HIV infection in areas where the practice is rare. A comprehensive study to assess the association between circumcision and different types STDs is recommended.

To determine the prevalence of alcohol consumption in Temeke district by social demographic characteristics. Population-based cross-sectional study was conducted in Temeke district involving persons above 15 years of age. We selected Keko ward for the study and simple random sampling procedure was used to select clusters of ten-cell leaders. All households in the selected ten-cell leaders were included in the study sample. The study was cleared by the Ethical Clearance Committee of the Muhimbili University of Health and Allied Sciences, Dar es Salaam. Chi-squared (chi2) test for contingency tables was used to assess statistical significance and the results were considered significant if p-value was less than 0.5. A total of 246 persons participated in the survey and of these 22% (54) were alcohol drinkers. The age group 25-35 years showed a high prevalence with a male preponderance. There was no difference in the drinking pattern between single and married subjects with 20.1% and 22% respectively. On education basis, 22.1% of primary school leavers drank alcohol. Teachers and businessmen drank alcohol more than other occupational groups with 33.3% and 25.6% respectively. Bad health effect was the most perceived alcohol related problem occurring in 65.4% of all the respondents. It was concluded that alcohol consumption was low in Temeke as compared to other regions and was seen more in males than females and bad health effect was the most perceived problem resulting from alcohol consumption. We recommend that similar studies should be done in other districts of Dar-es-Salaam to validate our findings.

To determine the prevalence of HIV-1 infection in Pemba and Zanzibar islands We used an interviewer-administered questionnaire that consisted of pre-coded and open-ended questions consisting of 29 items. The questionnaire was developed in English and translated into Swahili language before use. The questionnaire was pilot tested and modified before use. A total of 30 Shehias were randomly selected for the survey out of a total of 248 Shehias. A Shehia is the smallest government administrative unit in Pemba and Zanzibar that consists of two to three villages. The study sample was obtained through cluster random sampling of 76 households from each Shehia. Informed consent was sought from the Head of household and from each potential eligible participant. Eligibililty criteria included all persons aged 12 years and above who slept overnight in the selected household at the time of the study. Exclusion criteria included non-residents of Zanzibar and Pemba such as tourists, Informed consent from persons below the age of 18 years were witnessed and ratified by their parents, guardians, caretakers or neighbours. All consenting participants were included in the study sample. Blood sports were collected using filters and tested for HIV-1 using ELISA test at the Zanzibar Reference Laboratory. Samples found positive for ELISA were subjected to a 2nd ELISA test. The total number of persons who participated in the survey was 5852 out of 5868 eligible persons giving the overall response rate of 99.7%. Of the 5852 persons who participated in the survey, 41% (N = 2414) were males and 59% N = 3455) were females. The overall mean age of the study population was 30.4 years with age ranging from 12-65 years. The overall prevalence of HIV-1 infection was 0.6% with more women being significantly affected than men (0.9% versus 0.2%; adjusted OR = 2.88, 95% CI = 1.16-7.12). Of the 5852 persons who participated in the survey, 5.7% admitted having had casual partner in the past 6 months and of these 19.6% reported having used a condom during the most recent casual sex. We conclude that HIV-1 infection in Zanzibar is still low and women are more affected than men.

To estimate the prevalence of environmental tobacco smoke (ETS) inside or outside the home among school-going adolescents in Kampala, Uganda. Data from the Kampala Global Youth Tobacco Survey (GYTS) of 2002 was used. We estimated frequencies and proportions of self reported exposure to ETS by the study participants. With logistic analysis, we assessed the association between ETS (outcome) in the home or outside the home and the following variables: sex; parental smoking status; and whether best friend was a smoker or not. Of the 2427 non-smoker teenagers who participated in this study, 52.8% were females, 17.9% were exposed to ETS at home while 48.7% were exposed to ETS outside of the home. The majority of the participants (65.8%) were in favour of banning smoking in public places such as in hotels, taxi, in schools, on playgrounds, in discos, markets, and shops. Compared to female participants, males were more likely to be exposed to ETS outside of the home (OR=1.21; 95% CI (1.02, 1.441). Having parents and close friends who smoked cigarettes was positively associated with exposure to ETS at home or outside of the home. Responders whose parents smoked cigarettes were more than four times likely to be exposed to ETS at home than those whose parents were non-smokers (OR=4.88; 95% CI [3.76, 6.33]). Cultural factors may expose boys to ETS than girls. We also found that having parents who were smokers exposed adolescents to ETS outside the home and having best friends who smoked exposed adolescents to ETS. This may suggest that adolescents who are exposed to ETS in one way may also be at risk of exposure through other means.

Communicable disease outbreaks cause millions of deaths throughout Sub-Saharan Africa each year. Most of the diseases causing epidemics in the region have been nearly eradicated or brought under control in other parts of the world. In recent years, considerable effort has been directed toward public health initiatives and strategies with a potential for significant impact in the fight against infectious diseases. In 1998, the World Health Organization African Regional Office (WHO/AFRO) launched the Integrated Disease Surveillance and Response (IDSR) strategy aimed at mitigating the impact of communicable diseases, including epidemic-prone diseases, through improving surveillance, laboratory confirmation and appropriate and timely public health interventions. Over the past decade, WHO and its partners have been providing technical and financial resources to African countries to strengthen epidemic preparedness and response (EPR) activities. This review examined the major epidemics reported to WHO/AFRO from 2003 to 2007. we conduct a review of documents and reports obtained from WHO/AFRO, WHO inter-country team, and partners and held meeting and discussions with key stakeholders to elicit the experiences of local, regional and international efforts against these epidemics to evaluate the lessons learned and to stimulate discussion on the future course for enhancing EPR. The most commonly reported epidemic outbreaks in Africa include: cholera, dysentery, malaria and hemorrhagic fevers (e.g. Ebola, Rift Valley fever, Crimean-Congo fever and yellow fever). The cyclic meningococcal meningitis outbreak that affects countries along the "meningitis belt" (spanning Sub-Saharan Africa from Senegal and The Gambia to Kenya and Ethiopia) accounts for other major epidemics in the region. The reporting of disease outbreaks to WHO/AFRO has improved since the launch of the IDSR strategy in 1998. Although the epidemic trends for cholera showed a decline in case fatality rate (CFR) suggesting improvement in detection and quality of response by the health sector, the number of countries affected has increased. Major epidemic diseases continue to occur in most countries in the region. Among the major challenges to overcome are: poor coordination of EPR, weak public health infrastructure, lack of trained workers and inconsistent supply of diagnostic, treatment and prevention commodities. To successfully reduce the levels of morbidity and mortality resulting from epidemic outbreaks, urgent and long-term investments are needed to strengthen capacities for early detection and timely and effective response. Effective advocacy, collaboration and resource mobilization efforts involving local health officials, governments and the international community are critically needed to reduce the heavy burden of disease outbreaks on African populations.

This study examined the safe-delivery practices and its associated factors among rural Bangladeshi women. Cross-sectional survey data from Bangladesh Demographic and Health Survey (BDHS) 2004 were used. Rural Bangladesh. A total of 3874 ever-married rural women age 10-49 years. Measurements: Age, education, working, religion, clinic visit, association with media, place and types of attendants at delivery. About 94% deliveries took place at homes and 67% were assisted by the untrained traditional birth attendants called Dai. The qualified doctors and nurses (professionals) assisted only 9% of the deliveries while about 13% are by the trained traditional birth attendants. Age group has a significant effect on safe-delivery practices. Education of the respondents as well as their partner's has direct effect on delivery practices. The uneducated women were less likely to have their delivery assisted by the medically trained persons (MTPs) while women with 10 or more years of schooling had 29 times higher probability than the uneducated women. Currently working and religion had also statistically significant. Mass media influences directly delivery practices in rural areas. The women who listen to radio and watch television had more than 2 times higher probability of having delivery assisted by MTPs than that of non-user counterparts. There is more than 4 times higher chance of delivery assisted by the MTPs than that of women with no reading of news papers or magazines. Delivery practices in rural Bangladesh are unsafe, took place at homes, conducted by untrained traditional birth attendants and associated positively with demographic, socio-economic, cultural and programmatic factors.

The present study was carried out with the aim of evaluating the epidemiology of Chikungunya virus (CHIKV) in Vellore district and also to identify the most susceptible sex and age group to CHIKV infection. About 100 positive blood samples were collected from various localities Vellore, Katpadi, Thiruvallam, Sathuvachari and Gudiyatham in Vellore district and analysed. The total RNA was isolated from these infected blood samples and transcribed into its cDNA. The E1 gene of CHIKV was amplified and subsequently sequenced. A Phylogenetic analysis was carried out with the resultant sequence. Also the RNA secondary structure and restriction sites in the E1 gene of CHIKV were predicted using the softwares Genebee and NEBCutter, respectively. A survey on the outbreak of Chikungunya fever in and around Vellore district was carried out with the aim of identifying the most susceptible sex and age group to Chikungunya viral infection. The results of the present study based on the phylogenetic analysis and BLAST studies revealed that the E1 gene sequence of CHIKV under investigation showed 87% similarity with that of the sequence of the CHIKV strain AR18211. This study has thus revealed that the major strain responsible for the outbreak of Chikungunya fever in Vellore district was "AR18211" strain, an African genotype. Also the survey on CHIKV fever revealed the most susceptible age group to be between 20-40 years and the infection to be predominant among the male population.

A report of suspected anthrax was submitted by the Kasese District Health Office to the Epidemiology Surveillance Division of Ministry of Health. A joint team comprising officers from MOH, IPH and MPH officers proceeded to the district to investigate the reported threat of anthrax. The investigations were conducted in Bwera HSD, Bukonjo West County, in communities bordering Queen Elizabeth National Park. The main objectives of the study were to verify the existence of anthrax and assess the risk factors for the suspected outbreak of anthrax in Kasese district. The methods involved discussion with the DHT members; reviewing the surveillance data and hospital records, and reorienting the case definitions to the specific type of anthrax. In addition tracing the reported cases in the community in order to establish exposure to the risk factors and sensitize the community. Cutaneous anthrax was clinically diagnosed as the cause of the reported anthrax, both from the medical records and observation of cases found during the investigation. The index case was a 44 year old male, from Hurukungu village, Kyempara parish, a household with one wife and 4 children. This case skinned a goat that had died under mysterious circumstances and the meat was eaten with family members. Two other cases were members of the same family and the fourth case was from the same community and bought meat from the index case. All the four cases presented with a history of blister like lesions that eventually ulcerated with swelling of surrounding skin in different parts of the body. There were no other systemic symptoms reported in all the cases. All the suspected cases received antibiotics to which anthrax is sensitive. There were no laboratory investigations done by the time of the investigations since many of the cases identified were already on treatment and recovering from the infection, therefore no samples were taken from them. Review of records revealed that reporting of anthrax has continued since the year 2005 with cases ranging from I to 4 from villages that shares a common boarder with Queen Elizabeth National Game Park. This particular outbreak was associated with eating of meat from a goat that had died of unknown cause. The health workers from the health units where cases were reported were found to have the basic knowledge and skills to suspect anthrax. However, they had no guidelines to help them identify cases of anthrax accurately. The available Standard Case Definition (SCD) booklets, IDSR Technical Guidelines, and laboratory SOPs have no information on anthrax. No samples have ever been removed from suspected cases for laboratory investigation. The health units have the appropriate antibiotics for treatment of suspected case. The Local Council Chairpersons, Veterinary extension workers, and the health educators have sensitized the community in the past against eating dead animals and that they should notify the authorities, and bury all dead animals immediately. However this hasn't yet been done for the current outbreak. The outbreak of anthrax in Bwera sub-county followed eating of meat from a goat which had died from unknown causes. Suspected cases have not been confirmed by laboratory but treated empirically with antibiotics. All new cases of suspected anthrax that report at the lower health units without laboratory facilities should be referred to hospital for investigation to confirm the diagnosis. There is need to include guidelines on anthrax in the SCD Booklets, laboratory SOPs and IDSR technical guidelines. Resensitization of the affected communities about the prevention of anthrax should be done immediately.

Young people in Kenya engage in unprotected sexual intercourse with resultant high rates of unwanted pregnancy, STIs and HIV infection. To formulate effective and acceptable approaches that encourage safer sexual behavior, we need to understand young people sexual behavior. We thus conducted a study to determine prevalence and factors influencing consistent condom use among youths in Kenya. We carried out a cross-sectional study at the Youth Friendly Centre of Provincial General Hospital in Nakuru town. A self-administered questionnaire was used to collect data from persons aged 15 to 24 years using systematic random sampling method. Subjects who self reported positively on all three variables i.e." ever condom use", "condom use within the last three months", and "condom use during the last sexual encounter" were defined as "consistent condom users". Data analysis was performed using Chi-square test with alpha level of significance at 0.05. Among the 223 enrolled subjects 196 (87%) were sexually active. The prevalence of consistent condom use was 36%. independently promoters of consistent condom use were; talking with parents about condom (OR = 2.65; 95% CI = 137-5.12; p = 0.004); attaining college level education (OR = 2.55; 95% CI = 132-4.94; p = 0.006) and having multiple sexual partners (OR= 2.05; 95% CI = 1.01-4.16; p = 0.048). Belief that condom diminishes pleasure (OR = 0.50; 95% CI = 0.26-0.96; p = 0.037) and last sexual partner being a spouse (OR = 0.36; 95% CI = 0.13-0.97; p = 0.044) were independent hindrances to consistent condom use. Majority of youths are sexually active with few of them not consistently using condom. Parents should be informed on the sexual behavior of the youth inorder to discuss about safer sexual behavior with their youths while encourage abstinence or postponement of sexually activity. Youth peer education need to be strengthened to foster safer sexual behaviors.

The aim of this study was to determine factors associated with completion of immunization as an input in to strategies to raise the immunization coverage in Tanzania. This study used a panel data collected over four survey rounds at a minimum of six months apart to determine the causes of failure to complete immunization in Tanzania. The data were collected during between 1991 and 1994 in Kagera region Tanzania among children 12-23 months old. Data analysis was done using Statistical Analysis Software (SAS) version 9.1. Pooled logistic regression was used to determine the likelihood odds ratio of completing immunization. The study observed 550 children contributing 1541 children observation rounds across all panels. Immunization coverage was 87.7 percent and factors that significantly (p<0.05) increasing completion of immunization were having more than three under five children, high mother's education, being urban, road passable through out the year and high economic status. If head of household was a female compared to male it significantly reduced the odds of completing immunization. Strategies to improve immunization coverage have to give priority to households headed by a female, poor and those with poor access to health care.

The main objective of this cross-sectional study is to assess higher education students' attitudes, their practice on preventive measures against HIV/AIDS; and examined factors affecting attitude and practice of the students related to HIV/AIDS prevention. The 606 study participants were drawn from Addis Ababa University, which is the oldest and biggest public university in Ethiopia, through multistage sampling. Data were collected using survey quantitative (questionnaire) and qualitative (FGDs), and subsequently, analysis of the data was made through the use of descriptive statistics (Frequency and logistic regression model). The findings of the study revealed that 207 (34.2%) of respondents were sexually active during the survey. Of these, 144 (23.8%) of them had sexual intercourse with their partner or someone in the last 6 months. The mean and median age at first sex debut was computed as 17.8 and 18.0 years respectively. About 489 (80.7%) did not perceive being at risk of contracting HIV/AIDS. But 65.5% of the respondent had favorable attitude on HIV prevention. 359 (59.2%) of the respondents had experienced at least one of the three HIV prevention practice. Of which, more than half (52.4%) adopted abstinence as top preventive measure. The result also showed that out of the total respondents 47.2% had been tested for HIV/AIDS and more than 80% have willingness to take VCT service for HIV/AIDS. As to the multivariate analysis result; sex, previous residence, religious participation, pornographic viewing, currently alcohol intake, chewing khat and cigarette smoking were found to be determinant of AAU students' attitude on HIV prevention. Similarly, age, having pocket money, pornographic film show and currently khat chewing were determinants of practices on HIV prevention. Finally, based on the findings, the study has forwarded some workable recommendations.

The hazards of smoking in relation to lung cancer can never be over emphasized. In recent times shortly after Ebonyi State was created in 1996, the capital territory has increasingly been polluted by either quarry operators, motorcycle (Okada) riders or reckless cigarette smokers and bush burning. To investigate the havoc caused by all these on people, questionnaire was distributed among smokers and non smokers in various areas of specialization and habitations. In measuring the significance of association and the degree of association, a chi2 test and odds ratio method of analysis was employed. The result of the analysis showed that non-smokers do suffer lung cancer. It also revealed that the chances of a smoker to have lung cancer is 1.765 times higher than that of a non-smoker. Analysis also showed that lung cancer depends on age of smokers. It was later discovered that middle aged population are mostly affected, by the reason of chi2 partitioning. This research recommends that proper disposal of smoke by industrialists should be encouraged. In addition, there should be a legislation of indecent smoking habit. The purpose of this work is to measure the association between smoking and lung a cancer in a Nigerian population where Abakaliki Urban is taken as sampled population.

To assess the level of regard and misconceptions of modern family planning methods in Abraka communities. The interviewer's administered questionnaire method was used to gather the required information from 657 respondents randomly chosen from PO, Ajalomi, Erho, Oria, Otorho, Umeghe, Urhuoka and Uruagbesa communities in Abraka kingdom. Results show that 75.3% of those interviewed were aware of modern family planning but only 42.9% were using it to plan their families. Those using condom, safe periods and withdrawal constitute 32.6% of the 42.9% figure. Thus, data indicate a fairly high degree of awareness but little regard for family planning. Campaigns should be organized in order to educate Abraka communities on the benefits and need for family planning. Government should provide quality, comprehensive and subsidized family planning services. In addition, research efforts should be intensified on how to take advantage of the traditional methods of family planning to systematically introduce the modern method, so as to gradually eliminate the associated bias and misconceptions associated with modern methods of family planning.

Use of illicit substances of abuse is a major public health problem in developed countries like the US. However, this problem of illicit substance use has spread like a tumor to include currently developing countries where most of its youths and adolescents are actively engaged in this illegal practice. This problem is even more worse in poor resource countries, as use of these substances is accompanied with a lot of HIV- risk behaviours, and for cocaine and heroin drug injectors often share injecting equipments hence increasing the chances of contracting and spreading HIV infection. Apart from HIV infection, other infections include hepatitis B, C, abscesses and other ill-health problems such as drug dependence manifested with complex set of behaviours related to mental illnesses. For non-drug injectors, the chances of contracting and spreading HIV through their unsafe/unprotected sexual behaviours especially those having multiple partners is there. Use of these illicit substances have other consequences like compromising the dosing schedule or adherence / poor compliance to ARTs/ARVs among those enrolled. Furthermore, use of illicit substances may be accompanied with domestic sexual violence which is done without using any protective (condoms) measures) leading to HIV/AIDS and unplanned pregnancies. However, various studies and preventive approaches have been tried in the US on drug abusers in order to prevent the associated adverse health outcomes. There are many reasons why people use drugs. In many situations, drugs are being used as artificial problem-solvers such as frustrations, stress or tiredness. Drugs can often make a problem disappear for a short time but not usually the answer for solving the problem. They just help to remove it temporarily. Other people choose to use drugs to enjoy the feelings or for recreational purposes which many drugs produce. For example, many people, especially young people, experiment with using drugs to find out more about the sensations they produce. Drug use is a problem to users when it begins to cause some damage to their physical health, mental health and social well-being. These include mental illness, diseases caused by or related to use of drugs e.g. practice of sharing needles or syringes among drug injectors and also non-drug injectors may acquire HIV/AIDS and Hepatitis, crimes and violence. However, the number of harm associated with the use of drugs is increasing in Tanzania and other developing countries in Sub-Saharan Africa and globally in developed nations like the US and many others.

The entrance surface Dose (ESD) was determined among patients who presented for routine radiological examinations using thermoluminescent dosimeter (TLD) chips placed on averagely built adult [(30 cm) chest width, 60-90kg weight and 20-40years)] by multiplying the incident dose/entrances dose by the back scattered factor [BSF] gotten from an experiment. The values obtained from ESD measurements are as follows 8.03 mGy for Abdomen, 0.13 mGy for chest AP, 0.69 mGy for chest lateral, 0.5 mGy for cervical spine; AP: 0.38 mGy for cervical spine lateral; 4.75 mGy for hip AP: 12.83 mGy for hip lateral: 5.74mGy for lumbar spine, AP lumbar spine lateral is 15.15 mGy. 1.38m Gy is for pelvis AP. 2.93mGy for skull AP/PA 1.2mGy for skull lateral, 5.46mGy for thorax AP, while the lateral is 14.90m Gy. The average dose value is 9.28mGy Range 0.13-14.90mGy (Percentage standard error; +/- 1.45). From this studies Radiation doses delivered for routine investigations are generally lower than IAEA reference doses. Using these values for optimization of radiation protection practices for patient should be ensured since it does not rule out options for stochastic radiation.

Although Voluntary Counseling and Testing (VCT) has existed for more than 10 years, majority of Kenyans still do not know their HIV status, thus necessitating the introduction of other testing strategies to increase the number of people taking the test. The routine offer of an HIV test to all patients in health-care settings has been proposed to increase access to care. The main objective of this study was to identify factors associated with willingness to accept a routine offer of an HIV test. This was a cross sectional study. The Setting was in the Outpatient department at a large Referral Hospital in Western Kenya. A total of 384 adult patients (both males and females) were recruited using systematic random sampling. Information was collected on basic socio demographic characteristics, knowledge about the routine offer of an HIV test, attitudes towards the testing and HIV testing practise. Of the 384 respondents, 64.3% were unaware about the routine offer of HIV testing in Health facilities. Multivariate analysis identified the main predictors of willingness to accept an HIV test offered in hospital as the age (OR 3.7, C.I 0.068-1.075), level of education (OR 3.4, C.I 0.186-62.602), Knowledge about the routine HIV testing (OR 4.6,C.I 2.118-9.847), self-perception of HIV risk (OR 8.4,C.I 3.424-20.496) and attitude towards routine offer of HIV testing (OR 9.2, C.I 0.042-0.284). There is a need to come up with tailored training on the routine offer of an HIV test and devising strategies to address the main factors that influence the decision for patients to test as identified above.

To assess acceptability of parents/guardians of adolescents towards the introduction of sex and reproductive health education in the community and schools. A multi-stage random sampling technique was used to get 150 participants for this study. A structured questionnaire was used to interview the sampled participants and was supplemented with guided focus group discussion in Kinondoni Municipality of Dar es Salaam, Tanzania. The analysis of the findings shows that there is a mixed feeling on the introduction of sex and reproductive health education in schools. Participants strongly supported that they should talk with their adolescents about sexuality and reproductive health (88.6%) but their culture prohibits them from doing so (76.7%). Also supported that condoms could protect against HIV/AIDS and sexually transmitted infections (82%), but strongly opposed the use of condoms to their adolescents because it would encourage promiscuity (78%). When the data were analysed by faith of the religions of the participants, 64% were in favour of introducing sex education and reproductive health, but were opposed to use of condoms to their adolescents. All participants were against vijiweni, which were recreation centres for the youths because they taught bad manners to their adolescents. The preferred source of information about sex education and reproductive health should be from the parents/guardians (86%), religious leaders (70%), media (62%), health workers (61%) and school teachers (59%). All in all the will of introduction of sex education and reproductive health in the community is there but the approach need to be worked out carefully by taking into account of the cultural and religious factors. Parents/guardians, religious leaders and traditional charismatic leaders should take part in designing the programme and even being involved in teaching it. The other option is to lump together sex education and reproductive health education in science especially in biology which is already in place in Tanzania education programmes.

The aim of this study was to assess the knowledge, acceptability and attitude towards the use of spermicides among students of University of Dar es Salaam (UDSM). This was a descriptive cross-sectional study conducted over four-month period among UDSM students. A random sample of students was recruited from all three university campus namely University College of Land and Architectural Studies (UCLAS), Muhimbili University College of Health Sciences (MUCHS) and Mlimani Campus (MC). Questionnaires with both closed and open end-questions were used for data collection in which knowledge, attitude, and acceptability of spermicides were determined. The collected data were analyzed using SPSS/PC+ version 10.0, 1999 computer package. A total of 300 students participated in this study, out of which 154 (513%) were females and 146 (48.7%) males. Majority of the students 276 (92%) had poor knowledge of spermicidal products, and out of these, 146 (53%) were absolutely unable to describe the use of spermicides. Ninety-three percent of the students had never used spermicides. Of those who had never used spermicides, 84 (30%) said because they used other contraceptive means, 50 (17.8%) said they are expensive, 29 (10.3%) attributed this to unavailability of the products, 3 (1.1%) to fear of "contracting" cancer and 13(4.6%) to the unreliability. Furthermore, a few who had used them didn't trust the products as ideal means of contraception. The respondents had poor knowledge of spermicides. Spermicides were not accepted by the students because of the presumed side-effects, being very expensive and unreliable for contraception purpose. However, the respondents accepted spermicides usage as an ideal alternative to condom and effective means for a female-controlled method to prevent/reduce unwanted pregnancy and HIV risk. The study recommends that the Government/responsible authorities should encourage spermicides usage, particularly when coupled with microbicides, in reduction of unplanned pregnancies, sexually transmitted diseases (STDs) and HIV infection inclusive.

Adolescents in Zanzibar are at risk of reproductive health problems including teenage pregnancies, STIs and HIV, early sexual debut and abortion complications. The national policy guideline of adolescents reproductive health needs parents to support and provide information on sexuality and reproductive health to their adolescents, however, Zanzibar has been observed to be a rich and splendid cultural and religious legacy country whereby information related to sexuality is an avoided topic of explicit discussion. Therefore the purpose of this study was to assess acceptability of caretakers in providing information on sexuality to adolescents in health centers, family, community and schools using information motivation behavioral skills (IMB) model. Probability 3 stages sampling technique was used to obtain a representative sample of 192 participant of the study (98 were female and 94 were male) who were interviewed with the use of structured questionnaire in Urban District, Zanzibar. About 100 (54.3%) respondents accept the provision of information on sexuality to their adolescents. Only 81 (44%) respondents reported to have knowledge on information on sexuality. Only 48(26%) respondents perceived that their adolescents are more vulnerable to get reproductive health problems, 73 (39.7%) reported to have less restrictive social norms regarding the provision of information on sexuality, 106 (57.6%) have positive attitude towards the provision of information on sexuality to adolescent and 96 (52.20%) have high self efficacy in the provision of information on sexuality. Indicators of motivation showed significant association and were the predictors of acceptability and self efficacy. The level of acceptability of caretakers in the provision of information on sexuality to their adolescents was nearly at the border line (54%). Providing information on sexuality and improve self efficacy are the most important factors to consider in the interventions of increasing caretakers' acceptability in the provision of information on sexuality to adolescents; however, creating less restrictive social norms, build up positive attitude and sensitizing on realization of feelings of vulnerability to caretakers add weight in plans to increase acceptability.

The main objective of this study was to assess equity in access to health care provision under the Medicare Security for Small Scale Entrepreneurs (SSE). Methodological triangulation was used to an exploratory and randomized cross- sectional study in order to supplement information on the topic under investigation. Questionnaires were administered to 281 respondents and 6 Focus Group Discussions (FGDs) were held with males and females. Documentary review was also used. For quantitative aspect of the study, significant associations were measured using confidence intervals (95% CI) testing. Qualitative data were analyzed with assistance of Open code software. The results show that inequalities in access to health care services were found in respect to affordability of medical care costs, distance from home to health facilities, availability of drugs as well as medical equipments and supplies. As the result of existing inequalities some of clients were not satisfied with the provided health services. The study concludes by drawing policy and research implications of the findings.

This study was conducted at EIhassahisa Locality, Gezira State in Sudan in order to assess the accessibility to health care services available in the area for children. A cross-sectional household survey was performed. The study population included families that live in the locality. A sample of 1186 household was included in the study. The households were selected by using cluster sampling technique. Data was collected from one or both parents in the selected households through in person interviews. Data was computed and analyzed by SPSS software, frequencies and proportions were calculated. There are 162 health facilities in the study area, in which all categories of health cadre provide the health services. 962 (81.1%) of the families admitted that they do not have regular access to health care services. Although the study area was found to be packed with large number of health facilities, still the accessibility rate remains low.

Home management of malaria (HMM) strategy was based on presumptive diagnosis of malaria and use of correct dose of chloroquine. However, the development of chloroquine resistant parasites in most endemic areas necessitated the recommendation of artemisinin combination therapy (ACT); and this has been demonstrated to be effective in HMM. However, the recommendation that ACT should be dispensed only to laboratory confirmed cases underscores the need to review the accuracy of mothers' presumptive diagnosis and provide evidence for a switch to parasite based diagnostic test. This was a follow-up study nested to a larger controlled intervention study carried out to assess the effect of malaria treatment guideline on mothers' adherence to correct treatment of malaria in children. In a subset, thick blood smears were prepared from finger prick blood samples of febrile children who have been presumptively diagnosed to have malaria by mothers on Days 0, 1, 2, 3, 7 and 14 to detect parasitaemia. The presumed diagnosis was compared with the presence of parasitaemia. A total of 162 children with febrile illness (88 and 74 in intervention and control groups respectively) were studied. Sixty-four (72.7%) and 62 (83.8%) of the febrile cases presumed to have malaria in the intervention and control groups respectively had parasitaemia on Day 0. The sensitivity and specificity of mothers' diagnoses was 78.1% and 29.2%; 82.3% and 8.3%; in the intervention and control groups respectively. The low specificity of presumptive diagnosis has implication for the deployment of ACT at the community level in Nigeria. This supports current views on the need for a more sensitive and specific parasite-based diagnosis of malaria before ACT treatment. Further study to compare presumptive diagnosis of malaria with malaria diagnostic test carried out at the community level is needed to inform policy on the adoption of parasite based malaria diagnosis at community level.

Sample size estimation is a major component of the design of virtually every experiment in biosciences. Microbiologists face a challenge when allocating resources to surveys designed to determine the sampling unit of bacterial strains of interest. In this study we derived a Bayesian approach with a dirichlet prior based on a pilot study in to find an adequate sample size for E. coli subtypes' determination. Five strains of E. coli (st genes, eae gene, stx1 and stx2 genes, ial gene) were used in this study. The strains were grown overnight at 37 degrees C to obtain strains in a linear growth phase, according to McFarland's score. The resulting supernatants were used as templates in the PCR reactions. Then the results used with Dirichlet Distribution as a prior to find the Bayesian optimum sample size. 100 colonies were harvested from plate and examined in the PCR reaction, 50 colonies showed no specific genes, 40 detected as eae gene (78.8%), 6 colonies stx2 gene (11.7%), 2 colonies st gene (3.9%), 2 colonies stxl2 gene (3.9%) and only 1 colony detected as lall gene (1.9%). First according to the frequentist view sample size calculated indicating a different range of sample size from 25 colonies to unusual number, 4475 colonies. Then using Bayesian approach by posterior expectations instead of pilot results sample size were fund from the range of 291 colonies to 443 colonies. The results indicated that Bayesian approach technique leads to optimal sample size with similar power in compare to traditional technique where sample size calculated without any prior information.

This was designed to provide background information for the implementation of family life and HIV/AIDS education in post primary schools in the Enugu State. A cross sectional survey of the reproductive health knowledge and practices of 412 junior secondary school pupils from 12 schools in Enugu State, Nigeria was undertaken using a uniform set of structured self-administered questionnaire. The results revealed that while the pupils demonstrated fair knowledge of human biology, they lacked knowledge of self-protective mechanisms as it related to sexual health. About (50%) of the participants reported that they have had sex, at the age of less than 11 years when they must have been in the primary school and most (89.3%) at age 11-14 years. Half (50.9%) of the respondents hold the belief that a girl would not get pregnant in her first sexual encounter. Statistically more of those who have ever had sex were betrayed this ignorance (p = 0.004). The boys were less certain about what constitutes the wrong ideas about reproductive health systems than the girls (p = 0.042). In the same vein, there was a difference (p < 0.0001) in the proportion of the rural residents, vis-a-vis their urban counterparts that could correctly identify the wrong ideas about human reproduction. This situation urgently calls for concerted efforts at addressing the poor reproductive health knowledge of these sexually active young people, for the millennium development goals (MDGs) target to be realized in Nigeria.

There is an increasing awareness of the role played by the food retail characteristics in determining individuals' healthy food purchasing and consumption behaviors. The perceived costs of healthier food alternatives have been shown to contribute negatively to individual's food choices in developed societies. However, there is still a dearth of knowledge regarding this phenomenon in low to middle income countries particularly in Africa. This study explored health club member's experiences in buying healthier food options and compared their perceived cost of selected healthier and less healthy foods with actual market costs in a South African township. A cross-sectional study design using quantitative and qualitative research methods. The study was conducted in Khayelitsha, a township in the Western Cape Province in South Africa. Participants were 50 members of a health club, mostly female and above 50 years of age. The study was conducted in three phases. The first phase involved interviews with all 50 health club members. During the second phase ten purposively selected members participated in in-depth interviews based on their unhealthy food-purchasing and consumption patterns identified in the first phase. The third phase involved food price audits from supermarkets as well as convenient stores located in the study setting. Quantitative data were subjected to descriptive statistical analysis, while content analysis was used to analyze qualitative data. Most of the members were illiterate and unemployed, largely dependent on government grants. Qualitative findings showed that low household incomes, their inability to read and interpret nutritional information and personal food preferences contributed to Health club members' unhealthy food-purchasing behaviour. When objectively measured in local stores, the healthier food options proved to be more expensive than their less healthy equivalents. This was consistent with subjects' perceptions about the relative cost of the same foods in their local stores. Healthier foods tended to be more expensive than their less healthy options in local shops audited - both in reality and in the perceptions of health club members. Low income was reported to militate against health club members' healthy food-purchasing behaviour.

A recent epidemic of acute conjunctivitis in Dar es Salaam showed again the importance of developing a strong infectious diseases epidemiological surveillance network which is effective in minimising disease outbreaks. The current misunderstanding of diseases causation and management explains the repetitive nature of acute hemorrhagic conjunctivitis (AHC) in Dar es Salaam. This article aims at increasing public awareness by elaborating two diseases (Acute Hemorrhagic Conjunctivitis and Paederus spp keratoconjuctivitis, periorbital oedema-"Nairobi red eyes") confused by many as being associated with recurrent epidemics of conjunctivitis Dar es Salaam.

It is observed that most of the commercial boreholes in Mubi Metropolis are located along River Yedzeram which is the main river that runs across the town. Unfortunately, due to the geographical location of the town in savanna region with minimal water supply, water related small scale industries such as sachet water, block making, irrigation agriculture, cloth dying, car wash and other pollution activities such as mechanical workshops and public toilets are also located along the same River Yedzeram. Moreover, the inhabitants of the town either dump their refuse in the River or spread it on their farmlands as there is no provision of refuse dump site by the government. Therefore, five parameters (Nitrate, Magnesium, Copper, Calcium and Iron) were used to test thewater quality of water samples that were collected from twenty two commercial boreholes along the river, using the standard examination of water and waste water of the World Health Organization to determine the water quality of the boreholes. The study revealed that only eight out of the twenty two boreholes are of good quality, while the others are either of bad quality or not portable. ArcGIS 9.2 and ILWIS 3.3 software were used to analyze the laboratory results through the use of SQL queries. It was recommended that the government should provide portable water, establish water quality control board and make use of GIS for creation of database and analysis.

Research has identified a relationship between birthing practices and breastfeeding initiation Continuous support during labor and delivery is a key component to increasing breastfeeding initiation. The purpose of this project was to assess the impact of labor support on breastfeeding initiation in a setting in which women receive traditional birthing support from female family members. Research was conducted at the Edna Adan Maternity Hospital in Hargeisa, Somaliland using the grounded theory method of qualitative research. Semi-structured interviews, direct observations and participant observations were conducted. A purposeful, non-statistical sample was chosen: ten women, five family members, six health care providers and five birth observations were included. The CDC EZ-Text, a software program developed by the Center for Disease Control and Prevention for use in qualitative research, was used in managing and analyzing the data. Data analysis and interpretation was conducted using micro-analysis, open, axial and selective coding procedures. The results indicated that due to cultural influences, contradictory beliefs and practices, lack of critical thinking and lack of long term planning, traditional birthing support was not always indicative of immediate breastfeeding initiation. The presence of a labor companion is a low-cost, preventative intervention that is consistent with the cultural practices of Somaliland. Breastfeeding education and support should, therefore, include a tertiary approach which includes pregnant and birthing women, labor support persons or family members and health care providers.

To describe and compare histopathological findings with clinical criteria in diagnosis of TB adenitis. Lymph node biopsies were obtained from 213 patients. Specimens were processed for culture and histopathologic examination, using standard methods. One hundred blocks with good preservation of tissue morphology were selected for detailed histological examination. About 75% of 213 patients had granulomas. In the remaining 25%, neither histopathological nor microbiological evidence of mycobacterial disease was found. Of 100 blocks selected for detailed examination, 79 blocks had granulomatous changes. The granulomas were well organised in 24%, mixed in 33%, and poorly organised in 43%. Langhans giant cells and acid-fast bacilli were observed in 88.6% and 21.5% of the 79 blocks, respectively. Cultured specimens were positive in about 10% of 79 biopsy specimens. Histological evidence of mycobacterial disease was only found in three quarters of patients that were clinically diagnosed and started on empirical treatment for tuberculous adenitis. Neither histological nor mycobacteriological evidence was found in a quarter of the patients who were already on treatment for TB, basing on clinical criteria. These findings call for new research on simple diagnostic tools for patients who seek care for s ymptoms of extra-pulmonary TB.

Tanzania is one of the nations that are highly affected by HIV/AIDS epidemic. Invention of ARVs (Anti -Retroviral) brought hope of extended life to people living with HIV/AIDS (PLHA). Though ARV's are administered in several clinics particularly in Dar es Salaam, there is a problem to adherence. Some factors associated with non-adherence are investigated and ways to optimize adherence are suggested. This study was undertaken at three treatment and care clinics in Dar es Salaam. A sample of 197 individuals on ARV and 30 health care providers were interviewed. The sample comprised of 76 % females and 24% males, with mean age 34. About 74% of individuals on ARV were aged between 25 - 45 years. Logistic Regression and survival analysis models were used in the analysis. Individuals on ARV recommended factors responsible for non-adherence as lack of awareness 63.5%, stigma 56%, side effects 53.3%, and costs 28%. Other factors were being busy 25.4%, away from home 21.3%, forgetting 12.2% and ARVs out of stock 10.2%. Proportion of PLHA lost to follow up was 26%. Awareness and side effects were found to be statistically significant, with p-values of 0.042 and 0.068 respectively (alpha = 0.1). The median survival time for individuals on ARV was 42 months (95% CI: 41-44) with survival rate of above 0.7. Log-rank test showed significant differences between the male and female on having a shorter time to death. Females seemed to survive longer than males suggesting that females adhere more to ART than males. This calls for emphasis on HIV/AIDS education to the society especially to sensitize men. Another suggestion is that when a woman gets pregnant, both the expectant mother and father should attend maternal clinic so that they both take HIV test so as to increase man's participation.

To determine ARV drug adherence levels in children (aged 3 to 14 years) attending Kericho District Hospital (KDH), Kenya. A cross-sectional design was used to collect data from a random sample of caregivers of 230 children on ARVs for a study period of six months (i.e. 1st August 2010 to 31st January 2011). The study population comprised HIV infected children on ARVs and their caregivers. The caregivers whose children met the selection criteria were selected. A structured pre-tested, interviewer-administered questionnaire was used to interview the caregivers of the HIV infected children who were selected from among those who took the children for treatment. The interview was continued on the consecutive caregivers until the sample of 230 children was attained. The key variables examined were; demographic information of caregivers and children and drug adherence levels. Measures of adherence included; drug/pill counting and estimate of volumes of syrup remaining from the last prescription, caregiver reports (on keeping clinic appointments and timing of taking ARVs by the child), and drug refill data (from pharmacy records). Data was analyzed using SPSS version 12.0.1 with statistical significance set at P < 0.05. The adherence levels based on time of taking ARV drugs was 56.1%, keeping clinic appointments 45.7%, No ARVs returned (i.e. took all drugs assessed through pill counts) 27%, and pharmacy drug refill was 47.8%. The overall average adherence level was suboptimal at 44.2%. It was recommended that caregivers of the HIV infected children should be educated on importance of strict adherence to prescribed doses of ARVs to the children. Future research should explore using multiple measures of adherence and reasons for non-adherence among HIV infecting children. The drug adherence level was sub-optimal.

To determine important factors that affect antiretroviral drug adherence among HIV/AIDS male and female adult patients (18 years and above) attending Moi Teaching and Referral Hospital, Eldoret, Kenya. A cross sectional study involving 384 HIV/AIDS adult patients attending Moi Teaching and Referral Hospital, Eldoret was conducted. These patients were on ARV drugs. They were investigated for factors that affected their drug adherence based on observing the timing of doses and keeping of clinic appointments for drug refills during the months of May, June and July 2005. Data were collected from the respondents using interviewer-administered questionnaires to patients and self-administered questionnaires by ten key informants (nurses and clinicians in charge of HIV/AIDS clinic) selected by purposive sampling. The key variables examined were demographic, other characteristics of the patients and adherence factors. Data were analysed using Statistical Package for Social Sciences (SPSS) version 10.0 for frequencies, cross-tabulations and Chi-Squared test and statistical significance set at p < 0.05. Sixty-eight percent of the respondents on ARVs were females. 52.1% had secondary and post secondary education. They were aged between 18-63 years (mean age 36.1 +/- 8.5 years). Results showed that only 43.2% adhered to the prescribed time of taking drugs. The most commonly cited reasons for missing the prescribed dosing time by the patients were: Being away from home 68.8%, being too busy 58.9%, forgetting 49.0%, having too many medicines to take 32.6% and stigma attached to ARVs 28.9%. There was no significant difference between males and females based on timing of taking medications (chi2 = 2.9412, p = 0.0861). On the basis of keeping clinic appointments, all the respondents claimed to adhere to scheduled clinics. However, from hospital records, it was established that only 93.5% of the respondents kept clinic appointments. The most common reasons for poor adherence to clinic appointments were; Being away from home (50%), forgetting (50%), being too busy (50%), stigma (70%), feeling sick (80%) and changes in work routine (60%). The key factors affecting adherence were; being away from home, being busy and forgetting. It was recommended that patients should be educated on the importance of strict adherence to the prescribed doses of ARVs as a suitable measure of intervention. Future research should explore multiple-target interventions to resolve the barriers to adherence.

Non-adherence to the diabetes treatment regimen is possibly the most common reason for poor health outcomes among people with diabetes. The rates of non-adherence to diabetes regimen tasks are highly variable, but have significant consequences on diabetes outcomes and the effectiveness of treatments. The aim of this study was to determine the proportion (magnitude) of non-adherence and its contributing factors among diabetic patients attending clinics in Mwanza city. Specifically the study determined the relationship between non-adherence and various variables which are; alcohol use, knowledge on diabetes, its treatment and complication, travel distance to reach the clinic by patients and medication side effects. A total of 272 diabetic patients attending two diabetes clinics in Mwanza city were interviewed. Of the respondents, 118 (43.4%) were males. Their mean age was 51.22 (14.97 standard deviation). Among all respondents, 255 (93.8%) scored High level of knowledge on Diabetes and its treatment as compared with those with low knowledge making it not a significant contributor to non-adherence. Of the 272 patients, 77 (28.3%) reported non-adherent. Alcohol use, medication side effects and distance travelled to reach the clinic were the significant contributors to non-adherence (p = 0.001). Factors which were found contributing to non-adherence to diabetes treatment include: alcohol use, medication side effects and few clinics located far from most of patient. For improving adherence, availability of information with patients' perspectives about patients' expectations, needs and experiences in taking medication and about what might help them to become and remain adherent should be maintained.

The study aims at evaluating the potentials of soaps and germicides/disinfectants as adjunct topical anti-vulvovaginal candidasis agents. In vitro inhibitory activities of the test agents, prepared according to the manufacturer's specification for toilet and midwifery purposes were determined using modified agar well-diffusion method. Varied susceptibility patterns were exhibited by Candida albicans (26.5%), C. glabrata (18.4%), C. pseudotropicalis (14.3%) and C. tropicalis (40.8%) implicated in vulvovaginal candidasis, indicating Crusader oil (100%), Meriko (95%), Tetmosol (84.7%) and Aloe (68.4%) as the most inhibitory soaps against the Candida strains. The in vitro inhibitory activities of the germicides and disinfectants ranged between (Dettol; 34.6% and Purit; 84.6%) for C. albicans; (Roberts; 33.3% and Purit; 83.3%) for C. glabrata; (Roberts; 21.4% and Purit; 92.9%) for C. pseudotropicalis; (Dettol; 35.0% and Purit; 87.5%) for C. tropicalis respectively. All the Candida strains were totally inhibited by the germicides and disinfectants at the second lower dilutions, except in Morigad towards C. albicans (69.2%]) C. glabrata (72.2%), C. pseudotropicalis (92.9%) and C. tropicalis (82.5%) but none of the vaginal Lactobacillus strains was inhibited by the soaps, germicides or disinfectant. About 90% of a control group indicated relief after pubic cleansing with soaps, germicides and disinfectants. Results indicatied the safety of soaps, germicides and disinfectants as potential adjunct topical cleansing-agents in cases of vaginal itching and candidasis, a common mucosal infection caused by opportunistic yeasts of the Candida genus.

Aim of this study was to evaluate the impact of air pollution on hospital admissions for respiratory and cardiovascular diseases in an oil rich developing country, State of Qatar. A prospective cohort population based study was conducted at different stations of Qatar during the period (2002-2005) for recording the concentration of air pollutants daily for sulphur dioxide (SO2), nitric oxide (NO), nitrogen dioxide (NO2), carbon monoxide (CO), ozone (O3) and particulate matter (PM10). Hospital admission data were collected from the inpatient discharge database of the Medical Records Department, Hamad General Hospital. An average of 5.36 admissions from ischemic heart diseases was counted daily in all the population which was even higher than the respiratory diseases (3.4/day). Minimum temperature was inversely correlated with all pollutants except for O3 and SO2. There was an association between increasing air pollutant levels and patients admitted for respiratory and cardiovascular diseases.

Anaemia is the major cause of morbidity and mortality in paediatric age with much aetiology. The magnitude of childhood anaemia has been inadequately studied at Muhimbili National Hospital (MNH). The study was aimed at determining the frequency of anaemia and associated infections in patients admitted in general paediatric wards at MNH in Dar es Salaam. Study design: This was a descriptive cross-sectional study. Study setting: This was conducted at MNH in general paediatric wards from 20th August, 2009 to 15th December, 2009. Subjects: Patients, aged 1-84 months, consecutively admitted were recruited in the study. After informed verbal consent from the guardian or parent was obtained, information on demographic and clinical characteristics was collected from the parent or guardian. Physical examination and laboratory tests on blood ; stool samples for hookworm screening; blood slides for malaria parasites; Human Immunodeficiency Virus (HIV) screening; and blood peripheral smears were done on all subjects. Additional information was taken from medical files. Data management: The prevalence of anemia was determined as a percentage of all paediatric patients recruited during the time of data collection. All information was recorded using questionnaires and analysis was done using SPSS version 13.0. A p value of < 0.05 was considered statistically significant. A total of 315 children were assessed. The frequency of anaemia was 79.4%. This is much higher than the WHO prevalence of 67.6% in Africa for anaemia to be taken as a disease of public health importance. The proportion of malaria was 7.9%, HIV seropositive was 10.2% and hookworm was 1.0% of all admissions. There was an increased risk of anaemia in patients with HIV seropositive and or malaria although this was not statistically significant (RR > 1.0, p > 0.05). Anaemia in paediatric patients admitted at MNH is a disease of high public health importance in Dar es Salaam and may well carry a high burden in the rest of the country. Other risk factors of anaemia should be investigated with a goal of reducing the burden of anaemia.

To describe the clinical profile and outcomes of severely malnourished cases admitted at Zewditu Memorial hospital, Ethiopia. A retrospective descriptive data analysis of severely malnourished cases admitted to Zewditu Memorial Hospital from April 2005 to September 2008 was made. A total of 164 cases were enrolled and analyzed for various socio-demographic factors, comorbidities and outcomes. Both bivariate and multivariate models were performed to determine the outcome of the management by explanatory variables. Pearson's chi-square test of independence was used to test the existence of significant association of risk factors with the outcome. A p-value of less than 0.05 denoted significance in differences. The predominant age group suffered from marasmus was the infants (75.4%) while kwashiorkor was prevalent during the second and third year and the difference noted was statistically significant. The mean age for marasmus, kwash and marasmickwash incidence was 16.9, 25.9 and 27.3 months respectively. The proportion of underweight was higher after the age of 60 months. Death occurred in 21.3% of the cases suggesting that mortality rate was higher than the acceptable range (21.3% vs. < 20.0%). Presence of diarrhoea (AOR=3.5, 95%CI=1.2 to 10.2), ocdema (AOR=0.2, 97%CI=0.1 to 0.9), stunting (AOR=3.3, 97%CI=1.2 to 8.2) and short mean duration of hospital stay (AOR=4.4 95%CI=2.0 to 10.1) were predictors of death outcome. The observed case fatality rate is unacceptably high and the risk factors for death are identified. In the face of many shortcomings in the hospital setting, managing uncomplicated cases of severe acute malnutrition is not encouraging when compared with the promising results of community based therapeutic care. We recommend the staffs to be trained and retained.

WHO Second Task Force Criteria of adolescent hypertension (95th percentile for age) has been use for a long time and different studies have indicated wide variation of hypertension through out the world. To find out the validity of the WHO diagnostic criteria for adolescent hypertension. A cross-sectional study was undertaken in an urban slum of Chetla, Kolkata, among 1081 adolescent population (10-19 yrs of age). Initially 95th percentile values for age of systolic and diastolic blood pressure were calculated in different age groups and comparison was made between hypertensive subjects identified by the study values and the WHO reference values, using sensitivity and specificity parameters. In all the different age groups, the diagnostic criteria of hypertension in the study had sensitivity 100%, but specificity varied in the different age groups i.e. 95.34% (10-12 years), 93.89% (13-15 years), 97.41% (16-18 years), 95.34% (10-18 years) and 100% (19 year). Age specific reference values for blood pressure of adolescents should be formulated locally in different regions to aid in the identification of children with high blood pressure.

Growing sexuality among adolescents increases their risk of getting reproductive tract infections and pregnancy. This Cross sectional survey was done to assess the knowledge and attitude of higher secondary school children regarding contraception and population control. Majority of students (94.4%) were aware of contraceptives and their easy availability on chemist shop. However very few were aware of name and how to use them and 60% of them considered that condom is an emergency contraceptive. Lack of employment facilities as a consequence of uncontrolled population growth was the main concern of both boys and girls. The two children norm was acceptable to most, with one son and one daughter. All perceived that there is need to be informed about contraceptives. Most of the adolescents are misinformed about contraceptives and their attitude is not favorable as far as responsibility is concerned. There is an unmet need of contraceptive & population control knowledge and attitude among school adolescents and require urgent intervention.

To determine the prevalence of substance use among primary school pupils and out-of-school adolescents in Moshi rural district, northern Tanzania. A school-based cross-sectional study focusing on primary school adolescents in standards 6 and 7 in Kahe rural community. We also conducted a population-based cross-sectional study among out-of-school adolescents in the same rural villages. A self-administered questionnaire was used to collect data from the school-based survey while for the out-of-school survey the questionnaire was administered in the households using trained interviewers. A total of 545 in-school and 668 out-of-school adolescents participated in the study. Of the 545 school adolescents, 45.4% were males and 56.6% females while for the out-of-school adolescents, 68.1% were males and 31.9% females. Of the school adolescents, more males than females reported being alcohol drinkers (16.7% versus 9.2%; odds ratio (OR) = 1.9, 95% CI, 1.17 - 3.29). The prevalence proportions of cigarette smoking were 26.2% for men and 15.5% for women while prevalence proportions of marijuana smoking were 4.1% for men and 3.0% for women. As for the out-of-school adolescents, the prevalence proportions of alcohol use were 26.2% for men and 15.5% for women. The prevalence proportions of cigarette smoking were 14.3% for men and 1.9% for women while the prevalence proportions of marijuana smoking were 1.5% for men and 1.4% for women. Substance use among adolescents is very high suggesting the need for interventions in this rural population of Tanzania.

Dysmenorrhoea is common problem among adolescents worldwide. Its prevalence varies greatly in different populations and ethnic groups. Adolescents with severe dysmenorrhoea may miss classes and other social activities. The aim of this study was to determine the prevalence and coping strategies for dysmenorrhoea among secondary school adolescents in Ilala municipal, Tanzania. A cross sectional study was conducted in eight public and private secondary schools in Ilala municipal. A total of 880 girls in form II and form III who had attained menarche were interviewed using a self administered questionnaire between August and October 2007. The mean age at menarche was 13.3 years with the youngest at nine years and the oldest at sixteen years. Six hundred fifty two (74.1%) girls had dysmenorrhoea. Backache, breast tenderness and non specific joint pains were significantly more common symtoms among adolescents with dysmenorrhoea than without dysmenorrhoea. Medication was used by 362 (55.5 %) girls to relieve dysmenorrhoea. Commonest medications used were paracetamol and diclofenac. Adolescents who missed school due to dysmenorrhoea were 154 (23.6%) and 140 (21.5%) missed social activities. High proportion of secondary school adolescents has dysmenorrhoea in Ilala municipal with a significant number missing school and social activities. Reproductive health education in primary and secondary schools should be enhanced to increase awareness and care seeking.

Adolescence is the most important period of life where growth and development are accompanied by various physical, physiological, behavioral, and social changes leading to increased demand for nutrients which could pose a greater risk of malnutrition. To assess the magnitude of adolescents' undernutrition and its determinants in public schools of Ambo town. A cross-sectional study design with analytical component was conducted between March 20 and April 10, 2008. A total of 425 in-school adolescents were assessed for their nutritional status. Weight, height and other important socio-demographic and dietary information were taken using pre-tested questionnaire. Body Mass Index (BMI) was computed and compared to the reference standards. The overall prevalence of underweight and overweight was 27.5% and 4.3% respectively. The proportion of underweight was higher in males (29.8%) than females (24.6%) while overweight were higher in females (4.9%) than males (3.8%). However, the difference noted was not significant (P = 0.4). Underweight was significantly higher in early (38.1%) than late (18.6%) adolescent (p = 0.001). The most important predictors identified for underweight were adolescent's age, menarche onset, food source for consumption and family possession of cattle (p < 0.05). Underweight in the in-school adolescents is prevalent. To help adolescents build better futures with more civic education and life skills, an integrated nutrition and health related services that meet the needs of adolescents in the school community is recommended.

Correct and consistent condom use remains an important public health intervention against the spread of Human Immunodeficiency Virus and other sexually transmitted infections. There is paucity of information on sexual behaviour of in-school adolescents in Uganda. We, therefore, used secondary data of the Uganda Global School-based Health Survey (UGSHS) conducted in 2003 to determine the prevalence and correlates of condom use at last sexual intercourse in urban areas of Uganda. A two-stage cluster sampling technique was used to obtain a representative sample. Altogether 1709 students participated in the survey in urban areas of whom 179 (14.9% of males, and 7.9% of females) had sexual intercourse within 12 months before the survey. Overall 77.3% (79.7% of male, and 72.3% of female) adolescents used a condom at last sexual intercourse. Adolescents who drank alcohol and used drugs were 64% (OR = 1.64, 95% CI 1.54, 1.75) and 68%, (OR = 1.68, 95% CI 1.56, 1.81) more likely to have used a condom, respectively. Meanwhile, adolescents who ever got drunk, and who reported to ever had 2 or more sex partners were 55% (OR = 0.45, 95% CI 0.42, 0.48) and 35% (OR = 0.65, 95% CI 0.62, 0.68) less likely to have used a condom compared to those who had never got drunk, and who ever had 1 sex partner, respectively. Finally, adolescents who reported receiving no parental supervision were 45% (OR = 0.55, 95% CI 0.53, 0.58) less likely to have used a condom compared to those who reported receiving parental supervision. Parental supervision may be effective in promoting condom use among adolescents. Furthermore, drinking alcohol was associated with condom use probably due to peer pressure and easy access of condoms in drinking places as condoms are not actively promoted in schools. There is need for further research on how in-school adolescents could access condoms.

The study was designed to determine the socio-demographic correlates of sexual behaviours of the adolescents in Imo State secondary schools. Three objectives and three hypotheses were formulated to guide the study. A cross sectional survey design was used and sample size was 3360 (2.2%) adolescents. A structured, validated and reliable questionnaire (r = 0.79) and focus group discussion were used as the instruments for data collection. Data analysis was done using mean and ANOVA statistics. The result generally, showed that the average sexual behaviours of the adolescents were below the decision mean of 2.50 and as such the adolescents were said to be sexually inactive. In Imo State secondary schools, various family sizes did not significantly influence the sexual behaviours of the adolescents (F-cal. 2.39, F-tab. 3.00 & P > 0.05), family structure significantly influenced their sexual behaviours (F-cal. 17.78, F-tab. 3.00 & P < 0.05) and different financial strengths influenced the adolescents sexual behaviours significantly (F-cal. 22.88, F-tab. 2.37 & P < 0.05. Of great worry is that unrestricted/uncontrolled adolescents sexual behaviours may expose them to sexually transmitted infections/HIV/AIDS, unwanted pregnancies, illegal abortion and dropping out of school. Thus comprehensive sex education was recommended.

To determine the magnitude of perceived AIDS risk among out-of-school adolescents in Moshi rural district of Kilimanjaro region, northern Tanzania. A cross-sectional study involving face-to-face interviews with out-of-school adolescents in eleven rural villages in Moshi district, northern Tanzania. We found that of the 668 adolescents (10-19 years of age) surveyed, 45.4% were sexually active and significantly more men than women reported being sexually active (55.85 versus 23.0%, OR = 0.24, 95% CI = 0.16 to 0.34). Adolescents who had travelled to Moshi town or out of Tanzania were significantly more likely to be sexually active compared with those who have never travelled. Despite perception of AIDS risk, a large majority (70.5%) of sexually active adolescents reported having multiple sexual partners. Adolescents who perceived being at AIDS risk were less likely to report having multiple sexual partners and were more likely to report having used a condom at the last sexual intercourse. These findings indicate that adolescents in this rural population are still practising high risk sexual behaviours suggesting the need for youth-targeted intervention programmes in rural Tanzania.

The objective of this study was to determine the prevalence of perceived oral malodor and its correlates in terms of self assessed oral health status and reported health behaviors (oral hygiene practice, dental attendance, tobacco use and alcohol consumption) among adolescents in secondary schools in Temeke district, Dar es Salaam. Cross-sectional survey data were used. The sample consisted of adolescents (n= 400) 13 years old and above attending secondary schools in Temeke district. Eight schools were selected randomly from the sampling frame of all schools in the district (N=63). Self-administered questionnaires used to collect information from the adolescents included questions on socio-demographic details; perceived oral malodor; self rated oral health status and oral health related behavior (dental attendance, brushing, smoking and alcohol consumption). Data entry and analysis were done using Statistical Package for Social Sciences (SPSS) software version 13.0 .Chi-square and multiple logistic regressions were performed. Seventy two percents of the adolescents perceived oral malodor. More boys (62%) than girls (51%) rated their oral health to be poor. Almost all adolescents (97.5%) reported to brush their teeth; tongue brushing was 62% and 76% for boys and girls respectively. The percentage of adolescents who never attended to a dentist was 57% and 54% for boys and girls, respectively. Bleeding gums on brushing was reported by 64% of boys while in girls the percentage was 63%. Tobacco use was 23% and 16% for boys and girls, respectively and alcohol was consumed by 48% of boys and 31% of girls. Unadjusted logistic regressions revealed that subjects who perceived oral malodor were more likely to report having poor oral health status (OR = 1.5; CL= 1.1-2.3) and bleeding gums during brushing (OR = 1.8; CL = 1.1-2.3). Regarding oral health related behaviors, tongue brushing (OR=0.5; CI = 0.3-0.7), and alcohol consumption (OR = 0.6; CI = 0.4-0.9) did not vary in the expected direction as perceived oral malodor. Smoking habit (OR=0.7; C1=0.4-1.2) did not show a significant correlation with perceived oral malodor among adolescents in the selected schools of Temeke district. Oral malodor is prevalent among adolescents in Temeke district in Dar es Salaam. Information about perceived oral malodor and the factors associated with it might help in planning effective strategies to promote oral health and general health among this group of population

Adolescent pregnancies are known to be associated with increased risk of adverse outcomes. The objectives were to calculate the incidences of the obstetric and perinatal complications at the time of delivery of early adolescent and late adolescent mothers and then compare the same with adult pregnant mothers. A retrospective comparative study was conducted by targeting women delivered at Empangeni hospital. Mothers aged from 13-15 years were deemed as early adolescents, mothers aged from 16 - 18 years old were deemed as late adolescents and mothers aged from 19 - 21 years considered as adult pregnant mothers and were used as control groups in regards to perinatal and obstetric complications. Anaemia in pregnancy was considerably high among the early adolescent pregnant mothers (23%) compared to older adolescent (15%) and adult pregnant mothers (14%). Other conditions such as pregnancy induced hypertension, eclampsia, and diabetes were not notably different among the groups. Early adolescents mothers were twice (OR = 2.022, 95% CI: 1.226 - 3.337) as likely to be anaemic during pregnancy compared to adult mothers. Low birth weight delivery, FSB and MSB rates among the groups were significantly different (p > 0.05). Early adolescent pregnancies did not show any extra risks of obstetrics and pregnancy outcomes but socioeconomic problems may still exist. Thus to delay early conception with a view to let the young adolescent South African girls to improve their socioeconomic conditions appropriate strategies should be devised without any further delay.

Waist circumference and not body mass index explains a greater variance in obesity-related health risk. The present study assesses the link between BMI and WC in Iranian adults. In a population based cross-sectional study on 3600 adults, northern Iran, we investigated the link between WC and BMI using linear regression model. The Pearson correlation coefficient between WC and BMI were R = 0.61 (p < 0.001) for male and R = 0.75 (p < 0.001) for female. The fitted models were: WC(cm) = 44.45 +/- 1.79 BMI, (R2 = 0.37, p < 0.001) and WC(cm) = 36.85 +/- 1.89 BMI (R2 = 0.57, p < 0.001) respectively. After adjusting of age, gender and marital status, the association of BMI on WC is persisted. The overall discrimination ability of BMI for abdominal obesity as estimated by AUC was 0.865 (95% CI: 0.851-0.879, p < 0.001). The present linear link between BMI and WC measurements would help to estimate WC and its upper and lower confidence bond from height and weight.