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ANALYSIS ON THE BURDEN OF HELMINTHS-Plasmodium falciparum POLYPARASITISM, EFFECT ON ANAEMIA AND THE ROLE OF INTEGRATED SCHOOL BASED PARASITE CONTROL AND HEALTH EDUCATION IN ZIMBABWE.
No full textIntroduction: Globally, 207 million; 2 billion and 243 million people are infected with schistosomiasis (SCH), soil transmitted helminths (STH) and Plasmodium falciparum (P.f) respectively. Many of the affected people are primary school age children. Clinical outcomes of these parasitic infections include anaemia, impaired cognition and malnutrition. Although these parasites have different mechanisms through which they cause anaemia, data is scarce on the extent of helminths –Plasmodium polyparasitism and their effect on anaemia. We determined the extent of helminths-Plasmodium co-infections, their effect on anaemia and the efficacy of combined school based treatment intervention on prevalence of co-infections and anaemia among primary schoolchildren in rural and farming areas in Zimbabwe.
Overall objective: To determine the prevalence of single and helminths–Plasmodium co-infections among primary schoolchildren living in rural and commercial farming areas, the effect of co-infections on anaemia and the efficacy of combined school based treatment intervention on prevalence of co-infections and anemia.
Settings: The study was conducted in Nyamaropa rural area, Shamva districts and Burma Valley commercial farming areas in Mutare district, Zimbabwe.
Study design: The study was a longitudinal intervention trial, which involved treatment of infected children at baseline, 6, 12 and 33 months follow up surveys.
Methodology: Enrolled participants were screened for anaemia; schistosomiasis; STHs and P. falciparum (P.f) using the Hemocue machine, urine filtration technique, a combination of the Kato Katz and formal ether concentration techniques and Giemsa staining respectively at each survey.
Results: Helminths- Plasmodium co-infections were heterogeneously distributed and were observed in the commercial farming area only. Overall, the prevalence of Schistosoma haematobium in the rural and farming areas was 66.8% and 52.3%, respectively, that of S. mansoni was 12.4% and 22.7%.. P. f, hookworms, Ascaris lumbricoides and Trichuris trichiura occurred only in the farming area, with a prevalence of 27.9%, 23.7%, 2.1%, 2.3%, respectively. Hookworm and S. mansoni infections were associated with P. f (P < 0.001, OR = 2.48, 95% CI: 1.56-3.93 and P = 0.005, OR = 1.85, 95% CI: 1.20-2.87). Of the 475 children screened for all parasites and anaemia, received combined treatment at baseline and successfully followed up to 33 months post treatment survey, 11.2%; 10.9%; 1.3% and 5.1% had SCH + STHs; SCH + P. f; STH + P. f; SCH+ STH + P. f co-infections respectively at baseline. These co-infections declined to 6.3%; 2.1%; 0.4; 1.1%, respectively at 33 months follow up survey. Overall, anaemia declined from 45.7% at baseline to 15.4% at 33 months follow up survey after treatment intervention, p < 0.001. School health education increased the knowledge of grade 3 children about causes of helminths and P. falciparum
Conclusions: There is heterogeneity in the distribution of helminths –Plasmodium co-infections in diverse communities. Co-infections have a multiplicative effect on anaemia. Biannual combined school based treatment intervention reduces the prevalence of helminths-Plasmodium co-infections and anaemia. Determination of the extent of helminths –Plasmodium co-infection should be prioritized in planning allocation of limited resources for control. The Government of Zimbabwe nationalized this PhD work. The work also contributed towards the national policy formulation for the control of schistosomiasis, STH and other neglected tropical diseases in Zimbabwe.WHO/TDR & Essential National Health Research funding (Health and Child Welfare
Calcium is the molecular switch shifting the phytosulfokine receptor 1 (PSKR1) from kinase to guanylate cyclase activity
No full textConference presentationMany plant responses are mediated by interactions between intracellular calcium and the second messenger cGMP formed by guanylate cyclases (GCs). Previously we identified a novel class of receptor-GCs containing the GC catalytic center embedded within the kinase domain and showed that the recombinant cytoplasmic domain of phytosulfokine receptor AtPSKR1 has both guanylate cyclase and kinase activity in vitro (Kwezi et al. 2011 J Biol Chem 286: 22580-8). We now show that physiological increases in calcium levels enhance GC activity of AtPSKR1 whereas these calcium levels reversibly inhibit kinase activity. In addition PSKR1 kinase activity is reduced in the presence of the GC product cGMP. Recombinant AtPSKR1 can undergo in vitro autophosphorylation and we have confirmed it has 14 phosphorylation sites in its cytoplasmic domain including 8 serine, 3 threonine and 3 tyrosine residues. Three phospho-serine residues at the juxta-membrane position were mutated to either mimic phosphorylation on or off states. Kinase activity was enhanced in the on mutant and suppressed in the off mutant while GC activity was unaffected suggesting calcium acts as a molecular switch of PSKR1- mediated signalling that can be modulated by the phosphorylation state. The challenge now lies in understanding how molecular interactions between the GC and kinase domains are capitalized on in the plant
Calcium is the molecular switch shifting the phytosulfokine receptor 1 (PSKR1) from kinase to guanylate cyclase activity
No full textConference presentationMany plant responses are mediated by interactions between intracellular calcium and the second messenger cGMP formed by guanylate cyclases (GCs). Previously we identified a novel class of receptor-GCs containing the GC catalytic center embedded within the kinase domain and showed that the recombinant cytoplasmic domain of phytosulfokine receptor AtPSKR1 has both guanylate cyclase and kinase activity in vitro (Kwezi et al. 2011 J Biol Chem 286: 22580-8). We now show that physiological increases in calcium levels enhance GC activity of AtPSKR1 whereas these calcium levels reversibly inhibit kinase activity. In addition PSKR1 kinase activity is reduced in the presence of the GC product cGMP. Recombinant AtPSKR1 can undergo in vitro autophosphorylation and we have confirmed it has 14 phosphorylation sites in its cytoplasmic domain including 8 serine, 3 threonine and 3 tyrosine residues. Three phospho-serine residues at the juxta-membrane position were mutated to either mimic phosphorylation on or off states. Kinase activity was enhanced in the on mutant and suppressed in the off mutant while GC activity was unaffected suggesting calcium acts as a molecular switch of PSKR1- mediated signalling that can be modulated by the phosphorylation state. The challenge now lies in understanding how molecular interactions between the GC and kinase domains are capitalized on in the plant
Typhoid colitis
No full textSalmonellosis is one of the commonest endemic diseases in Tropical Africa. Furthermore, typhoid fever is a disease that is unique to man with no other animal species acquiring an illness similar to man even after oral ingestion of the live 0rganisms (Homick et al., 1970). Typhoid fever has a myriad of complications. Typhoid colitis is distinctly uncommon judging from the paucity of reports in the literature. We report two cases of typhoid colitis who had massive rectal hemorrhage, which should alert one to the possiblility of typhoid colitis. One of the cases developed myocarditis as well
Organochlorine pesticide residues in Mothers’ milk; evaluation of possible Drug interaction in humans
No full textThe aim of the study was to investigate exposure levels of organochlorine pesticides (OCPs) in mother’s milk and in selected staple foods. The study also aimed to evaluated effects of 1,1,1-trochloro-2-bis-(4-chlorophenyl)ethane (DDT) on paracetamol half-life in highly exposed and least exposed breast-feeding mothers as a way of investigating possible drug interaction.
This was an experimental study where milk and food samples from Esigodini, Harare, Kadoma Kariba Nyanga and Mudzi were collected and analysed for OCPs levels using GC-ECD. Evaluation of induction of the hepatic cytochrome P450 enzymes by DDT was carried out by pre-treatment of female rats with a single intraperitoneal dose of DDT (0.3 mg/g) body weight. Cytochrome P450 enzyme was quantified by potassium phosphate buffering the microsomal fraction followed by spectral determination of the reduction of cytochrome P450. Blood samples from selected mothers in areas showing results of higher exposure levels to DDT and selected mothers with low exposure levels to DDT (controls) were evaluated for paracetamol drug interaction. Concentration levels of paracetamol in rats were measured using UV-Visible spectrophotometry. Levels of paracetamol in human mothers were measured using the Immunochemistry System (ICS) based on immunochemical precipitation of paracetamol and nephelometric detection of the precipitate.
The highest mean levels of DDT in mother’s milk were found in Mudzi with levels were16838.90 ng/g and the lowest was found in Esigodini with 934.12 ng/g. Results obtained from the analysis of hexachlorohexane (HCH) levels were comparably lower than DDT levels in the selected areas. There was a statistical significant correlation (r=0.8857, p= 0.0188) between DDT levels in staple food and mother’s milk. However, there was no statistical significant correlation (r=0.6571, p= 0.1562) between HCH levels in staple food and mother’s milk.
Maximum induction of cytochrome P450 enzyme for test animals was at its highest (8.51 n mol /mg) on day 14 when compared to control animals, which had 0.55 n mol/mg at day 14. Hepatomegally was directly related to higher levels of cytochrome P450 in test animals while no liver enlargement was observed in control animals.
DDT induced female rats and DDT exposed breast-feeding mothers showed interference with the pharmacokinetics of paracetamol at therapeutic dose level. The half-life of paracetamol in DDT pre-treated rats was 144 minutes when compared to control rats with 380 minutes a difference of 236 minutes. A similar trend was observed in the sampled breast-feeding mothers; analysis of the pharmacokinetic (half-life) data for highly DDT exposed mothers (212 minutes) and 13 least exposed (318 minutes), showed a significant difference (106 minutes) of paracetamol half-life.
The conclusion from the study is that Kariba and Mudzi areas are highly exposed to DDT while Harare and Esigodini areas are least exposed. Exposure levels in breast milk are correlated to levels analysed in staple foods. Continued use of DDT for vector control is welcomed, but it should be done with intense monitoring to prevent long term effects of POPs on exposed individuals. More research is recommended so that scientists could assess the effects of the induction properties of OCPs on the efficacy, toxicity and the therapeutic index on dosage of many drugs used by animals and humans
The association between knowledge levels regarding male circumcision and uptake of male circumcision among males aged 18 to 45 years at Nyanga District Hospital Manicaland province
No full textThe purpose of the study was to determine the association between knowledge levels regarding male circumcision and male circumcision uptake among males aged 18 to 45 years at Nyanga District Hospital Manicaland Province. The research came as result of low uptake of male circumcision at a rate of 10 % since its inception in 2009 from a targeted background of 85 % of males to be circumcised by 2015(ZIMSTAT, 2013). A cross sectional analytic study design was utilised where knowledge levels and uptake were assessed simultaneously at a single point to establish association. Systematic interval sampling was used to select a sample size of 160 respondents. Data collection was done using a structured questionnaire comprising of demographic information in section A, uptake of male circumcision in in section B and knowledge levels regarding male circumcision in section C. Validity and reliability of the instrument was ensured by carrying out a pilot study at Mt Melleray Mission Hospital. The Statistical Package for Social Sciences (SPSS) was utilised in analysing data using descriptive and inferential statistics. The Pearson Coefficient was (r = 0.418 p = < 0.001) showing a significant positive linear correlation. Increased knowledge levels regarding male circumcision have a positive impact on the uptake of male circumcision. The regression analysis was 0.175 meaning that 17.5 % of male circumcision was due to high knowledge levels of male circumcision. However, there is need to explore other factors like culture, attitudes and behaviour. The low uptake of male circumcision is attributed to knowledge as well as other factors like fear of pain; fear of sexual impairment hence the need to assure clients of quality services that will not cause them harm. Embracing male circumcision will reduce HIV and AIDS disease burden by reducing new HIV infections, a scenario that will reduce parent to child transmission of HIV infection. Maternal HIV and AIDS related mortality deaths are averted thus MDG 4, 5 and 6 are addressed
An analysis of the visual acuity outcomes following surgical repair of penetrating corneal injuries among patients seen at Sekuru Kaguvi Hospital (SKH), eye unit at Parirenyatwa Central Hospital in Harare, Zimbabwe
No full textTrauma is an important cause of morbidity and mortality in most disciplines in the practice of medicine and constitutes a great proportion of patients seen in emergency departments. Ocular trauma causes significant visual morbidity and fortunately mortality from purely ocular injuries is rare unless the patient develops complications that spread into the cranium. Although, studies have been done to find out causes of ocular trauma that result in hospital admission, including one at SKH, the prevalence of good visual outcomes has not been evaluated. This study was therefore conducted to evaluate the prevalence of good visual outcomes following penetrating corneal injury and surgical repair at SKH.
Objectives
The principal objective was to analyze the visual outcomes of patients in the study population who underwent surgical repair for penetrating corneal injuries at SKH. The specific objectives were to describe the demographics of the study population, to elicit the causes of penetrating corneal injuries and to evaluate the best corrected monocular visual acuities of the patients’ eyes under study.
Design of Study
A hospital based prospective study.
Study Setting
Study was conducted at Sekuru Kaguvi Hospital, Parirenyatwa Group of Hospitals.
Study Population
Patients who had surgical repair of penetrating corneal injuries at SKH between August 2012 and April 2013, meeting enrolment criteria were recruited.
Methods
Authorization to carry out the study at SKH was granted by the Joint Research and Ethics Committee. Patients with penetrating corneal injuries referred to SKH were managed as per standard operating procedure. Day 1 post operatively the researcher interviewed and examined patients for eligibility to enroll into study. Data about the patients' demography, history about the injury and examination findings were captured onto data sheet. Patients were followed up a total of 7 weeks post surgical repair and were seen Day 1, 2 weeks, 6 weeks and 7 weeks post operatively. At six weeks post op, corneal sutures were removed on the slit lamp. Best corrected monocular visual acuities of the injured eyes were evaluated at week 7 objectively and subjectively. Examination findings of state of anterior and posterior segments were recorded.
Results
Seventy (70) patients were recruited into study. Median age of the patients was 39 years, range 6 to 72 years. The male: female ratio was 2.7:1. The proportion of patients that achieved best corrected monocular visual acuities (BCVA) of 6/60 or better was 59% (n=41). There was an association between the BCVA and location of the corneal scar (p=0.001). The association between the BCVA and the status of the lens was also statistically significant (p=0.001). The main causes of bad visual outcome (BCVA worse than 6/60) were irregular astigmatism, vitreous hemorrhage and corneal scar in the visual axis and dense traumatic cataracts.
Males were more than twice at risk of getting injured. Age and gender were risk factors for injury with males below 40 years of age being more at risk of injury. The main causes of injury were vegetative matter and metallic objects. There was a statistically significant association between object of injury and gender (p=0.016).
Conclusions
The results showed that the proportion of patients that achieved good visual outcomes (BCVA of 6/60 or better) at Sekuru Kaguvi Hospital after surgical repair for penetrating corneal injury was 59% during the study period. Irregular corneal astigmatism, vitreous hemorrhage and central corneal scarring were the major causes of visual outcomes worse than 6/60. Males were affected more than females by a ratio of 2.7:1. The causes of injuries could suggest gender roles in society, where males were injured mostly by metallic objects and females by vegetative material
Choledochal cyst associated with HIV (Human Immunodeficincy Virus) disease
No full textCholedochal cysts are believed to be congenital dilatations of the intrahepatic or extrahepatic bile ducts, or both, of unkown aetiology-.1 They were first described by Vital and Ezler in 1723.2 However, the aetiology of choledochal cyts remains speculative despite a considerable research effort over the years
Factors associated with occurrence of multi drug resistant tuberculosis in a Harare city, 2015
No full textIntroduction: Multi drug resistance tuberculosis (MDR-TB) is a form of tuberculosis (TB)
caused by bacilli resistant to Isoniazid and Rifampicin. Rifampicin and Isoniazid are the two most important first line anti TB medicines. The World Health Organisation has declared MDR TB a public health emergency of global concern. Drug resistance can either be primary or acquired during TB treatment. The MDR TB notification rate has been increasing in Zimbabwe since 2010. New MDR TB cases have also been on an increase from a low of 42 in 2011 to a high of 60 in 2014. Annual newly notified drug susceptible TB cases have been on a decline over the past five (5) years. A study was carried out to determine the major risk factors associated with occurrence of MDR TB in Harare, Zimbabwe.
Methods and Materials: An unmatched case control study was conducted in Harare City. The outcome of interest in the study was MDR TB. A semi structured interview guide questionnaire was used to collect information on exposure from the respondents. A case was a TB patient confirmed by Gene Xpert and Drug Sensitivity Test (DST) to have resistance to Rifampicin. A control was a TB patient who had completed treatment and had a recorded cured outcome. A checklist was used to assess case detection activities in the TB service at health facilities. Data collected were entered into the EPI Info 3.5.4. The same software package was used to calculate frequencies, means and odds ratios. Stratified and forward logistic regression was carried out to determine independent risk factors associated with MDR TB.
Results: A total of 42 cases and 84 controls were enrolled in to the study. A total of 5 poly
clinic Presumptive TB registers and Health Facility TB registers were reviewed. There was no delayed case finding for risk MDR TB presumptive case in Harare. The significant risk factors in the study were having a history of previous TB treatment (OR=65.9 95% CI 19-223), having been a TB contact before (OR=2.56 95% CI 1.06-6.15), history of stopping TB treatment in previous catergory (OR=6.62 95% CI 1.91-23).Smoking, alcohol use, HIV (OR=1.13 95% CI: 0.3-2.76) and diabetes mellitus (OR=1.15 95% CI=0.21-10.00) were not significantly associated with MDR TB in Harare. A history of travelling outside the country was associated with less risk of having MDR TB (OR=0.66 95% CI: 0.3-1.4). Those who were employed were less likely to have MDR TB (OR=0.12 95% CI 0.04-0.29). There was a significant difference in knowledge on risk of defaulting TB treatment (p=0.02) and treatment completion (p=0.007) between cases and control.
Conclusion: History of TB treatment was the leading risk factor. A history of being a TB
patient contact, a history of stopping TB treatment were significantly associated with having MDR TB in the City MDR TB. HIV and diabetes mellitus were not significantly associated with having MDR TB. Based on the findings of this study MDR TB in Harare City is likely to be acquired than primary, as those who had prior exposure to anti-TB medicine were more likely to have MDR TB. There was no delayed case finding for high risk presumptive MDR TB patients. Those who were employed were less likely to have MDR TB
Factors influencing women living with HIV/AIDS’ intention to fall pregnant among those attending the OI/ART clinic in Murambinda, Buhera District, Manicaland Province, Zimbabwe, 2010
No full textBackground: With increases in HIV testing facilities in Zimbabwe, more women are aware of their HIV status before falling pregnant. This was found in a Murambinda survey in 2008. It is every woman’s right to fall pregnant, however, those living with HIV/AIDS need to be guided well to protect the health of the mother and her baby preventing Mother to Child transmission of HIV/AIDS (MTCT). We carried out a study to establish the factors contributing to WLHA’s intention to fall pregnant in order to focus this guidance.
Methods: An analytical cross sectional study was carried out July-August 2010 at the Opportunistic Infection/ Anti Retroviral Treatment (OI/ART) clinic of Murambinda Mission Hospital. 421 WLHA of reproductive age were systematically sampled from those waiting in the queue to attend the OI/ART clinic. An interviewer administered questionnaire was used to collect data from them. Focus group discussions, counselling observations and check lists were also used to obtain information regarding factors influencing the intention of WLHA to fall pregnant.
Results: We interviewed 421 HIV positive women of reproductive age. Significant factors were being aged less than 36 [OR=4.45 (CI=2.78-7.16)], being married [OR=1.90 (CI=1.25-2.87)], having secondary education or above [OR=1.83 (CI=1.16-2.88)], having parity of less than 4 [OR=2.72 (CI=1.75-4.22], spousal influence [OR=1.74 (CI=1.01-3.03)], partner disclosure [OR=0.50 (CI=0.27-0.87)], believing community approves intention to fall pregnant [OR=7.75 (CI=4.11-14.61)] and belonging to a support group [OR=0.62 (CI=0.40-0.91)]. Independent determinants of intention to fall pregnant were being aged less than 36
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[aOR=2.15, (2.02- 2.98)], having parity of less than 4 [aOR=1.82 (1.10-3.02)] and believing community approves intention to fall pregnant [aOR=6.18 (5.75-6.39)]
Conclusion: Being married, being aged less than 36, being of secondary education and above, having parity of less than 4, spousal influence and believing community approves decision to fall pregnant increased the likelihood of the intention to fall pregnant. Partner disclosure and belonging to a support group decreased the likelihood of the intention to fall pregnant. Plans to strengthen and increase support groups for women and men living with HIV/AIDS have begun