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Antiretroviral therapy for HIV-1 infected adolescents in Uganda: assessing the impact on growth and sexual maturation
No full textThere is a paucity of knowledge about perinatally infected human immunodeficiency virus (HIV) positive children surviving into their adolescent years, especially from sub-Saharan Africa. Although studies have described the effects of the disease on the physical and sexual maturation of this population, their response to highly active antiretroviral therapy has not been systematically studied. At the pediatric infectious diseases clinic in Mulago hospital, Kampala, Uganda, we evaluated the effect of antiretroviral therapy (ART) on 118 treatment-naive, perinatally-infected HIV positive adolescents between the ages of 10-19 for 12 months. We monitored physical growth using The Centers for Disease Control and Prevention and recently published World Health Organization (WHO) reference growth standards for height and weight measurements as well as sexual maturation using Tanner staging. Laboratory tests including: complete blood count, absolute CD4 cell count and percentage, and HIV-1 RNA viral load, were performed at baseline and at 3-month intervals. Of 118 children, 64% were female; the median age was 13.6 years old. At baseline, 75% were classified as WHO clinical stages III and IV, with a median CD4 count of 124 cells/ul. Apart from four adolescents, all were on first-line antiretroviral therapy with 2 nucleoside reverse transcriptase inhibitors and 1 non-nucleoside reverse transcriptase inhibitors. After 6 months, the median CD4 count was 304 cells/µL, increasing to 370 cells/µL, by 12 months. Antiretroviral therapy was virologically suppressive (HIV-1 RNA viral load <400 copies/mL) in 79% of the adolescents at 6 months and in 89% at 12 months. Six (5%) patients died during the 12-month study. The median baseline height for age Z score was -2.41 which improved to a median of -1.96 by 12 months (P <0.0001). The median baseline weight for age Z score was -2.61 and improved to -1.26 by 12 months (P <0.0001). The median body mass index Z score increased from -1.39 to -0.47 by 12 months (P <0.0001). At baseline, 63% of the adolescents were noted to have delayed pubertal maturation; this only reduced slightly to 60% after 12 months. Adolescents with predominantly perinatally-acquired HIV infection and significant disease burden showed appropriate virologic and immunological response to ART in addition to having clinically significant improvements in growth and some improvement in sexual maturation
Learning lessons and moving forward: how to reduce financial barriers to obstetric care in low-income contexts
No full textEtude de 106 cas d'ulcères de Buruli avec atteintes osseuses traités à Zagnanado, Bénin
No full textL’ulcère de Buruli (UB) est principalement connu par ses atteintes cutanées. Néanmoins, M. ulcerans peut aussi causer des
atteintes osseuses, principalement en Afrique. En 2004, nous avions déjà présenté l’évolution clinique et l’étude microbiologique de 73 patients atteints de formes osseuses traités au Centre Sanitaire et Nutritionnel Gbemoten de Zagnanado, Bénin
(Portaels, 2004). Depuis lors, d’autres patients ont été pris en charge par ce même centre et les facteurs de risque de dissémination osseuse ont été mieux étudiés
What do we mean by 'major illness'? The need for new approaches to research on the impact of ill-health on poverty
No full textPrevalence of illness and household ill-health risk coping strategies in rural China; a Chinese literature review
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Availability of essential drugs and sustainability of village revolving drug funds in remote areas of Lao PDR
No full textAnalysis of the leprosy literature indexed in Medline (1950-2007)
No full textSome 19,201 leprosy-related articles were identified in the Medline database for the period 1950-2007. These were analysed for distribution and evolution of a number of variables: publication years, languages, document types, journals, authors, major aspects and countries involved, and author addresses. Next to a number of tables presenting the actual results, some noteworthy trends and possible pitfalls in the interpretation of these results are discussed. The analysis shows that the number of leprosy-related articles peaked in the 1980s and has been in decline ever since, as well in absolute as in relative numbers. Coverage of non-English language literature has decreased far more strongly than that of English language articles. The scholarly input of a number of countries where the leprosy burden is the highest, such as India and Brazil, is clearly visible in the distribution of journals, authors, and for some, language, but this is certainly not the case for all countries afflicted
Risk sharing as solution for providing access to emergency obstetric care: experiences with obstetric risk insurance in Mauritania
No full textHuman exposure to fumonisins from home grown maize in Tanzania
No full textFumonisins contaminate maize worldwide resulting in unacceptable fumonisin exposures in people relying on maize as staple food. This study determined fumonisins B1 (FB1) and B2 (FB2) in maize from 120 rural households: 30 from each of four main maize producing regions of Tabora, Ruvuma, Iringa and Kilimanjaro in Tanzania in order to estimate total fumonisin (FB1 + FB2) exposures to adult individuals in the households. The average daily per capita maize consumption of 771 g, recommended by the Tanzania Food and Nutrition Centre (TFNC) for an adult relying on it as a main meal, and also average daily per capita maize consumptions of 129, 308 and 356 g documented for Tanzania, were used in the exposure estimation. The fumonisins were determined by HPLC using fluorescence detection. Total fumonisins exposure (µg/kg body weight (bw)/day) was determined by multiplying average daily per capita maize consumption (kg) by fumonisin level in maize (µg/kg) from a given household and then dividing by an average bw of an adult of 60 kg. Of the 120 samples, 52% were contaminated with fumonisins at levels of up to 11,048 µg/kg (median; 363 µg/kg). Based on the recommended maize consumption of 771 g/person/day, fumonisin exposures to adult individuals in 38% of the households would exceed the provisional maximum tolerable daily intake (PMTDI) of 2 µg/kg bw, recommended by the Joint FAO/WHO Expert Committee on Food Additives. At the least documented maize consumption of 129 g/person/day, fumonisin exposures in 16% of the households were still above the PMTDI. Reduction of the maize consumption level to 40 g/person/day is an impractical, and reduction of the maximum contamination level to 155 µg/kg is a possibly practical, option for effective minimisation of fumonisin exposures in these communities. A relatively larger study is needed in order to generate comprehensive data for the formulation of appropriate strategies to minimise fumonisin exposures in Tanzania