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Are guidelines for field treatment of leprosy reactions evidence-based? A comprehensive literature review
No full textPurpose: Much of the stigma associated with leprosy is caused by disfiguring disabilities following irreversible nerve damage and much of this damage is the end result of leprosy reactions which are either not recognized in early enough stages, not treated appropriately or both. In an effort to improve access to care, to reduce stigma and to integrate leprosy into general health care services, guidelines for standardized treatment in field conditions of the infection itself and of leprosy reactions have been developed and implemented. This has sparked debate among experts concerning the efficacy of treatment protocols for especially leprosy reactions outlined in the guidelines. The principle points of contention are the duration of treatment, dosage and tapering strategies of the drug mainly used, prednisolone. This study investigates on what evidence these guidelines are based. Methods: Electronic databases were used in search of randomized controlled trials and other non-randomized evidence that could shed light on the validity of the strategies advocated and already implemented in most leprosy control programs worldwide. Results: Randomized controlled trials were found only for reversal reactions (type 1 reaction), and it could be concluded that the current strategies for field treatment of this type of reaction are not efficacious and do not yield better results than placebos. Instead, indications are that longer and higher dosed treatment strategies are needed to yield better results and this is supported by other non-randomized evidence. Conclusions: Further randomized controlled trials are needed to determine optimal dosages, tapering strategies and duration of treatment. Non-randomized evidence suggests that the protocols are not optimal for type 2 reactions either and may need to be reviewed based on further research. An outline for a randomized controlled trial is presented in an effort to further provide evidence for optimal treatment strategies for field treatment of type 1 leprosy reactions
Provider-initiated HIV testing for paediatric inpatients and their caretakers is feasible and acceptable
No full textObjectives Early diagnosis of HIV-infected children remains a major challenge in Africa. Children who are hospitalised represent an opportunity for HIV diagnosis and appropriate treatment. We introduced HIV Counselling and Testing (HCT) for hospitalised children and their caretakers in Mulago teaching hospital in Uganda to assess its feasibility.
Methods We analysed routine program data for children and caretakers who were tested between February 2005 and February 2008 to assess the proportion of children and caretakers who were HIV-infected. We also assessed the level of immune suppression (CD4 percentage) in a subset of HIV infected children tested between January 2007 and December 2007.
Results Caretakers agreed to HIV testing for 8990 (92.8%) of the 9687 children who were offered HIV testing. Among the caretakers, 89.8% agreed to be tested. At the time of hospitalization, 41.3% of the caretakers had previously tested for HIV. Although 313 parents (mothers and fathers) reported that they had previously tested HIV positive, only 113 (36.3%) of these had tested their children prior to hospitalization. Overall HIV prevalence among caretakers was 16.7%. HIV prevalence among children was 12.4%, highest on the nutrition ward (30.8%). Of those children who underwent CD4 counts, 56.4% had a CD4 percentage of <20%.
Conclusion HCT for hospitalized children and their caretakers identified a significant number of HIV infected children and caretakers. More than half of the children had advanced HIV disease. More intensive efforts are needed to ensure earlier diagnosis and linkage to care for HIV infected children
Human resource aspects of antiretroviral treatment delivery models: current practices and recommendations
No full textPURPOSE OF VIEW: To illustrate and critically assess what is currently being published on the human resources for health dimension of antiretroviral therapy (ART) delivery models. RECENT FINDINGS: The use of human resources for health can have an effect on two crucial aspects of successful ART programmes, namely the scale-up capacity and the long-term retention in care. Task shifting as the delegation of tasks from higher qualified to lower qualified cadres has become a widespread practice in ART delivery models in low-income countries in recent years. It is increasingly shown to effectively reduce the workload for scarce medical doctors without compromising the quality of care. At the same time, it becomes clear that task shifting can only be successful when accompanied by intensive training, supervision and support from existing health system structures. SUMMARY: Although a number of recent publications have focussed on task shifting in ART delivery models, there is a lack of accessible information on the link between task shifting and patient outcomes. Current ART delivery models do not focus sufficiently on retention in care as arguably one of the most important issues for the long-term success of ART programmes. There is a need for context-specific re-designing of current ART delivery models in order to increase access to ART and improve long-term retention
Evaluation of latent class analysis and decision thresholds to guide the diagnosis of pediatric tuberculosis in a Rwandan reference hospital [electronic only]
No full textSETTING: A pediatric ward of a university hospital in Kigali, Rwanda, a region with a high HIV seroprevalence. OBJECTIVE: To estimate the diagnostic accuracy of symptoms, signs, and paraclinical investigations for tuberculosis in children, and to propose a clinical rule based on the results. DESIGN: During a 2-year period all children with cough for more than 2 weeks and/or fever for more than 2 weeks and/or reported weight loss were prospectively included. A set of clinical and paraclinical data were analyzed with latent class analysis. Comparison of post-test probability based on this analysis with a therapeutic threshold for TB was used to develop a guideline. RESULTS: In the 309 children HIV prevalence was 56%, bacteriology was positive in 9%, and the tuberculin skin test (TST) was >10 mm in 20%. TB prevalence was 32%. Bacteriology and TST had a specificity of 97% and cough had a sensitivity of 91%. Decision analysis suggests treating children presenting one of the inclusion criteria, combined with positive bacteriology or TST >10 mm or contact with a TB patient. CONCLUSIONS: Latent class analysis confirmed earlier identified predictors for TB and allowed development of an easy to use clinical rule, applicable in reference hospitals of countries with high HIV endemicity
Preventie en behandeling van A/H1N1-influenza bij patiënten met immuungemedieerde inflammatoire aandoeningen onder immunotherapie
No full textPig-farming systems and porcine cysticercosis in the north of Cameroon
No full textA survey was conducted in 150 households owning 1756 pigs in the rural areas of Mayo-Danay division in the north of Cameroon. A questionnaire survey was carried out to collect information on the pig-farming system and to identify potential risk factors for Taenia solium cysticercosis infection in pigs. Blood samples were collected from 398 pigs with the aim of estimating the seroprevalence of T. solium cysticercosis. The results showed that 90.7% of the pigs are free roaming during the dry season and that 42.7% of households keeping pigs in the rural areas have no latrine facility. Seventy-six per cent of the interviewed pig owners confirmed that members of the household used open-field defecation. Enzyme-linked immunosorbent assay (ELISA) for antigen and antibody detection showed an apparent prevalence of cysticercosis of 24.6% and 32.2%, respectively. A Bayesian approach, using the conditional dependence between the two diagnostic tests, indicated that the true seroprevalence of cysticercosis in Mayo-Danay was 26.6%. Binary logistic regression analysis indicated that a lack of knowledge of the taeniasis-cysticercosis complex and the absence of a pig pen in the household were associated with pig cysticercosi