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Morocco has made significant strides in building its HIV research capacity. Based on a wealth of empirical data, the objective of this study was to conduct a comprehensive and systematic literature review and analytical synthesis of HIV epidemiological evidence in this country. Data were retrieved using three major sources of literature and data. HIV transmission dynamics were found to be focused in high-risk populations, with female sex workers (FSWs) and clients contributing the largest share of new HIV infections. There is a pattern of emerging epidemics among some high-risk populations, and some epidemics, particularly among FSWs, appear to be established and stable. The scale of the local HIV epidemics and populations affected show highly heterogeneous geographical distribution. To optimize the national HIV response, surveillance and prevention efforts need to be expanded among high-risk populations and in geographic settings where low intensity and possibly concentrated HIV epidemics are emerging or are already endemic. [ABSTRACT FROM PUBLISHER]

To meet the demands of our highly technological and globally competitive society, it is becoming increasingly important for all learners in South Africa to obtain skills and knowledge in mathematics. However, South Africa performed the worst of all the countries who participated in the Trends in International Mathematics and Science Study (TIMMS). Education in South Africa is now confronted with the dilemma of how to improve the mathematics performance of learners. One way of dealing with this dilemma is to apply Howard Gardner's Theory of Multiple Intelligences in the classroom. This intervention should contribute positively to the South African Government's Foundation for Learning Campaign. This article suggests specific ways in which teachers can incorporate the different intelligences in their teaching and learning activities in the mathematics classroom. Recommendations are made for the application of the Multiple Intelligences Theory in the mathematics classroom, and topics for future research are suggested. [ABSTRACT FROM PUBLISHER]

Although interspecific body size frequency distributions are well documented for many taxa, including the insects, intraspecific body size frequency distributions (IaBSFDs) are more poorly known, and their variation among mass-based and linear estimates of size has not been widely explored. Here we provide IaBSFDs for 16 species of insects based on both mass and linear estimates and large sample sizes (n≥100). In addition, we review the published IaBSFDs for insects, though doing so is complicated by their under-emphasis in the literature. The form of IaBSFDs can differ substantially between mass-based and linear measures. Nonetheless, in non-social insects they tend to be normally distributed (18 of 27 species) or in fewer instances positively skewed. Negatively skewed distributions are infrequently reported and log transformation readily removes the positive skew. Sexual size dimorphism does not generally cause bimodality in IaBSFDs. The available information on IaBSFDs in the social insects suggests that these distributions are usually positively skewed or bimodal (24 of 30 species). However, only c. 15% of ant genera are polymorphic, suggesting that normal distributions are probably more common, but less frequently investigated. Although only 57 species, representing seven of the 29 orders of insects, have been considered here, it appears that whilst IaBSFDs are usually normal, other distribution shapes can be found in several species, though most notably among the social insects. By contrast, the interspecific body size frequency distribution is typically right-skewed in insects and in most other taxa. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to determine the prevalence of diabetes, impaired glucose tolerance (IGT), impaired fasting glycemia (IFG), and associated risk factors in a rural South African black community.Research Design and Methods: This was a cross-sectional survey conducted by random cluster sampling of adults aged >15 years. Participants had a 75-g oral glucose tolerance test using the 1998 World Health Organization criteria for disorders of glycemia.Results: Of 1,300 subjects selected, 1,025 subjects (815 women) participated (response rate 78.9%). The overall age-adjusted prevalence of diabetes was 3.9%, IGT 4.8%, and IFG 1.5%. The prevalence was similar in men and women for diabetes (men 3.5%; women 3.9%) and IGT (men 4.6%; women 4.7%) but higher in men for IFG (men 4.0%; women 0.8%). The prevalence of diabetes and IGT increased with age both in men and women, with peak prevalence in the 55- to 64-year age-group for diabetes and in the >or=65-year age-group for IGT. Of the cases of diabetes, 84.8% were discovered during the survey. In multivariate analysis, the significant independent risk factors associated with diabetes included family history (odds ratio 3.5), alcohol ingestion (2.8), waist circumference (1.1), systolic blood pressure (1.0), serum triglycerides (2.3), and total cholesterol (1.8); hip circumference was protective (0.9).Conclusions: There is a moderate prevalence of diabetes and a high prevalence of total disorders of glycemia, which suggests that this community, unlike other rural communities in Africa, is well into an epidemic of glucose intolerance. There is a low proportion of known diabetes and a significant association with potentially modifiable risk factors. [ABSTRACT FROM AUTHOR]

Objective: To examine the quality of HIV sero-surveillance systems in 127 low-income and middle-income countries by 2007, as well as gaps in data needed for reliable estimates of HIV prevalence and size of populations at risk for infection.Methods: The quality of countries' surveillance systems was scored using information from 2001 through 2007. Sero-surveillance data were compiled from the US Census Bureau's HIV/AIDS Surveillance Database, from countries' national HIV surveillance reports available to UNAIDS, from demographic and health survey (DHS) data, from the scientific literature and from countries' Estimation and Projection Programme (EPP) data files. The quality of systems was scored according to the classification of the epidemic in each country (generalised, concentrated or low-level).Result: The number of countries categorised as fully functioning in 2007 was 40. 43 countries were identified as partially functioning while 44 were categorised as poorly functioning. Low scores were most often attributed to a lack of recent data or data from appropriate risk groups.Conclusion: Many countries still have poorly functioning surveillance systems. The inclusion of HIV testing in national population-based surveys in recent years has resulted in some countries with generalised epidemics receiving higher coverage scores, but many countries with concentrated or low-level epidemics continue to lack data on high-risk populations. [ABSTRACT FROM AUTHOR]

Background: Estimates of the impact of HIV in countries with generalised epidemics are generally based on antenatal clinic surveillance data collected over time. In an attempt to obtain geographically more representative estimates of HIV prevalence, many countries are now also conducting national population-based surveys in which HIV testing is included. We compare adult HIV prevalence estimates from antenatal clinic surveillance to those from national population-based surveys to assess the implications for calibrating surveillance data.Methods: HIV prevalence estimates derived from fitting prevalence curves to antenatal clinic surveillance data are statistically compared to prevalence from national population-based surveys using data from 26 countries with generalised epidemics for the year in which the survey was conducted. Appropriate transformations are applied to inform the correction factors needed to adjust prevalence in countries where population-based surveys have not been conducted.Results: HIV prevalence derived from antenatal clinic surveillance data generally overestimate population-based survey prevalence by about 20% (95% confidence interval: 10% to 30%) in both urban and rural areas.Conclusions: In countries where national population-based HIV surveys have been conducted, survey estimates of HIV prevalence (adjusted for potential survey biases as appropriate) can be used directly to calibrate antenatal clinic surveillance data. In countries where national HIV surveys have not been conducted, HIV prevalence derived from antenatal clinic surveillance data should be multiplied by about 0.8 to adjust for overestimation. [ABSTRACT FROM AUTHOR]

The UNAIDS Estimation and Projection Package (EPP) was developed to aid in country-level estimation and short-term projection of HIV/AIDS epidemics. This paper describes advances reflected in the most recent update of this tool (EPP 2007), and identifies key issues that remain to be addressed in future versions. The major change to EPP 2007 is the addition of uncertainty estimation for generalised epidemics using the technique of Bayesian melding, but many additional changes have been made to improve the user interface and efficiency of the package. This paper describes the interface for uncertainty analysis, changes to the user interface for calibration procedures and other user interface changes to improve EPP's utility in different settings. While formal uncertainty assessment remains an unresolved challenge in low-level and concentrated epidemics, the Bayesian melding approach has been applied to provide analysts in these settings with a visual depiction of the range of models that may be consistent with their data. In fitting the model to countries with longer-running epidemics in sub-Saharan Africa, a number of limitations have been identified in the current model with respect to accommodating behaviour change and accurately replicating certain observed epidemic patterns. This paper discusses these issues along with their implications for future changes to EPP and to the underlying UNAIDS Reference Group model. [ABSTRACT FROM AUTHOR]

Background. The variability in CD4[+] cell counts within and among human immunodeficiency virus (HIV)-positive and -negative African populations has not been explained but has important implications for understanding the incidence of HIV-related opportunistic infections, especially tuberculosis, in both individuals and populations. Methods. In HIV-negative African adults, CD4+ cell counts vary within populations (interquartile ranges [IQRs], 169-603 cells/microL) and among populations (means vary from 699 to 1244 cells/microL), with similarly wide variations in HIV-positive adults. We developed dynamic mathematical models to predict the distribution of CD4[+] cell counts in HIV-positive adults using the distribution in HIV-negative adults. Results. Under the assumption that survival is independent of the CD4[+] cell count before seroconversion, we fitted the observed distributions in HIV-positive adults. At a CD4[+] cell count of 200 cells/microL, the median life expectancy of HIV-positive Zambians (4.0 years) was predicted to be 1.7 times that of HIV-positive South Africans (2.3 years). Conclusions. The model provides a way to estimate the changing distribution of CD4[+] cell counts and, hence, the changing incidence of HIV-related opportunistic infections as the epidemic matures. This could substantially improve the planning of health services, including the need and demand for antiretroviral therapy. Better data are needed to test the model and its assumptions more rigorously and to fully understand the variability in CD4[+] cell counts within and among populations. Copyright © 2006 Infectious Diseases Society of America [ABSTRACT FROM AUTHOR]

Background: Sentinel surveillance among pregnant women attending antenatal clinics (ANCs) has been the main source of information on HIV trends in sub-Saharan Africa. These data have also been used to generate national HIV and AIDS estimates. New technologies and resources have allowed many countries to conduct national population based surveys that include HIV prevalence measurement, as an additional source of information on the AIDS epidemic. Methods: The authors reviewed the reports of 20 national population based surveys from 19 countries carried out in sub-Saharan Africa since 2001. They examined the sampling methodology, HIV testing and response rates, and female:male and urban:rural prevalence ratios. They also constructed adjusted prevalence scenarios assuming different relative risks for survey non-responders. Results: The national population based surveys vary considerably in quality, as reflected in the household response rate (ranging from 75.4% to 99.7%), women's testing rate (ranging from 68.2% to 97.3%), and men's testing rate (ranging from 62.2% to 95.4%), while for some surveys detailed response information is lacking. While 95% confidence intervals around the female:male and urban:rural prevalence ratios in individual countries are large, the median female:male ratio of the combined set of surveys results is 1.5 and the median urban:rural ratio 1.7. A scenario assuming that non-responders have twice the HIV prevalence of those who fully participated in the survey suggests that individual non-response could result in an adjusted HIV prevalence 1.03 to 1.34 times higher than the observed prevalence. Conclusions: Population based surveys can provide useful information on HIV prevalence levels and distribution. This information is being used to improve national HIV and AIDS estimates. Further refinements in data collection, analysis, and reporting, combined with high participation rates, can further improve HIV and AIDS estimates at national and regional level. [ABSTRACT FROM AUTHOR]

Background: Since 1998 the Joint United Nations Programme on HIV/AIDS and the World Health Organization has provided estimates on the magnitude of the HIV epidemic for individual countries. Starting with the 2003 estimates, plausibility bounds about the estimates were also reported. The bounds are intended to serve as a guide as to what reasonable or plausible ranges are for the uncertainty in HIV incidence, prevalence, and mortality. Methods: Plausibility bounds were developed for three situations: for countries with generalised epidemics, for countries with low level or concentrated epidemics (LLC), and for regions. The techniques used build on those developed for the previous reporting round. However the current bounds are based on the available surveillance and survey data from each individual country rather than on data from a few prototypical countries. Results: The uncertainty around the HIV estimates depends on the quality of the surveillance system in the country. Countries with population based HIV seroprevalence surveys have the tightest plausibility bounds (average relative range about the adult HIV prevalence (ARR) of -18% to +19%.) Generalised epidemic countries without a survey have the next tightest ranges (average ARR of -46% to +59%). Those LLC countries which have conducted multiple surveys over time for HIV among the populations most at risk have the bounds similar to those in generalised epidemic countries (ARR -40% to +67%). As the number and quality of the studies in LLC countries goes down, the plausibility bounds increase (ARR of -38% to +102% for countries with medium quality data and ARR of -53% to +183% for countries with poor quality data). The plausibility bounds for regions directly reflect the bounds for the countries in those regions. Conclusions: Although scientific, the plausibility bounds do not represent and should not be interpreted as formal statistical confidence intervals. However in order to make the bounds as meaningful as possible the authors have tried to apply reasonable statistical approaches and assumptions to their derivation. An understanding of the uncertainty in the HIV estimates may help policy makers take better informed decisions to address the epidemic in their respective countries. [ABSTRACT FROM AUTHOR]

Objective: This paper describes improvements and updates to an established approach to making epidemiological estimates of HIV prevalence in countries with low level and concentrated epidemics. Methods: The structure of the software used to make estimates is briefly described, with particular attention to changes and improvements. Discussion: The approach focuses on identifying populations which, through their behaviour, are at high risk of infection with HIV or who are exposed through the risk behaviour of their sexual partners. Estimates of size and HIV prevalence of these populations allow the total number of HIV infected people in a country or region to be estimated. Major changes in the software focus on the move away from short term projections and towards developing an epidemiological curve that more accurately represents the change in prevalence of HIV over time. The software continues to provide an output file for use in the Spectrum software so as to estimate the demographic impact of HIV infection at country level. [ABSTRACT FROM AUTHOR]

Objective: Patterns of transmission of HIV are different among different regions of the world and change over time within regions. In order to adapt prevention strategies to changing patterns of risk, we need to understand the behaviours that put people at risk of infection and how new infections are distributed among risk groups. Methods: A model is described to calculate the expected incidence of HIV infections in the adult population by mode of exposure using the current distribution of prevalent infections and the patterns of risk within different populations. For illustration the model is applied to Thailand and Kenya. Results: New infections in Kenya were mainly transmitted through heterosexual contact (90%), while a small but significant number were related to injecting drug use (4.8%) and men who have sex with men (4.5%). In Thailand, the epidemic has spread over time to the sexual partners of vulnerable groups and in 2005 the majority of new infections occurred among the low risk heterosexual population (43%). Men having sex with men accounted for 21% and sex work (including sex workers, clients, and partners of clients) for 18% of new infections. Medical interventions did not contribute significantly to new infections in either Kenya or Thailand. Conclusions: The model provides a simple tool to inform the planning of effective, appropriately targeted, country specific intervention programmes. However, better surveillance systems are needed in countries to obtain more reliable biological and behavioural data in order to improve the estimates of incidence by risk group. [ABSTRACT FROM AUTHOR]

This study extended the association between hookworm transmission in KwaZulu-Natal and the sandy coastal plain by investigating the parasite's occurrence in isolated areas of sandy soils further inland. A school-based prevalence survey was carried out in selected inland sandy areas and in surrounding areas dominated by clay soils within a narrow altitudinal range of between 500 and 700 m to reduce the effect of altitude on climate-related factors (rainfall and temperature). Sandy areas situated on the coastal plain were included in the analysis for comparative purposes. Soil samples (0–50 mm depth) were collected from each locality to assess their nematode loadings and to analyse selected physical and chemical properties. Significant differences were found between the moderate prevalence of hookworm infection among children living in inland areas with sandy soils (17.3%) and the low prevalence in surrounding non-sandy areas (5.3%, P < 0.001), and between infection among children living in all inland areas (9.3%) and the high prevalence on the coastal plain (62.5%, P < 0.001). Amounts of fine and medium sand were highest in both the coastal plain soils and in inland sandy areas and these fractions showed a significant positive correlation with hookworm prevalence and nematode loadings. Clay, coarse sand and organic matter contents were highest in surrounding non-sandy soils and showed a significant negative correlation with the nematode variables. No statistically significant correlations were found with soil pH at study localities. We conclude that properties of inland sandy soils, particularly particle size distribution, correlate well with hookworm prevalence and nematode loadings and therefore provide a more suitable habitat for nematodes than surrounding non-sandy areas. These results suggest that particle size distribution of sand fractions, organic matter and clay content in the soil influence the survival of hookworm larvae and hence the parasite's transmission. [ABSTRACT FROM AUTHOR]

We investigate the prevalence of, and risk factors for, HIV infection among women in an urban South African setting. A random sample of 834 women was recruited into a community-based cross-sectional study. HIV prevalence was 37.1% with higher prevalence among migrant women (46.0%) than non-migrant women (34.7%), (odds ratio [OR]=1.61, 95% confidence interval [CI]: 1.11-2.31). The highest HIV prevalence (50.9%) was between ages 26 and 35 years. Having two or more lifetime partners increased the risk of HIV infection (OR=4.88, 95% CI: 3.01-7.89). Migration, age, marital status, alcohol use, syphilis and gonorrhoea were independently associated with HIV infection. Migration increases the risk of HIV infection. Provision of services to treat sexually transmitted diseases and educational empowerment programmes that will promote safer sex among migrant women are urgently needed. [ABSTRACT FROM AUTHOR]

We investigated environmental factors influencing the distribution of hookworm infection in KwaZulu-Natal, South Africa. Prevalence data were sourced from previous studies and additional surveys carried out to supplement the database. When geo-referenced the data revealed that higher prevalences are limited to areas below 150 m above sea level, and low prevalences to areas above this altitude. Using univariate analysis we investigated the differences in environmental factors in the two areas. The relationship between hookworm prevalence, altitude and climate-derived variables was assessed using Pearson correlation coefficient, and that of soil type using the t-test. Multivariate analysis was used to determine environmental factors that combine best to provide favourable conditions for hookworm distribution. The results revealed that areas 150 m above sea level, i.e. inland, supported low mean hookworm prevalences (x = 6, n = 21), and were characterized by soils with a clay content of more than 45%, variable temperatures and moderate rainfall. Hookworm prevalence also decreased southwards as temperatures became slightly cooler, rainfall remained more-or-less constant and the coastal plain narrowed. In the multivariate model prevalence was most significantly correlated with the mean daily minimum temperature for January followed by the mean number of rainy days for January. This indicates the importance of summer conditions in the transmission of hookworm infection in KwaZulu-Natal and suggests that transmission may be seasonal. [ABSTRACT FROM AUTHOR]

Abstract Aims Previous cross-sectional studies have established that South African Indians have a high prevalence of Type 2 diabetes mellitus. A prospective community study was undertaken to determine the incidence of Type 2 diabetes and the risk factors associated with its development in a cohort of South African Indians who had been studied 10 years previously. Methods This is a report on 563 subjects who participated both at baseline and at the 10-year follow-up study. In the baseline study, 2479 subjects (> 15 years) were studied; using 1985 World Health Organization criteria for glucose tolerance based on 75 g oral glucose tolerance tests (OGTT), the crude prevalence of diabetes mellitus (Diabetes) was 9.8% and of impaired glucose tolerance (IGT) 5.8% (age and sex-adjusted prevalence 13% and 6.9%, respectively). Results At the 10-year follow-up study, 563 of the subjects who could be traced consented to a repeat OGTT; of these, 91 (16.2%) were classified as Diabetes and 41 (7.3%) as IGT. Of the subjects who did not have diabetes at baseline (n = 517), 49 (9.5%) progressed to diabetes (PTD) and 40 (7.7%) had IGT. The crude cumulative incidence of diabetes was 9.5% (rate of progression 0.95% per annum; incidence density 9.5/1000 person years) with an age and sex-adjusted cumulative incidence of 8.3% (rate of progression 0.95% per annum; incidence density 8.3/1000 person years). Examination of risk factors predictive of subsequent diabetes development was undertaken by analysis of baseline (year 0) variables in the 517 subjects who did not have diabetes at baseline. In multivariate analysis using a logistic regression model, the significant predictive risk factors for future diabetes included 2-h post load plasma glucose (2 PG) (P < 0.0001, odds ratio (OR) 1.7, 95% confidence interval (CI) 1.4–2.1), body mass index (BMI) (P < 0.006, OR 1.1, 95% CI 1.0–1.3) and obesity (P < 0.01, OR 4.6, 95% CI 1.4–14.7). Conclusions This long-term study... [ABSTRACT FROM AUTHOR]

For all of the last century, the economy of South Africa, and so also of its neighbouring countries, has depended on migrant labour from rural areas. This is particularly so for the mining industry, especially hard-rock mining, and this has led to a system of 'oscillating' migration whereby men from rural areas come to live and work on the mines, without their wives or families, but return home regularly. This pattern of oscillating migration is an important determinant of health and, especially at the start of the epidemic, contributed to the spread of HIV in the region. In this paper we describe an extensive, community-led, intervention designed to develop ways to manage and limit the spread of HIV in Carletonville, the largest gold-mining complex in the world. We first consider the political and economic context within which earlier attempts to develop HIV intervention programmes were made and then show how the Carletonville project was designed to go beyond these early attempts and avoid some of the pitfalls encountered then. The Carletonville project was based on a set of assumptions. First, that HIV should not be treated as another biomedical problem to be dealt with by changing individual behaviour but rather that it must be understood within the social, cultural and normative conditions that pertain in particular communities. Secondly, that in the short to medium term the most effective interventions would involve the treatment of sexually transmitted diseases and the use of community-based peer educators to promote safer sexual practices and the use of condoms. Thirdly, that for the intervention to be sustainable in the long term, it would require the full commitment of all the local stakeholders including the state, the private sector, the trade unions and local community-based organizations. Fourthly, that in order to understand the nature and pattern of the epidemic, to focus our intervention efforts so that they have the maximum effect, to make se... [ABSTRACT FROM AUTHOR]

South Africa is experiencing an explosive epidemic of HIV/AIDS, with about one in four women attending ante-natal clinics nationwide being HIV-positive. In order to understand the natural history of the epidemic, to design and target interventions to manage it and to evaluate the impact of interventions that are implemented, it is essential to gather information on the patterns of infection. In particular it is important to know how these vary with gender, age, migrancy status and between urban and rural settings. Ideally, one should measure age-specific incidence but this is difficult to do. Many datasets are available, however, on age-specific prevalence of infection and these are used to investigate the risk of infection with age among a number of different populations. The populations under consideration include women attending ante-natal clinics, urban and rural populations, migrant workers and commercial sex workers. Data are also presented from one work-based survey and from a study of cancer patients at a major hospital in Soweto. We were able to identify four different patterns of infection among a) women attending ante-natal clinics; b) women in the general population; c) men in the general population; and d) migrant workers. It is interesting that we were unable to show differences between urban and rural populations. Furthermore, the patterns of infection appear to be fairly constant over time, although as the epidemic saturates and reaches a steady state this must change. These data highlight, in particular, the extremely high risk of infection among 15-25-year-old women and among migrant workers of all ages. They should serve not only to highlight the urgency of the situation and the need to deal with the spread of infection effectively, but should also provide a basis for detailed epidemiological modelling, which can be used to predict the future course of the epidemic, plan an effective response and evaluate the impact of interventions. [ABSTRACT FROM AUTHOR]

Demographic forecasting models of the South African population, incorporating geographical distribution and age prevalence data on HIV infection, have been used to predict future mortality due to AIDS. In the year 2010, approximately 500 000 AIDS-related deaths are predicted, up from 100 000 this year. If anything, these models have underestimated the course of the epidemic so far. There is a need for better models to understand the dynamics of AIDS as well as to measure the effects of co-factors, in order to marshall the most effective response nationally. [ABSTRACT FROM AUTHOR]

Summary The purpose of this study was to document thromboelastographic (TEG) changes in abruptio placentae and to compare these results with that of conventional tests used to monitor coagulation. This was a prospective study of 30 patients with abruptio placentae. All coagulation investigations including the TEG were performed on admission, immediately following delivery, and after periods of 4 hours and 24 hours. Results showed that standard coagulation tests detected coagulation abnormalities except the platelet count returned to normal limits within 24 hours of delivery. There was strong correlation between fibrinogen levels and the TEG parameters, ma and k time ( r=0.8). There was moderate correlation between platelet count and ma ( r=0.6). In conclusion, minor abnormalities in the clotting profile are clinically unimportant. The TEG does not detect such minor abnormalities because of its inherent ability to test the coagulation cascade as a whole. Major abnormalities are clinically relevant and the TEG detect 75% of them. Further, the TEG establishes the diagnosis of hypercoagulability an early sign of disseminated intravascular coagulation. Although standard laboratory tests are still necessary to detect coagulation abnormalities on admission, the TEG is a useful test in large obstetric units where laboratory results are not immediately available for the purposes of monitoring and treating ongoing coagulation defects. [ABSTRACT FROM AUTHOR]

Summary Although the Eclampsia Trial Collaborative Group reported that magnesium sulphate was more effective in preventing recurrent convulsions in eclampsia than phenytoin, confirmatory evidence that phenytoin is not useful as a prophylactic anticonvulsant agent in eclampsia is necessary. This prospective descriptive study enrolled 68 women with eclampsia. Recurrence of seizures occurred in 18 (26.5%) patients following phenytoin therapy. In 16 patients, the seizure recurrence occurred between the loading dose and first maintenance dose at 6 hours. There was no statistical difference in the clinical characteristics of those who had seizure recurrence compared with those that did not. Seizure recurrence following phenytoin therapy in eclampsia is unacceptably high. These results suggest that phenytoin is not effective as a prophylactic anticonvulsant in eclampsia. No conclusions about its effectiveness compared with alternative prophylactic anticonvulsants can be made from this descriptive study. [ABSTRACT FROM AUTHOR]

Objective: This report examines early sexual debut (Methods: Analysis of sexual behaviour data for men 15-24 years (n = 314) from representative cross sectional household survey.Results: 13.1% of 15-24 year old men experienced sexual debut before age 15. Men with sexual debut at less than age 15 were more likely to report risk behaviours at first sexual experience: no condom use (19%), a casual partner (26.8%), and not feeling they had been "ready and wanted to have sex" (19.5%). In multivariate analysis, early sexual debut was strongly associated with > or = 3 partners in the past 3 years (OR = 10.26, p<0.01).Conclusions: Men who initiate sex before age 15 form a distinct risk group in this setting. Specific interventions are needed for young men in the pre-teen years, before sexual debut. [ABSTRACT FROM AUTHOR]

Background: HIV surveillance systems aim to monitor trends of HIV infection, the geographical distribution and its magnitude, and the impact of HIV. The quality of HIV surveillance is a key element in determining the uncertainty ranges around HIV estimates. This paper aims to assess the quality of HIV surveillance systems in low- and middle-income countries in 2009 compared with 2007.Methods: Four dimensions related to the quality of surveillance systems are assessed: frequency and timeliness of data; appropriateness of populations; consistency of locations and groups; and representativeness of the groups. An algorithm for scoring the quality of surveillance systems was used separately for low and concentrated epidemics and for generalised epidemics.Results: The number of countries categorised as fully functioning in 2009 was 35, down from 40 in 2007. 47 countries were identified as partially functioning, while 56 were categorised as poorly functioning. When compared with 2007, the quality of HIV surveillance remains similar. The number of ANC sites in sub-Saharan Africa has increased over time. The number of countries with low and concentrated epidemics that do not have functioning HIV surveillance systems has increased from 53 to 56 between 2007 and 2009.Conclusion: Overall, the quality of surveillance in low- and middle-income countries has remained stable. Still too many countries have poorly functioning surveillance systems. Several countries with generalised epidemics have conducted more than one population-based survey which can be used to confirm trends. In countries with concentrated or low-level epidemics, the lack of data on high-risk populations remains a challenge. [ABSTRACT FROM AUTHOR]