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Objective: To establish the environmental reservoirs of Cryptococcus neoformans and Cryptococcus gattii in Nairobi, Kenya. Design: Prospective study.Kenya Medical Research Institute, Mycology laboratory, Nairobi, Kenya.A total of 400 environmental samples from different sites were analysed including; avian droppings, tree swabs, soil contaminated with avian droppings and swabs from garbage damping sites. Samples were subjected to various phenotypic tests including microscopic morphology, physiological and biochemical tests, pigmentation on bird seed agar and reaction on Canavanine-Glycine-Bromothymol Blue agar.Cryptococcus neoformans was isolated from 23/200 (11.5%) dropping samples and Cryptococcus gattii in 5/200 (2.5%) of the same samples. Cryptococcus gattii was isolated from 7/60 (11.7%) tree swabs and Cryptococcus neoformans in 5/60 (8.5%) of the same samples. From other sites there was no Cryptococcus gattii recovered with (5/50: 10%), (6/60: 10%), (2/30: 6.7%) Cryptococcus neoformans recovered from chicken cage, garbage damping site and soil respectively.Findings clearly showed a high presence of Cryptococcus neoformans and Cryptococcus gattii from several environmental sites in Nairobi, Kenya. This could probably explain the high incidence of cryptococcal meningitis in HIV/AIDS patients in Kenya.

To determine the microbial load in food, examination of safety measures and possibility of implementing an Hazard Analysis Critical Control Points (HACCP) system.The target population for this study consisted of restaurants owners in Thika. Municipality (n = 30). Simple randomsamples of restaurantswere selected on a systematic sampling method of microbial analysis in cooked, non-cooked, raw food and water sanitation in the selected restaurants.Two hundred and ninety eight restaurants within Thika Municipality were selected. Of these, 30 were sampled for microbiological testing.From the study, 221 (74%) of the restaurants were ready to eat establishments where food was prepared early enough to hold and only 77(26%) of the total restaurants, customers made an order of food they wanted. 118(63%) of the restaurant operators/staff had knowledge on quality control on food safety measures, 24 (8%) of the restaurants applied these knowledge while 256 (86%) of the restaurants staff showed that food contains ingredients that were hazard if poorly handled. 238 (80%) of the resultants used weighing and sorting of food materials, 45 (15%) used preservation methods and the rest used dry foods as critical control points on food safety measures.The study showed that there was need for implementation of Hazard Analysis Critical Control Points (HACCP) system to enhance food safety. Knowledge of HACCP was very low with 89 (30%) of the restaurants applying some of quality measures to the food production process systems. There was contamination with Coliforms, Escherichia coli and Staphylococcus aureus microbial though at very low level. The means of Coliforms, Escherichia coli and Staphylococcus aureas microbial in sampled food were 9.7 x 103CFU/gm, 8.2 x 103 CFU/gm and 5.4 x 103 CFU/gm respectively with Coliforms taking the highest mean.

To describe the pattern of occurrence of malocclusion and orthodontic treatment need.A descriptive cross-sectional survey.Six public primary schools in Nairobi, Kenya.A randomly selected sample of 1382 children aged 12 to 15 years. Clinical examination for malocclusion was conducted using the Dental Aesthetic Index (DAI). Orthodontic treatment need was derived using the regression equation stated in the DAI.Among the 1382 (672 males and 710 females) children examined, 70 children (5.1%) had missing teeth. Crowding and spacing in the incisal segments occurred in 652 (47.2%) and 644 (46.6%) children respectively. Anterior irregularities were found in 533 (38.6%) of the subjects in the maxilla and 430 (31.1%) in the mandible. Anterior crossbite was found in 86 (6.2%) of the children. The anterior open-bite occurred in 194 (14%) of the children with significantly more open-bite in females than males (p=0007). The maxillary median diastema and antero -posterior molar relation discrepancies were found in 289 (20.2%) and 344 (24.9%) of the sample respectively. The sample mean DAI score was 26.6 (SD 7.8). Seven hundred and thirty two (53.0%) of the children examined had either no need or slight need for treatment whereas 650 (47%) were found with orthodontic treatment needs ranging from elective 318 (23%), highly desireable 176 (12.7%) to mandatory 156 (11.3%).There was an overall high prevalence of malocclusion with 11.3% of the sample exhibiting handicapping malocclusion. Notably, there were no significant gender differences for most of the traits except for anterior open-bite which was found to occur more in females than males.

The objective of the study was to assess the effectiveness of alternative strategies of malaria chemoprophylaxis on the reduction of malaria episodes and prevalence of parasitaemia among pregnant women in Kigoma urban district in western Tanzania.Randomised antimalarial prophylactic trial.The study was conducted in an urban maternal and child health (MCH) clinic in Kigoma town.All pregnant women attending antenatal care services at Kigoma urban MCH clinic were eligible. Informed consent was sought from each pregnant woman for participation in the study. INTERVENTION MEASURES: The intervention measures were intermittent and continuous malaria chemoprophylaxis using chloroquine and proguanil.Reduction of malaria episodes and parasitaemia and haemoglobin levels among participating pregnant women in Kigoma urban district.Baseline data indicates that the overall mean haemoglobin concentrations among the primigravidae and multigravidae women were similar within the intervention and comparison groups (F-test (df = 5, N = 701) = 1.27, P = 0.27). Similarly, no significant difference was observed in the prevalence of malaria parasitaemia within the primigravidae intervention and comparison groups (chi 2 test (df = 5, N = 701) = 5.4, P = 0.4). Hence, the process of randomisation produced comparable intervention and comparison groups with balanced characteristics. Specific results of the baseline studies are presented in the companion paper.We conclude that the process of randomisation resulted in comparable intervention and comparison groups. As malaria is a common cause of considerable morbidity and mortality among pregnant women in Tanzania, the present study provided useful data for improving reproductive health in Kigoma region, western Tanzania.This randomized antimalarial prophylactic trial assessed the effectiveness of alternative malaria chemoprophylaxis strategies on the reduction of malaria episodes and prevalence of parasitemia among pregnant women in urban Kigoma, Tanzania. All pregnant women attending antenatal care services at an urban maternal and child health clinic were randomly exposed to either intermittent or continuous malaria chemoprophylaxis using chloroquine and proguanil. The main outcome measures of the study were reduction of malaria episodes and parasitemia and hemoglobin levels among pregnant women. Baseline findings suggest that the overall mean hemoglobin concentrations among primigravida and multigravida women were similar within the intervention and comparison groups (P = 0.27). Similarly, no significant difference was observed in the prevalence of malaria parasitemia within the primigravida intervention and comparison groups (P = 0.4). Hence, the process of randomization produced comparable intervention and comparison groups with balanced characteristics. As malaria is a common cause of morbidity and mortality among pregnant women in Tanzania, this study provided useful data for improving reproductive health in the Kigoma region.

Objective: To assess malocclusion and orthodontic treatment needs among 12-15-year-olds in Moshi municipality, Tanzania. Design: A cross-sectional study. Setting: Moshi municipality, Tanzania. Subjects: Two hundred and eighty nine randomly selected primary school children in Moshi municipality in the year 2003. Results: Maxillary median diastema occurred in 20.1% of the children. Crowding and spacing in the incisor segments occurred in 41.2% and 28.4% respectively with significantly more crowding in males than in females (p = 0.009). Anterior irregularities occurred in 46% of the sample in the maxilla and 51.6% in the mandible. These irregularities were significantly more common in the females than in males in the maxilla and mandible (p=0.014, p=0.037 respectively). Reverse overjet was extremely rare (0.3%). Anterior openbite and antero-posterior molar relation discrepancies occurred in 6.2% and 32.5% of the sample, respectively. Crowding, irregularities in the incisor segments and antero-posterior molar relation discrepancies were dominant malocclusion traits in this population. The sample mean DAI score was 24.6 points (CI 95% 23.86–25.36). There was no statistically significant gender difference of DAI scores (p = 0.473). About 65% of the subjects had either no need or had slight need for treatment whereas 35.3% were found with orthodontic treatment needs ranging from elective (21.5%), highly desirable (6.9%) to mandatory (6.9%). There was no significant gender difference in the categories of treatment need (p = 0.942). Unmet orthodontic treatment needs were present in this population with a very small proportion of subjects exhibiting handicapping malocclusion. Conclusion: The information from this study forms part of the basis not only for further research, but also for planning orthodontic care in this community where unmet orthodontic treatment needs are present.

To determine prevalence and pattern of alcohol use, evaluate the level of awareness of the harmful consequences of drinking, and determine the relationship between alcohol use and some selected factors among commercial road transport workers.Cross-sectional survey.All the five motor parks spread over Ile-Ife, a semi-urban community in south western Nigeria.out of the 403 transport workers, 400 (99.3%) agreed to participate in the study. The questionnaire of one respondent was rejected. The current prevalence rate of alcohol use was 67.2%. Forty seven percent were 'heavy' users; 15.3% 'moderate' users and 37.7% were occasional or 'mild' users. All the users were engaged in the use of commonly available alcoholic beverages in the vicinity of the motor parks. Majority of the respondents (74.5%) reported drinking after work; 13.5% in the mornings; 10.1% when off-duty and 1.9%, during work. Frustrations that are associated with their work topped the list of reasons adduced for drinking. Belonging to lower age groups was significantly associated with current drinking (chi2 = 17.46, df = 3, p0.001). The proportions of respondents with unsatisfactory level of awareness regarding the association of current drinking with road traffic accidents, and with physical complications were high.Current alcohol use and use in a hazardous manner is an important public health problem among commercial road transport workers in Nigeria. There is an urgent need to modify existing legislations or enact new laws on 'driving under the influence' of alcohol, and enforce them.

Background: Kenya has a soaring rate of road traffic fatalities. Available evidence suggests significant alcohol-relatedness to trauma. We know little about the prevalence of alcohol-related injuries in Nairobi. Objective: To determine the extent and pattern of alcohol use in subjects admitted following road traffic accident. Design: A descriptive hospital based survey. Setting: Kenyatta National Hospital (KNH)- a university affiliated hospital in Nairobi, Kenya. Results: The overall incidence of alcohol use was 26.3%. This was higher in males (29.6%) than females (9.1%). Use was 24.4%, 31.0%, 28.6% and 13.6% in the 16-25, 26-35, 36-45 and 46-55 age groups respectively. The mean ages, pre-hospital times and ISS were similar for the AUG and NAUG. The incidence of males, weekend injuries, night collisions, and pedestrian involvement was 94.4%, 69.4%, 41.7%, 77.8% in the AUG and 83.2%, 35.6%, 19.8% and 61.4% in the NAUG respectively. The incidence of head and extremity injuries in AUG was 27.8% and 50% respectively compared to 11.9% and 66.3% in the NAUG. Treatment costs were higher for the NAUG. Conclusions: The results suggest a high incidence and potential alcohol-relatedness to road trauma in Nairobi. The study calls for objective evaluation of the extent, interactions and effects of this modifiable trauma factor. East African Medical Journal Vol.82(3) 2005: 145-148

Objective: To assess excreta and waste disposal facilities available and their impact on sanitation related diseases in Epworth, an informal settlement on the outskirts of Harare. Design: Descriptive cross-sectional survey. Setting: This was a community based study of Epworth informal settlement. Subjects: A total of 308 households were interviewed. Participating households were randomly selected from the three communities of Epworth. Secondary medical archival data on diarrhoeal disease prevalence was collected from local clinics and district health offices in the study areas. Results: Only 7% of households were connected to the sewer system. The study revealed that in Zinyengere extension 13% had no toilet facilities, 48% had simple pits and 37% had Blair VIP latrines. In Overspill 2% had no toilet facilities, 28% had simple latrines and 36% had Blair VIP latrines while in New Gada 20% had no toilet facilities, 24% had simple pits and 23% had Blair VIP latrines. Although a significant percentage had latrines (83.2%), over 50% of the population were not satisfied with the toilet facilities they were using. All the respondents expressed dissatisfaction with their domestic waste disposal practices with 46.6% admitting to have indiscriminately dumped waste. According to the community, diarrhoeal diseases were the most prevalent diseases (50%) related to poor sanitation. Health statistics also indicated that diarrhoea was a major problem in this community. Conclusion: It is recommended that households and the local authorities concentrate on improving the provision of toilets, water and waste disposal facilities as a way of improving the health state of the community. East African Medical Journal Vol.81(8) 2004: 422-426

Objectives: To determine the carriage rates of potential pathogens in the lower genital tract and factors associated with colonization among women with incomplete abortion. Design: A cross-sectional study. Setting: The Manual Vacuum Aspiration room of the Korle-Bu Teaching Hospital, Accra, Ghana. Subjects: Two hundred women undergoing Manual Vacuum Aspiration at the Korle- Bu Teaching Hospital. Methods: Eligible patients were screened for the presence of organisms in the lower genital tract by microscopy and culture of high vaginal and endocervical swabs. Results: Nearly two-thirds of the patients (64.2%) had potential pathogens in the lower genital tract. Bacterial vaginosis alone was present in 47% and a combination of bacterial vaginosis and Candida albicans was present in 17.2%. Residence in an urban slum showed a significant association with the presence of potential pathogens (Odds ratio 2.6; p-value 0.04). Conclusion: Organisms responsible for bacterial vaginosis were the most frequently isolated potential pathogens in the cervical canal of patients with incomplete abortion at the Korle-Bu Teaching Hospital. Management of these patients should therefore include antibiotic prophylaxis against bacterial vaginosis. East African Medical Journal Vol.81(8) 2004: 398-401

Objectives: Household environment factors are known to be associated with child mortality in urban and rural areas of many developing countries. In Mozambique, no study to date has addressed this relationship. This study is aimed to access the contribution of household environment factors to urban childhood mortality in Mozambique. Design: Retrospective follow-up study. Setting: Urban Mozambique. Subjects: One thousand and forty eight children born in urban areas of Mozambique within five years of the 1997 Demographic and Health Survey. Methods: Cox regression analysis was performed on a sample of 1048 children born in urban areas of Mozambique within five years of the 1997 Demographic and Health Survey. Results: Children of mother's who lived in households with no toilet facility or with well as a source of drinking water had a high risk of dying compared to children who lived in households with flush toilet and piped water. Conclusion: Type of toilet facility and source of drinking water play an important role in the risk of childhood mortality in urban areas of Mozambique and the relationship seems to be mediated partly by demographic and socioeconomic factors. East African Medical Journal Vol.81(8) 2004: 408-414

Background: Oral diseases is still a major problem in most developing countries. Within the Republic of South Africa, there remains areas where few or no studies have been done on the oral health status. The emerging district health system with decentralisation of health services to address past inequity in health care in South Africa also provides compelling case for data collection at regional levels. Objectives: To assess the prevalence and severity of dental caries of school children; determine the caries patterns of the study population and to provide useful data for the planning of oral health services in this region. Design: Descriptive analytical study. Setting: School children in the Donald Fraser Health District, Venda in the Northern province, Republic of South Africa. Subjects/Methods: A total of 519 school children in the age groups 6, 12 and 15 years were examined by a calibrated examiner for dental caries using WHO diagnostic criteria. Both the schools, which were divided into rural and peri-urban locations and the children that participated were randomly selected. Results: A mean dmft(sd) of 2.68(3.29) in six year olds and a mean DMFT (sd) scores of 0.61(1.50) and 1.26 (2.18) were recorded in the 12 and 15 year olds respectively. In the six year olds the upper anterior teeth showed highest susceptibility to caries, clearly indicating that black children suffer from early infant caries. At ages of 12 and 15 the mandibular molars were the teeth most affected. The decayed component constituted the main part of the dmft and DMFT scores. Ninety-nine percent of these lesions were untreated and the restorative care was almost nil. Conclusion: An important finding was the doubling of the mean DMFT from the 12-yearolds to 15-year olds and the caries levels for all age groups was higher than the provincial average. The treatment required were mostly extractions and simple fillings, the majority of which could be managed by dental auxillaries using the Atraumatic Restorative Treatment Technique. This study indicates that preventive oral health measures should be implemented on the younger age groups in order to control dental caries. East African Medical Journal Vol. 81 No. 5 May 2004: 236-243

Objective: To assess utilization of partner notification as a tool in prevention and control of Sexually transmitted infections in Nairobi City Council clinics. Design: A cross-sectional study carried out between April and September 2000. Setting: Nairobi City Council health clinics were stratified into eight administrative divisions and a total of 16 out of 54 primary health clinics with at least four STIs patients per day were selected. A standard questionnaire was administered to every fourth patient with clinical diagnosis of STIs who gave consent on exist. Sexual partners referred by index cases during the five day period from each clinic were also enrolled into the study. An additional questionnaire was administered to HCP who were managing STIs patients and their sex partners. Results: Of 407 STIs patients recruited between April and September 2000, 20.6% were primary and 2% were secondary referrals giving an average referral rate of 23%. Respondents with multiple sex partners were less likely to refer their partners compared to those who had one partner (17.9% vs 82.1%, p

Objectives: To determine the seroprevalence of diphtheria in 767 children aged 0-6 years and to identify the relationship between diphtheria seroprevalence and several sociodemographic characteristics of the study subjects in the Erzurum, Erzincan and Kars cities situated in Eastern Turkey. Design: A cross sectional study. Setting: The subjects were recruited from three cities (Erzurum, Erzincan, Kars). The sampling method of 30 clusters recommended for field studies was used for a predetermined number of selecting subjects in the rural and urban areas in each city. Subjects: Of the 767 children included in this study, 423 were from Erzurum, 187 from Kars and 157 from Erzincan. Diphtheria serology was used to examine the blood samples by ELISA method. Results: Positive diphtheria seroprevalence was detected in 77.9% of 767 subjects in Eastern Turkey. Seroprevalence was 74.5% in children younger than one year of age, increased to 84% at the age of 3-4 years, and reduced to 80% at the age of 4-5 years and 69.8% at the age of 5-6 years. The seroprevalence rates were similar in sex and number of siblings. Seroprevalence of diphtheria increased with educational level of parents in the rural area. Conclusion: Positive seroprevalence against diphtheria in eastern Turkey is disturbingly low. East African Medical Journal Vol.80(12) 2003: 617-621

Background: Domestic accidental deaths constitute a public health burden in the Niger Delta Region of Nigeria. This study is aimed at highlighting this public health burden. Objective: This is study is aimed at highlighting this public health burden. Design: A six year retrospective study using mortuary records. Setting: University of port Harcourt Teaching Hospital, Port Harcout, Nigeria. Patients and Methods: Coroner's forms data were used from University of port HArcout Teaching Hospital anatomical pathology department, which is the foremost health institution in the region serving a core population of about six million people. Results: Eighty three domestic accidental deaths seen at the University of Port Harcourt Teaching Hospital in the Niger Delta Region of Nigeria between January 1995 and December 2001 were analysed. The 83 deaths occurred in 63 males and 20 females, giving a ratio of 3:1, between the ages of six months and 86 years. There was a bimodal age distribution, with 20 cases (24.1%) occurring in preschool age children, and 22 cases (26.5%) occurring in the elderly over 70 years. Fifty one deaths (61.4%) occurred in the urban areas, while 32 cases (36.8%) occurred in the rural areas. Seventeen cases (20.5%) occurred from falls from height or same level, thereby, constituting the commonest mechanism of injuries that lead to death in the elderly. In children, the commonest mechanism of injuries leading to death was poisoning. The yearly incidence of these deaths is decreasing with the peak of 26.5% in 1995, and 6.0% in 1999. Conclusion: Enforceable legislation by government coupled with public education to reduce occurrence should be encouraged. Safety at home must be taken very seriously. East African Medical Journal Vol.80(12) 2003: 622-626

Objectives : To determine the prevalence and pattern of drug use among secondary school students in rural and urban communities in south western Nigeria. Design : A survey of senior secondary school students for drug use using a modified form of the World Health Organisation (WHO) questionnaire for student drug use surveys after a pilot study. Setting : Rural and urban communities in two local government areas in Ilesa, Osun State in south western part of Nigeria. Subjects : A total of 600 students drawn from six secondary schools. Main outcome measures : Prevalence rates of drugs use, drug use pattern by sex, class, urban/rural location of school and age of initiation into drug use. Intervention : Determination of drug use prevalence rates and pattern under anonymous condition. Results : Questionnaires of 567 respondents were analysed. Their mean age was 17.0 years (S.D±1.69). The most commonly used drugs and their current prevalence rates were salicylate analgesics, 48.7%; stimulants, 20.9%; antibiotics, 16.6%; alcohol, 13.4%; hypnosedatives, 8.9% and tobacco, 3.0%. Current and lifetime use of alcohol as well as current, past and lifetime use of tobacco occurred significantly more commonly among the males. Past and lifetime use of tobacco was significantly more common in the rural school. For the majority of respondents, initiation into drug use started at a very early age (14 years or below). The majority were mild current users of the drugs, except tobacco for which the majority were daily users. Conclusion : Secondary school students in south western Nigeria engage in use of commonly available drugs like their counterparts elsewhere. Stringent measures should be taken to effect supply and demand reduction. (East African Medical Journal: 2002 79(6): 299-305)

To investigate the prevalence, intensity of infection and control of soil-transmitted nematodes in primary school pupils of urban, suburban and rural localities.Buea Health District.A cross section experimental study.Three hundred and forty primary school children.Mebendazole treatment complemented with health education.The overall prevalence rate of soil-transmitted nematodes in the Buea Health District was 59.1%. The infection rate was significantly different in the urban, suburban and rural localities of the health district (P0.01), with the rural area having the highest rate of infection. Ascaris lumbricoides was the most predominant parasite. The intensity of infection with the various helminth species was not significantly different between children of urban, suburban and rural localities. Mebendazole treatment significantly reduced the intensities of infection with Ascaris and Trichuris (P0.05). The treatment, however, was ineffective against hookworm infection. Re-infection rate with Ascaris and Trichuris was slower in children who additionally received health education than in those who received only anthelminthic treatment.Ascaris lumbricoides, Trichuris trichiura and hookworms are the predominant nematodes reported in children of urban, suburban and rural localities in the health district. Health education is advocated as a complement to chemotherapy in the control of soil-transmitted nematodes.

Background : Albuminuria is long recognised as a sign of renal disease in diabetes. In type 1 diabetes, renal disease occurs after a longer duration of diabetic state. In type 2 diabetes, it is more variable. Objective : To determine the prevalence and any risk factors of albuminuria in shortterm ( Design : Cross sectional, descriptive study. Microalbuminuria was assessed using using micro II strips. Setting : Outpatient diabetic clinic at Kenyatta National Hospital, Nairobi. Subjects : Patients who were newly diagnosed or had had type 2 diabetes for 2 years or less. Main outcome measures: Microalbuminuria, lipids, glycated haemoglobin, fasting blood glucose and blood pressure. Results : One hundred and thirty nine patients who had type 2 diabetes mellitus for ≤2 yrs were seen, but only 100 patients were included in the study over a six month period. Their mean (SD) age was 53.7 (9.3) years. Mean (SD) duration of diabetes was 10.3 (7.5) months. Fifty per cent of the study patients were hypertensive. Only 48% had HbAlc 9%. The lipid profile of total, LDL – HDL-cholesterol and triglycerides were predominantly within normal limits. Twenty six per cent were established to have albuminuria of which one patient had macroalbuminuria. Blood pressure, glycated haemoglobin and lipid parameters were not significantly different from patients without albuminuria. Conclusion : Albuminuria occurred in a significant proportion of patients with short term type 2 diabetes. Comparable to studies done elsewhere on short-term type 2 diabetes, albuminuria is both a sign of nephropathy and a cardiovascular risk factor. It should be looked for in all patients with type 2 diabetes attending this clinic, even at diagnosis. (East African Medical Journal: 2002 79(8): 399-404)

Objective : To determine the type and pattern of antibiotic susceptibility of the pathogenic micro-organisms causing chronic suppurative otitis media (CSOM) in our environment. Design : A retrospective study of ear discharges from patients presenting consecutively with chronic suppurative otitis media. Settings : University of Ilorin Teaching Hospital, a major referral centre in the Middle Belt region of Nigeria. Main outcome measures : Bacterial isolates and their sensitivity patterns. Subjects : Three hundred and seventy five patients aged between eight months and 70 years referred to the ear, nose, and throat clinic of The University of llorin Teaching Hospital were enrolled in the study. Results : About 95.5% and 4.5% of the specimens were culture positive and negative respectively. The commonest bacterial aetiologic agents were Pseudomonas aeruginosa (26.0%) and Proteus spp (21.8%). Peak prevalence of 30.5% occurred among the 0-5 years age group. Seventy five per cent of isolates were gram-negative bacteria. Ofloxacin produced 100% sensitivity in both gram positive and gram-negative organisms tested. Colistin, ceftazidime and cefuroxime were highly active ( _80%) against the gram-negative bacteria while erythromycin and cloxacillin were very effective ( _80%) against the gram-positive isolates. Conclusion : Chronic suppurative otitis media is still highly prevalent in our environment, affecting mainly children. The antibiotic susceptibility pattern of pathogenic isolates is different from those of other regions of Nigeria with increasing resistance recorded for some organisms. Hence, where possible and available, susceptibility tests should guide the management of CSOM in this environment, otherwise, ofloxacin if indicated and cloxacillin/ erythromycin may provide relief and delay emergence of resistant strains. (East African Medical Journal: 2002 79(4): 202-205)

Objective: To determine the profile of potentially pathogenic enteric parasites and bacterial agents in municipal refuse dumps in Ibadan Nigeria. Design: A cross-sectional survey. Setting: Five major market places refuse dumps in Ibadan municipality Nigeria. Methods: The major market places in Ibadan city were randomly selected by lottery method. The refuse sludge were sampled and examined parusitologically and bacteriologically using the methods as described. Data analysis was done by using chi square test where applicable. Results: Cases of multiple intestinal parasites and bacterial agents were commonly encountered in the sludge refuse samples. The commonly found parasitic agents were of both human and veterinary importance. These include Ascaris Lumbricoides (9.3 egp) Entamoeba histolytica (8.07 cyst per gram) Hookworndstrongyle (6.27 egp) and Ascaris suum (1.07 egp). Others were Ascaris vitolorum (1.09epg) Strongyloides papillosu (0.52 larvae per gram.) Schistosoma suis (0.31 epg) Dicrocoelium dendriticum(O.9egp). The most commonly found bacterial agents were Klebsiella species Escherichia Coli Proteus species streptococci and other gram-positive organisms. Climatic conditions affected the distribution of both parasites and bacterial agents in the sludge (P

Objective : To determine the pattern of occurrence of cleft lip/palate and the factors that may have influenced treatment outcome. Design : Descriptive Study. Setting : Jos University Teaching Hospital, Jos, Nigeria. Subject : This study included 107 consecutive patients with cleft lip/palate managed between January 1991 and June 1997. Main outcome measures : The pattern of occurrence of cleft lip/palate, the peculiarities of the malformation in this environment as well as factors that influenced treatment outcome. Results : The 107 patients were aged between one day and twenty-six years at presentation. There were three adults aged between 18 and 26 years with a mean of 22.3 years and 104 children with a mean age of 9.5 months. The male/female ratio was 1. 1:1, the anomaly was 2.4 times commoner on the left and the cleft lip alone was the most frequent mode of presentation (52%). The incidence was higher in the 3rd and 4th siblings. In 13% of these patients, there were other associated congenital anomalies such as Van der Woude's Syndrome, Down's Syndrome and congenital heart disease. Complications were noted in 16(14.9%) patients and these included dehiscence after repair in 8(7.5%) patients, oronasal fistulae in 2(1.9%), nasal speech in 4(3.7%) and hypertrophic scar in 2(1.9%). Eighty nine percent of these repairs were satisfactory to the parents of the affected children. All the adult patients were satisfied with their repair. Conclusion : The low incidence of this anomaly in our environment may be due to underreporting in the rural areas. Public enlightenment programs should help improve early presentation. (East African Medical Journal: 2002 79(10): 510-513)

To determine platelet abnormalities in patients with menigococcal meningitis.Case control study.Fifty seven cases of mennigococcal meningitis based on a cerebrospinal fluid gram stain for gram negative diplococcus or positive culture were recruited. Fifty-seven controls matched for age and sex were also recruited. The following platelet functions tests were performed; platelet counts, platelet adhesiveness, platelet aggregation and clot retraction.Fifty seven patients (41 males and 16 females) with meningococcal meningitis were studied. Their mean age was 25.5 +/- 8.32 years with a range of 15 to 45 years. Five patients had purpura, four peripheral gangrene, eight conjunctival haemorrhages and one was in shock. There was a statistical significant difference in the platelet aggregation and clot retraction between the patients and controls at p-values of 0.0001 and 0.0002 respectively. There was no significant difference in the platelet count and adhesiveness between the patients and the controls at a p-value of 0.203 and 0.22 respectively. No association was found between the platelet functions and the clinical presentations.Patients with meningococcal meningitis have abnormalities in the platelet functions mainly in aggregation and adhesiveness.

Objective: To assess the level of exposure to information about oral health from local sources, risk awareness, oral health beliefs and behaviours among male and female students attending higher learning institutions in Dar es Salaam. Design: A cross sectional survey. Setting: Government recognised higher education institutions in Dar es Salaam, Tanzania in 1999. Subjects: The study population comprised of 1123 university students in Dar es Salaam. Main outcome measures: Level of risk awareness, exposure to oral health information, oral health beliefs and behaviour among students. Results: Despite apparent misconceptions, the level of risk awareness was generally high and did not differ between male and female students. Univariate analysis of variance revealed that female students were exposed to more oral health information, had stronger oral beliefs and performed preventive behaviours more frequently than did their male counterparts. In multiple linear regression analysis, beliefs about the importance of preventive behaviours were significantly related to the frequency with which such habits occurred (β = 0.19, p < 0.001) across gender and students status. This relationship was significantly stronger among females (β = 0.33, p < 0.001) than among males (β = 0.11 p < 0.05). Conclusion: The results indicate that strengthening beliefs in the presence of accurate knowledge might successfully promote students' oral health enhancing behaviour. (East African Medical Journal: 2002 79(6): 328-333)

To investigate the prevalence of major depression in deliberate self-harm individuals.A cross sectional descriptive study.Three tertiary health care centres in Harare, Zimbabwe.Three hundred and eighty seven deliberate self-harm consecutive subjects were recruited from July 1, 1997 to December 31, 1997 for this study. Diagnostic procedures included complete medical history, physical and neurological examinations. The DSM-IV criterion for major depression was used for the diagnostic purpose.The prevalence of major depression, number of attempts and recent life events, methods used, feeling in deliberate self-harm individuals.The prevalence of major depression was 20.7% (n=80, 95% CI=16.7-24.2) according to the DSM-IV criterion. Sixty-two percent (95% CI=57.2-66.8) of the subjects with DSH were agedor = 30 years. Significant differences (P0.05) were found between DSH subjects with and without major depression related to age, education, life events and number of previous attempts.The most predictive factors associated with DSH risks are age, depression, recent loss, divorced, loss of job and history of previous attempts. Further studies are needed to address some causes of DSH.

Objective: To assess the attitudes of general practitioners in Harare, Zimbabwe, towards the use of clinical practice guidelines (CPG's). Design: Cross sectional survey. Setting: General practitioners in private practice within the urban Harare (Zimbabwe) environs. Subjects: Two hundred and thirty two general practitioners in Harare, Zimbabwe. Main outcome measures: The response to a questionnaire enlisting attitudes to CPGs. Results: Questionnaires were sent to 232 general practitioners. Of these, 137 (59.1%) returned a completed questionnaire. Among the respondents, 95.6% felt that general practitioners should be involved in the development of guidelines, 72.6% had read at least one guideline, 65.9% were prepared to use guidelines in their practice, 61.6% thought that guidelines would improve their treatment ability, and 59.7 % thought that guidelines would improve their knowledge of disease. 76.5 % felt that the government should not legislate, 66.2% felt that guidelines reduce practitioners' flexibility and 57.9% felt that guidelines wrould not improve their diagnostic ability. Conclusion: The respondents were, in general, favourabl y disposed towards CPGs. Most had already read some guidelines, and about two thirds were prepared to use them. Almost all respondents felt that general practitioners should be involved in the development of guidelines for use in general practice. These general practitioners felt that guidelines were likely to help them treat patients than to make a diagnosis. Despite these favourable attitudes, many practitioners felt that guidelines would limit their personal flexibility in caring for patients. Organisations developing or implementing CPGs in general practice should address these concerns.

To determine the aetiology of chronic otitis media (COM) in Dar es Salaam and to find out the shelf life of boric acid in spirit ear drops (BAISED).Cross-sectional study.Muhimbili Medical Centre and selected primary schools within Dar es Salaam.Bacterial isolates and their sensitivity patterns and shelf life of BAISED.One hundred and seventy six pus swab specimens obtained from 150 patients with COM for more than three months were submitted for culture and antimicrobial sensitivity testing in 1997.The isolates included Pseudomonas aeruginosa (51.7%), Staphylococcus aureus (17.2%), Proteus mirabilis (13.2%), Klebsiella spp. (8.0%), Escherichia coli (5.8%) and unidentified coliforms in 4.0%. All isolates were sensitive to gentamicin. Sensitivity of Pseudomonas aeruginosa and Proteus mirabilis to kanamycin was 98.5% and 100%, respectively. P. aeruginosa was sensitive to chloramphenicol, ampicillin and tetracycline by 58.1%, 10.1% and 8.3%, respectively. Three per cent BAISED inhibited the growth of all Pseudomonas aeruginosa even after it has been stored at room temperature for six weeks.Based on these results, the drug of choice for management of COM in Dar es Salaam is gentamicin. However, given its ototoxicity effects and the fact that BAISED is effective and affordable, the later should be the treatment of choice.

To determine the pattern of histopathological variants of intracranial neoplasms, relative distribution of the variants in the age groups and also to determine the gender differences that exist in these tumours.Case control study.Department of Pathology, University College Hospital, Ibadan, Nigeria.Two hundred and ten histologically confirmed cases of intracranial neoplasms seen during eleven-year period (1980 to 1990) were analysed.Slides of tumours stained with haematoxylin and eosin, reticulin and phosphotungstic acid haematoxylin.Two hundred and ten intracronial neoplasms comprising 172 primary and 48 secondary neoplasms were seen. One hundred and thirty five neoplasms occurred in adults and 75 in children. There was no gender difference, the ratio being 1:1. Gliomas accounted for the largest group of tumours followed by metastases to the brain. Of the gliomas, astrocytoma was the commonest. Craniopharyngiomas were found to be common in children. Germ cell tumours were found to be uncommon.Gliomas are the commonest group of intracranial neoplasms in both adults and children. This is followed by metastatic tumours. Tumours of the sella turcica are predominantly found in children. Involvement of the brain in disseminated Burkitt's lymphomas is predominantly found in Africans as the Burkitt's tumour is uncommon in non Africans.

To evaluate the effectiveness of sildenafil (Viagra) in the treatment of male erectile dysfunction in Nairobi.Prospective open label extension study.Urology clinics at the Nairobi Hospital, Kenyatta National Hospital and the author's private clinic in Hurlingham, Nairobi.Two hundred and nineteen adult male patients with erectile dysfunction.The age range was 33-80 years with a mean of 62.5 years and a peak incidence in the 60-69 year age group. One hundred and nineteen patients (54.34%) had organic causes, 85 patients (38.81%) had psychogenic causes and 15 patients had mixed causes. Two hundred patients (91.32%) had improved sexual function after treatment with viagra. This improvement was sustained during the study period of sixteen weeks and included improved erectile and orgasmic functions and overall sexual satisfaction. One hundred and fifty seven of these patients responded to therapy with 50 mg of viagra; 40 patients with 25 mg and three patients with 100 mg of therapy. Nineteen patients (8.68%) had no improvement in sexual function after viagra administration. Seven patients (3.2%) had adverse effects which were mild and transient. They included mild headaches in three patients, mild dyspepsia in two patients and facial flushing and nausea and vomiting in one patient, respectively.Oral sildenafil (Viagra) is an effective well tolerated and simple treatment for male erectile dysfunction in the majority of cases. The cost of treatment at about ten United States dollars for the 50 mg tablet is prohibitive and may limit its wide use by many deserving patients in this locality.This prospective open-label extension study was carried out to evaluate the effectiveness of sildenafil (Viagra) in the treatment of male erectile dysfunction in Nairobi, Kenya. A total of 219 adult male patients with erectile dysfunction were instructed to take 50 mg, 25 mg, or 100 mg of sildenafil orally 1 hour prior to planned sexual activity, but not more than once every 24 hours. Patients were reviewed at 4-week intervals for 16 weeks to assess the efficacy and adverse effects of the drug. The age range was 33-80 years with a mean of 62.5 years and a peak incidence in the 60-69 year age group. The causes of erectile dysfunction were organic (n = 119, 54.34%), psychogenic (n = 85, 38.81%), and mixed (n = 15). 200 patients (91.32%) had improved sexual function after treatment with Viagra. This improvement included improved erectile and orgasmic functions and overall sexual satisfaction. 157 patients responded to the 50-mg treatment regimen; 40, to the 25-mg regimen; and 3, to the 100-mg regimen. No improvement in sexual function was reported in 19 patients (8.68%) after Viagra administration. In addition, 7 patients reported mild and transient adverse effects of the drug, including mild headache, dyspepsia, facial flushing, nausea, and vomiting. In conclusion, oral sildenafil (Viagra) is an effective well-tolerated and simple treatment for male erectile dysfunction in the majority of cases. However, the cost of treatment may prohibit and limit its wide use by many deserving patients in this area.

To determine baseline data among pregnant women consenting to participate in a randomised trial of alternative strategies of malaria chemoprophylaxis in Kigoma urban district, western Tanzania.Cross-sectional study.The study was conducted in an urban MCH clinic in Kigoma town in western Tanzania.All consenting pregnant women who fulfilled entry criteria were recruited into the study. BASELINE STUDIES: Baseline data were collected prior to randomisation of women to antimalarial prophylactic regimens. Baseline measurements included examination for blood depleting parasitic infections (stool and urine examinations), haemoglobin levels, haematocrit, sickling test, and blood slide for malaria parasites.A total of 728 pregnant women consented to participate in the interview and of these 705 participated in baseline studies constituting a participation rate of 96.8%. The age of participating women ranged from 14 to 45 years with a mean age of 23.7 years (standard deviation [SD] = 5.4) while the mean number of pregnancies ranged from 1 to 13 with a mean of 3.2 (SD = 2.2). The prevalence of malaria parasitaemia among the pregnant women examined was 9.4% (N = 705) while the prevalence of anaemia (defined as Hb8.5 gdl-1) was 12.4% (N = 579). No significant difference was observed in prevalence proportions of malaria parasitaemia in relation to age, parity, marital status and use of mosquito bednets. However the prevalence of anaemia among women in the age group 31-45 years was significantly lower than that observed among women in the age group 14-20 years (2.9% versus 18.9%; crude odds ratio [OR] = 0.13; 95% confidence interval [CI], 0.02-0.55). Sickle cell disease (HbAS) was found in 2.3% (N = 564) of the pregnant women examined.It is concluded that the prevalence of malaria parasitaemia and anaemia was very high in this population suggesting the need for interventions directed at controlling these major causes of maternal morbidity and mortality in Tanzania.This cross-sectional study conducted in Kigoma urban district, western Tanzania, determined the baseline data among pregnant women consenting to participate in a randomized trial of alternative malaria chemoprophylaxis strategies. Baseline data were obtained prior to randomization of women to antimalarial prophylactic regimens (intermittent or continuous chloroquine and proguanil). Baseline measurements included examination for blood depleting parasitic infections (stool and urine examinations), hemoglobin levels, hematocrit, sickling test, and blood slide for malaria parasites. A total of 728 pregnant women consented to participate, and of these, 705 participated in baseline studies constituting a participation rate of 96.8%. The age range was 14-45 years, while the number of pregnancies ranged from 1 to 13. The prevalence of malaria parasitemia among the subjects was 9.4% (N = 705), while the prevalence of anemia was 12.4% (N = 579). There was no significant difference in prevalence proportions of malaria parasitemia in relation to age, parity, marital status and use of mosquito bednets. However, the prevalence of anemia among women aged 31-14 years was significantly lower than among women in the age group 14-20 years (2.9% vs. 18.9%; crude odds ratio = 0.13; 95% confidence interval, 0.02-0.55). Sickle cell disease (HbAS) was found in 2.3% (N = 564) of the pregnant women examined. The prevalence of malaria parasitemia and anemia was very high in this population, suggesting the need for effective disease control interventions.

To investigate certain anatomical features of the vermiform appendix and the prevalence of acute appendicitis among Sudanese citizens in Khartoum province.A prospective descriptive study of consecutive patients operated by a particular doctor.Omdurman and Khartoum Teaching Hospitals from November 1995 to February 1996.Appendicectomy and recording particular characteristics of the appendix.(i) appendix position, (ii) variations of mesopharynx and (iii) length of appendix.Acute appendicitis was found to be more common in males than in females and among adults than children. The average length was 8.9 cm in males and 9.4 cms in females. The appendix was commonly found to be retrocaecal (58.3%) on pelvic (21.7%) or paracaecal (11.7%). Anomalies of the appendix were more common in children than adults and occurred in 47% of cases.Average length of the vermiform appendix was longer in females than in males. Ectopic positions such as left-sided appendix were not detected in this study.

To determine the prevalence of rheumatic heart disease (RHD), and the impact of potential risk factors on its occurrence among school children in Addis Ababa.Cross-sectional survey of school children for the presence or absence of RHD.Randomly selected ten government and five private schools from the list of all government and private schools in Addis Ababa teaching grades 7 and 8.All school children attending grades 7 and 8 in the randomly selected schools.Clinical findings suggestive of RHD confirmed by echocardiographic and Doppler studies.Out of the 10,053 school children selected for the study 9,388 (93%) were examined. Sixty of the 9,388 school children examined were subsequently confirmed to have RHD giving an overall prevalence rate of 6.4 per 1000 children. The prevalence for government and private schools representing low and high socio-economic groups were 7.1 and 1 per 1000 children respectively (Fisher's exact = 0.019). Crowding conditions at home, in schools and in the bedrooms were not associated with the risk of RHD (chi 2 = 4.968; por = 0.174).This study confirmed that the prevalence of RHD, at least in the low socio-economic group is among the highest in the world. This evidence highlights the need for an urgent control programme.

To determine the antibody titre levels to typhoid/paratyphoid fever organisms among apparently healthy volunteers.Cross sectional study.General community and University Teaching Hospital.Volunteer sample of 323 apparently healthy individuals with body temperaturesor = 37.8 degrees C.Questionnaire administration to classify volunteers into three socio-economic status (SES).There were 35.29% of the apparently healthy population in Jos community with antibodies to typhoid/paratyphoid fever organisms. The presence of these antibodies were neither sex nor SES related. Normal antibody titres were up to 1:40 and 1:80 for O and H Salmonella antigens respectively. Contrary to the general belief, typhoid/paratyphoid fevers have not affected virtually everybody in Nigeria. The difference between those without previous history and those with previous history was significant (p0.05) with those in the former category having a higher percentage.For a single sero-diagnosis to have any diagnostic value in Jos community and its environs, only a four-fold rise to what has been found to be normal should be significant. This means that only titres of 1:160 and 1:320 and above for O and H antigens should be considered significant.

To determine diagnostic criteria for tuberculosis among sputum smear acid fast bacilli negative patients with chronic cough, based on symptoms, signs and simple laboratory tests.A two-month prospective follow up study.Muhimbili Medical Centre, Dar es Salaam, Tanzania.One hundred and seventy- eight consecutive patients admitted between 1st November, 1994 and 31st March, 1995 with chronic productive cough.Sputum smear acid fast bacilli (AAFB) negative with TB, discriminating ability of clinical and laboratory parameters.Forty three (24.2%) were sputum smear positive for acid fast bacilli (AAFB). In 90 (50.6%) patients, AAFB could be isolated in specimen other than sputum and in 45 (25.3%) no AAFB could be isolated. In a univariate analysis of all symptoms, signs and laboratory test results, cough of four or more weeks, haemoptysis, oral candidiasis, chest consolidation, pleural effusion, mid zone and upper zone chest x-ray opacities were significantly different between sputum AAFB negative TB and non TB patients. Discriminant analysis revealed six highly significant variables: Mantoux reaction, pleural effusion, Kaposi's lesion, cervical lymphadenopathy, matted lymph node, mid zone and upper zone CXR infiltrates. From these variables an equation was derived to calculate the probability that a sputum smear negative patient had tuberculosis. Then a scoring system was developed that classified correctly 84% of cases of sputum AAFB negative patients into tuberculosis or non tuberculosis.In sputum smear AAFB negative patient clinically suspected to have tuberculosis, Mantoux reaction, cervical lymphadenopathy, matted lymph nodes, absence of mid lower zone infiltration on CXR and presence of pleural effusion could be used for presumptive diagnosis, but they would not make a therapeutic trial unnecessary.

To establish the role played by spiritual churches in the observed increase rate of antenatal clinic default in Calabar, Nigeria.Cross sectional comparative study.Calabar, an urban community, the capital of Cross River State in south-eastern part of Nigeria.Women who booked for antenatal care in the University of Calabar Teaching Hospital but delivered outside orthodox health facilities.A total of 44.3%, of our antenatal clinic defaulters delivered in spiritual churches. Fear of spiritual attack by wicked people and prophetic warning in church (48.3%) and high hospital bills (26.8%) were the major reasons for this act. Perineal tear, primary postpartum haemorrhage and prolonged labour were associated more with delivery in church than hospital delivery or home delivery or delivery by TBAs (p0.01). Birth asphyxia and birth trauma were also significantly higher in church than hospital and other unorthodox delivery centres (p0.01). All the maternal deaths occurred in church and perinatal mortality was higher in church than other delivery facilities.The spiritual churches play a major role in the increasing rate of antenatal clinic default in Calabar. The pregnancy outcome in these spiritual churches is worse than when delivered in hospital, by TBAs or at home. Adequate health education; reduction in delivery fees in hospitals and general improvement in the socio-economic status of the populace may help reduce these high maternal and perinatal morbidity and mortality in the spiritual churches.

To determine the correlates of psychiatric morbidity and the factors that may influence the recognition of psychiatric cases in primary care.In the cross-sectional survey, the sample was selected by systematic sampling technique. Each subject was interviewed in sequence by a research nurse, a psychiatrist and a general practitioner (GP).The primary care facility at the University College Hospital, Ibadan.Eight GPs and 414 (44% males, 56% females) patients were selected.A socio-demographic questionnaire, the present state examination (PSE), and clinical interview were administered to the subjects. Eysench personality questionnaire (EPQ) was completed by GPs. The research nurses scored each GP on an enthusiasm scale.The diagnosis by psychiatrist and GPs recorded on doctors' information sheet: the PSE scores of subjects, the EPQ scores of GPs and their observed enthusiasm ratings among others were the main measures.The psychiatric morbidity rate was 43.4% in the centre. GPs accuracy was 0.7 and Kappa score was 0.44. EPQ Neuroticism and Psychoticism scores correlated negatively with GPs ability to recognise cases, whereas enthusiasm correlated positively. GPs had difficulty in recognising minor psychiatric disorders accounting for 94.4% of morbidity in the primary care. Morbidity was significantly associated with female sex, age 45-54 years, self-employment, low level of education and being currently married. Females and the self-employed were over-represented among GPs' cases.More data from similar studies across cultures would provide useful insight into strategies that could bring about early recognition and treatment of minor psychiatric disorders in the primary health care.

To determine immunoglobulin levels in HIV-1 seronegative and HIV-1 seropositive children at different clinical stages of HIV infection.Cross-sectional study.Lugalo and Mwanayamala mother and child clinics in Dar es Salaam.Two hundred and ninety-nine children aged 18 months to five years.Estimation of immunoglobulin classes (IgG, IgA, IgM, IgD and IgE).Mean serum levels of all immunoglobulin classes were significantly higher (p0.0001) among the HIV-1 seropositive children (IgG = 22.9 g/l, IgA = 2.2 g/l, IgM 2.7 g/l, IgD 101.5 IU/ml and IgE 887.7 IU/ml) than among the HIV-1 seronegative children (IgG = 11.3 g/l, IgA = 1.0 g/l, IgM = 1.5 g/l, IgD = 27.8 UI/ml and IgE 341.3 UI/ml). The percentages of HIV-infected children with immunoglobulin concentrations above mean level were 83% for IgG, 77% for IgA, 78% for IgM, 73% for IgD and 78% for IgE.HIV seropositive children have higher levels of immunoglobulin than seronegative children. There was no correlation between the levels of immunoglobulin classes and CDC clinical staging.This cross-sectional analysis examined serum levels of the 5 immunoglobulin (Ig) isotypes in HIV-1 seronegative and HIV-1 seropositive children at different clinical stages of HIV infection in Dar es Salaam, Tanzania. The study employed 299 children between 18 months and 5 years of age attending the mother and child health clinics at Lugalo and Mwanayamala. Blood samples from 150 HIV-1 seropositive (75 males and 75 females) and 149 HIV-1 seronegative (82 males and 67 females) were collected and examined via Ig assay and HIV serology. Results revealed that the mean serum Ig levels were higher (p 0.0001) among HIV-1 seropositive children (IgG = 22.9 g/l, IgA = 2.2 g/l, IgM = 2.7 g/l, IgD = 101.5 IU/ml, IgE = 887.7 IU/ml) than among HIV-1 seronegative children (IgG = 11.3 g/l, IgA = 1.0 g/l, IgM = 1.5 g/l, IgD = 27.8 IU/ml, IgE = 341.3 IU/ml). The percentage of Ig concentrations were significantly higher in the HIV-1 seropositive than in the HIV-1 seronegative children (83% for IgG, 77% for IgA, 78% for IgM, 73% for IgD, and 78% for IgE). In conclusion, this study confirms the increase in serum Ig levels in HIV-1 seropositive children and the insignificant correlation between high Ig levels and US Centers for Disease Control clinical staging.

To determine the pattern of growth and development of institutionalised infants and to compare the outcome with that of infants living with their biological mothers.A cross-sectional survey.Seven children's homes; Kenyatta National Hospital's New Born Unit and Well Baby Clinics in Nairobi, Kenya.Eighty-two abandoned babies who fulfilled the selection criteria were recruited and for each abandoned baby two mothered babies matched for age and sex were selected from the well baby clinics.Anthropometric measures of weight, length, head circumference and left mid arm circumference (LUMAC) were taken and the mean values and Z scores determined to demonstrate growth pattern and nutritional status of the babies. The Revised Denver Development Screening Test (RDDST) was used to assess the development pattern of infants.Seventy per cent of infants were below six months old and 73% were abandoned within the first week of life. Abandoned babies were significantly thinner with the mean LUMAC of 10.8 cm versus 12.3 cm (p = 0.02) Institutionalised babies were significantly wasted (p = 0.00001) and stunted (p = 0.00001). Abandoned babies were significantly delayed in development (p0.0001). In all the four sectors tested for, institutionalised babies showed significant delay, p0.0001 in each sector.This study demonstrates that infants under institutional care have poorer growth and development compared to mothered infants.This cross-sectional study examined the pattern of growth and development of infants in some of the baby institutions in Nairobi and compared the outcome with that of infants living with their biological mothers. The participating institutions included the Kenyatta National Hospital and 7 children's homes within the city. The study recruited 82 abandoned babies aged 1-18 months who had been abandoned for at least 2 weeks. Each abandoned baby was paired with 2 mothered babies matched for age and sex. Anthropometric measures of weight, length, head circumference, and left mid arm circumference (LUMAC) were taken. The mean values and Z scores were determined to assess growth pattern and nutritional status of the babies. The results showed that abandoned babies were significantly thinner, with a mean LUMAC of 10.8 cm vs. 12.3 cm. Moreover, abandoned babies were significantly wasted (p = 0.00001), stunted (p = 0.00001), and delayed in development (p 0.0001). These findings indicate that institutionalized infants have poorer growth and development compared to mothered infants.

To test the association between vitamin D deficiency rickets and protein-energy malnutrition in Ethiopian children.Ethio-Swedish Children's Hospital, a tertiary health facility catering for children coming from Addis Ababa and the surrounding districts.A case-control study.One hundred and fifty seven children under three years of age who had vitamin D deficiency rickets constituted the cases. Controls were the same number of children matched with cases for sex and age within one month and were seen within a week of case recruitment.Cases and controls were similar (p0.5) in terms of maternal education, paternal age, paternal education and family size. Factors strongly and independently associated with rickets were underweight, nutritional status [OR = 12.7 (95% CI 4.47-11.08)], marasmus [OR = 6.3 (95% CI 2.81-19.66)], lack of exposure to sunshine [OR = 3.5 (95% CI 1.33-5.84)] and non-married maternal marital status [OR = 5.1 (95% CI 2.90-10.62)].Protein-energy-malnutrition is strongly associated with vitamin D deficiency rickets. Intervention strategies targeting vitamin D deficiency rickets should give emphasis to children with protein energy malnutrition. Further work will be required to define the causal links between rickets and the risk factors identified in the present study.This case-control study assessed the association between vitamin D deficiency rickets and protein-energy malnutrition in Ethiopian children. Data were collected over a period of 18 months (January 1997 to May 1998) from 157 children with rickets and from an equal number of age- and sex-matched controls. Findings revealed that both cases and controls were similar in terms of maternal education, paternal age, paternal education, and family size. The factors strongly and independently associated with rickets were underweight condition, nutritional status, marasmus, lack of exposure to sunshine, and maternal nonmarried status. Therefore, this study suggest that intervention strategies targeting vitamin D deficiency rickets should give emphasis to children with protein-energy malnutrition, since it is strongly and independently associated with vitamin D deficiency rickets.

To assess birthweight, length and head circumference of live births, and to examine the effect of maternal age, parity and gestational age on birth size of the live births.A prospective study.Tikur Anbessa, Zewditu, Gandhi memorial and St. Pauls hospitals, in Addis Ababa, Ethiopia.Four thousand two hundred and six consecutive live births from July 1996 to January 1997.Weight, length and head circumference of the newborns.Among the 4206 consecutive live births, 4047 were singleton and 159 were twins. Two thousand one hundred and sixty (51.7%) were males and 2046 (48.6%) were females. The mean birthweight of singleton live births was 3065 +/- 465 g, with modal group of 3000-4000 g. The incidence of low birthweight was 9.1%. The mean length for all singleton live births was 48.6 +/- 3.3 cm and modal group of 46-52 cm. The mean head circumference was 34.4 + 2.9 cm; modal group 31-37 cm. The incidence of low birthweight of the newborns was significantly higher for females, younger maternal age, primiparas and pre-term babies. On the multivariate analysis, gestational age and sex of the newborn respectively had significant effects on birthweight, length and head circumference of the neonates controlling for the other variables. On the other hand parity and maternal age had significant effects only on the birthweight of the neonates.This study has provided information on the effects of some of maternal characteristics on the size, particularly length and head circumference of newborns which were not given emphasis on previous birthweight studies. We suggest proper recording and analysis of birthweight, length and head circumferences be given importance for monitoring and evaluating maternal and child health programmes.This prospective study examined the effect of maternal age, parity, and gestational age on the size of the newborn and assessed the birth weight, length, and head circumference of live births in Addis Ababa, Ethiopia. Birth sizes of a total of 4206 consecutive live births from the four referral hospitals from July 1996 to January 1997 were measured. The mean birth weight of the 4047 singleton live births was 3065 +or- 465 g, with a modal group of 3000-4000 g; 9.1% were of low birth weight. Their mean length was 48.6 +or- 3.3 cm, with a modal group of 46-52 cm. Moreover, the incidence of low birth weight was found to be significantly higher for female neonates, younger maternal age, primiparas, and preterm live births. Multivariate analysis showed that gestational age and sex of the newborn, respectively, had significant effects on birth weight, length, and head circumference of the newborns controlling for the other variables, while parity and age of the mother had significant effects only on the birth weight of the newborns. In conclusion, proper recording and analysis of birth weight, length, and head measurements should be given importance for monitoring and evaluating maternal and child health programs.

To determine the knowledge, attitudes and practices (KAP) of mothers and the knowledge of health workers regarding care of the newborn umbilical cord.Cross-sectional survey.Mothers with infants less than three months of age attending well child clinics and health workers (HW) in the clinics, maternity and newborn units of public health, facilities serving an urban slum area in Nairobi, Kenya.Of the 307 mothers interviewed, 91% and 28% of mothers knew of the need for hygiene whilst cutting and tying the cord, respectively. Regarding postnatal cord care, 40% had good knowledge and 66% good practice. Fifty-one percent of mothers knew and 54% practised postnatal cord care for the appropriate duration of time. Seventy-nine percent of mothers were afraid of handling an unhealed cord. After multivariate analysis, the following variables showed significant independent association with good maternal KAP; increased level of education (OR 2.3, p0.001), living in middle class areas rather than slums (OR 1.5, p0.03), increased maternal age (OR 1.8, p0.001), acquisition of knowledge from a HW rather than from other sources (OR 1.5, p0.001), and living in stone/brick houses rather than mud houses (p = 0.01). Fifty per cent of HW had correct knowledge on type of postnatal cord care, and 79% had correct knowledge on duration required for the same. The knowledge of 50% on type of care was incorrect by international standards, but was in keeping with Nursing Council of Kenya teaching.Mothers had good knowledge on the need for hygiene when cutting the cord, had poor knowledge and practice in other aspects of cord care, and were afraid of handling the cord. Poor KAP was associated with young, poor mothers of low education, who had acquired their knowledge from sources other than HW. The knowledge of a large proportion of HW was incorrect and outdated. We recommend that health education on cord care be given at all levels of contact with mothers and that knowledge of all primary HW on cord care be updated.Using a cross-sectional survey, this study investigated the knowledge, attitudes, and practices (KAP) of mothers and the knowledge of health workers regarding care of the umbilical cord. The study interviewed a total of 307 mothers with infants less than 3 months old and 64 health workers (HWs) in an urban slum area in Nairobi, Kenya. The results showed that 91% and 28% of mothers knew of the need for hygiene while cutting and tying the cord, respectively. As to postnatal cord care, 40% had good knowledge and 66% had good practice. However, 79% of mothers were afraid of handling an unhealed cord. Results of multivariate analysis showed that the following variables had significant independent association with good maternal KAP: increased level of education, living in middle class areas, increased maternal age, and acquisition of knowledge from HWs rather than from other sources. 50% of HWs had correct knowledge on type of postnatal cord care, but the knowledge of 50% on type of care was incorrect by international standards. Based on the findings, it was recommended that good health and cord care practices be taught at all levels of contact with mothers and that knowledge of all primary HWs on cord care be updated.

To assess drug-resistance of the malaria parasite in elite residents of Kampala city, Uganda.Recruited into the study were patients with complaints of fever, backache and headache or general malaise and body joint pains, could recall their previous treatment for the current complaints and could show laboratory reports indicating presence of malaria parasites. Blood was taken from those patients and examined for malaria parasites.Kampala Diagnostic and Imaging Consultants Clinic, Kampala, Uganda from 1994 to 1997.Out of 268 patients, 27%, 26%, 12%, 11%, 6%, 6% and 5% strains of malaria parasites were respectively resistant to chloroquine, quinine, metakelfin, fansidar, halfan, artenam and camoquine. Double drug resistance was also observed in the patients who had taken chloroquine and quinine (21%), chloroquine and fansidar (16%) and quinine and fansidar (10%) out of 86. Some strains exhibited resistance to chloroquine, quinine and fansidar (12.6%) out of 71. R III was observed in 17 strains of malaria parasites, eight of them were for chloroquine, four for fansidar and three for quinine. Twenty-six patients had frequent recurrence of malaria lasting for over one year.One third of Plasmodium falciparum strains by 1997 had acquired resistance to chloroquine and quinine and some were gradually acquiring multi-drug resistance, leading to frequent recurrence of malaria and use of many different types of antimalarials.This study assessed the resistance of malaria parasites to single and multiple drugs among elite residents of Kampala City, Uganda. The study was conducted at Kampala Diagnostic and Imaging Consultants Clinic from 1994 to 1997. It enrolled patients with complaints of fever, backache and headache or general body malaise and joint pains, who could recall their previous treatment for the current complaints and could show laboratory reports indicating the presence of malaria parasites. Blood samples of the patients were collected and examined. Out of 268 patients, 27%, 26%, 12%, 11%, 6%, 6%, and 5% strains of malaria parasites were respectively resistant to chloroquine, quinine, metakelfin, fansidar, halfan, artenam, and camoquine. Among patients who had taken two drugs, double drug resistance was observed in those who had taken chloroquine and quinine (21%), chloroquine and fansidar (16%), and quinine and fansidar (10%). Moreover, 26 patients had frequent recurrence of malaria lasting for over 1 year. In conclusion, one-third of Plasmodium falciparum strains by 1997 had acquired resistance to chloroquine and quinine and some were slowly acquiring multidrug resistance resulting in frequent recurrence of malaria and use of many different types of antimalarials.

To establish reference blood levels of total blood cholesterol (TC), lipoprotein cholesterol (LDL-CHDL-C) and triglyceride (TG) and determine the prevalence of hypercholesterolaemia and other coronary heart disease risk factors.Cross sectional study.The blood bank at the Gondar College of Medical Sciences Hospital--a teaching and referral hospital in northwest Ethiopia.Adult, healthy men who who voluntarily donated blood between March 1996 and July 1997.Mean, median and ranges of TC, LDL-C, HDL-C and TG; prevalence rates of hypercholesterolaemia, overweight, smoking and elevated blood pressures. Effect of age, BMI, residence, monthly income on blood lipid levels.A total of 501 donors were investigated and of these 316 (63%) were urban residents. The mean (SD) TC, LDL-C, HDL-C and TG levels in urban donors were 162.5 (35.1), 93.8 (33.9), 47.1 (8.1) and 108.1 (52.5); and in donors from rural area were 158.5 (30), 91.0 (30), 47.4 (7.4), and 98.6 (55.3), respectively; without significant difference between them. However, urban residency was significantly associated (B = 7.2, 95% CI = 1.5-12.9) with the total cholesterol level. The prevalence of hypercholesterolaemia (TC200 mg) was 10.4% in urban donors and 8.1% in rural donors (chi 2 = 0.75, p = 0.39). The prevalence rates of smoking, high blood pressure and overweight in donors from urban and rural areas were, 14% versus 6%, 14% versus 14% and 1.6% versus 1.1%, respectively.The prevalence of hypercholesterolaemia and other coronary heart disease risk factors are low in both urban and rural donors in northwest Ethiopia.

Over a period of 12 months, a total of 852 stool samples from patients (both children and adults) with acute diarrhoeal diseases attending some public and government recognised health institutions in Lagos metropolis were screened for diarrhoeagenic bacterial agents. One hundred and eighty two bacterial isolates were found out of which 83 (45.6%) were Escherichia coli, 38 (20.9%) Shigella spp, 31 (17%) Salmonella spp, 16 (8.8%) Klebsiella spp, eight (4.4%) Aeromonas spp, while there were only six (3.3%) isolates for Plesiomonas spp. Of the 83 isolates for E. coli group, 49 (59%) were enteropathogenic (EPEC), 17 (20.5%) enterotoxigenic (ETEC), 10 (12.1%) enteroinvasive (EIEC) and seven (8.4%) enterohaemorrhagic (EHEC). The EPEC strains particularly serotype 055, were mostly encountered in children aged over five years. On the other hand, EIEC and ETEC strains were found mainly in adults while EHEC O157: H7 strains occurred in all the age groups studied. This study further stresses the important role of EIEC and ETEC in acute diarrhoeal diseases and the possible implication of EHEC in acute gastroenteritis, especially in children in Lagos, Nigeria.

To evaluate the importance of Cryptococcus neoformans, an opportunistic in meningitis, in healthy and HIV infected patients in Kumasi, Ghana.A prospective study; isolating the aetiologic agents of meningitis from cerebrospinal fluid (CSF) using standard methods.Kumasi city, Ashanti region of central Ghana.One thousand five hundred and seventy patients suspected of meningitis, including 28 HIV infected and AIDS patients.The pattern and distribution of the main etiologic agents of meningitis in Kumasi, Ghana shown.Of the 1570 CSF samples examined, 1256 (80%) showed no abnormality. Of the 314 (20%) with abnormalities, 147 were bacterial, and 167 diagnosed aseptic. No cryptococcal cells were found.There is a paucity of cryptococcal meningitis in Kumasi, Ghana, and it is not recommended to screen routinely for the fungus in meningitis investigations.

To determine the frequency of haemoglobin (Hb) measurement and some socio-demographic characteristics in women attending antenatal clinic.Prospective cross-sectional study.Antenatal clinic, Korle-Bu Teaching Hospital.Nine hundred and thirty two pregnant mothers attending antenatal clinic at the hospital. Patients with sickle cell disease, thalassaemia, sickling test positive or unknown sickling status were excluded.Proportion of patients whose records showed various frequencies of Hb determinations and the proportion of those with anaemia at 26 weeks and 34 weeks gestations.One hundred and seventy five (18.8%) patients did not have antenatal Hb measurement; 248 (26.6%) had two, and 251 (26.9%) had more than two measurements. The mean of booking Hb was 10.6 + 1.53 gm/dl. Of the 458 subjects with reliable dates, 293 had their booking Hb measurement at26 weeks. For this sub-group the mean was 10.8 +/- 1.43 gm/dl. (22.5% were10 gm/dl). For 272 subjects with reliable dates whose last Hb measurement was at34 weeks, the mean last Hb was 11.0 +/- 1.37 gm/dl. (last Hb was10 gm/dl in 19.1%). Nulliparity and booking antenatal weight64.0 kg were significantly associated with Hb10 gm/dl at some time during pregnancy.Anaemia in pregnancy is common in this urban population. Combined effects of iron-folate supplementation, malaria chemoprophylaxis as well as early booking and a waiver of antenatal care user fees for needy patients are suggested as remedial measures.

This study was part of the effort of the International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee to evaluate the epidemiology of asthma and allergic diseases around the world. Three thousand and fifty eight randomly selected children aged 13-14 years were studied, using a standard questionnaire developed and field tested by the ISAAC Steering Committee, to establish the prevalence and severity of symptoms of asthma, allergic rhinoconjunctivitis and atopic eczema. Of the 3,058 children, there were 1,659 (54.3%) females and 1,399 (45.7%) males (F:M ratio 1.2:1). The cumulative prevalence rates of wheezing, rhinitis other than common cold, and symptoms of eczema were 16.4%, 54.1% and 26.1%, respectively while within the immediate 12-month period, the rates were 10.7%, 45.2% and 22.4%, respectively. However, rhinitis associated with itchy eyes (allergic rhinoconjunctivitis) was reported by 39.2% of the school children. The prevalence of doctor-diagnosed asthma was 18.4%. Multiple logistic regression analysis showed that a higher prevalence of wheezing and rhinitis was associated with itchy eyes. The prevalence of severe symptoms of asthma, allergic rhinitis and eczema were higher when compared with a similar study in Kenya. However, the prevalence of symptoms of asthma was lower and that of allergic rhinoconjunctivitis higher in our series. There is a need for further studies to investigate the risk factors which might be responsible for the apparently different patterns in these two African countries.

To determine the feasibility and acceptability of collecting data on sexual practices, knowledge, attitudes and perception of risk with regard to HIV and STD infection in two clinic populations.A cross sectional survey carried out between June and July 1992.An urban and a rural health centre in western Kenya.One hundred and sixty women attending Maternal Child Health (MCH) and Family Planning Clinics (FP).Screening STDs including N. gonorrhoea, C. trachomatis, T. vaginalis and syphilis. In addition subjects were interviewed about sexual practices, knowledge, attitudes and perception of risk with regard to HIV and STD infection.The presence of any STD including HIV was detected in 36.2% of women at the urban clinic and 21.2% of women at the rural clinic. The demographics of the two populations were similar with respect to age but were significantly different for several variables including marital status, ethnicity and education. Knowledge of STDs and HIV was nearly universal in both clinic populations with96% of patients being aware of the existence of such diseases. 76.3% of women at the urban clinic felt they could get an STD as compared to 48.8% at the rural clinic (p0.02). This awareness of vulnerability among the urban population was also seen for HIV.It appears to be feasible to conduct studies of sexual practices and perceptions of risk for STD/HIV acquisition in women attending health centres in Kenya.

To establish the extent of alcohol involvement in motor vehicle crashes occurring in Eldoret in western Kenya.A descriptive hospital-based study.Crash-involved patients aged 16 years and above presenting for treatment in all hospitals located in Eldoret town over a period of six months.Casualties were enrolled consecutively. A questionnaire eliciting demographics and crash circumstances was administered. Blood alcohol concentration (BAC) was evaluated either by breath tests or venous blood sample analysis in consenting casualties presenting within 10 hours of the crash. BAC levels of 5 mg% and greater were taken as a positive test; patients registering BAC levels equal to or greater than 50 mg% were considered as being intoxicated.Of the 188 patients evaluated, 23.4% were BAC positive and 12.2% were intoxicated. Males were twice as likely as females to have been drinking prior to the crash (26.4% versus 13.6%; p = 0.08). Significantly greater proportions of night-time and weekend crashes involved intoxicated subjects (p = 0.02 and p = 0.03, respectively). Motor vehicle drives were the most affected by alcohol (60%), whereas pedestrians (33.3%), passengers (16%) and pedal cyclists (8.3%) were involved to a lesser extent. In comparison to passengers, drivers were eight times more likely to have been drinking (OR = 7.9, p = 0.04).Alcohol is a contributing factor in a substantial proportion of traffic crashes occurring in western Kenya. Policy response and specific interventions for discouraging driving under the influence of alcohol, including the establishment and enforcement of a legal BAC limit are needed.

To establish the types of E. coli isolates that are found in river water around Nairobi and to assess the potential risk of use of this water to human health.Multiple stratified sampling was carried out. Surface sampling was used in the entire study.The study was carried out on river waters surrounding Nairobi, Kenya.Forty Escherichia coli strains isolated from river water.Serotyping, toxin gene tests and susceptibility to tetracyclines, ampicillin, chloramphenicol and kanamycin were analysed.None of the isolates could be specifically serotyped using the available antisera. Toxin gene production tests using the colony hybridisation technique revealed that nine (22.5%) of the strains were positive for heat stable (ST) toxin, seven (17.5%) to the heat labile (LT) toxin and two (5%) to both. Using the Agar Disk Diffusion technique, eighty per cent of the strains were susceptible to all four antibiotics, while twenty per cent of the strains showed multiple resistance. None of the strains was resistant to all four antibiotics while no strain showed resistance to kanamycin.None of the E. coli isolates was serotypable and it was therefore not possible to determine whether serologically identical strains of ETEC were haboured by man or animals. Toxin gene tests results showed that there is some risk of infection by diarrhoea causing ETEC to man and animals. Toxin gene tests results showed that there is some risk of infection by diarrhoea causing ETEC to man and animals if they consume this water untreated and there is evidence to show resistance of bacteria to antibiotics, hence appropriate health measures should be adhered to.

Over a period of ten months, all the patients admitted for drug dependence were tested for HBsAg. The positive cases were tested for anti-HDV. The anti-HDV-positive patients were further tested for liver function tests (LFTs) and anti-HCV. A total of one thousand three hundred and twenty one patients were tested. Out of this, 1038 were intravenous drug users (IDUs) and 283 were non-IDUs. Eighty one patients were HBsAg positive (75 IDUs and six non-IDUs). Eleven patients were anti-HDV positive--all were IDUs. The overall prevalence of anti-HDV among HBsAg-positive patients was 13.6%. Among HBsAg-positive IDUs, it was 14.7% and it was 0.0% for HBsAg-positive non-IDUs. Nine (81.8%) of the eleven anti-HDV-positive patients were also positive for anti-HCV and eight (72.7%) had abnormal LFTs. In view of the association of hepatitis B, C and D viruses with chronic liver disease recommendations have been made to control the spread of these viruses and to prevent liver disease.

The pattern of peptic ulcer disease in Zaria has been that of an increasing frequency of perforation, reaching a peak of 45% by 1983. In a retrospective study of 88 consecutive patients managed surgically for duodenal and gastric ulcers between 1984 and 1995, 41% had gastric outlet obstruction and only 17% had perforation. However, the ratio of perforated duodenal ulcer: perforated gastric ulcer has more than doubled from 2.6:1 to 6.5:1. Until now the pattern of peptic ulcer disease in northern Nigeria was different from that in southern Nigeria and most parts of black Africa but this review suggests a reversion to the pattern in these other places. Though these findings may be due to the effects of a changing economy, they may represent a change in the intrinsic behaviour of peptic ulcers in our environment. Ulcer perforation continues to carry a high mortality and truncal vagotomy and drainage remains the surgical treatment of choice for duodenal and gastric ulcers in our institution.