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BackgroundIn resource-limited settings where anti-retroviral treatment (ART) is being scaled-up, the World Health Organization (WHO) recommends the surveillance of transmitted HIV drug resistance (HIVDR). We used the WHO's HIVDR threshold survey method to assess transmitted HIVDR in three antenatal clinic (ANC) sites along the corridor between the two most populous cities in Swaziland, where ART was introduced in 2003.MethodsFrom July–August 2006, remnant sera were aliquoted from HIV serosurvey specimens collected from 70 primagravidas ResultsAmong the 70 eligible specimens, 61 were sequenced – 60 (98%) were identified as subtype C and one as subtype B. No major nucleoside or non-nucleoside reverse transcriptase inhibitor mutations occurred among the first 34 consecutive specimens, which supported a transmitted resistance categorization to these drug classes as ConclusionOur survey indicates that prevalence of transmitted HIVDR among recently infected pregnant women along the Manzini-Mbabane corridor is low (

Between December 1983 and December 1986 705 adult and pediatric cases of acquired immunodeficiency syndrome (AIDS) were officially reported to the Rwandan Ministry of Health and Social Affairs. 459 of these cases involved adults 129 (28%) of whom have already died. Rwandan adult AIDS cases have a male to female ratio of 1 to 7.1 supporting heterosexual transmission of infection especially through female prostitution. 70% of all reported AIDS cases are in the 20-39-year age group. Signs and symptoms in the 121 adult AIDS patients whose records were available for review included diarrhea (52%) weight loss (81%) and fever (74%). 10% presented with meningitis and 14% with Kaposis sarcoma. Minor signs included persistent cough generalized pruritus generalized lymphadenopathy zona oroesophageal candidiasis and disseminated tuberculosis. In terms of the socioeconomic status of these 121 cases 33 were jobless but living in the capital city 26 were prostitutes 20 were middle or upper-class government employees 8 were businessmen 6 were truck drivers and 4 were in the military. Each of the 121 AIDS patients whose case record was examined had a history of sexual promiscuity. Of the 246 Rwandan children under 15 years of age with AIDS 48 (19%) have died. 37% of the pediatric AIDS cases emerged in the 1st year of life; another 55% of cases developed between the 1st and 3rd birthdays. Maternal transmission is assumed responsible for the high number of AIDS cases in small children and infected children appear to have little chance of surviving beyond 3 years of age. Despite limited financial resources the Government of Rwanda has made substantial progress in preventing the Spread of AIDS through a public education campaign and blood screening. The principal preventive strategy is to persuade at-risk and diseased populations to modify the behaviors implicated in the transmission of AIDS.

This report outlines findings and recommendations of a national pharmacovigilance workshop held in August 2012 in South Africa (SA). A survey of current pharmacovigilance activities, conducted in preparation for the meeting, identified multiple programmes collecting drug safety data in SA, with limited co-ordination at national level. The meeting resolved that existing pharmacovigilance programmes need to be strengthened and consolidated to ensure that important local safety issues are addressed, data can be pooled and compared and outputs shared more widely. Pharmacovigilance activities should inform treatment guidelines with the goal of improving patient care. A variety of pharmaco-epidemiological approaches should be employed, including nesting drug safety studies within existing sentinel cohorts and the creation of a pregnancy exposure registry. The attendees agreed on key principles that will inform a national pharmacovigilance plan and compiled a list of priority pharmacovigilance issues facing public health programmes in SA.

In resource-limited settings where antiretroviral treatment (ART) is being scaled-up, the World Health Organization (WHO) recommends the surveillance of transmitted HIV drug resistance (HIVDR). We used the WHO's HIVDR threshold survey method to assess transmitted HIVDR in three antenatal clinic (ANC) sites along the corridor between the two most populous cities in Swaziland, where ART was introduced in 2003.From July-August 2006, remnant sera were aliquoted from HIV serosurvey specimens collected from 70 primagravidas25 years old attending ANC during the national HIV serosurvey. Genotyping was performed at the National Institute for Communicable Diseases, South Africa. Transmitted resistance was defined by the WHO's surveillance list of mutations. HIVDR prevalence was categorized using the WHO's threshold survey binomial sequential sampling method.Among the 70 eligible specimens, 61 were sequenced--60 (98%) were identified as subtype C and one as subtype B. No major nucleoside or non-nucleoside reverse transcriptase inhibitor mutations occurred among the first 34 consecutive specimens, which supported a transmitted resistance categorization to these drug classes as5%. One protease inhibitor mutation, M461, was seen among the first 44 specimens, supporting a categorization of PI resistance as5%.Our survey indicates that prevalence of transmitted HIVDR among recently infected pregnant women along the Manzini-Mbabane corridor is low (5%). Surveys will be carried out in this area biannually and may be extended to other areas. Surveys for transmitted resistance make up one element among a spectrum of activities to assess and support minimization of HIVDR.

Several attempts were made without great success to improve vaccination programs in Rwanda before the Expanded Program of Immunization (EPI) was initiated in 1978. The program of immunization against polio, diphtheria, whooping cough, tetanus, tuberculosis, and measles has reached 80% of children in Rwanda at least once, but it has not yet had a demonstrable effect on mortality. Among the factors hindering achievement of program objectives were the insufficient information provided to parents and inaccessibility of program posts, but failure to mobilize the population was perhaps the greatest shortcoming. The EPI has had a particularly significant effect in reducing morbidity due to measles (from 155.0/10,000 in 1980 to 18.6 in 1987, after an epidemic in 1986) and whooping cough (16,187 cases in 1980 and 996 in 1987). The number of cases of polio, tetanus, and tuberculosis has however not declined significantly since 1978, and the number of cases of tuberculosis has actually increased. Many of the cases of tuberculosis and tetanus were in adults while the EPI stresses immunization of children, suggesting that greater efforts are needed to prevent these diseases in adults. The government of Rwanda with the aid of several international organizations plans to intensify the immunization program over the course of 5 years from 1988-92. The program has specific coverage goals culminating in 100% coverage of infants under 1 year for the 6 diseases and 100% coverage of pregnant women for tetanus by 1992. Program strategies will include decentralization of vaccination activities to health regions, integration of vaccination into the routine of health centers, and improved logistics and maintenance of the cold chain. An intensive communication program will seek collaboration of the political, religious, and educational authorities and use of available media to inform the population of the benefits and availability of the vaccination program.

The project for the struggle against childhood diseases began in Rwanda in 1984. Lack of birth spacing, malnutrition, unhealthy environments and infectious diseases sicken and kill children in all of Africa, and many may be alleviated by simple measures. The project focuses on diarrhea and malaria, attempting to reduce mortality by 25%, administering chloroquine to children with fever and pregnant mothers for malaria, and oral rehydration therapy (ORT) for diarrhea. Goals are breastfeeding and gradual weaning being as universal as possible, and proper alimentation for sufferers of infant diarrhea. ORT is expected to be administered by the mother herself, and should reduce the 60% to 70% of diarrhea deaths caused by dehydration. Measles, whooping cough, neonatal tetanus, polio, diphtheria, and tuberculosis among children will be the targets of innoculation campaigns. All of the diseases are major child killers in Africa; measles are responsible for an estimated 31.3% of child deaths from 1 to 4, 10.3% in the 1st year of life. Community oriented primary care of the type necessary to execute these programs is not presently a priority among medical personnel; it should become an important component of medical education. Education to counter ignorance and the designation of the family as the primary instrument of good health will assure child survival and eliminate the need for multiple births to maintain the family.

The positive predictive values for HIV seropositivity are compared using WHO and US Centers for Disease Control (CDC) clinical case definitions of acquired immunodeficiency syndrome (AIDS) for cases in Rwanda Africa. It is postulated that the article by Colebunders and co-workers should encourage clinicians and epidemiologists working in Africa to adopt the World Health Organizations provisional clinical case definition for AIDS. Although the predictive value for HIV seropositivity calculated in urban-based adults as measured by the 2 different criteria is comparable (both criteria yield a 93% positive predictive value) this high % is not reached for cases of AIDS diagnosed for rural adults or urban-based children using the WHO criteria. These data confirm the opinion of Colebunders and co-workers that regional variations in the prevalence of HIV infection can interfere with the positive predictive value for HIV seropositivity of this definition. Workers in other countries should test the validity of the WHO criteria in their own settings and evaluate the WHO case definition adapted to pediatric AIDS in Africa.