Blood donor counselling for HIV: results of a multi-country feasibility study

A qualitative characterisation study was conducted by the World Health Organisation's Global Programme on AIDS, and the International Federation of Red Cross and Red Crescent Societies, in six developing countries in order to determine the feasibility of introducing blood donor counselling into procedures for blood donation at blood transfusion sites. After careful preparation of consultants, in-country visits were made to include structured discussions with key BTS and Red Cross, and national AIDS programme staff, and donors, and observations of relevant facilities. Necessary resources, management requirements, obstacles to and options for blood donor counselling were explicated, together with information on the role of HIV testing in motivating blood donation, and problems associated with this and with donor notification. Blood donor counselling is seen as feasible, provided minimum conditions can be established to ensure appropriate standards and availability of resources.

Risk of infection and estimated incidence of tuberculosis in northern Uganda

The main goals of our study were to evaluate: 1) the annual risk of tuberculosis infection (ARTI) and its annual decrease in Uganda; 2) the expected incidence of new tuberculosis cases and the notification rate; and 3) the role of incentives given to children tested in increasing compliance with the survey procedures. The methodology is based on performing the standard World Health Organization (WHO) tuberculin test on children of the same age groups at intervals of 10-15 yrs, identifying infected persons by induration distribution analysis, and converting the prevalence rates detected into risk rates according to the ARTI model. Two thousand six hundred and twenty one school children aged 10 yrs old and bacilli Calmette-Guérin (BCG) nonvaccinated, in six study areas, were injected with two tuberculin units (TU) of purified protein derivative (PPD) RT 23 Copenhagen. The detected prevalence was 14 +/- 1.4% (prevalence +/- 95% confidence interval (95% CI)) and the ARTI value 1.2 +/- 0.9%, with an estimated annual decrease of 0.83% from 1958 to 1970 and 2.9% in the 1970-1987 period. The estimated expected incidence of new cases in Uganda was 59 smear positive and 75 smear negative/extrapulmonary cases per 100,000 population in 1987, and 53 and 65, respectively, in 1990, with an overall 68% notification coverage. No significant improvement in children returning for reading was observed in the group receiving incentives. We conclude that the average decrease (2.9%) probably represents the natural decline of tuberculosis in Uganda. The coverage appears encouraging, although the ARTI detected could be underestimated, since the existing ARTI model was developed and validated before the human immunodeficiency virus (HIV) era.(ABSTRACT TRUNCATED AT 250 WORDS)

A survey of occupational blood contact and HIV infection among traditional birth attendants in Rwanda

OBJECTIVE

To investigate the risk of occupationally acquired HIV infection among traditional birth attendants (TBA) in Rwanda, Africa.

DESIGN AND METHODS

A serosurvey was conducted among 219 TBA practicing in a rural but densely populated area in southern Rwanda. Each TBA was interviewed about sociodemographic information, work-related habits and practices, and presence of nonoccupational risk factors for HIV infection. The frequency of skin exposure to HIV-infected blood was estimated for each TBA from HIV seroprevalence data collected previously from pregnant women stratified by the geographic zones in which the TBA practiced.

RESULTS

Four TBA (1.8%) tested HIV-1-antibody-positive; all four had reported nonoccupational risk factors for HIV infection. We estimated that the 215 HIV-negative TBA had 2234 potentially infectious blood-skin contacts out of a total of approximately 35,000 deliveries assisted in the past 5 years. However, we found no evidence of HIV infection caused by occupational blood contact (none out of 2234; upper limit of the 95% confidence interval because of one potentially infectious blood-skin contact = 0.2%).

CONCLUSION

Although these findings may not be universal to all TBA in Africa, the risk of occupationally acquired HIV infection among TBA appears small. The high frequency of blood-skin contact among TBA in Rwanda highlights the need to include infection control precautions in the training of TBA.

Assessment of maternal mortality in Tanzania

OBJECTIVE

To assess maternal mortality.

DESIGN

Prospective community-based survey, a sisterhood method survey and hospital data.

SETTING

The study was performed in communities in a rural area in Northwestern Tanzania and the local district hospital.

RESULTS

Four hundred and forty-seven pregnant women in the community survey were followed up as far as six weeks after delivery; there were 2865 respondents in the sisterhood survey; the hospital study involved 7526 deliveries. Maternal morality ratios derived from the prospective community-based survey, the sisterhood method survey and hospital data analysis were 241, 297, and 845 per 100,000 live births, respectively.

CONCLUSIONS

Hospital data tend to overestimate maternal mortality in these communities. The sisterhood method is easier and more convenient than a prospective community-based study.

[Sexually transmitted diseases, HIV infection and AIDS in Mudzi, Zimbabwe. A study of knowledge, attitudes and practice in a rural area in southern Africa]

We describe a study conducted in a rural area of Zimbabwe. We examined all patients who attend for treatment of a presenting sexually transmitted disease for a period of one month in 1989 and 1992. In addition we studied the knowledge of, attitudes towards and practices as regards HIV-infection and AIDS in 1992. The annual rate of sexually transmitted diseases was not different in the two periods studied. Most of the females with symptoms of sexually transmitted diseases were married and had been infected by their husbands. Most males too were married, but had been infected by prostitutes. There was a reduction in the proportion of patients who were employed as teachers, policemen or in the army. The use of condoms seems to have increased. Males were generally better informed about HIV-infection and AIDS than females were. As much as 26% of the females and 40% of the males had a close friend/relative who had died from AIDS and 69% of the females and 81% of the males had found it necessary to change their sexual behaviour after hearing about AIDS. Most people knew the most important parts of transmission, and about condoms as a means of protection, but the rate of sexually transmitted diseases remains very high. New strategies are needed in the preventive work.

Prognostic indicators in adult cerebral malaria: a study in Burundi, an area of high prevalence of HIV infection

We examined the possible risk factors for poor prognostic in cerebral malaria in 31 adults from Burundi, an area of high prevalence rate of HIV-1 infection. Depth of coma, temperature, vomiting, seizures, parasite load, or anaemia did not modify the outcome. High levels of creatinine, bilirubin, and/or lactates were indicators of poor prognostic. HIV-1 infection did not affect the clinical or biological presentation of cerebral malaria, and did not appear to influence the outcome.

Induction of abortion by condom-Foley catheter method in pregnant women with intra-uterine foetal death

To induce abortion in women with intra-uterine foetal death (IUFD), during a two-year period (August 1990 to October 1992), at Yekatit 12 Hospital, Addis Abeba, Ethiopia, condom-Foley catheter method (CFCM) with oxytocin, and oxytocin infusion alone were compared. All 25 pregnant women randomly assigned to the CFCM aborted within 24 hr, a 100% success rate with an induction-abortion time interval of 14.6 hr (p < 0.001), whereas among 20 patients who were treated with oxytocin infusion alone, induction failed in all. Repeated induction in the second group resulted in a marked delay of abortion; these patients were crossed over to either combined medical and surgical induction or to the CFCM depending on their cervical status. The rapid cervical dilatation and safe abortion in pregnant women with IUFD make the CFCM a superior procedure to induction of abortion with oxytocin infusion alone. In places where there is no experience with the use of prostaglandins and the agent, which may have undesirable side-effects, is unavailable, the CFCM is a simple cost-effective technique which could be used safely.

Clinical profile and pattern of infection in Ethiopian children with severe protein-energy malnutrition

The results of a prospective study on the clinical profile and pattern of infection in 90 Ethiopian children with severe protein-energy malnutrition (PEM) is presented. The study group consisted of 44(49%) with marasmus, 29(32%) with marasmic-kwashiorkor and 17(19%) with kwashiorkor. Their age ranged from 4 to 60 months and the median age at admission was 11.5, 15 and 20 months, respectively. Over 80% of the patients were infected and the lungs were the commonest sites. Bacterial pathogens, predominantly Gram negative enteric organisms, were isolated from 36% of blood and 37% of urine specimens. Tuberculosis and non-typhoidal salmonellae showed a higher tendency of causing disseminated disease. Rickets and overt vitamin A deficiency were seen in 37% and 17% of the patients, respectively. Septicaemia, gastroenteritis, pneumonia and disseminated tuberculosis accounted for an overall case fatality rate of 32%. Mortality was higher in children with total serum protein of 5gm% or less. The clinical profile and the pattern of infection varied from observations made elsewhere in developing countries which also showed discrepant results. More comprehensive and carefully designed work is proposed to elucidate the clinical and geographic heterogeneity of severe PEM.

Peptide serology for analysis of the inter- and intra-individual variation in the HIV-1 V3 domain

OBJECTIVE

To investigate whether the specificity of antibody responses to the gp120 V3 domain in HIV-1-infected individuals is related to the variability of this region.

METHODS

Sera from a cohort of 22 HIV-1-infected Ugandans were tested against peptides derived from each individual's autologous proviral V3 apex sequence. Autologous peptide reactivity was compared with reactivity to peptides derived from two Ugandan consensus sequences and previously isolated US/European and African viruses. Peptides from individuals with heterogeneous V3 apex sequences, representing different HIV-1 variants, were obtained and tested against the corresponding sera.

RESULTS

A notable cross-reactivity to different V3 apex peptides was observed. However, in the majority of sera, antibody reactivity to the autologous peptides was found to exceed reactivity to any of the other peptides tested. V3 proviral sequences from the Ugandan cohort studied have been shown to be closely related to the HIV-1MN isolate and thus, their sera gave better reactivity to V3MN and related peptides than to peptides representing other African HIV-1 isolates. In individuals with heterogeneous V3 proviral sequences, we could distinguish divergent antibody responses to the genomic variants differing by single amino acids.

CONCLUSION

Analysis of seroreactivity to peptides might constitute a relevant tool for investigating the variability of the HIV-1 gp120 V3 domain within infected populations and single individuals.

Sexually transmitted diseases in the history of Uganda

First noticed in Uganda in 1863 by a European explorer, sexually transmitted diseases (STDs) were cited as a major cause of morbidity and mortality throughout this century. In 1908 the venereal diseases campaign was launched marking the real introduction of western medicine. By the mid-1920s, the campaign was combined with the medical service but throughout the colonial period (1901-1962) venereal diseases were considered intractable. A 1991 survey revealed alarming incidence rates and in light of the importance of STDs as a co-factor in the transmission of HIV, it is of paramount importance to implement more effective control measures.

Female mortality in reproductive ages in Dar es Salaam, Tanzania

An audit of all cases of female mortality in the reproductive age groups has been performed in Dar es Salaam during 1991-93. Multiple sources of information was used to collect information on deaths. None of the sources of information on death was alone adequate. 73% of the interviews was done at home. The mother or another close relative was interviewed in more than 70% of the cases. A total of 645 deaths were identified and 18% of these were related to pregnancy. Fever, shortness of breath and weight loss were the most common symptoms before death followed by pallor and vomiting. Almost 90% visited a health facility before death. AIDS (27%), tuberculosis (13%) and malaria (12%) were the most common causes of death. Diagnosis could not be made from audit data in 22 cases, and the relatives attributed 7.6% of all deaths to witchcraft or just God's will. AIDS and related diseases are now a major cause of death in the female reproductive age group. There is need to identify preventive measures of this disease as well as prevention of malaria and tuberculosis.

Survey of knowledge, behaviour and attitudes relating to HIV infection and AIDS among Kenyan secondary school students

To evaluate the knowledge, attitudes and sexual behaviour with respect to HIV and AIDS among Kenyan secondary school students, a questionnaire was issued to 3,018 students of mean age 16.3 years in 11 Kenyan schools. Questions of knowledge were answered correctly by an average of 77.1% of students. Areas where students' knowledge was less complete included the inability of mosquitoes to transmit the virus, the protective effect of condoms, the lack of protection from medications, the fatal and incurable nature of AIDS, and the fact that those infected with HIV may appear healthy. No prior sexual experience was reported by 71.3% of females and 25.2% of males. Multiple sexual partners were reported by 41.2% of males and 7.3% of females. Sixty per cent of students denied ever using condoms during sex and only 6.8% of those with multiple partners used them all the time. A prior sexually-transmitted disease was reported by 5.6% of students. Although a high level of knowledge regarding HIV and AIDS is evident among Kenyan students there is a sizable number who admit to extensive sexual experience, but who are not using condoms, thereby putting themselves at risk.

Malaria knowledge, attitudes and practices in Malawi: survey population characteristics

A national knowledge, attitudes and practices (KAP) survey was conducted in March-April 1992 to examine malaria illness and the people's response to illness and malaria prevention. Fifty-one households in each of 30 randomly selected communities were sampled and information was recorded from 1,531 households and 7,025 individuals. The population is characterized by low income (average household and per capita income were US $490 and $122, respectively) and low education levels (among adult women, 45% had no formal education and only 3.9% completed more than 8 years of schooling). Characteristics of the population were similar to those found in the 1987 national census, suggesting that the survey population was representative of the larger population of Malawi. Children under 5 years of age made up 15.8% of the population and had the highest rates of fever illness; these children experienced an estimated 9.7 cases/year of fever illness consistent with malaria. Although adults reported fever less frequently, women of reproductive age experienced an estimated 6.9 episodes of fever annually. The burden of malaria morbidity in this population is extremely high and occurs in all age groups.