Weight evolution and perceptions of adults living with HIV following initiation of antiretroviral therapy in a South African urban setting

BACKGROUND

Obesity and undernutrition are common in South Africa and influence the health outcomes of people living with the human immunodeficiency virus (PLHIV).

AIM

To describe the anthropometric changes and perceptions of body weight in adults initiated on antiretroviral therapy (ART).

METHODS

A cohort of 230 PLHIV was enrolled at an HIV clinic in Durban. Changes in their body mass index, and waist and hip girth were measured 6-monthly in the 12 months following initiation of ART. Data on demographic and socio-economic variables, CD4 counts, opportunistic infections and drug regimens used were recorded. Perceptions of body weight and desire to change these were ascertained.

RESULTS

Weight perceptions of respondents were incongruent with their body mass index, with the trend being to judge themselves as weighing less than their actual weight. Those wanting to gain weight gained an average of 7.8 kg - 2.8 times more than those satisfied with their weight (p<0.001). After 12 months on ART, there was a statistically significant increase in anthropometric measurements (p<0.001) with 43 of the 110 women having waist circumferences that increased their risk of cardiovascular disease; the incidence of lipodystrophy was 35% (62/177) (95% confidence interval 27-42%), 36% (64/177) were overweight and 22% (39/177) were obese, compared with 21% (49.230) and 12% (28/230) respectively at baseline (p=0.002).

CONCLUSION

There is a strong association between PLHIV's perception of body weight, their desire to gain weight and their actual weight gain on ART. Lipodystrophy, weight gain and truncal obesity are common among PLHIV after initiating ART.

Changes in healthcare workers' knowledge about tuberculosis following a tuberculosis training programme

BACKGROUND

In resource-limited countries, health policy makers and practitioners need to know whether healthcare workers have sufficient knowledge of tuberculosis and its management.

OBJECTIVES

We conducted a study to: (1) measure knowledge changes among healthcare workers who participated in a tuberculosis training programme; and (2) make recommendations about future tuberculosis training for healthcare workers in the KwaZulu-Natal Department of Health.

METHODS

A cross-sectional study conducted in 2007 measured changes in tuberculosis knowledge of doctors, nurses and other healthcare workers after a training programme based on World Health Organization tuberculosis training modules. Data were collected before and after training using a self-administered, 98-item questionnaire covering eight components.

RESULTS

A total of 267 healthcare workers, mean age 40.7 years, answered both pre- and post-training questionnaires. Mean total knowledge scores were low despite significant changes (p<0.001) from a pre-training score of 59.5% to a post-training score of 66.5%. Nurses showed significant improvements in mean total knowledge scores (p<0.001) but had the lowest mean total knowledge score post-training, 63.2%. Doctors had significantly better pre-training (p<0.001) and post-training (p<0.001) mean total knowledge scores compared to nurses.

CONCLUSIONS

Improvement in healthcare workers' overall knowledge of tuberculosis during a training programme was not clinically significant. Periodic field training and supervision should be considered to ensure tuberculosis knowledge improvements.

Knowledge, attitudes and sexual practices regarding HIV/AIDS among the Eritrean military

OBJECTIVE

Eritrea is a small-country situated in the Horn of Africa with an HIV prevalence of 2.4% among pregnant women in 2005. Approximately 200,000 young, productive members of the population of 5.5 million are mobilised in the army through National Service conscription. Most members of the military are young, sexually active people, a category inclined towards high-risk sexual behaviour putting them at risk of sexually transmitted and HIV infection.

METHODS

A cross-sectional study using a random sample of 836 members of a representative category of the Eritrean army was conducted, utilising a self-completed questionnaire designed to assess knowledge, attitudes, behaviour and perceptions about sexually transmitted infections and HIV/AIDS.

RESULTS

While the survey showed high levels of knowledge and relatively positive attitudes and beliefs about sexually transmitted infections including HIV, some inconsistencies in attitudes were discernible. Some respondents retained misconceptions about protection methods. While most respondents were prepared to undergo voluntary counselling and testing, fewer were prepared to disclose their status and judgemental attitudes existed toward those living with HIV. While condoms appear available and accessible, there needs to be encouragement of regular and consistent use of condoms, particularly with those with more than one partner.

CONCLUSIONS

The Eritrean military has initiated HIV/AIDS education programmes and improved access to condoms. These programmes, however, need to be strengthened especially around attitudes to those infected with HIV. The development and improvement of partnerships between government, non-governmental and international organisations is essential to strengthen the fight against HIV/AIDS in Eritrea

Impact of delayed introduction of sulfadoxine-pyrimethamine and arthemeter-lumefantrine on malaria epidemiology in KwaZulu-Natal, South Africa

OBJECTIVE

To investigate how delayed introduction of sulfadoxine-pyrimethamine (Fansidar) and arthemeter-lumefantrine (Coartem) as first-line drugs for malaria in KwaZulu-Natal contributed to the reported epidemics of 1985-1988 and 1997-2001.

METHODS

Ecological study assessing the association between malaria incidence and the emergence and degree of resistance to chloroquine from 1982 to 1988 and to sulfadoxine-pyrimethamine from 1991 to 2001, when each was the first-line malaria treatment.

RESULTS

The relative risk for malaria infection after the level of drug resistance reached 10% was 4.5 (95% CI: 4.0-5.2) in the chloroquine period and 5.9 (95% CI: 5.7-6.1) in the sulfadoxine-pyrimethamine period. In the chloroquine period, the relative risk of death from malaria was tenfold (95% CI: 1.3-78.1) and the case fatality doubled after drug resistance had reached 10%. The risk of death during the sulfadoxine-pyrimethamine period was 10.8 (95% CI: 5.9-19.2) and case fatality 1.8 times higher after drug resistance had reached 10%, than before.

CONCLUSION

Malaria epidemics in KwaZulu-Natal, South Africa have been exacerbated by failing drug regimens. The establishment of sentinel sites for monitoring drug failure and the prompt adoption of guidelines based on World Health Organization standards in drug resistance should improve malaria control.

Prevalence and causes of low vision and blindness in northern KwaZulu

A survey of the prevalence of blindness and low vision was conducted in the Ingwavuma district of KwaZulu to assess the effectiveness of existing eye care facilities in the prevention and treatment of impaired vision and blindness. One hundred subjects from each of 60 randomly selected clusters (N = 6,090) were screened. Of these, 293 were identified and referred to an ophthalmologist for examination. Of the 268 (91,5%) examined, 241 were found to have visual impairment. Sixty-one of these people were blind, 85 had low vision, 61 were blind in one eye but had normal vision in the other, and 34 had low vision in one eye but normal vision in the other. The prevalence of blindness was 1,0% (95% confidence interval 0,7-1,2%), and the prevalence of impaired vision was 1,4% (95% confidence interval 1,1-1,7%). Age-related cataract (59,0%) and chronic glaucoma (22,9%) were the two main causes of blindness. Age-related cataract (75,3%), refractive error (10,0%) and chronic glaucoma (4,7%) were the main causes of impaired vision. Existing eye care services for the region have reduced the prevalence of blindness by only 7,0%. The training of ophthalmic nurses and the establishment of a sight-saver clinic in the area are necessary to reduce the prevalence of low vision and blindness.

The effect of histamine and histamine antagonists on gastric acid secretion and mucosal blood flow in man

Histamine has been investigated for its effect on gastric acid secretion and mucosal blood flow in man. Dose-response curves were constructed and analysed in the presence of H1- and H2-antagonists. Mepyramine had no effect on acid secretion or mucosal blood flow. Cimetidine reduced acid secretion but had no effect on blood flow. This suggests that the vasculature is less sensitive to cimetidine than the parietal cell.

The effect of highly selective vagotomy on the relationship between gastric mucosal blood flow and acid secretion in man

Previous work has shown that the duodenal ulcer population can be defined by a lower ratio between gastric mucosal blood flow and acid secretion (during pentagastrin stimulation) than is found in normal subjects. The results of the present investigation have shown that the ratio is restored to normality by highly selective vagotomy. This suggests that increased tonic activity of the vagus on the parietal cell is one of the important disorders in duodenal ulceration.

The effect of footwear on venous pressure at the ankle

The response to exercise of venous pressure at the ankle was measured in two groups of normal subjects when barefoot, wearing normal shoes and in exercise sandals. The results demonstrate a significantly greater fall in venous pressure in exercise sandals than in shoes approximating to that of barefoot walking. In patients with superficial varices, the fall in venous pressure during exercise when wearing exercise sandals was again highly significant when compared to walking in shoes, approximating to normal values, and the possible therapeutic application of this finding is discussed.

Decreased liver and lung drug-metabolizing activity in mice treated with Corynebacterium parvum

Injections of killed suspensions of Corynebacterium parvum (i.p.) in young male mice were followed by time- and dose-dependent decreases in the drug-metabolizing activity of liver microsomes and lung homogenates. In vitro assays with model substrates [aminopyrine, aniline, p-nitroanisole, and benzo(a)pyrene] were used to quantitate drug-metabolizing activity. It is likely that such decreases in mixed function oxidases activity will act to significantly alter the pharmacokinetics of concurrently or subsequently administered drugs. The results provide a possible mechanism to explain several previously reported immunochemotherapeutic interactions.