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Biomedical subjects

S Moses

Publications and source records attributed to S Moses.

At least 73 records · Page 4Linked to original sources
PubMed1994

Human immunodeficiency virus infection in long-distance truck drivers in east Africa.

BACKGROUND: A cross-sectional survey was performed to determine the seroprevalence and correlates of human immunodeficiency virus (HIV) infection among long-distance truck drivers in Kenya. METHODS: Truck drivers along the Mombasa-Nairobi highway were enrolled at a roadside research clinic. A standardized interview and serologic evaluation for HIV and syphilis were conducted. RESULTS: We enrolled 970 truck drivers and their assistants of whom 257 (27%) had HIV antibodies. In univariate analysis, HIV infection was correlated with older age, non-Kenyan nationality, Christian religion, longer duration of truck driving, travel outside of Kenya, less frequent visits to wives, and more frequent visits to prostitutes. Uncircumcised status, history of genital ulcer disease or urethritis during the previous 5 years, and a positive Treponema pallidum hemagglutination assay for syphilis were each associated with positive HIV serostatus. Univariate correlates of uncircumcised status included younger age, non-Kenyan nationality, Christian religion, travel outside of Kenya, and less frequent visits to prostitutes. There was a significant association between uncircumcised status and 5-year history of genital ulcer disease or serologic evidence of syphilis, but not with 5-year history of urethritis. In multivariate analysis, HIV infection was independently associated with uncircumcised status (adjusted odds ratio [OR], 4.9; 95% confidence interval [CI], 2.8 to 8.4), history of genital ulcer disease (adjusted OR, 2.4; 95% CI, 1.5 to 4.1), history of urethritis (adjusted OR, 1.8; 95% CI, 1.1 to 2.9), more frequent sex with prostitutes (more than once per month; adjusted OR, 1.7; 95% CI, 1.1 to 2.8), and positive T pallidum hemagglutination assay (adjusted OR, 1.2; 95% CI, 1.0 to 1.4). The attributable risk percentage for the association between HIV and uncircumcised status was 70%, and the population attributable risk was 25%. CONCLUSIONS: Truck drivers in east Africa are at high risk of HIV infection. The strongest correlates of HIV seropositivity were uncircumcised status and history of both ulcerative and nonulcerative sexually transmitted diseases.

Adolescent↗
PubMed1994

Sexual behaviour in Kenya: implications for sexually transmitted disease transmission and control.

Sexual behaviour in Kenya in relation to STD transmission was investigated with a view to forming a basis for the more rational design of STD/HIV control interventions. Questionnaires were administered to a sample of 762 men and women attending eight health facilities in two urban centres. Equal numbers of STD patients (cases) and non-STD related clinic attenders (clinic controls) were selected, matched by gender and clinic. Another sample of 427 men and women was obtained from a random sampling of households in a slum area in Nairobi (community controls). Male STD patients who were unmarried, or married but living apart from their wives, reported a higher mean number of sex partners in the previous three months than did male clinic or community controls. Unmarried female STD patients reported a higher mean number of sex partners in the previous three months than did unmarried female clinic or community controls. Both male and female STD patients were more likely to report having been involved in commercial sex transactions in the previous three months than clinic or community controls. Considerable heterogeneity in sexual behaviour was apparent. In multivariate analysis, the most important predictor of STD acquisition for both men and women was the number of reported sex partners in the previous three months. In addition, for men only, marital status (unmarried, or married but living apart from their wives) and purchasing sex were significant predictors of being an STD patient. These data confirm the importance of commercial sex in STD transmission, and suggest that men play a bridging role between female sex workers and the general population of women.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

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.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Health care-seeking behavior related to the transmission of sexually transmitted diseases in Kenya.

OBJECTIVES: The purpose of this study was to identify health-care seeking and related behaviors relevant to controlling sexually transmitted diseases in Kenya. METHODS: A total of 380 patients with sexually transmitted diseases (n = 189 men and 191 women) at eight public clinics were questioned about their health-care seeking and sexual behaviors. RESULTS: Women waited longer than men to attend study clinics and were more likely to continue to have sex while symptomatic. A large proportion of patients had sought treatment previously in both the public and private sectors without relief of symptoms, resulting in delays in presenting to study clinics. For women, being married and giving a recent history of selling sex were both independently associated with continuing to have sex while symptomatic. CONCLUSIONS: Reducing the transmission of sexually transmitted diseases in Kenya will require improved access, particularly for women, to effective health services, preferably at the point of first contact with the health system. It is also critical to encourage people to reduce sexual activity while symptomatic, seek treatment promptly, and increase condom use.

Female↗
PubMed1994

Preparation for AIDS vaccine evaluation in Mombasa, Kenya: establishment of seronegative cohorts of commercial sex workers and trucking company employees.

In preparation for human immunodeficiency virus (HIV) prophylactic vaccine trials, prospective cohorts of HIV seronegative female commercial sex workers and male trucking company employees were established in Mombasa, Kenya, with the aims of defining HIV seroincidence and correlates of HIV seroconversion. Female and male cohorts were followed at 1- and 3-month intervals, respectively, with questionnaires, physical examinations, evaluation for sexually transmitted diseases, and HIV serologic testing. Between February and September, 1993, 1,277 women and 748 men were tested for antibodies to HIV-1. Seroprevalence was 55.4% among commercial sex workers and 17.7% among trucking company employees. Three hundred fifty-two HIV-seronegative women and 507 seronegative men were enrolled in the cohort studies. Annualized seroincidence rates of HIV infection were 16.4% (95% CI 8.8-27.0) among commercial sex workers and 6.6% (95% CI 2.5-13.8) among trucking company employees. These cohorts may be valuable resource for evaluating HIV vaccines and other potential preventive interventions.

AIDS Vaccines↗
PubMed1992

Impact of user fees on attendance at a referral centre for sexually transmitted diseases in Kenya.

We investigated the impact of a short-lived policy of charging fees to patients attending public-sector outpatient health facilities in Kenya by collecting data on attendance at Nairobi's Special Treatment Clinic for sexually transmitted diseases (STDs) before (23 months), during (9 months), and after (15 months) the user-charge period. During the user-charge period, the seasonally adjusted total mean monthly attendance of men decreased significantly to 40% (95% CI 36-45) of that before fees were levied. Attendance rose in the post-user-charge period, but reached only 64% (59-68) of the pre-user-charge level. For women, the adjusted total mean monthly attendance during the user-charge period was reduced significantly to 65% (55-77) of the pre-user-charge level. Mean monthly attendance by women rose in the post-user-charge period to 22% (9-37) above the pre-user-charge level. There was no evidence of an increase in attendance over the course of the user-charge period among either men or women. The introduction of user fees probably increased the number of untreated STDs in the population, with potentially serious long-term health implications. The user-fee experience in Kenya should be carefully evaluated before similar measures are introduced elsewhere.

Community Health Centers↗
PubMed1992

Fatal familial infantile glycogen storage disease: multisystem phosphofructokinase deficiency.

An infant girl of consanguinous Bedouin parents suffered from fatal early onset of progressive generalized muscle weakness. Her older brother suffered from similar weakness and cardiomyopathy, which led to his death at the age of 21 months. A muscle biopsy performed on the propositus at the age of 9 months was PAS-negative, and showed nonspecific myopathic changes. A second muscle biopsy, performed at 21 months of age, a few days before her death, and postmortem study of heart and liver, disclosed excessive extralysosomal glycogen storage and reduced phosphofructokinase-1 (PFK-1) activity. Because the genes encoded for PFK-1 in liver and muscle are located on separate chromosomes, the reduced enzyme activity in both tissues could not be related to a single mutation for this enzyme. Activity of 6-phosphofructose-2-kinase (PFK-2), a recently discovered physiological activator to all PFK-1 isozymes, was normal in the liver. The possibility that this multisystem PFK-1 deficiency may be related to the absence of a yet unknown activator, common to all PFK-1 isozymes, is discussed.

Biopsy↗
PubMed1992

Rapid increase of both HIV-1 infection and syphilis among pregnant women in Nairobi, Kenya.

OBJECTIVE: To determine the prevalence of HIV-1 and syphilis antibodies in a population of pregnant women in Nairobi, Kenya, between 1989 and 1991. METHODS: As part of an ongoing prospective study on the effect of HIV-1 infection and sexually transmitted diseases, 4883 pregnant women were screened for HIV-1 and syphilis antibodies in one health-centre in Nairobi. RESULTS: HIV-1 seroprevalence increased from 6.5 to 13.0% (P < 0.001) and syphilis seroreactivity from 2.9 to 5.3% (P = 0.002), while there was no change in gonococcal infection rates. The most rapid increase in HIV-1 prevalence was observed in women aged less than 25 years. There was no evidence of demographic fluctuations in the population during this time, or of changes in sexual behaviour, except that fewer women enrolled in 1991 reported having more than one sex partner, compared with women enrolled in 1989 (39.1 versus 20.0%; P = 0.0001). HIV-1-seropositive women were more likely to be seroreactive for syphilis than HIV-1-seronegative mothers (7.7 versus 3.2%; odds ratio = 2.5; 95% confidence interval, 1.7-3.8; P < 0.001), but there was no difference between the two groups in terms of gonorrhoea prevalence. CONCLUSION: These data confirm an association between HIV-1 and syphilis infection, and indicate that both are spreading rapidly among women in Nairobi outside high-risk groups. Increased efforts to control both infections are urgently required.

Antibodies, Viral↗
PubMed1991

Controlling HIV in Africa: effectiveness and cost of an intervention in a high-frequency STD transmitter core group.

Since 1985, a population of over 1,000 predominantly HIV-positive female prostitutes residing in a low-income area of Nairobi, has been enrolled in a sexually transmitted disease (STD)/HIV control programme. The major elements of the programme include the diagnosis and treatment of conventional STD, and the promotion of condom use to prevent the transmission of HIV and other sexually transmitted infections. Using estimates of numbers of HIV-seropositive prostitutes, numbers of sexual contacts, susceptibility of clients to HIV, HIV transmission efficiency, rates of condom use and the basic reproductive rate of HIV infection in Kenya, we estimate that the programme is responsible for preventing between 6,000 and 10,000 new cases of HIV infection per year among clients and contacts of clients. The total annual operating cost of the programme is approximately US$77,000 or between US$8.00 and US$12.00 for each case of HIV infection prevented. Programmes to reduce the transmission of HIV and other sexually transmitted infections which are targeted at high-frequency STD transmitters, such as prostitutes, can be effective and relatively inexpensive to undertake. More such programmes should be developed and evaluated in different settings.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Impact of single session post-partum counselling of HIV infected women on their subsequent reproductive behaviour.

During an ongoing study investigating the impact of maternal HIV infection on pregnancy outcome at a large maternity hospital in Nairobi, Kenya, asymptomatic HIV positive women who had recently delivered were informed of their HIV sero-status and counselled by a trained nurse regarding contraception and reproductive behaviour in a single session. Both HIV infected women and a comparison group of uninfected women matched for pregnancy outcome were followed up after an interval of one year. Contraceptive use, condom use and pregnancy rates were similar in both groups. Only 37% of HIV infected women had informed their partners of their sero-status. The single session of counselling for the HIV positive women did not seem to influence decisions on subsequent condom use or reproductive behaviour. More intensive approaches to counselling need to be developed and evaluated, but may be difficult to implement in the busy maternity and antenatal clinics commonly found in developing countries.

Abortion, Induced↗
PubMed1990

Geographical patterns of male circumcision practices in Africa: association with HIV seroprevalence.

To ascertain whether male circumcision might explain some of the geographical variation in human immunodeficiency virus (HIV) seroprevalence in Africa, we investigated the association between the practice of male circumcision at a societal level and HIV seroprevalence. Male circumcision practices for over 700 African societies were identified, and HIV seroprevalence in general adult populations from 140 distinct locations in 41 countries was obtained. In locations where male circumcision is practised, HIV seroprevalence was considerably lower than in areas where it is not practised. This study supports the hypothesis that lack of circumcision in males is a risk factor for HIV transmission.

Adolescent↗
PubMed1990

Differences in professional activities, perceptions of professional problems, and practice patterns between men and women graduates of Jefferson Medical College.

Differences between men and women graduates of one medical school in practice patterns, professional activities, and problems were investigated. A questionnaire was mailed in 1986 to 600 physicians, randomly selected from 1,102 who had graduated from Jefferson Medical College of Thomas Jefferson University between 1977 and 1981. Four hundred fifty (364 men and 86 women) responded (75%). The women were less likely than the men to be employed full-time; however, proportionately more women than men held full-time academic appointments, treated patients from low-income families, and served in underserved areas in inner cities. The women reported working fewer hours per week and having fewer patients than did the men. The women published scientific articles as often as did the men but were less likely to serve on professional committees, receive professional awards, or develop medical procedures. The women were less concerned about the oversupply of physicians and malpractice litigation. Implications of the findings for health manpower planning and practice pattern expectations are discussed.

Adult↗