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At least 973 records · Page 54Linked to original sources
PubMed1993

The prevalence of antibodies to the human T lymphotropic virus (HTLV) in Ghana, West Africa.

We conducted a population-based serosurvey of urban areas and rural regions of southern Ghana, West Africa. Subjects (3763) of all ages were enrolled from 25 city and village sites and in studies of groups of special interest. "Positive" results were difficult to define because of a high frequency of results that were indeterminate on immunoblotting, the current standard for confirmation of HTLV-I. However, polymerase chain reaction results and HTLV type-specific discriminatory tests proved HTLV-I was present in Ghana. No HTLV-2 positivity was observed. By using strict criteria that considered indeterminate results as negative, the overall prevalence was found to be between 1 and 2% in all areas, with no difference by geographic location. Prevalence rose with age and was higher in adult women than men. However, in substudies of selected populations, we found HTLV prevalence among 124 persons with lymphomas and hematological malignancies was not different from that in the general population. Furthermore, the prevalence in prostitutes was similar to that in the general population and in pregnant women. HTLV-I is present in West Africa, but we were unable to associate HTLV-I seropositivity with malignancy or with prostitution.

Adolescent↗
PubMed1994

Contribution of tuberculosis to slim disease in Africa.

OBJECTIVES: To assess the contribution of tuberculosis to the aetiology of the HIV wasting syndrome (slim) in Africa, a condition usually considered an enteropathy. METHODS: Clinical examination and representative necropsy study of adult patients positive for HIV. SETTING: Hospital medical wards in Abidjan, Ivory Coast. SUBJECTS: Adults positive for HIV. MAIN OUTCOME MEASURES: CD4 T lymphocyte counts before death, clinical and anthropometric data, and gross and microscopic pathology. RESULTS: Necropsy was done on 212 HIV positive adults. Tuberculosis was found in 41 of 93 with the clinical HIV wasting syndrome and in 32 of 119 without (odds ratio 2.1, 95% confidence interval 1.2 to 4.0). A significant association existed between the prevalence of tuberculosis at necropsy and the degree of cadaveric wasting (no wasting 25% (15/59); moderate wasting 40% (23/58); skeletal wasting 44% (42/95); P = 0.02). Wasting was also associated with a history of chronic diarrhoea, but no association existed between diarrhoea and tuberculosis. Median CD4 T lymphocyte counts were lowest in wasted patients irrespective of findings at necropsy and in those with chronic diarrhoea (< 60 x 10(6)/l). CONCLUSION: Wasting and chronic diarrhoea are late stage manifestations of HIV disease in Africa. The importance of tuberculosis as a contributing factor in the pathogenesis of the slim syndrome has been underestimated. In nearly half of patients dying with severe wasting, tuberculosis was the dominant pathological finding.

Adolescent↗
PubMed1987

HIV antibodies in a remote rural area in Rwanda, Central Africa: an analysis of potential risk factors for HIV seropositivity.

Detection of HIV antibodies by means of an immunoenzymatic assay, an indirect immunofluorescence technique and Western blot was attempted on 375 serum samples collected in the Murunda area, a remote rural area situated in Rwanda, central Africa. Two out of 147 (1.4%) adults from a strict rural area, five out of 59 (8.5%) adults from an adjacent market place, and 49 out of 169 (30%) STD clinic attenders from the same area were HIV seropositive. In the first two groups, HIV seropositivity was associated with a history of sexually transmitted disease (STD) in the previous 2 years (P less than 0.001) and with a history of travel to a Rwandese urban centre in the previous 5 years (P less than 0.05). This study suggests that HIV seroprevalence is low in rural central Africa compared with urban centres. Risk factors for HIV seropositivity are similar in rural and urban-based adults in Rwanda, i.e. heterosexual promiscuity and STDs. Many HIV seropositive rural subjects from this study are likely to have acquired HIV infection through sexual contacts in Rwandese cities.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Risk factors for the spread of AIDS in rural Africa: evidence from a comparative seroepidemiological survey of AIDS, hepatitis B and syphilis in southwestern Uganda.

Before commencing rational control programmes for AIDS in Africa it is desirable to determine the relative importance of heterosexual and various non-sexual modes of transmission. We investigated this by comparing the seroepidemiologies of AIDS, hepatitis B and syphilis at two rural hospitals in southwest Uganda. During August 1986, 3% of 357 outpatients, reflecting the age and sex composition of the general population, were anti-HIV positive. Anti-HIV seropositivity, both in the outpatients and among 36 suspected prostitutes and 14 suspected AIDS cases, was confined to individuals aged 20 or over. For men, seropositivity was associated with sexual contact with prostitutes (a risk factor for 61% of young men in the study). In the prostitute group, 25% were anti-HIV positive and 46% were positive on the Treponema pallidum haemagglutination (TPHA) test for syphilis. The risk factors for HIV, but not hepatitis B, were the same as for having a history of sexually transmitted disease (STD). However, there was, surprisingly, an association between a history of STD and seropositivity for hepatitis B virus but not for HIV infection. The geographical and age distributions of seropositivity for HIV and hepatitis B virus were also quite different. Finally, blood transfusions, scarification and exposure to mosquitoes (as assessed by a history of malaria) were not evident risk factors for either HIV or hepatitis B virus. AIDS in rural Africa seems to differ in its epidemiology from hepatitis B and appears to be spread predominantly by pre-existing patterns of heterosexual activity responsible for high rates of other sexually transmitted diseases.

AIDS Serodiagnosis↗
PubMed1988

Pathogenetic role of HIV infection in Kaposi's sarcoma of equatorial East Africa.

Thirty residents of north-central Tanzania with various forms of Kaposi's sarcoma (KS) were evaluated. The absolute number of peripheral blood OKT4 lymphocytes in patients and Tanzanian control subjects tended to be low (in comparison with healthy young American adults), and many had inverted T4/T8 ratios. Plasma polyclonal beta- and gamma-globulin concentrations were increased in many patients with KS and in control patients in Tanzania with chronic dermatopathies, but not in African hospital employees and patients undergoing elective surgery. Three of nine patients with locally aggressive KS possessed antibodies to human T-cell lymphotropic virus type III/lyphadenopathy-associated virus (HIV), but none had evidence of the acquired immunodeficiency syndrome (AIDS) or the AIDS-related complex. Three patients with disseminated, rapidly progressive KS and high HIV-antibody titers had an immunologic and clinical picture consistent with AIDS. Two of 13 patients with the classic plaque/nodular form of KS had low plasma titers of HIV antibody, but the significance of these serologic findings is not known. The evidence suggests that HIV plays a role in the pathogenesis of some cases of KS in East Africa, but most patients with KS in East Africa have no evidence of overt immunologic deficiency or HIV infection.

AIDS-Related Complex↗
PubMedDate not supplied

[An approach to food consumption in an urban environment. The case of west Africa].

West Africa has undergone rapid economic and political changes during the last 20 years. After the failure of economic policies implemented since independence, programs for structural adjustment have strongly influenced the economy. Food problems affect each country differently. The Sahel has experienced food shortages and starvation whereas in forested countries the food supply has remained stable. Nevertheless, food policies have not succeeded in contributing to urban and rural development. The rate of urbanization in west Africa is generally low but the rate of urban population growth is particularly high, much more than the growth rates of industry and infrastructure. Although metropolitan areas are affected by poverty, they offer more hope and opportunities than rural areas. Urban markets have expanded and diversified as social differences have also increased and contributed to changes in consumption structure. Urban growth has contributed to the increase of imported food: this is indicated by both the strong dependency and the change of food habits towards western food patterns. Recently however, west African urban dwellers are still preferring local items if they are affordable. When imported products are used, they are integrated within a stable meal plan consisting of a single dish with a base and a sauce, which is typical of African food preparation. Surveys of consumption-budgets are still only available on a national scale. These can provide accurate information about food consumption patterns of families, particularly for significant trends. However, they do not provide information about the dynamics of food consumption, neither for urban areas or the individual. Now a significant proportion of individual food consumption occurs outside of the home, mainly with food provided by street vendors. This new consumption habit is a response to the urban food crisis. Consumption of street-vendor-food comprises one component but this cannot be dissociated from in-home food consumption. Despite the growing importance of street-vendor food consumption, it has still not been adequately documented. Theoretically, food consumption is an evolving concept. Single disciplines, such as economics or nutrition, first studied food consumption. More recently, social sciences developed new approaches with various interpretations, which were sometimes contradictory. The evolution of urban food consumption and the numerous related problems support the approach proposed by some authors suggesting a mixed analysis integrating both economics and cultural factors. Operationally, a global and dynamic approach to food styles must consider urban heterogeneity and diversity of situations. For example, food consumption by people maintaining their in-home food habits shows the pertinence of studies focusing on individuals. Therefore, the food course concept may be a useful method for the study of food consumption.

Africa, Western↗
PubMedDate not supplied

HIV-1 and HIV-2 in Ghana, west Africa: community surveys compared to surveys of pregnant women.

We conducted a population-based serosurvey of HIV-1/2 in 2,410 residents of two urban and two rural areas of southern Ghana, West Africa and compared the results to serosurveys of 1,417 pregnant women. Using conservative criteria, we found the prevalence of HIV-1/2 in community survey adults (> 15 years old) to be 1.5% in women and 1.0% in men. Among pregnant women, the prevalence was 9.3% in one rural area but only 1.0% in other areas. Many samples, especially among the pregnant women were HIV-1 and -2 dual reactive on serology. We attribute the disparity between prevalence in the community survey participants and pregnant women to local socio-economic factors. Women in this area have a tradition of working throughout West Africa as trader/ commercial sex workers. When pregnant or ill, they return to their home villages to be with their families. HIV surveillance programs which rely on pregnant women need to be sure that sampled populations are truly typical of the communities they are intended to represent.

Adolescent↗
PubMedDate not supplied

The burden of viral hepatitis in Africa.

The burden of viral hepatitis in Africa is difficult to quantify precisely because of inaccurate statistical data and under-reporting. Of the various agents causing viral hepatitis, data on hepatitis B virus have been relatively more available and suggest that 15 to 60 per cent of the normal population in many African countries may be positive for one or more of the serologic markers of hepatitis B virus infection, whilst the corresponding values for patients with PLCC ranged from 49 to 80 per cent. Liver disease was the third most common (12.1%) of all 4,568 deaths on the medical wards of the University College Hospital, Ibadan, Nigeria over a 14-year period. Of all causes of deaths from liver disease, PLCC alone accounted for 42.5% while liver cirrhosis accounted for 21.1% of the deaths and, in both disease, HBV was the commonest cause. PLCC, which accounted for 491 out of 100,000 admissions in that teaching hospital, was the commonest malignancy on the medical wards and was the commonest cause of deaths from cancers in middle-aged and elderly Nigerians. Recent reports suggest that the prevalence of Hepatitis C infection in normal Africans may be as high as 10.9% while the corresponding value for patients with PLCC would be about 18.7 to 38 per cent. There is a need for control of hepatitis particularly hepatitis B virus infection through health education, active immunization of all new-borns and other people at risk in Africa.

Africa↗
PubMed1983

The diffusion of influenza in sub-Saharan Africa during the 1918-1919 pandemic.

The focus of this study is the spread of influenza in Africa south of the Sahara during the pandemic of 1918-1919. Most known types of diffusion pattern, i.e. radial, wave-like and linear, have been identified; however, the disease spread to rapidly that four particularly devastating linear patterns stand out. One of the most incredible aspects of the regularity in epidemic velocity along these pathways was that the colonial transportation network was of fairly recent origin. Given modern transportation linkages, the ever-present danger of the resurgence of the agent or agents that caused the pandemic could result in a much greater disaster in Africa and other Third World areas if unabated by effective inoculation programs.

Africa, Eastern↗
PubMed1996

Tuberculosis in sub-Saharan Africa: a regional assessment of the impact of the human immunodeficiency virus and National Tuberculosis Control Program quality.

BACKGROUND: The effect of the human immunodeficiency virus (HIV) epidemic on tuberculosis (TB) has been evaluated for certain countries in sub-Saharan Africa. However, no multi-country comparisons have been performed of the magnitude of the changes in TB case rates and the roles of the HIV epidemic and national TB control program (NTP) quality in these changes. METHODS: We examined trends in TB case rates after 1985 for 20 sub-Saharan African countries, and also from 1975-1984 for 10 of these countries (core countries). Average annual changes in TB case rates after 1985 were stratified by 1992 urban low-risk HIV seroprevalence and by NTP quality, as determined by a survey of international TB experts. RESULTS: Case rates in the core countries decreased by an average of -1.6% per year prior to 1985, but increased by an average of +7.0% per year after 1985 (+7.7% per year after 1985 in all 20 countries). Average annual case rates after 1985 increased approximately twice as fast in countries with high vs low or intermediate HIV seroprevalence ratings. In both the core countries and all 20 countries, the average annual rate of rise in case rates after 1985 decreased as NTP quality rating increased. This relationship persisted even after stratification by HIV seroprevalence rating. CONCLUSIONS: TB case rates have increased in sub-Saharan Africa since 1985. These increases were relatively greater as HIV seroprevalence increased, and relatively lower as NTP quality increased. Improving NTP quality is essential to mitigate the resurgence of TB in the HIV era.

AIDS-Related Opportunistic Infections↗
PubMed1992

Population and poverty in Africa.

"This paper sets out the position in Sub-Saharan Africa...regarding poverty and population. Africa has as much danger of starvation and depopulation [due to AIDS] as of over population. The paper sets out a model of poverty based on the twin concepts of capabilities and entitlements. This is [a] micro level approach and points to the importance of health and education as well as physical assets in analysing poverty. Issues of gender are always kept central. Income, access to public goods, physical assets and human capital are the four determinants of the status of any individual visavis poverty."

Acquired Immunodeficiency Syndrome↗
PubMed2000

The eradication of contagious bovine pleuropneumonia from south western Africa. A plan for action.

Contagious bovine pleuropneumonia (CBPP) caused by the Mycoplasma mycoides subspecies mycoides SC is one of the major plagues affecting cattle. With the imminent eradication of rinderpest from Africa, CBPP will become the major epidemic disease on the continent, because the majority of countries in sub-Saharan Africa have the infection in their cattle. There is an enclave of CBPP on the borders of Angola, Botswana, Namibia, and Zambia. There has been endemic infection in the cattle herds on the borders of Angola and Namibia for more than 100 years, with irregular spread from these animals to the cattle of Botswana or Zambia. However, much of Angola and Namibia and all of Botswana and Zambia are currently free from the disease. This paper explains the origins of the problem and describes the current disease situation. A plan for the eradication of CBPP from this area is proposed and discussed. If this plan is successful it will release valuable resources to tackle other constraints on livestock and food production. Furthermore, it will act as a model for the eradication of CBPP from the remainder of the continent.

Africa↗
PubMed1993

Comparison of three regimens for malaria prophylaxis in travellers to east, central, and southern Africa.

OBJECTIVES: Confirmation of breakthroughs in three different malaria chemoprophylactic regimens (chloroquine 300 mg weekly and proguanil 100 mg daily; chloroquine 300 mg weekly and proguanil 200 mg daily; proguanil 200 mg daily) and assessment of compliance. DESIGN: Prospective, randomised multicentre trial. SETTING: Five vaccination centres in the Netherlands. SUBJECTS: Dutch travellers to east, central, and southern Africa. MAIN OUTCOME MEASURES: Plasmodium falciparum seen on blood film; concentrations of drugs measured in blood spots. RESULTS: P falciparum infection was confirmed in 12 (21%) of 58 travellers with fever suspected to be due to malaria. No difference in prophylaxis failures between the regimens was found. Breakthroughs were difficult to confirm, as compliance could be determined in only 30% of the participants with fever and chloroquine in their regimen. One breakthrough was proved. The risk per 1000 people per month for travellers was 5.4 (95% confidence interval 2.4 to 12.6) for chloroquine 300 mg weekly and proguanil 100 mg daily, 2.8 (0.9 to 10.1) for chloroquine 300 mg weekly and proguanil 200 mg daily, and 6.0 (2.6 to 14.0) for proguanil 200 mg daily. CONCLUSION: Prophylaxis failures occurred in less than 1% of the participants, and only 21% of those with a fever were suffering from falciparum malaria. Compliance was moderate. The chloroquine-proguanil combination can still be recommended for visitors to east, central, and southern Africa.

Africa, Central↗
PubMed1989

Inflammatory bowel disease in rural sub-Saharan Africa: rarity of diagnosis in patients attending mission hospitals.

One hundred and eighteen missionaries working on 75 mission stations or hospitals in 24 sub-Saharan African countries provided information about their medical practice in the preceding year of 1981. Details were collected of the total number of patients seen and admitted during the year, and the number of cases of bloody diarrhoea, typhoid and inflammatory bowel disease. Over 1 million outpatients and about 190,000 inpatients were treated. These included 12,859 cases of bloody diarrhoea, of whom 1,914 had typhoid. Twenty-two cases of inflammatory bowel disease were also reported. Histological support was least available in West Africa and only 25% of hospitals had access to this facility. Nevertheless, the frequency with which inflammatory bowel disease in sub-Saharan Africa is difficult and limited by access to diagnostic facilities. It is likely to be some time before reliable estimates of the incidence and prevalence of Crohn's disease and ulcerative colitis in the rural African population can be made.

Africa, Eastern↗
PubMed2001

Y-chromosome differentiation in Northwest Africa.

Variation of seven Y-chromosomal DNA polymorphisms, one microsatellite (DYS19), and six biallelic markers (DYS287, DYS271, SRY-2627, SRY-1532, 92R7, and M9), were studied in males from Northwest Africa. To evaluate the degree of differentiation in this region, males from neighboring areas such as the Iberian Peninsula and sub-Saharan Africa were also typed. The results show a large number of paternal lineages of Northwest African origin (over 75%), supporting a long-term population continuity in the area. When the analysis of molecular variance (AMOVA) was performed both on the microsatellite and biallelic marker combinations or haplogroups, a large degree of differentiation among areas was revealed. In spite of these geographic differences, some gene flow between areas was detected by the presence of haplogroups with other geographical origins.

Africa South of the Sahara↗
PubMed1995

Noma: a neglected scourge of children in sub-Saharan Africa.

Poverty is the single most important risk indicator for noma (cancrum oris), a severe gangrene of the soft and hard tissues of the mouth, face, and neighbouring areas. The risk factors associated with an increased probability of noma developing include the following: malnutrition, poor oral hygiene, and a state of debilitation resulting from human immunodeficiency virus (HIV) infection, measles, and other childhood diseases prevalent in the tropics. There are many similarities between noma and necrobacillosis of the body surface of wallabies (Macropus reforgriseus), and it is proposed that noma results from oral contamination by a heavy load of Bacteroidaceae (particularly Fusobacterium necrophorum) and a consortium of other microorganisms. These opportunistic pathogens invade oral tissues whose defences are weakened by malnutrition, acute necrotizing gingivitis, debilitating conditions, trauma, and other oral mucosal ulcers. The current escalation in the incidence of noma in Africa can be attributed to the worsening economic crisis in the region, which has adversely affected the health and well-being of children through deteriorating sanitation, declining nutritional status and the associated immunosuppression, and increased exposure to infectious diseases. Prevention of noma in Africa will require measures that address these problems, and most importantly, eliminate faecal contamination of foods and water supplies.

Africa South of the Sahara↗
PubMed1997

The absence of adult mortality data for sub-Saharan Africa: a practical solution.

Information on cause of death among adults in sub-Saharan Africa is essentially nonexistent. Published sources provide statistics on both cause-specific and overall rates of mortality, but closer examination reveals that these data consist mostly of extrapolations and outright guesses. In the absence of accurate and comprehensive registries of vital events for the majority of the region's inhabitants, longitudinal studies of defined population-based cohorts represent the only realistic strategy to fill this void in basic public health information. The advantage of longitudinal studies is particularly clear for chronic diseases, the category for which the least is known. Noncommunicable diseases account for a significant portion of adult deaths in sub-Saharan Africa, yet the empirical bases for public health policies and interventions are essentially absent. Verbal autopsy has great potential to contribute to understanding about the cause of death among African adults. This method is discussed in the present article, and practical considerations for longitudinal studies using this methodology are reviewed.

Adolescent↗
PubMed1979

Surgical safaris with the East Africa Flying Doctor Service.

A few hundred small mission and government hospitals serve the 20 million people who live in rural East Africa. The physician-patient ratio is 1:25,000. Surgical support to many of these hospitals is provided through the East Africa Flying Doctor Service of the African Medical and Research Foundation. Small aircraft that are coordinated by a wide radio network bring surgical capability to a maximum number of patients in this area of 1,300,000 sq km (500,00 sq miles). The clinical problems, differential diagnoses, operative decisions, risk, and complications of surgical care all have a distinctly African quality. The working conditions and variety and magnitude of problems provide a stimulating challenge. Surgical safaris are a catalyst for gaining acceptance of modern scientific methods by Africa's tradition-oriented tribesmen.

Aircraft↗