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East African journal of public health [journal]
- Substandard and counterfeit antimicrobials: recent trends and implications to key public health interventions in developing countries. [Journal Article, Review]
- East Afr J Public Health 2012 Jun; 9(2):85-9.
The objective of this review is to produce evidence on the prevalence and trends in the availability of substandard and counterfeit antimicrobials in the global market and its consequences on key public health interventions in developing countriesReview of various literatures collected through the internet and other sources. Literature search using PubMed and Medline databases and Google search engine was conducted to identify related publications on the subject. Relevant published and unpublished literature was also consulted as additional source of information.During the past few decades, the trade of substandard and counterfeit medicines has increased substantially. Past experiences indicate that almost any kind of medicine can be counterfeited. In developing countries, primary targets are those antimicrobials that are commonly used in the treatment of life-threatening conditions including malaria, tuberculosis and HIV/AIDS. The findings in this review support the strong contention that substandard and counterfeit antimicrobials are available in the developing world in very high proportions. This is becoming one of the major causes of treatment failures leading to excessive mortality and morbidity. Moreover, it is implicated for contributing to the development of drug resistant organisms in many infectious diseases of public health significance such as malaria, tuberculosis and HIV/AIDS.If trends in the prevalence of counterfeit/substandard drugs continue at the current scale, there is a huge threat to interventions underway on major killer diseases in the developing world. So, public health interventions in developing countries should include quality control of antimicrobials as an integral part of program implementation. The national drug regulatory authorities in those countries should also be strengthened to enhance their capacity in enforcing regulations pertaining the registration, production, distribution and use of antimicrobial drugs.
- Utilisation of delivery services in Zaria, northern Nigeria: factors affecting choice of place of delivery. [Journal Article]
- East Afr J Public Health 2012 Jun; 9(2):80-4.
To determine the effect of companionship during labour and delivery, and the preferred delivery position, on the choice of place of delivery among women in Zaria, with a view to providing more acceptable services.315 consenting women attending the antenatal clinic at primary health facility in Zaria were interviewed.62.24% of the women had their last delivery at home. Reasons for not wanting to deliver in health facility included the fact that it was too expensive (48.19%), concern that a companion would not be allowed to stay with them during labour and delivery (12.05%), unfriendly healthcare providers (10.84%), and concern about not being allowed to deliver in their preferred position (4.82%).Women in Zaria value social support and freedom to decide the position to adopt during labour and delivery. Healthcare providers and policy makers need to be sensitive to such needs that affect uptake of services.
- Exploration of knowledge, attitudes and behaviours of street children on the prevention of HIV and AIDS in the Huye district, Rwanda. [Journal Article]
- East Afr J Public Health 2012 Jun; 9(2):74-9.
HIV and AIDS is a pandemic that continues to ravage humanity worldwide, especially among the youth. Street children are victims of society and are up to 10-25 times more affected by HIV and AIDS than their counterparts who live with their families.The purpose of the study was to explore the knowledge, attitudes and behaviors of street children with regard to the prevention of HIV and AIDS.A cross sectional study with a quantitative approach was carried out in two street children centres in the Huye district, which is situated in the Southern Province of Rwanda. Non probability convenience sampling was used and 83 participants between the ages of 10 and 18 years old were invited to participate. These comprised of 43 females (51.8%) and 40 males (48.2%), A questionnaire, which was translated into Kinyarwanda, was used to collect data from the participants.The findings indicated that the knowledge level of the participants was moderate at 71.7%. However, they still had misconceptions regarding HIV and AIDS as 16.9% of the participants said that there is a vaccine for HIV and AIDS and that it is curable. While 78.3% of the participants knew that HIV could be transmitted by body fluids, only 45.8% and 49.4% knew that it could be transmitted by oral sex and anal sex respectively. The current study revealed that 36.1% of the participants were currently sexually active and 53.7% had not used a condom during their last sexual intercourse. A total of 21.7% of the participants had been given money; drugs or place to sleep in exchange for sex and 20.7% declared that they had unwillingly been forced to have sex.It is evident that although street children have a moderate knowledge level about HIV and AIDS, they still have certain misconceptions and are exposed to HIV and AIDS due to their risky behaviours. The health professionals should implement a programme of HIV and AIDS prevention among street children so that the street children life may be saved.
- Hypertension control and other cardiovascular risk factors among diabetic patients at Muhimbili National Hospital, Tanzania. [Journal Article]
- East Afr J Public Health 2012 Jun; 9(2):70-3.
Hypertension among diabetics is a well recognized cardiovascular risk factor. This study aimed at determining the prevalence of hypertension, its control and the prevalence of other cardiovascular risk factors among diabetic patients.We consecutively enrolled 150 adult diabetics. Their age, sex weight, height, blood pressure, fasting capillary blood glucose, lipid and renal profiles, hypertension and diabetes therapy were ascertained.Hypertension prevalence was 54.7%. Treatment and control rates of hypertension were 81.7% and 34% respectively. Hypertensive patients were older, more overweight/obese, had a longer duration of diabetes and elevated serum creatinine. The prevalence of Dyslipidemia, overweight and obesity were 88%, 48.7% and 18.7% respectively. Poor diabetes control was observed in 76.7% of patients. Cigarette smoking was uncommon.Hypertension, hyperglycemia, dyslipidemia and obesity are prevalent among our diabetic patients. Both hypertension and glycemia were poorly controlled. Addressing individuals' global cardiovascular risk profiles is vital in diabetics.
- The typology of female sex workers in Dar-es-Salaam: implications to HIV and AIDS interventions targeting female sex workers in Tanzania. [Journal Article]
- East Afr J Public Health 2012 Jun; 9(2):62-9.
To establish the categories of female sex workers in Dar es Salaam.We conducted in depth-interviews with 32 female sex workers (FSWs) in five geographic areas of Dar-es-Salaam known to be the primary residential and working places, three local government leaders in three of the five areas known to have brothels and two NGO representatives working with this population.There are about 14 categories of FSWs with fluid perceived 'boundaries', which could change given factors like the availability of clients, active prostitution control mechanisms, the weather, the female sex worker's need for money and the type of sexual services demanded.different categories provided by the study participants are only useful in the Dar-es-Salaam context but generalization to other places in Tanzania might not be quite possible. However, using these classifications provides an understanding of how they construct their real world with regard to sex work, experiences, (health) needs and shared characteristics that are important when planning for all aspects of research designs and the implementation of interventions targeting them. The Ministry of Health and Social Welfare (MoHSW), through the National AIDS Control Program (NACP), stakeholders and development partners should conduct more research in this area to generate more information that would facilitate lobbying and advocating for repealing colonial-rooted anti-prostitution laws and replacing them with policies aiming at assisting them.
- Occurrence of extended spectrum beta (b)-lactamases in multi-drug resistant Escherichia coli isolated from a clinical setting in Jimma University Specialized Hospital, Jimma, southwest Ethiopia. [Journal Article, Research Support, Non-U.S. Gov't]
- East Afr J Public Health 2012 Jun; 9(2):58-61.
Resistance to antibiotics has grave consequences leading to treatment failure and increased health care costs. This public health risk has become a global problem with some countries like Ethiopia seriously affected. Members of the family enterobacteriaceae, including E. coli, are among the most important human pathogens accounting for the majority of bacterial strains isolated from clinical patient samples. Moreover, there is insufficient data regarding Extended-spectrum Beta-lactamase (ESBL) prevalence among Escherichia coli strains from Ethiopia. Thus, the objective was to determine the production of ESBL among clinical isolates and assess the in vitro susceptibility of the E. coli to the routinely used selected antibiotics.We collected a total of 359 clinical specimens (56 urine, 116 sputum, 72 stool and 15 wound swabs) from in- and outpatients at Jimma University Specialised Hospital, Jimma zone, southwest Ethiopia.E. coli was isolated from 67 (18.66%) clinical specimens, of which 24 (36%) isolates were ESBL producers. The resistance pattern to the tested antibiotics was: penicillin (97%), amoxacillin and ampicillin (86.6% each), tetracycline (73.1%), amoxacillin-clavulanate (70.1%), co-trimoxazole (56.7%), chloramphenicol (35.8%), ciprofloxacine (20.9%), norfloxacine (16.4%), cefotaxime (9%), ceftazidime (6%), gentamicin (3%). All the isolates tested showed resistance to two or more drugs, and were considered to be multi-drug resistant.A higher rate (46%) of ESBL production and multi-drug resistance was seen among isolates from inpatients as compared to outpatients (33%) at the hospital.
- Perceptions of AIDS risk and condom use among out-of-school adolescents in Moshi rural district, northern Tanzania. [Journal Article, Research Support, Non-U.S. Gov't]
- East Afr J Public Health 2012 Jun; 9(2):53-7.
To determine the magnitude of perceived AIDS risk among out-of-school adolescents in Moshi rural district of Kilimanjaro region, northern Tanzania.A cross-sectional study involving face-to-face interviews with out-of-school adolescents in eleven rural villages in Moshi district, northern Tanzania.We found that of the 668 adolescents (10-19 years of age) surveyed, 45.4% were sexually active and significantly more men than women reported being sexually active (55.85 versus 23.0%, OR = 0.24, 95% CI = 0.16 to 0.34). Adolescents who had travelled to Moshi town or out of Tanzania were significantly more likely to be sexually active compared with those who have never travelled. Despite perception of AIDS risk, a large majority (70.5%) of sexually active adolescents reported having multiple sexual partners. Adolescents who perceived being at AIDS risk were less likely to report having multiple sexual partners and were more likely to report having used a condom at the last sexual intercourse.These findings indicate that adolescents in this rural population are still practising high risk sexual behaviours suggesting the need for youth-targeted intervention programmes in rural Tanzania.
- Undernutrition of orphans and vulnerable children: a comparison of cash transfer beneficiaries and non beneficiaries in Korogocho slums, Nairobi. [Comparative Study, Journal Article, Research Support, Non-U.S. Gov't]
- East Afr J Public Health 2012 Sep; 9(3):132-8.
To assess the prevalence and associated factors for undernutrition among the beneficiaries of Kenya Cash Transfer Program compared to non-beneficiaries in Korogocho, Nairobi. Optimal nutrition reduces the prevalence of undernutrition and contributes to improved child survival and development.A comparative descriptive cross-sectional study design in which a total of 336 children were sampled from the two groups each consisting 168 children. A questionnaire was administered to caregivers. A Food Frequency Questionnaire and a 24 Hour Recall sought information on foods consumed. Anthropometric measurements were taken based on standard procedures. Wasting, underweight and stunting were determined based on a z-score of > or = -2 or < -2 SD. A chi-square test was used to test significance associations of wasting, underweight and stunting with other variables.A majority (89.3%) and (73.8%) of the principal caregivers were females among the beneficiaries and non-beneficiaries respectively. Among the beneficiaries, prevalence of wasting was 6%, underweight 6% and stunting 32.7%. Among non-beneficiaries, undernutrition was higher with wasting 9.5%, underweight 17.9% and stunting 37.5%. There was a significant difference (chi2 = 11.351, df = 1, p = 0.001) for underweight among the beneficiaries and non-beneficiaries. Nutrient inadequacies were high in vitamin A, folate and zinc in both beneficiaries and non-beneficiaries. In beneficiaries, undernutrition was significantly (p < 0.05) associated with number of children aged 6-59 months in the household, cash transfer used on food, carbohydrate intake, protein intake and frequency of breastfeeding. Among non-beneficiaries, undernutrition was significantly (p < 0.05) associated with number of household members, number of children 6-59 months in the household and income spent on food.There was improved nutritional status among the beneficiaries compared to non-beneficiaries. However, there is need of training beneficiaries on the best use of the cash transfers and educating them on consumption of adequate food to improve nutrient intake and eventually their nutritional status.
- Influence of political culture on service provision in Kenyan rural health facilities. [Journal Article]
- East Afr J Public Health 2012 Sep; 9(3):128-31.
To explore the overall implications for an enhanced health system administrative capacity that not only takes account of global and regional developments, but that is also seen as legitimate domestically and is well equipped theoretically to deliver quality health care services in Kenyan rural health facilities.The study used public hospitals as test cases. A field study was undertaken in western Kenya where four institutions were identified as research sites. In all the sites, a survey questionnaire was administered to both the community of health service providers as well as service users.The study found that health care service reforms must begin at a more fundamental level rather than just organizational development, human resource development and capacity building.The paper concludes by re-emphasizing the need to minimize the traditional tensions between the political and the public administration interface and the need to ensure that health care reforms are embedded or at least reflect the political choice and social structure of Kenyans in general.
- Prevalence of HIV-1 infection in Zanzibar: results from a national HIV-1 serosurvey 2002. [Journal Article, Research Support, Non-U.S. Gov't]
- East Afr J Public Health 2012 Sep; 9(3):123-7.
To determine the prevalence of HIV-1 infection in Pemba and Zanzibar islandsWe used an interviewer-administered questionnaire that consisted of pre-coded and open-ended questions consisting of 29 items. The questionnaire was developed in English and translated into Swahili language before use. The questionnaire was pilot tested and modified before use. A total of 30 Shehias were randomly selected for the survey out of a total of 248 Shehias. A Shehia is the smallest government administrative unit in Pemba and Zanzibar that consists of two to three villages. The study sample was obtained through cluster random sampling of 76 households from each Shehia. Informed consent was sought from the Head of household and from each potential eligible participant. Eligibililty criteria included all persons aged 12 years and above who slept overnight in the selected household at the time of the study. Exclusion criteria included non-residents of Zanzibar and Pemba such as tourists, Informed consent from persons below the age of 18 years were witnessed and ratified by their parents, guardians, caretakers or neighbours. All consenting participants were included in the study sample. Blood sports were collected using filters and tested for HIV-1 using ELISA test at the Zanzibar Reference Laboratory. Samples found positive for ELISA were subjected to a 2nd ELISA test.The total number of persons who participated in the survey was 5852 out of 5868 eligible persons giving the overall response rate of 99.7%. Of the 5852 persons who participated in the survey, 41% (N = 2414) were males and 59% N = 3455) were females. The overall mean age of the study population was 30.4 years with age ranging from 12-65 years. The overall prevalence of HIV-1 infection was 0.6% with more women being significantly affected than men (0.9% versus 0.2%; adjusted OR = 2.88, 95% CI = 1.16-7.12). Of the 5852 persons who participated in the survey, 5.7% admitted having had casual partner in the past 6 months and of these 19.6% reported having used a condom during the most recent casual sex.We conclude that HIV-1 infection in Zanzibar is still low and women are more affected than men.