Transactions of The Royal Society of Tropical Medicine and Hygiene

Hobsley, Michael; Tovey, Frank I.; Holton, John

doi: 10.1016/j.trstmh.2008.04.035pmid: 18589464

SummaryIn patients with Helicobacter pylori-positive duodenal ulcer (DU), the organism must be eradicated to achieve rapid, stable healing. However, evidence is against much else that is commonly accepted. (1) Does H. pylori cause the ulcer? Evidence against includes archaeopathology, geographical prevalence, temporal relationships and H. pylori-negative DU patients. DU can recur after eradication of H. pylori infection, and DUs may remain healed after reduction of acid secretion despite persistent infection. The faster healing of ulcers when H. pylori has been eradicated is due to the organism's interference with neoangiogenesis and the healing of wounded epithelial cells. (2) Does H. pylori infection persist until pharmacologically eradicated? Studies based on current infection show that H. pylori infection is a labile state that can change in 3 months. High rates of gastric acid secretion result in spontaneous cure, whereas low rates permit re-infection. Hydrochloric acid, necessary for producing a DU, is strongly associated with the likelihood of an ulcer. At the start, patients owe their ulcer to gastric hypersecretion of hydrochloric acid; approximately 60% may be H. pylori-negative. If acid is suppressed, the less acid milieu encourages invasion by H. pylori, especially if the strain is virulent.

Shankar, Esaki Muthu; Solomon, Sunil Suhas; Vignesh, Ramachandran; Murugavel, Kailapuri G.; Sundaram, Muthu; Solomon, Suniti; Balakrishnan, Pachamuthu; Kumarasamy, Nagalingeswaran

doi: 10.1016/j.trstmh.2008.04.034pmid: 18513775

Pappas, Georgios; Fragoulis, Konstantinos N.; Falagas, Matthew E.

doi: 10.1016/j.trstmh.2008.04.006pmid: 18513766

SummaryZoonoses are a diverse group of infections whose significance is underestimated and understudied. The prevalence of zoonoses is higher in the developing world, where health professionals are often deprived of the rapid and free availability of related scientific information; however, continuous evolution of the World Wide Web (WWW) may offer such an option. This review sought to evaluate the content of available WWW resources on zoonoses. Two authors independently identified relevant websites. The selected websites were considered of merit upon consensus of all the authors. Only websites with freely available content were included. Websites on individual zoonoses were excluded. Through the numerous sites encountered on the WWW on zoonoses, there are certain ones that offer adequate information for the public and others that can serve as useful initiators for the non-specialist. Most sites approach zoonoses one-dimensionally, either as a public health, medical or veterinarian problem. The few sites that offer updates on zoonoses unfortunately focus on regional news. Ample information for the public and non-specialists on zoonoses can be traced on the WWW. However, what is missing is a site that will continuously update health professionals who deal with zoonoses in all their medical, veterinary and public health aspects.

Lang, Trudie; Chilengi, Roma; Noor, Ramadhani A.; Ogutu, Bernhards; Todd, James E.; Kilama, Wen L.; Targett, Geoffrey A.

doi: 10.1016/j.trstmh.2008.06.009pmid: 18644610

SummaryThe recent increase in funding for diseases endemic in resource-poor countries has led to a progressive rise in the number of trials conducted in Africa for product development purposes or to answer important questions on reduction of disease burden. This causes an increasing demand for data safety monitoring boards (DSMBs) within Africa, where there is currently a shortage of appropriately skilled people. To address this, and in line with capacity-building efforts directed at improved quality research, AMANET invited the authors to create a curriculum and to train selected Africans with the skills required for members of DSMBs. Based on experience, the facilitators made an overview of clinical trial designs, a comprehensive review of data safety monitoring guidelines and other relevant DSMB governance issues. The wealth of guidelines and recommendations available for establishing and running DSMBs focus mainly on trials set in developed countries. The authors drew from these guidelines a practical summary of those relevant for Africa. This interactive process enabled recommendation of a straightforward set of principles to guide the establishment of DSMBs in Africa, which strike that essential balance between protecting trial participants and allowing investigators to answer their scientific questions.

Bwirire, L.D.; Fitzgerald, M.; Zachariah, R.; Chikafa, V.; Massaquoi, M.; Moens, M.; Kamoto, K.; Schouten, E.J.

doi: 10.1016/j.trstmh.2008.04.002pmid: 18485431

SummaryThis study was conducted to identify reasons for a high and progressive loss to follow-up among HIV-positive mothers within a prevention-of-mother-to-child HIV transmission (PMTCT) program in a rural district hospital in Malawi. Three focus group discussions were conducted among a total of 25 antenatal and post-natal mothers as well as nurse midwives (median age 39 years, range 22–55 years). The main reasons for loss to follow-up included: (1) not being prepared for HIV testing and its implications before the antenatal clinic (ANC) visit; (2) fear of stigma, discrimination, household conflict and even divorce on disclosure of HIV status; (3) lack of support from husbands who do not want to undergo HIV testing; (4) the feeling that one is obliged to rely on artificial feeding, which is associated with social and cultural taboos; (5) long waiting times at the ANC; and (6) inability to afford transport costs related to the long distances to the hospital. This study reveals a number of community- and provider-related operational and cultural barriers hindering the overall acceptability of PMTCT that need to be addressed urgently. Mothers attending antenatal services need to be better informed and supported, at both community and health-provider level.

Phommasack, Bounlay; Saklokham, Khamhoung; Chanthavisouk, Chitsavang; Nakhonesid-Fish, Viengsavanh; Strandgaard, Hanne; Montresor, Antonio; Shuey, Dean A.; Ehrenberg, John

doi: 10.1016/j.trstmh.2008.04.036pmid: 18554674

Babu, Bontha V.; Mishra, Suchismita

doi: 10.1016/j.trstmh.2008.05.023pmid: 18632125

SummaryThe present study aimed to identify the factors responsible for compliance and non-compliance of mass drug administration (MDA) under the programme to eliminate lymphatic filariasis (LF) from Orissa, India. It was based on both quantitative (through household MDA coverage survey) and qualitative data (through semi-structured interviews with heads of compliant and non-compliant households) collected during an MDA held in November 2005 in two districts of Orissa. In these districts, 83% of the eligible population received the drug (coverage) and only 49.5% people actually consumed the drug (compliance). Seventeen percent of the population did not even receive the drug. The predominant reason for not receiving the drug at household level was that the drug distributor did not visit the household, while the fear of adverse reactions is the predominant reason for not consuming it. The qualitative data revealed that the major contributor to taking the drug was the awareness that drug protects them from LF. Motivation by health workers was another reason for compliance. In many endemic areas, the issues related to non-compliance were taken casually during implementation. Hence, it is imperative to make the programme more efficient by addressing the issues linked to low compliance.

Ike, S.O.

doi: 10.1016/j.trstmh.2008.06.008pmid: 18644609

SummaryThis was a hospital-based study designed to determine the prevalence and pattern of valvular heart diseases (VHD) seen at the echocardiographic laboratory of the University of Nigeria Teaching Hospital, Enugu, Nigeria. It was also aimed at evaluating the age and gender distribution, as well as the aetiological diagnosis, of these disease presentations. All the 2527 patients referred for echocardiography over the 10 year period from February 1991 to January 2001 were consecutively studied. VHDs were diagnosed in 957 (38%) of the patients. There were 529 males and 428 females, with an age range of 6 months to 89 years. One hundred and forty-eight (16%) of them presented in the first two decades of life. Mitral valve diseases accounted for 654 (68%), aortic valve diseases 233 (25%), tricuspid valve diseases 51 (5%) and pulmonary valve diseases 19 (2%) of the cases. All four valves were involved in 15 (2%) patients. Rheumatic aetiology was the most common presumptive diagnosis, with 568 (59%) patients. The frequency pattern of VHDs in this study was high. This poses a number of challenges, one of which is the need for availability of interventions, such as non-invasive and minimally invasive surgeries.

Owolabi, Mayowa Ojo

doi: 10.1016/j.trstmh.2008.05.003pmid: 18556034

SummaryStroke is a leading cause of disability in developing countries. It is crucial to identify factors influencing health-related quality of life (HRQOL) in stroke survivors in this setting so that such factors can be efficiently manipulated in order to maximize HRQOL improvement. This is the first study of these determinants in Nigerian stroke patients. One hundred consecutive consenting stroke survivors were studied in Ibadan. The stroke levity scale (SLS) was used to assess stroke severity. HRQOL was assessed using the psychometrically robust HRQOL in stroke patients (HRQOLISP) questionnaire. HRQOL determinants were sought among variables such as age, gender, socio-economic class (SEC), post-stroke duration, side, type and number of strokes, SLS, modified Rankin scale (mRS), social support, and Likert-graded responses to laughter and negative feelings frequencies. Gender, aphasia, handedness, stroke side, type and frequency as well as SEC had no significant impact on HRQOL. The determinants of HRQOL were SLS, mRS, social support, laughter and negative feelings frequencies. Aside from stroke levity and disability, psychosocial factors such as emotional responses and social support determine HRQOL in stroke survivors. Both neuroscience and clinical management of stroke might benefit from a corresponding broader integrative conceptual framework for life after stroke.

Sasidharan, S.; Uyub, A.M.; Azlan, A.A.

doi: 10.1016/j.trstmh.2008.05.006pmid: 18586289

SummaryHeIicobacter pylori infection rate was determined in 697 consecutive patients with ulcer, gastritis, duodenitis and non-ulcer dyspepsia by endoscopy at a Malaysian hospital in 1999–2002. Biopsies of the gastric antrum and body were subjected to the urease test, Gram staining of impression smears and culture examination. Infection was defined as a positive result in at least one test. The infection rates were 32.1, 10.4, 20.0 and 16.2% in ulcer, gastritis, duodenitis and non-ulcer dyspepsia patients, respectively. Overall, the prevalence of H. pylori infection was 14.6%, with the rate among the Indian (21.7%), Chinese (19.2%) and Bangladeshi foreign worker (23.1%) groups significantly higher (P < 0.05) than that of the Malays (5.8%). Generally, the prevalence rate among males (18.9%) was significantly higher (P < 0.001) than that among females (9.0%), but for a particular ethnic group, such trend and significant differences (P < 0.05) were observed only among the Malays. In terms of gender, the prevalence rates of Malay males and females were also significantly lower (P < 0.05) than those of Chinese and Indians. In conclusion, there is a significant difference in H. pylori infection prevalence rates among ethnic groups (highest in Indians, then Chinese and unusually low in Malays) and gender groups (highest in males) in Malaysia.