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Biomedical subjects

M W Borgdorff

Publications and source records attributed to M W Borgdorff.

At least 73 records · Page 4Linked to original sources
PubMed1999

Tuberculosis chemotherapy and sputum conversion among HIV-seropositive and HIV-seronegative patients in south-eastern Uganda.

OBJECTIVE: To investigate if there is a difference in response to tuberculosis treatment between HIV seronegative and HIV seropositive patients following two months of intensive phase tuberculosis treatment. DESIGN: Prospective cohort study. SETTING: St. Francis Leprosy Centre, south-east Uganda. SUBJECTS: Four hundred fifty seven patients with never previously treated sputum smear-positive tuberculosis admitted during a two-year period in 1991/1993. INTERVENTION: Intensive phase treatment with streptomycin, isoniazid, rifampicin and pyrazinamide. MAIN OUTCOME MEASURES: Sputum conversion from a positive to a negative smear at eight weeks of treatment. RESULTS: HIV seropositivity prevalence was 28%. Among HIV seronegative patients, conversion to a negative smear status occurred in 76% persons compared to 78% in HIV seropositive patients. This difference was not statistically significant (OR = 0.9; 95% CI, 0.6-1.5). HIV seropositive patients, however, were more likely to die (p = 0.017). A high prevalence of resistance to isoniazid and streptomycin was found. Isoniazid resistance was more likely in HIV seronegative patients with M. tuberculosis strains compared to HIV seropositive persons (p < 0.005). Initial resistance to antituberculosis drugs did not have a significant effect on smear conversion. CONCLUSION: This study demonstrates that HIV-seropositive status is not a principal factor in delaying sputum conversion among patients receiving intensive phase tuberculosis treatment.

AIDS-Related Opportunistic Infections↗
PubMed1998

Analysis of tuberculosis transmission between nationalities in the Netherlands in the period 1993-1995 using DNA fingerprinting.

Immigration from high prevalence areas may contribute to an increased risk of tuberculosis in Europe. This study aimed at quantifying transmission of tuberculosis between and within nationalities among residents of the Netherlands. DNA "fingerprints," on the basis of restriction fragment length polymorphism using marker IS6110, were made of all Mycobacterium tuberculosis isolates in the Netherlands from January 1993 through June 1995. Clusters were defined as groups of patients that had isolates with identical fingerprints. It was assumed that the probability of a patient being the source of a cluster was proportional to the incidence rate of potential sources times the probability that a potential source would give rise to a cluster. The transmission index was defined as the average number of secondary cases of infectious tuberculosis caused directly or indirectly through recent transmission by a single potential source case and was used to estimate the effective reproductive rate associated with recent transmission, ReFAST. Among a total of 623 Dutch tuberculosis cases, 17% (95% confidence interval 9-25%) of cases were attributable to recent transmission from a non-Dutch source. The transmission index varied strongly by nationality, and was highest among the Surinamese (1.3), Moroccan (0.8), and Turkish (0.8) populations; ReFAST was 0.26. Aggregation of tuberculosis cases of given nationalities within clusters was most pronounced among recent immigrants from Somalia and (ex-)Yugoslavia. The authors conclude that differences in transmission between subpopulations can be quantified and may be used to evaluate and direct tuberculosis control.

Adolescent↗
PubMed1998

Improved injection practices after the introduction of treatment and sterility guidelines in Tanzania.

OBJECTIVE: To evaluate the effect of introduction of treatment and sterilization guidelines on the number of avoidable injections and on the sterility of needles and syringes. METHODS: In 1991, 66 randomly selected health units in Mwanza Region, Tanzania, were visited and factors were determined that might contribute to HIV transmission by injections. In a workshop with all senior health workers from the region, findings were presented and treatment and sterilization guidelines developed. Thereafter, seminars were held at each health centre of the region. Four months after the intervention, data were collected at the same health facilities in order to assess changes in prescribing practices, sterilization procedures, and sterility of needles and syringes. RESULTS: The knowledge on indications for injections improved markedly for paramedical staff. The proportion of outpatients receiving an injection dropped from 23% to 10% and the proportion of patients receiving an avoidable injection dropped from 16% to 6%. Procedures for sterilization, keeping sterilized equipment, and administration of injections improved. A smaller proportion of sterilized needles and syringes tended to be contaminated in dispensaries, but this reduction from 44% to 22% was not significant. CONCLUSION: Considerable improvement in knowledge, prescription practices and sterility procedures was observed at dispensary level after carrying out a training programme.

Allied Health Personnel↗
PubMed1998

Risk of gastroenteritis among triathletes in relation to faecal pollution of fresh waters.

BACKGROUND: We conducted a prospective cohort study among endurance athletes to investigate the effects of microbiological water quality on the risk of gastroenteritis after bathing in fresh waters that meet current water quality standards. We aimed to establish quantitative relationships, in order to evaluate current bathing water standards. METHODS: The study was spread over two summers, during which 827 triathletes (swimmers) in seven Olympic distance triathlons and 773 participants in 15 run-bike-runs (non-swimming controls) participated. Intensive water quality monitoring was used to assess exposure to faecal indicator organisms and detailed questionnaires were used to collect data on the occurrence of health complaints and potential confounding factors. RESULTS: The microbiological water quality at the time of the triathlons met current Dutch and European bathing water standards. Dependent on the case definition studied, gastroenteritis developed in 0.4-5.2% of swimmers and 0.1-2.1% of non-swimmers in the week following exposure (odds ratio [OR] = 1.6-2.3). Attack rates and burden of disease varied with the case definition used. Among swimmers, the attack rate of gastroenteritis was significantly increased when the geometric mean concentration of thermotolerant coliforms in the water at the time of exposure was > or = 220/100 ml or the geometric mean concentration of Escherichia coli was > or = 355/100 ml (OR comparing high versus low exposure 2.9-4.7 dependent on the case definition studied). Thermotolerant coliform concentrations at these triathlons ranged from 100/100 ml (the EU guide level) to 960/100 ml (the EU imperative level is 2000/100 ml). Below the threshold levels attack rates were comparable with attack rates among non-swimmers. A relation with other indicators of faecal pollution was not observed. CONCLUSIONS: We observed that swimming in fresh waters that met the European imperative level for thermotolerant coliforms but failed the European guide level was associated with a significant risk of gastroenteritis among triathletes. This means that the current European imperative level for thermotolerant coliforms provides insufficient protection to gastrointestinal illness for those who are comparable with triathletes.

Adult↗
PubMed1998

Mortality among tuberculosis patients in The Netherlands in the period 1993-1995.

This study aimed to estimate excess mortality among tuberculosis patients in The Netherlands and identify risk factors for tuberculosis-associated mortality. The national tuberculosis register provided data on patients diagnosed in the period 1993-1995. Excess mortality in tuberculosis cases, according to age and sex, was determined by comparison with national mortality rates. Risk factors were identified and adjustment for confounders was carried out using Cox's proportional hazard analysis. Of 4,340 patients alive at diagnosis, 258 died within 1 yr while on treatment. The Kaplan-Meier survival probability after 1 yr was 93%. Tuberculosis patients had a standardized mortality ratio of 8.3. Independent risk factors for mortality were: gender; age; presence of a malignancy or human immunodeficiency virus (HIV) infection; addiction to alcohol or drugs; localization of tuberculosis; and the type of medical officer having made the diagnosis. Of all deaths, 83% occurred in two risk groups comprising 21% of tuberculosis patients: those aged > or =65 yrs and those having HIV infection or a malignancy. Tuberculosis patients in The Netherlands are at a considerably increased risk of death. However, the prognosis is very good for those aged less than 65 yrs and without human immunodeficiency virus infection or a malignancy.

Adult↗
PubMed1997

The geographical distribution of tick bites and erythema migrans in general practice in The Netherlands.

BACKGROUND: Lyme disease is caused by Borrelia burgdorferi which is transmitted in Europe by the tick ixodes ricinus. Erythema migrans is a skin lesion which is pathognomonic of Lyme disease. A retrospective study was carried out to determine the geographical distribution of the occurrence of tick bites and erythema migrans in the Netherlands and to identify ecological risk factors. METHODS: In April 1995, all general practitioners (GPs) in the Netherlands were asked to complete a postal questionnaire on the number of tick bites and erythema migrans case-patients seen in 1994 and the size of the practice. Reminders were sent to non-responders. Information on ecological risk factors by local government area was obtained from a geographical information system. RESULTS: The response rate was 79.9%. In 1994, GPs reported seeing approximately 33,000 patients with tick bites and 6500 with erythema migrans. The incidence rate of erythema migrans was estimated at 4.3 per 10,000 population. Ecological risk factors for both tick bites and erythema migrans were the proportion of the area covered by woods, sandy soil, dry uncultivated land, the number of tourist-nights per inhabitant and sheep population density. The cattle population density was a risk factor for erythema migrans. CONCLUSIONS: Using simple methods, a crude estimate of the incidence rate of erythema migrans was obtained rapidly, and high risk areas were identified. Lyme disease appears to be an important problem in the Netherlands.

Animals↗
PubMed1997

Surveillance of foodborne diseases: what are the options?

Epidemiological data are needed for a variety of reasons, namely, informing public health authorities about the nature and magnitude of foodborne illnesses and their epidemiology, for the early detection of foodborne disease outbreaks, and for the planning, implementation and evaluation of food safety programmes. Thus, epidemiological surveillance of foodborne diseases is fundamental to any food safety programme. Various methods of foodborne surveillance may be utilized: (i) records for registration of deaths and hospital discharges; (ii) disease notification, (iii) sentinel surveillance, (iv) laboratory surveillance, (v) outbreak investigation and (vi) epidemiological research. This article reviews each method, its advantages and disadvantages, and its relevance for meeting the various objectives and needs.

Death Certificates↗
PubMed1996

Changes in male sexual behaviour in response to the AIDS epidemic: evidence from a cohort study in urban Tanzania.

OBJECTIVE: To examine changes in sexual behaviour among men in urban Tanzania. DESIGN: An observational cohort study among factory workers during 1991-1994. METHODS: Data from five follow-up visits with structured questionnaire-guided interviews and biomedical data were analysed to examine trends in sexual behaviour and sexually transmitted disease/HIV among 752 men. In-depth interviews were conducted to evaluate the magnitude of reporting bias. RESULTS: During the 2 years of observation, the proportion of men with more than one sexual partner during the month preceding the interview declined from 22.3 to 12.2%. The proportion of men reporting casual sex partners during the last month was almost halved: from 9.8 to 5.2%. The decline in the reporting of extramarital partners was gradual and pronounced. There were only minor changes in reported condom use, notably an increase in use with casual partners, and no changes in coital frequency. Data from in-depth interviews confirmed that reduction in sexual partners was the predominant change. CONCLUSIONS: This study documents that, in response to the AIDS epidemic, changes in male sexual behaviour are taking place in urban areas in Africa. The predominant change among these men, who are predominantly married and aged over 25 years, is a reduction of the number of sexual partners, although condom use remains low.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Injection practices in Mwanza Region, Tanzania: prescriptions, patient demand and sterility.

This paper describes prescription and sterilization practices in Mwanza Region, Tanzania, before the introduction of interventions aiming at reducing HIV transmission by injections. Sixty-six health facilities from Mwanza Region were included in the study. Data were collected in interviews and questionnaires, through structured observation, bacteriological culture and record analysis. Criteria for avoidable injections were based on recommendations of the Essential Drugs Programme and on a regional consensus workshop. One in 4 out-patients received an injection 70% of which were avoidable. Most were given for acute respiratory infections, skin diseases and urinary tract infections. Forty per cent of cultures taken from sterilized needles and syringes yielded growth of microorganisms. Of 120 patients interviewed most preferred to be treated with injections for almost any complaint. Patient demand for injections was felt to be a problem in 85% of the health facilities and may have contributed to overprescription of injectables. Consensus treatment and sterilization guidelines as well as a health education programme were developed and introduced to all health workers through seminars.

Adolescent↗
PubMed1995

HIV-1 incidence and HIV-1 associated mortality in a cohort of urban factory workers in Tanzania.

OBJECTIVE: To determine HIV-1 incidence and HIV-1 associated mortality in a prospective cohort study. To determine whether the cohort is suitable for studies aiming to determine the impact of interventions on HIV-1 incidence. METHODS: The study population was a cohort of 1772 urban factory workers (1478 men and 294 women) in northwest Tanzania. The study took place from October 1991 to September 1993. Outcome measures were HIV-1 seroconversion and death. RESULTS: HIV-1 incidence was 1.2 (95% CI 0.7-2.0) per 100 person-years (pyr). Crude annual mortality was 4.9 per 100 pyr in those with and 0.3 in those without HIV-1 infection, giving an age and sex adjusted mortality ratio of 12.9 (95% CI 5.4-30.7). Of all deaths, 62% were attributable to HIV-1 infection. CONCLUSION: HIV-1 infection was a major public health problem, being the major cause of death in this adult population. At an HIV-1 incidence of 1.2 per 100 pyr, a large cohort size would be required to evaluate the impact of interventions on HIV-1 incidence.

Adolescent↗
PubMed1994

Changes in blood transfusion practices after the introduction of consensus guidelines in Mwanza region, Tanzania.

OBJECTIVE: To assess the effect of introducing consensus guidelines on avoidable blood transfusions in Mwanza region, Tanzania. METHODS: Avoidable blood transfusions were determined among 842 blood transfusion recipients in eight hospitals in 1991. In a workshop with senior health workers from the region, consensus guidelines for the prescription of blood transfusions were developed and introduced in the hospitals and after 7 months intervention data were collected on 1042 blood transfusion recipients. The 1991 and 1992 data were compared to estimate the change in the proportion of avoidable blood transfusions. RESULTS: In blood transfusion recipients aged < 5 years there was a significant reduction in the proportion of avoidable blood transfusions from 257 (52%) out of 498 to 197 (33%) out of 595 (P < 0.001), especially at the peripheral hospitals. For children the proportion decreased from 25 to 17% (P < 0.05) and for operated patients the percentage remained at 24%. In pregnant women there was a significant increase in the proportion of avoidable blood transfusions from 10 to 27% and in adults from 37 (25%) out of 146 to 121 (50%) out of 242. The improvement in peripheral hospitals was offset by a similar deterioration in the referral hospital, thus no overall reduction was achieved in the proportion of avoidable blood transfusions. CONCLUSION: The development and introduction of consensus guidelines was not sufficient to change prescribing practice. The proportion of avoidable blood transfusions decreased only in hospitals where compliance was maintained through regular clinic meetings and strict supervision by senior medical staff.

Blood Transfusion↗
PubMed1994

Sexual partner change and condom use among urban factory workers in northwest Tanzania.

OBJECTIVE: To describe sexual partner change and condom use at the intake of a cohort study of urban factory workers in Tanzania. METHODS: From October 1991 to March 1992, 926 male and 170 female factory workers were interviewed using a structured, pre-coded questionnaire. Questionnaire reliability was assessed by pre-testing and comparison with results of unstructured interviews and carrying out repeat questionnaires on a sub-sample. RESULTS: Almost half of both men and women had had sexual intercourse by their 17th birthday. The period of premarital sex had an interquartile range of 2 to 10 years in men and 0 to 2.5 years in women. Having had sexual intercourse in the past month with more than one partner was reported by 22% of the men and 5% of the women. Factors associated with multiple partners in men were being born in or near Mwanza Region, having low education and low income, and being married. Condoms had been used in the past month by 3% only, mainly with casual partners. Condom use in men was associated with being young, living in town, being born in Kagera Region, high education and high income, being circumcised, and having causal or steady (non- martial) partners. CONCLUSION: Information, education and communication (IEC) on sexual relationships and condom use should start at an early age, and include education at primary schools. Much sexual partner change appears to occur through steady (non-marital) partnerships, indicating the need for IEC to be expanded beyond groups such as commercial sex workers and their clients.

Adolescent↗
PubMed1994

Intake of a cohort study of urban factory workers in northwest Tanzania. Risk factors for HIV-1 infection.

A cohort study has been started of urban factory workers and their spouses in Tanzania, in order to 1) identify risk factors for HIV-1 seroconversion, and 2) document changes over time in risk behaviour, in particular condom use and partner change, and determine whether these are associated with a reduced incidence of HIV-1 and other sexually transmitted diseases. We report findings at intake from October 1991 to March 1992. Study participants were interviewed, examined, and screened for HIV-1 and syphilis. HIV-1 prevalence was 91/926 (10%) in males and 36/217 (17%) in females. Statistically significant risk factors for HIV-1 infection in males were age group, region of birth, not being married for more than 5 years, being uncircumcised, having had a genital ulcer in the past four months, and having received injections from medical staff in the past four months. HIV-1 incidence in this group is expected to be between 1% and 2% per year. It is concluded that a longitudinal study is needed to assess the importance of partner change. This cohort appears to be suitable for such a study as HIV-1 incidence is expected to be fairly high, HIV-1 prevalence and risk factors are comparable to those of the general population and cooperation of the factory workers is good.

Adolescent↗