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Biomedical subjects

Q Abdool Karim

Publications and source records attributed to Q Abdool Karim.

17 recordsLinked to original sources
PubMed2006

TB treatment outcomes following directly-observed treatment at an urban outpatient specialist TB facility in South Africa.

The treatment of 450 consecutive new patients with pulmonary TB was evaluated to determine outcome following directly-observed treatment. In all, 176 (39.1%) patients were cured, 23 (5.1%) completed treatment, 80 (17.8%) defaulted treatment, 24 (5.3%) died, 54 (12.0%) were lost to follow-up and 93 (20.7%) were transferred out. Increasing age was significant for death. Males were more likely to default and those with negative pretreatment sputum smears and those who were unemployed were more likely to be lost to follow-up. The overall treatment success rate remains low. Our data suggests that greater emphasis is needed to improve TB treatment success.

Adult↗
PubMed1999

Phase 1 trial of nonoxynol-9 film among sex workers in South Africa.

OBJECTIVES: To assess the acceptability and safety of a vaginal nonoxynol-9 film in a group of sex workers at a truck stop in South Africa. DESIGN: A randomized double-blinded crossover trial was conducted between April 1995 and July 1995. INTERVENTION: Seventy-two mg nonoxynol-9 film and an identical glycerine placebo film. METHODS: Following informed consent, each study participant was randomly assigned the designated pre-coded film for 1 month. The second month was a film-free washout period and the participants used the alternate film in the third month. Besides measuring behavioural and clinical outcomes, colposcopy examination for genital lesions, serology and microbiology investigations for sexually transmitted diseases and semi-quantitative PCR for vaginal HIV load estimates were performed. RESULTS: Twenty women participated in the study. The women reported, on average, 19 sexual encounters per week. Vaginal intercourse was protected 25% of the time by condoms. On average, 11 vaginal films, either nonoxynol-9 or placebos were inserted per week. There were no statistically significant differences between the two treatment groups for genital lesions (P = 0.29), reported side effects (P = 0.73), and viral load (P = 0.9). However, the proportions of clinically detected genital lesions (six out of eight versus two out of eight) and self-reported side-effects (five out of eight versus three out of eight) were higher in the nonoxynol-9 group when compared with the placebo group. Incident sexually transmitted diseases occurred more frequently in the placebo group. An increased viral load was associated with the development of a genital lesion (relative risk, 6.0; 95% confidence interval, 0.81-44.4). CONCLUSIONS: The 72 mg film formulation of nonoxynol-9 was an acceptable product for use in this population of sex workers. Although no statistically significant differences in adverse outcomes were detected, clinically there appeared to be an increase in minor lesions and self-reported side-effects with nonoxynol-9 and less protection against sexually transmitted diseases with the placebo. Furthermore, HIV shedding was correlated with the presence of incident vaginal or cervical lesions. This brings into question the potential narrow margin of safety for this product; additional Phase 2 studies are therefore required.

Administration, Intravaginal↗
PubMed1998

Informed consent for HIV testing in a South African hospital: is it truly informed and truly voluntary?

OBJECTIVE: The purpose of this study was to assess informed consent to human immunodeficiency virus (HIV) testing in a perinatal HIV transmission study in a major referral hospital serving a largely Black population in South Africa. METHODS: First-time antenatal clinic attenders who were randomly selected from those enrolled in the perinatal HIV study (n = 56) answered questionnaires before and after counseling. RESULTS: Knowledge of HIV transmission and prevention, high at the outset, was little improved after counseling. The acceptance rate for HIV testing was high. Despite assurances that participation was voluntary, 88% of the women said they felt compelled to participate in the study. CONCLUSIONS: Informed consent in this setting was truly informed but not truly voluntary.

AIDS Serodiagnosis↗
PubMed1997

Government responses to HIV/AIDS in Africa: what have we learnt?

While we should not lose sight of the development of vaccines and cures, more immediate priorities include the implementation of effective STD control. The syndromic management approach developed in Zimbabwe to overcome laboratory constraints is a cost-effective way of managing STD. Of urgency is the integration of STD services into primary health-care services, appropriate training of staff, adequate provision and control over drugs and condoms, and incorporation of traditional healers and community-based education on STD. A second area of priority is the strengthening of the interaction between prevention, care and support activities, which act in synergy. Effective prevention and care require easy access to testing facilities with pre- and post-test counselling, appropriate structures and services to provide affordable and sustained care and support to those found to be infected with HIV, provision of drugs for the treatment of opportunistic infections, and the creation of a social environment and a legislation which protect against any form of discrimination the rights of people living with HIV, their sexual partners and their families.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Unsustainability of a measles immunisation campaign--rise in measles incidence within 2 years of the campaign.

The 1990 national mass measles immunisation campaign resulted in a marked reduction in measles incidence in Natal/KwaZulu in the first 6 months after the campaign. Data from the measles ward admissions book at Clairwood Hospital were collated for the period 1 January 1989 to 31 May 1992 to assess the sustainability of the effects of the campaign. For the first 12 months after the campaign, measles admissions were consistently low. Thereafter, the number increased steadily, rising sharply to above pre-campaign levels 21 months after the campaign. The age distribution of measles patients indicated that the initial fall in the 10-12-month age group had been reversed in the second year after the campaign, suggesting that the high vaccination coverage achieved for this age group during the campaign had not been maintained. Measles admissions to Clairwood Hospital indicate that the effect of the measles immunisation campaign has not been sustained and that urgent action is required to avert a possible epidemic.

Child↗
PubMed1992

Seroprevalence of HIV infection in rural South Africa.

OBJECTIVES: To establish the prevalence of HIV infection in rural South Africa and to investigate demographic factors that influence this prevalence. DESIGN: An anonymous HIV seroprevalence survey was performed in conjunction with a population-based malaria surveillance programme. SETTING: The rural area of northern Natal/KwaZulu, South Africa. PARTICIPANTS: A total of 5023 black African participants were recruited by malaria surveillance agents during house-to-house visits; each house in an endemic malaria area is visited approximately once every 6 weeks. Participants included 4044 healthy and 979 febrile individuals (i.e., suspected of having malaria). MAIN OUTCOME MEASURES: HIV-1 and HIV-2 serological status, degree of mobility, age and sex. RESULTS: Sixty of the 5023 blood specimens were confirmed to be HIV-1-antibody-positive by Western blot, an overall prevalence of 1.2% (95% confidence interval, 0.9-1.5). None of the specimens was positive for HIV-2 antibodies. After adjusting for age, presence of fever and migrancy, women had a 3.2-fold higher prevalence of HIV-1 infection than men. HIV-1 infection was approximately three times more common among subjects who had changed their place of residence recently (2.9 versus 1.0%, P < 0.01). CONCLUSIONS: The prevalence of HIV-1 infection is higher among women than men resident in rural Natal/KwaZulu, South Africa. This is at least in part the result of oscillatory migration, particularly of men who work in urban areas but have families and homes in rural areas. Migration is associated with a higher prevalence of HIV-1 infection, suggesting that improving social conditions so that families are not separated and become settled in their communities is one way to help reduce the spread of HIV-1.

Adolescent↗
PubMed1992

Teenagers seeking condoms at family planning services. Part I. A user's perspective.

The promotion of condom use is an essential part of any AIDS prevention programme. By distributing condoms and promoting their use, clinics that provide family planning services can play an important role in preventing the spread of AIDS. This study assesses the accessibility of condoms to teenagers at selected family planning services in Durban. Twelve randomly selected clinics in Durban were visited by each of 4 teenage fieldworkers. During these visits, the fieldworkers' experiences were recorded in detailed notes which were subsequently analysed for content. The fieldworkers experienced difficulty in locating a few of the clinics and some were embarrassed by security staff. The two female fieldworkers, in particular, were intimidated by their reception at the clinics and found resistance to their requests for condoms. On two occasions, supplies of condoms had run out. When condoms were available, they were distributed in a setting that lacked privacy. Information on how to use condoms, if offered at all, was supplied by way of pamphlets and information on AIDS was rarely offered. Overall, the experiences of the fieldworkers indicated that it was difficult for teenagers to obtain condoms from clinics providing family planning services in Durban. It is recommended that there be signs indicating the location of the clinics, and that privacy be ensured and adequate stocks of condoms maintained. Most importantly, clinic staff need to use every opportunity to discuss AIDS prevention with teenagers attending the clinic.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Teenagers seeking condoms at family planning services. Part II. A provider's perspective.

This study assessed the ability and preparedness of staff at family planning clinics in Durban to assist in AIDS prevention by promoting condom use among teenagers. Staff at 12 randomly selected clinics were interviewed to assess their attitudes towards teenagers seeking condoms, the information imparted on AIDS and condom use, constraints faced in delivering services, and their perceived role in controlling the spread of AIDS. Despite their awareness of AIDS, those interviewed perceived their role to be that of promoting contraception. Condoms were perceived as a poor choice of contraceptive and their use was discouraged. The pamphlets dispensed along with condoms were thought to provide adequate information about condom use. Information on AIDS was given only if the clinic attender initiated discussion on the subject. Most of the clinic staff were keen to discuss other issues during their consultations, but felt constrained by the large numbers of people they had to attend to and the lack of adequate facilities. If family planning services are to play a role in controlling the spread of AIDS, the first step must be to make this function part of the overall policy. For there to be effective counselling on AIDS prevention, in-service training of current staff is required, as well as more staff and improvements in facilities to ensure greater privacy.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Reasons for lack of condom use among high school students.

This exploratory qualitative study was undertaken to identify barriers to condom use among high school students in Natal. Phase 1, a group discussion, with 50 high school students of all races from 10 schools, revealed that 17 (34%) were sexually active, 8 (47%) of these had used a condom at least once, but none had used condoms in every sexual encounter. Phase 2 comprised 36 focus group discussions involving about 650 black high school students. These discussions confirmed the finding of phase 1 that high school students were not using condoms to any significant degree. In their opinion, condoms limited sexual pleasure, indicated a lack of trust in the partner's faithfulness, challenged the male ego, and were associated with sexually transmitted diseases. Their contraceptive properties were viewed with suspicion and considered undesirable by those teenagers who wished to prove their fertility. In addition, condom use was not sufficiently well understood and condoms were not accessible or available when required. We recommend that condom promotion strategies should include an adequate explanation of how condoms work and detailed information on their local availability. They should be available at a government-subsidised price through more accessible outlets; popular figures and recognised leaders should be encouraged to support anti-AIDS campaigns and condom use, particularly in the public media.

Adolescent↗
PubMed1991

Impact of a measles immunisation campaign on measles admissions to a Natal hospital.

During May and June 1990, a national mass measles immunisation campaign was undertaken in South Africa. This study is an assessment of the impact of the campaign on measles admissions to a provincial referral hospital that has specifically designated wards for children with communicable diseases. Data from the measles ward admissions book for the 18 months before the campaign (1 January 1989-30 June 1990) and 6 months after the campaign (1 July 1990-31 December 1990) were compared. Since the campaign, the average number of measles admissions has declined by 64.4% from 87 to 31 per month (P less than 0.01). Before the campaign, 21.3% of measles patients admitted were aged 7-9 months compared with 27.6% after the campaign, highlighting the urgent need to improve the measles vaccination coverage in this age group. An analysis of the geographical source of patients showed that measles continued to occur after the campaign in most of the areas where it existed before the campaign. It is concluded that important gains have been achieved by the campaign. These will be rapidly eroded and epidemics of measles may occur if measles vaccination efforts wane and slump back to pre-campaign levels. It is important to capitalise on the momentum generated through the campaign by continuing to support efforts of existing health care services to improve and maintain high levels of measles immunisation coverage.

Child↗
PubMed1991

Sexual behaviour and knowledge of AIDS among urban black mothers. Implications for AIDS intervention programmes.

Questionnaires were administered to 122 urban black mothers of teenagers in order to: (i) understand aspects of their sexual behaviour and knowledge of the acquired immunodeficiency syndrome (AIDS); and (ii) assess their communication with their teenage children with regard to AIDS and sexual behaviour. The subjects comprised a 12.5% random sample of all houses in Lamontville, a black township south of Durban. The level of AIDS knowledge among mothers was high, while their sexual behaviour, characterised by a high pregnancy rate and a high proportion who have had children by more than one consort, placed them at high risk of acquiring human immunodeficiency virus (HIV) infection. No mother had experienced sexual intercourse during which her partner used a condom. Communication with their teenage children was poor; none of the mothers had spoken with them about AIDS and 89.3% had not discussed contraceptive methods with their teenage children. We found that urban black mothers were at high risk of acquiring HIV and, despite their knowledge of the modes of transmission and prevention of HIV infection, they had not begun using condoms as a risk-reducing measure, nor had they communicated the risk of unprotected sex to their teenage children. We recommend that AIDS intervention strategies should not concentrate only on passing on knowledge but also on providing women with the communication skills to negotiate the use of condoms with their partners and to convey the risk of HIV infection to their teenage children.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Under-reporting in hepatitis B notifications.

Notification and laboratory data for the period January 1985-December 1988 were compared in order to estimate: (i) the minimum level of under-reporting of hepatitis B; and (ii) the consistency of the level of under-reporting, both regionally and nationally. Ratios between hepatitis B notifications and positive hepatitis B laboratory tests (reporting ratios) were calculated to quantify the discrepancy between these parameters. There were at least 7 positive hepatitis B laboratory results for each notified case of hepatitis B during each year studied. The differences between the national reporting ratios for each of the study years were small, indicating that nationally the level of reporting of hepatitis B is fairly consistent. The Cape region had the highest and most constant level of hepatitis B reporting compared with other regions. We conclude that the national incidence of hepatitis B is at least 7 times higher than that calculated from notification data. Further, the inter-year analysis of hepatitis B notification data to identify trends nationally and within the Cape region is valid. However, caution is called for when comparing the incidence rates between regions due to inter-region and region-specific inter-year inconsistencies in reporting levels.

Hepatitis B↗
PubMedDate not supplied

Microbicide research and development--where to?

PURPOSE: Against the backdrop of increasing numbers of HIV infections in women and the limitations of current safer sex messages, several calls have been made for the development of women-initiated methods of prevention as an essential component of the armamentarium to reduce women's vulnerability of acquiring infection with HIV. An effective microbicide is a critical survival tool in instances and situations where existing proven prevention strategies have failed to be adopted. METHOD: The results of published N-9 clinical trials in terms of anti-HIV activity, safety data, and anti-sexually transmitted infection (STI) activity are discussed. RESULTS: There is no evidence of efficacy against HIV in three clinical trials, there is scanty evidence for protection against STIs, and there is considerable evidence of dose-related adverse effects. CONCLUSION: During this time, a vast array of potential microbicides with differing modes of action have been discovered, and some have undergone preclinical and early clinical testing. Effort, time, and resources might be better spent on advancing preclinical and clinical testing of these other candidate microbicides.

Anti-Bacterial Agents↗